WOUNDS. 



fntures are truly beneficial or not. Thus we do not admit 

 that they ought to be ufed as frequently as the remarks of 

 the above dilUnguidied profeflbr would warrant ; and the 

 majority of fuperficial wounds, in which union by the firft in- 

 tention is indicated, certainly, fo far from being benefited 

 by futures, would be injured. Further obfervations, how- 

 ever, on this fubjeft will be found in the article Suture. 



When futures are judged necelTary, their operation is 

 always aflifted by the application of fuitable comprefles and 

 a bandage, the good effefls to be derived from pofition of 

 the part being alfo not neglefted. The flitches ought in 

 general to be removed between the third and feventh day ; 

 for if they are allowed to remain longer, or even in fome 

 cafes fo long, they excite inflammation, and fometimes 

 ulceration. 



Such then are the means which furgeons adopt for keep- 

 ing the oppofite furfaces of wounds in contaft, until an 

 union has taken place. When the parts grow together 

 again without any fuppuration, the mode of cure, as we 

 have already explained, is well known to furgeons by the 

 term union by tbejirjl intention. Of the nature of this pro- 

 cefs, and of the way in which a conneftion is eftablifhed 

 again between the parts which have been divided, we have 

 endeavoured to give fome account in a preceding volume ; 

 we (hall not, therefore, expatiate on the fubjeft. See Union 

 by the Firjl Intention. 



The firft plailers and dreflings applied with a view of 

 bringing about this defirable method of cure, (hould be 

 allowed to continue at leaft three or four days, unlefs any 

 untoward fymptoms, fuch as exceffive pain, the renewal of 

 hemorrhage, &c. indicate the contrary. The feverity of 

 the pain is fometimes owing to the future, fometimes to 

 :he immoderate tightnefs of the roller, and occafionally to 

 there being extraneous fubftances yet lodged in the wound. 



When too much inflammation is apprehended, the band- 

 age fliould never be tight ; and wetting it with cold water 

 may be of ufe by keeping the parts cool. Perfeft quietude, 

 ind the ufual antiphlogiftic remedies, are alfo not to be 

 smitted. The old plan of covering the dreffings with thick 

 ivoollen rollers, caps, and large mafles of tow, has now 

 gone very much out of fafliion, as being inconfiftent with 

 ;hofe principles which are recognized by every fcientific 

 urgeon as beft. calculated to avert and leffen inflammation. 



When the firft dreflings are removed, the furgeon often 

 iinds union by the firft intention only accomphflied at certain 

 parts of the injury ; and the conneftion, even there, ftill 

 requires further fupport. However, when the wound is 

 irefled again, it is generally unnecefTary to apply as many 

 ilrips of adhefive plalter as were employed in the firft in- 

 tance. Their number may be gradually leflened at each 

 uture drefling. The futures, if there be any, fliould alfo 

 ae now withdrawn, as they will do no more good, and their 

 :ontinued prefence may excite irritation and do harm. 

 Suffice it to add, that throughout the fubfequent treatment 

 :he reft of the dreflings fliould be light, fimple, and un- 

 rritating. 



Of the Cure of Wounds ly Granulations, isfc — We re- 

 marked, that wounds are healed by two proceffes, one of 

 ivhich was not attended with the formation of pus, was 

 :he quickeft and moft perfedl in its effefts, and was called 

 union by the firjl intention, or adhefion. The other procefs 

 Gow requires defcription. " When, in the treatment of 

 1 wound," fays profelfor Thomfon, " the re-union by adhe- 

 lon, or by the firft intention, has either not been attempted 

 at all, or, if attempted, has failed, nature brings about a 

 ;ure by that flower and more complicated operation, which 

 we now denominate the procefs of granulation ; a procefs 



Vol. XXXVIII. 



termed (as we have already remarked) by Galen re-union by 

 the fecond intention. By many of the older furgeons, this 

 mode of healing wounds is defcribed by the appellation of 

 fyfarcofis, or concarnation, terms perhaps lefs liable to ob- 

 jeftion than that of granulation, which, in ftrift propriety, 

 is a term expreffive of only one of the ftages of this mode 

 of re-union, and which, of courfc, in order to avoid all 

 ambiguity in the language we employ, ought not to have 

 been ufed as a general term for the whole. In re-union by 

 the fecond intention, the edges of the wound fwell and 

 inflame more than in the procefs by adhefion ; but, as in 

 that procefs, fo in this, a layer of coagulable or organizable 

 lymph is thrown out upon the divided furfaces. This 

 layer is foon penetrated by blood- veflels, and, like the inter- 

 medium in adhefions, (fee Union by the Firjl Intention,) 

 becomes an organized and living fubftance. So far thefe 

 modes of re-union are fimilar ; but in a ftiort time after this 

 layer of coagulable lymph has been thrown out upon the 

 open and expofed furfaces of a wound, there is thrown out 

 alfo upon the fame furfaces a quantity of pus, or the matter 

 of fores. This fluid, like the coagulable lymph, is the 

 immediate produft of a change induced in the aftion of the 

 capillary veflels exifting in the divided fubftances of the 

 wound, a change by which they feem to become fecreting 

 inftead of circulating tubes. The aftion by which pus is 

 formed is now Aenomm3.ieA fuppuration : the old furgeons 

 gave to it the name of digejlion. See Suppuration. 



" When the furfaces of the wound have been feverely 

 injured, or when the patient is of a bad habit of body, a 

 greater or lefs portion of thefe furfaces lofing its vitality, 

 feparates from the remaining found part, and comes away 

 in the form of a flough. The older furgeons, who are molt 

 minutely accurate in the defcriptions which they have 

 left us of difeafed appearances, call this the deterjion or 

 mundijication of the wound : the furgeons of the prefent 

 day, Jloughing, or the feparation of the Jlough. See the 

 article Gangrene. 



" In the healthy conditions of the body, and when the 

 edges of the wound are uninjured, the fmooth furface of 

 the layer of coagulable lymph which covers the bottom of 

 the wound is, in the courfe of a few days after the fuppu- 

 ration has taken place, raifed into a number of fmall emi- 

 nences, like grains or papills. Thefe little eminences are 

 termed granulations, and their formation in the healing of 

 wounds, the procefs of granulation. By the older furgeons, 

 this ftep, in the procefs of re-union by the fecond intention, 

 was commonly termed incarnation, or concarnation, terms 

 expreffive of the formation of a portion of new flefti." See 

 Granulation. 



" On the furfaces of thefe granulations, but moft fre- 

 quently on the edges of the wound next to the fl^in, fmail 

 white fpecks appear ; the quantity of pus which is fecreted 

 gradually diminiflies, and the blueifti-white fpecks, by con- 

 tinuing to increafe in number and fize, come at laft to cover 

 the furface of the wound. On examination, the furface of 

 the wound will now be found to be covered by a kind of 

 new flcin and cuticle. The formation of this new lliin has 

 long been denominated the procefs of cicatrization, and the 

 procefs of re-union by the fecond intention being now fully 

 accompliflied, the wound is faid to be completely cicatrized." 

 Thomfon's Leftures, p. 288. 



The re-union of a wound by the firft intention is the 

 work of one, two, or three days ; while re-union by the 

 fecond intention always requires a period of feveral days, and 

 fometimes in difeafed conftitutions, or parts which have been 

 much injured, of months, or of years. Thomfon, p. 290. 



As the fame well-informed writer remarks in another 

 4 Z place, 



