WOUNDS. 



head is then to be brought round in the oppofite direaion, prove ineffeftual. In fuch inftances, the plafter ftiould be 

 and paffed through tlie (lit. The bandage is now to be very frefli, and its quality may be made rather more adhefive 

 drawn moderately tight, and its two heads being carried than in ordinary cafes. ■ ,. ^ . „ . 



- '.". - -r- -.^u- .„j Adhefive platter is generally applied in drips, between 



every two of which an interfpace is recommended, to be left, 

 for the purpofe of allowing any difcharge to efcape. To 

 bring the edges of the wound effeftuilly together, and at 

 the fame time to leave a little room for the exit of the dif- 

 charge, are the objefts to which we ought particularly 



round the Hmb againT the fame artifice is to be repeated. 

 A fufficient number of turns of the roller muft be made to 

 cover the whole length of the limb. 



When the wound is deep, it is recommended to place 

 fmall longitudinal comprefTes beneath the roller, at a httle 

 diftance from the edges of the wound. r r r 



As the uniting bandage can only be made ufe ot tor 

 longitudinal wounds, which never have a confiderable ten- 

 dency to gape, nothing can be more abfurd than the appli- 

 cation of it with immoderate tightnefs. By fuch cruel and 

 injudicious pradice, many a limb and life have been loft ; 

 for, if the bandage be very tight on its firft application, 

 what a dangerous conftridion of the limb or part mult 

 follow, when the fwelling, necelTarily arifing from the 

 wound, has had time to come on. It is thus that infuf- 

 ferable pain, gangrene, and fphacelus, have frequently been 

 brought on, when, if the part had been fimply dreffed and 

 left unconfined, every thing would have gone on moft 

 favourably. It is right to ftate, however, that modern 

 furgeons are not partial to the uniting bandage, and we 

 freely declare our conviftion, that it is a means which may 

 ▼ery well be difpenfcd with in praftice. 



If it has any advantages, they confift in its having more 

 power than the adhefive plafter alone to maintain the 

 oppofite fides of deep wounds in contaft, and in its aifting 

 without the irritation frequently arifing from the application 

 of refinous fubftances to the lltin. It is not, however, 

 exempt from ferious inconveniences. Its total concealment 

 of the wound, its lying in irregular folds, fo as to create 

 an uneven cicatrix, and the preffure and conftriftion attend- 

 ing its ufe, &c. might be mentioned. { See Firft Lines of 



to attend in the employment of adhefive plafter : hence, M 

 when the ftrips arc broad, it is not unfrequcnt to cut out an tI 

 oval piece of each ftrip juft where it crofFes the line of the 

 wound. Equal parts of the emplaftrum plumbi, and of the 

 emplaftrum refinx, form the compofition generally ufed in 

 this country for adhefive plafter. They are melted over a 

 flow fire and well mixed together, after which they are 

 fpread upon linen with a warm fpatula. 



Sutures, or Stitches, are of feveral kinds, but the only 

 one which is now ufually employed in the cure of wounds is 

 the interrupted future. The quilled future is rarely ufed at 

 prefent, though it vi^as formerly much in favour, and is not 

 yet pafTed over by fyftematic writers. As a defeription of 

 thefe futures has been given in a feparate article (fee 

 Suture), we fhall not repeat the particulars of the manner 

 of making them. The twijled future is not infrequently 

 preferred for holding together the edges of cuts in the face, 

 where the parts are liable to be in almoft conftant motion, 

 and where the avoidance of the disfigurement of a large 

 fear is peculiarly defirable. This is the future which is 

 always employed in the cure of the Harelip, in which article 

 a defeription of it will be found. Thefe, and a future 

 called gaflroraphe, which will be noticed in fpeaking of 

 tvoundi of the abdomen, are all the kinds of futures which 

 are ever employed by modern praftitioners. The glover's 



5.) So little is the uniting bandage future, or contiauedjlitcb, is now nearly rcjefted from prac- 



have feen fome thoufands 



Surgery, p. 68. edit 



now employed, that although we 



of wounds, we have not noticed its ufe in a fingle inftance 



during the laft twelve or fifteen years. When prelfure can 



be made to afiift the other drelTings, furgeons almoft always 



refort to comprefl"es and a fimple roller. In a few particular 



cafes, in which the limb would be too much difturbed 



by the application and removal of a common roller, the 



eighteen-tailed bandage is to be preferred. See Bandage, 



and pRACTunE of the Thigh. 



Adhefive plajler may be faid to be the moft common means 



employed in the praftice of furgery for bringing the edges 



of Vfounds together. When ufed for this purpofe, it was 



fometimes technically called by the old furgeons the dry 



future, in oppofition to futures ftriftly fo named, which are 



ufually made with a needle, and are invariably attended with 



a degree of bleeding. It was at one time fuppofed, that 



adhefive plafter could be of no material ufe, except in 



fuperficial wounds of the flcin. It is true, that adhefive 



plafter has no direft efFeft in bringing together the fides 



of a deep inufcular wound ; yet we ought to recolleft, 



that by drawing the integuments over the deeper part of 



the injury, it at once prevents the continuance of the ex- 



pofed ftate of the cut furfaces, under which fuppuration 



■would unavoidably follow. Nor does the ufe of adhefive 



plafter hinder recourfe to other meafures more calculated to 



bring the oppofite furfaces of the deeper part of the wound 



into contaft, fuch as the obfervance of a proper pofition, 



and the ufe of comprefies and a bandage. It is alfo an 



error to fuppofe that adhefive plafter cannot be ufed in 



fituations where hair grows, or where it will foon become 



wet. If the part be well fhaved, and perfeftly dried at 



firft, the application will not become loofe fo foon as to 



tice, and confined to the fewing up of dead bodies ; a pur 

 pofe for which it is better adapted than for the union of any 

 wound in a living fubjeft. 



On the fubjeft of the propriety and advantage of ufing 

 futures, as a means of keeping the fides of wounds in con- 

 taft, much diverfity of fentiment has prevailed. Some 

 furgeons, efpecially M. Pibrac and M. Louis, have urgently 

 recommended their entire diicontinuance ; and their obferv- 

 ations are accompanied by fafts which muft have confi- 

 derable weight. Their opinions and arguments, we acknow- 

 ledge, have conftantly influenced us in praftice; and if we 

 do not join in the fentiment, that futures ought to be en- 

 tirely abandoned, we at leaft believe that they are ftill a great 

 deal too much ufed. M. Pibrac and M. Louis, however, 

 are entitled to great praife for having leffened the employ- 

 ment of needles in furgery ; and though there are few 

 inftances in which the utihty of futures appears to be con- 

 firmed by experience, there are many others in which the 

 praftice is altogether unneceflary and injudicious. " The 

 praftice of ftitching," fays Dr. Thomfon, " is undoubtedly 

 much lefs followed at prefent than in any former period of 

 the furgical art ; and unlefs in fuperficial wounds, where we 

 wifii to heal by the firft intention, or in wounds where (as 

 in thofe of the abdomen) it is neceffary that the edges 

 ftiould not be allowed to feparate from each other, the ufe 

 of ftitches may be, in moft inftances, advantageoufly fuper- 

 feded by adhefive plafters and proper bandaging. It is by 

 limiting the ufe of futures, not by profcribing them alto- 

 gether, that the furgeon is likely to derive advantage from 

 the employment of means fo powerful." (See Leftures on 

 Inflammation, p. 287.) There are certainly hardly any two 

 furgeons who think exaftly ahke about the cafes' in which 



futures 



