a ne A ~ = 
Nature establishes the cure of wounded parts in 
two ways. The one process is that of immediate 
adhesion, which is accomplished in a few days, 
when the wound is technically said to have been 
united by the first intention; the other is by the 
slower means of suppuration and granulation, 
through which the wound is gradually filled up, 
and a cicatrix ultimately formed, and the process 
is then entitled the cure by the second intention. 
The conditions which are favourable to the heal- 
ing of a wound by the first intention are, rest, 
approximation of ,the divided surfaces, cessation 
of heemorrhage, and seclusion from the contact of 
the air. These conditions being obtained, there 
follows, for a few hours after the accident, a dis- 
charge from the wounded vessels of a serous or 
| watery-looking fluid, which then changes into 
' an effusion of what is termed coagulable lymph. 
This substance displays a strong tendency to 
| organization; and being gradually thickened by 
the absorption of its thinner parts, it serves as a 
-glue, to bind together the cut surfaces, which is 
generally accomplished at the end of two or 
three days, though the union be not as yet firm 
and perfect. Through this lymph the blood-ves- 
sels prolong themselves, and the organization of 
the new matter being at length fully established, 
the cure may be said to be completed, the whole 
process usually occupying less than a week. For 
the success of this process, a degree of increased 
action in the parts, denoted by slight heat and 
redness, is required ; but this increased action 
ought not to amount to inflammation, or, at 
least, the inflammation must be to a very trifling 
extent, otherwise the cure will be greatly re- 
tarded, and must be finally completed by the 
second intention. If, on the other hand, there 
be a deficiency of action, the healing process 
ceases to go on, and the wound assumes the ap- 
pearance of a callous fissure, giving origin to a 
thin watery discharge. The cure by the first 
intention is that which ought to be attempted 
on every occasion, where there is the slightest 
prospect of its success, as it may be effected with 
great expedition, and presents a small scar, the 
part remaining clothed with original skin, a co- 
vering much better than any substitute which 
can be formed to supply its place. But if it 
should prove impossible to attain the conditions 
necessary for completing the union by the first 
intention, we must look for the appearance of a 
different series of phenomena. ‘The pain arising 
from the injury continues and increases in se- 
verity ; and towards the beginning of the second 
day after the accident, other symptoms of in- 
flammation show themselves, such as increased 
heat and redness, with swelling of the parts 
closely adjoining. The discharge is at first thin 
and nearly colourless, though sometimes tinged 
with blood; and afterwards the surface becomes 
covered with an effusion of lymph. About the 
third day, there begin to display themselves a 
number of minute red-coloured cones, soft, and 
i y WIGU ND: 
bleeding on the slightest contact, which denote 
the commencement of the process of organization 
in the effused lymph, and are known by the 
name of granulations. These, on being subjected 
to maceration, appear to be composed merely of 
cellular tissue, and do not present any analogy, 
in point of structure, with the particular organ 
from which they proceed, or of which they are 
henceforward destined to form a part. In the 
mean time, the discharge becomes opaque, and 
of a yellowish-white colour, possessing the other 
properties of what has been termed purulent 
matter, and becoming thicker, more viscid, and 
of a purer white, as the cure advances. The pro- 
cess of granulation now proceeds, until the whole 
cavity of the wound be filled with the newly 
generated substance. A thin blue pellicle is 
then observed at the edge, which increases in 
breadth, and proceeding from the circumference 
to the centre, gradually completes the covering 
of the wound. During this period, the sensi- 
bility of the wounded part decreases, and the 
heat and painful distention disappear as the in- 
flammation subsides. The newly formed cellular 
tissue acquires a contractile power, by which the 
wound is curtailed in its dimensions, and the 
divided surfaces are brought closer together, the 
bond of union putting on finally a fibrous ap- 
pearance and consistency. | Lastly, the new- 
formed skin, from being of a blue colour, deli- 
cate in its texture, and highly vascular, becomes 
changed into a dense, firm, and almost insensible 
substance, contracting at the same time its di- 
mensions still farther. With this concludes the 
healthy and natural process of cure by the second 
intention, which, it may be observed, admits of 
division into three stages,—those, viz., of inflam- 
mation, usually in large wounds accompanied by 
general sympathetic fever, and lasting from three 
to six days; suppuration, the duration of which 
is irregular ; and cicatrization, by which the 
healing of the wound is at length fully accom- 
plished. 
A mild degree of inflammation necessarily, as 
we have seen, accompanies the process of granu- 
lation and suppuration ; but should this inflam- 
matory action run to excess, or become deficient, 
the cure is alike impeded. Hence we have 
wounds which are prevented from healing by 
excess of action, and wounds whose cure is im- 
peded by defect of action; or, as every wound 
secreting matter may be considered as an ulcer, 
we have what are termed irritable and indolent 
ulcers. The irritable ulcer is attended with acute 
pain. Its surface is sometimes whitish or ash- 
coloured, but oftener of a brownish-red. There 
are no distinct granulations, the margin is ab- 
rupt and irregular, and the discharge is thin 
and serous, often tinged with blood, and fre- 
quently so acrid as to excoriate the neighbour- 
ing parts. Irritable ulcers occur in subjects 
whose powers of life have been too highly fos- 
tered, and in animals of a delicate and suscep- 
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