WOUNDS. 



known ; for the faid Signior Andrea* dotli live, and can 

 itltiiy the fame.' 



" Bkgny, in his Zodiacus Medico-Gallicus, for the month 

 oi March, 1 680, mentions a cafe, in which a nofe that had 

 been cut off with a fabre was replaced by a mihtary furgeon 

 of the name of Winfauk, and in which a perfect re-union 

 was obtained, he affirms, by the ufe of llitches, and of 

 agglutinating plafters. 



" A third cafe of the fame kind is related by Garengeot, 

 at the 55th page of the third volume of his Operations of 

 Surgery. ' In the month of September, 1 724, a foldier of 

 the regiment of Conti, coming out of L'Epee Royale from 

 an inn, at the corner of the ftreet Deux-Ecus, was attacked 

 by one of his comrades, and in the ftniggle had his nofe 

 bitten off, io as to remove almoft all the cartilaginous part. 

 His adverfary perceiving that he had a bit of llefh in his 

 mouth, fpat it into the gutter, and endeavoured to crufh it 

 by trampling upon it. The foldier, who on his part was 

 i\ot lefs fpirited, took up the end of his nofe, and threw it 

 i.ilo the (hop of M. Galm, a brother-praftitioner of mine, 

 till he fhould run after his adverfary. During this time, 

 M. Galm examined the nofe that had been tlirown into his 

 1 '.op, and as it was covered with dirt, he wafhed it at the well. 

 'i'he foldier returning to be dreffed, M. Galin walhed his 

 wound and face, which was covered with blood, with a little 

 V, .trm wine, and then put the extremity of the nofe into this 

 h^uor to heat it a little. Having in this manner cleanfed 

 ''\i wound, M. Galin now put the nofe into its natural 

 ; .lation, and retained it there by means of an agglutinating 

 'after and bandage. Next day the re -union appeared to be 



king place ; and on the fourth day, I myfelf dreffed him 

 Mih M. Galiu, and faw that the extremity of the nofe was 

 iierfeftly re-united and cicatrized.' 



" Thefe (fays profeflor Thomfon) are the only cafes 

 which I have been able to find diftinftly ftated of the re-union 

 of a nofe which had been completely cut off. This event, 

 from analogy, we have reafon to believe is poffible, and 

 nothing fhort of a contrary teftimony in the inftances I have 

 related could juftify us, I conceive, in denying the truth of 

 the faa." 



Dr. Thoml^on then details a cafe, extrafted from 

 vol. xxxiii. of the Journal de Medecine, where the point of 

 a finger which had been cut off was re-united by M. Boffu, 

 furgeon at Arras. Dr. Thomfon alfo mentions, that he 

 has been informed by different perfons entitled to credit of 

 a confiderable number of cafes fimilar to the preceding, in 

 which the points of fingers and toes completely feparated 

 ■were after\i'ards re-united. 



Although it mull be acknowledged that the foregoing 

 cafes of the union of parts completely fevered from the 

 body are uncommon, the fame obfervation does not apply 

 to inftances in which the detached part ilill retains a partial 

 and flight conneftion with the reft of tlie body, by means 

 perhaps of only a few fibres or little bit of llcin. " Many 

 cafes," fays Dr. Thomfon, " are upon record, and many 

 more have been obferved, in which parts have re-united, 

 which were divided all to a very fmall portion of cutis, — a 

 portion fo fmall that it is not eafy to conceive that any 

 effeftual circulation could be carried on through it ; and in 

 thefe cafes it deferves to be remarked, that it was generally 

 the nofe, or the extremities of the fingers and toej, which 

 re-united, after having been feparated and replaced. I have 

 feen two examples of the re-union of the nofe, where it was 

 almoft entirely feparated. In one of them it adhered only 

 by the fl<in of one of the aise, and in the other chiefly by 

 the feptum. Arczus mentions a cafe in which the nofe, 

 with moft of the upper jaw, was fo feparated as to hang 



down upon the chin, -and yet a re-union was efTeaed. A 

 cafe is mentioned by Lombard, in which the nofe, neaHv 

 cut off and unreplaced for fome hours in winter, was made 

 to re-adhere by ftitching and proper dreffings. Another 

 cafe of the fame kind occurred to Loubet." {Leftureson 

 Inflammation, p. 243.) In the Diftionary of Pradical 

 Surgery, an inftance is mentioned, in which an ear that 

 had been completely feparated from the head, with the ex- 

 ception of a fmall hit of ikin, was united again with the 

 aid of a future ; and Dr. Thomfon has himfelf feen portions 

 of the little toe and little finger, after being nearly cut off, 

 fuccefsfully re-united. 



The knowledge of all thefe fadls cannot but prove ufcful 

 in the practice of furgery, inafmuch as it teaches the prac- 

 titioner to attempt the union of parts, under circuraftances 

 wl>ich would otherwife appear entirely hopelefs and dif- 

 coiiraging. 



In promoting union by the firft intention, furgery is 

 merely to officiate as the handmaid of nature. There are 

 only two indications to be fulfilled : the firft is to bring the 

 edges of the wound into reciprocal contaft, and keep them 

 fo ; the other is to avert the accefs of immoderate inflam- 

 mation, by which the agglutination of the wound would 

 certainly be prevented. The firft objeft is accomplifhed by 

 a proper pofition of the wounded part, by bandages, by 

 adhefive plafter, and by futures. The fecond is fulfilled by 

 a ftria obfervance of the antiphlogiftic regimen, and par- 

 ticularly by avoiding every kind of motion and difturbance 

 of the wound. The reft is the work of nature. 



The po/ititn of the part is to be regulated on the principle 

 of relaxing the wounded integuments and mufcles. If the 

 extenfor mufcles are injured, the joints which they move 

 ought to be placed in an extended poflure ; if the flexor 

 mufcles are wounded, the limb is to be bent. When the in- 

 teguments alone are cut, the fame pofture which relaxes the 

 mufcles fituated immediately beneath the wound alfo ferves 

 in general to relax the flcin. In tranfverfe wounds of mufcular 

 fibres, it is aftonifliing what immenfe effeft the obferva.ice 

 of a proper pofture produces. This is never to be neglefted, 

 whatever may be the other means adopted. 



Bandages may frequently be made to contribute very 

 effentially to keeping the fides of wounds duly in contaft 

 with each other. This is ftrikingly illuftrated in cafes of 

 harelip, where we fee that the oppofite edges of the fiffure 

 may be brought forward fo as to touch, and be maintained 

 in this pofition by the fimple ufe of compreffes and a 

 bandage. Such was the mode of treatment preferred by 

 M. Louis after the operation for the harelip, and were it 

 not for the greater convenience and certainty of the twifted 

 future, it is the plan to which furgeons would yet have 

 recourfe. (See Harelip.) The uniting, or, as it was 

 formerly named, the incarnative bandage, is one which ope- 

 rates in keeping the oppofite furfaces of wounds accurately 

 applied to each other, fo that the opportunity may be 

 afforded for them to unite and grow together again. The 

 common uniting bandage can only be ufed in wounds 

 which take a direftion correfponding to the length of the 

 body or limbs, and which are fituated where a bandage can 

 be employed with convenience and effeft. It confifts of a 

 double-headed roller, having a flit betwreen the two heads. 

 The flit muft be fufficiently large to allow one head of the 

 roller to pafs through it with facility. The wound having 

 had the requifite dreffings put on it, the furgeon is to take 

 one head of the roller in each hand, and apply the bandage 

 to that part of the limb which is oppofite the wound. 

 One head of the roller is then to be brought round, fo as 

 to bring the flit over the br?;ich of continuity. The other 



head 



