WOUNDS. 



place, moa wounds admit of being healed partly by adhe- 

 fion, and partly by the procefs ofgranulation. We have 

 rery good examples of this in the wounds made in ampu- 

 tation of the extremities, and in the extirpation of the 

 mamma, or of other large tumours. We know, or at leaft 

 we have reafon in thefe inftances from the tirll to fuipeft, 

 that the whole of the wound will not heal by adheiion ; but 

 we are ignorant whether a large or a fmall portion will be 

 healed by that procefs ; and accordingly, we at firft pro- 

 ceed in the drefling of fuch wounds, as if we expected or 

 intended that the whole ihould heal by adhefion. We 

 bring the edges of the wound together by adhefive ftraps, 

 or Hitches, and fupport thefe by proper bandaging. The 

 adhefive llraps are of great ufe even in thofe wounds in 

 which it is impoffible to bring the edges at lirfl into contaft. 

 They bring and retain the edges near each other ; they 

 diminilh the fize of the wound ; they keep furfaces in con- 

 tad which have a difpofition to adhere ; and ultimately, by 

 the gradual elongation of the old fliin, even where the 

 diftances between the fizes is at firll confiderable, they 

 bring the feparated edges to unite together. Op. cit. 

 p. 293. 



With refpeft, however, to the particular mode of drefs- 

 ing wounds which are to heal by granulations, it feems 

 unneceffary to enter into any long detail in the prefent 

 place ; becaufe the treatment is to be condufted on the 

 very fame principles which apply to fores, and which we 

 have fo fully explained in another article. See Ulcer. 



We (hall conclude this feftion of the fubjeft of wounds 

 with a few ufeful rules, which profelTor Thomfon recom- 

 mends to be obferved in the drefling and examination of 

 thefe cafes. 



In examining or drefling a wound, we ought never to 

 give the patient more pain from our modes of procedure, 

 or methods of drefling, than is abfolutely neceifary for his 

 prefent good and future fecurity. For inllance, we ought 

 never to probe a wound where probing can be of no ule ; 

 and we fhould be contented to remain ignorant of thofe 

 things, the knowledge of which could only gratify an idle 

 curiofity. 



Another good rule is, to have all the frefli dreflings per- 

 feftly ready before the removal of thofe which have been 

 previoufly apphed. A fponge and warm water, adhefive 

 Itraps, pledgets of various ointments, lint, comprefles, and 

 bandages, are to be at hand, and not to be fought for at 

 the very moment when they are required for ufe. 



As in many inftances the removal of the drefling?, and 

 the application of others, take up a coniiderable time, we 

 ought carefully to refleft what the pofition is which will 

 be raoft eafy to the patient, and at the fame time moft con- 

 venient to the furgeon. 



When the bandage, adhefive plafter, and other dreflTings, 

 have become hard and dry< and glued together, and to the 

 furrounding (Icin by blood, or other difcharge from the 

 wound, the furgeon fhould foften and loofen the applications 

 by wetting them a fufBcient length of time with wai'm 

 water, which is to be prefled out of a fponge upon them, 

 a bafiu being held below the part for the reception of the 

 water as it falls off the drefiings. This duty is of much 

 importance in faving the patient from a great deal of 

 agony, which the abrupt removal of the adherent dreflings 

 •would produce. 



In removing the dreflings which are under the bandage, 

 we muil be careful that the ligatures are not entangled, and 

 that we do not pull them forcibly away. Pulling at the 

 ligatures during the firft dreflings, as profelTor Thomfon 

 remarks, always occafions pain ; aod if, in removing the 



9 



dreflings, the threads be incautioufly torn ofl', a greater or 

 lefs degree of hemorrhage may be produced, and much 

 diftrefs, if not danger, occafioned. To avoid this accident, 

 therefore, we ought always to fearch for the ligatures pre- 

 vious to the removal of the dreflings, and to feparate them 

 from thefe dreflings when they adhere, as they moil fre- j| 

 quently do. ^ 



Having formed and feparated the ligatures, we muft next 

 proceed to remove the adhefive ftraps by which the edges 

 of the wound are more immediately kept in contaft. It 

 moftly happens, that a greater or lefs portion of thefe ftraps 

 is loolened from the furface of the wound by the fluid 

 which exudes from it. This is the part, therefore, from 

 which ( fays Dr. Thomfon ) we Ihould firll proceed to fepa- 

 rate thefe llraps, becaufe it is here that the edges of the 

 wound may be fuppofed to recede fartheil from each other, 

 an^ the pus to have found the freeft exit. But the manner 

 in which the remaining adhering portion of ftrap is to be 

 feparated, is not, as may firft appear, a matter of indifference. 

 There is but one way in which it can be properly taken off, 

 though it is one which is often neglected in praAice. In 

 removing thefe ftraps, we are always to lay hold of them 

 by the ends, firft by the one, and then by the other end, 

 and to pull them off in the direfticn of the wound, taking 

 care never to raife the end of the ftrap much above the 

 level of the Ikin, nor to continue to pull by the end we 

 hold, after we have feparated it as far as the wound. Were 

 the ftraps pulled off in a diredlion from and not towards 

 the wound, the edges of the injury to which they adhere 

 would be drawn away from each other ; the flight adhe- 

 fions which have formed between one fide of the wound and 

 the other would be torn, and the procefs of re-union dif- 

 turbed and retarded. If we raife the end of the ftrap, we 

 alfo tear the edge of the wound from the fubjacent parts 

 to which it adheres. 



Another good piece of advice given by profeffor Thomfon 

 is, that only one adhefive ftrap, or at moft two, fhould be 

 removed at once ; and the part from which it has been re- 

 moved being carefully wiped with the fponge, and dried 

 with a foft Unen cloth, a frefli ftrap is always to be applied 

 before another is removed. It is from inattention to this 

 rule that we fee the furfaces of wounds and fores daily torn 

 open at each drefling, merely by the weight of the parts 

 which havejuft been united. 



The edges of the wound, particularly if it be a large one, 

 fhould always be held together by an afliftant during the 

 time of dreffing. 



When there are feveral wounds, only one is to be opened 

 and drefTed at a time, fo that all unneceffary expofure of 

 the parts may be avoided. 



At each drefling care muft be taken to prevent lodgments 

 of matter, by placing the comprefl^es and ftraps of plafter 

 in the manner beft adapted to prefs upon and obhterate any 

 cavity in which the pus has a tendency to accumulate. 



A pledget of fome raild cerate or ointment is ufually 

 applied ove» the adhefive plafter, and its fize fhould exceed 

 that of the wound. It is preferable to dry lint, which be- 

 comes adherent, troublefome to remove, and often conceals 

 and fticks to the ligatures. If lint be necelTary, it may be 

 employed over the pledget. Modern furgeons, however, 

 are far more fparing of thick mafFes of lint, low, flannel- 

 rollers, &c. than their predecefFors, as we have previoufly 

 explained. 



On the fubjeA of bandages we fhall here add nothing to 

 what has been already ftated in the foregoing feftion of this 

 article. 



In the drefSng of wounds, fays Dr. Thomfon, particu- 

 larly 



