Hunter transferred the spurs of a cock to its comb, and the testicles of a cock into the abdomen of a hen, and found in each case that vascular union took place, and the vitality of the transferred part maintained.
These instances only illustrated the restorative nature of the process of union by the first intention. It is not often that parts unite after having been once separated. A small vascular connection being pre served, tends greatly to render this process more likely to occur ; and numerous instances are recorded of fingers and toes being nearly sepa rated, and afterwards uniting by the first intention. One of the most remarkable examples in which the surgeon avails himself of a know ledge of this fact, is in what is called the Taliacotian operation. In this operation a new nose is made by paring the edges of the destitute part, and cutting a pyramidal piece of skin from the forehead, its union with the rest of the skin still being maintained at the point, and bring ing it down upon the face iu the form of a nose, when it unites with the pared edges, and a decent substitute for the lost member is thus produced. [TALIACOTIUS, GASPAR, in BIOG. Div.] In order to induce wounds to unite by the first intention, the edges ought not to be brought together tin all bleeding has ceased, for the slightest quantity of blood retards and may altogether interrupt this process. When the edges of the wound are ready to be brought together, there are several modes which may be pursued of keeping them in contact. Previous to bringing tho edges together, cold water may be applied to the wound upon lint. This will keep down any tendency to over-action or inflammation. It was at one time supposed that the process by which coagulable lymph was thrown out from wounds was one of inflammation, and that it was desirable that the part should be kept warm to encourage this sanatory inflammatory process. But the researches of the late Dr. 3lcCartney, of Dublin, seem to have set this question at rest ; and most physiologists look upon this process as a secretion going on under increased action, but not as an act of inflammation.
Of the various modes of keeping the edges of wounds in apposition, the application of adhesive plaster is the most common, and certainly applicable to the greater number of ordinary incised wounds. The plaster should be applied in such a manner as to maintain the edges of the wound in contact. There are, however, some wounds which are too extensive for the use of adhesive plaster, and then the suture is used, which consists in bringing the edges of the wound together by sewing them up. s [Serene.] On this subject Mr. Liston remarks, in his Elements of Surgery' (p. 208) " Of late I have greatly dispensed with stitches and the common adhesive plaster, using, instead of the latter, slips of glazed ribbon smeared with a saturated solution of isinglass in brandy, which is much less irritating and more tenacious than the common adhesive compost. The parts are fixed temporarily with a single stitch, or two
at most, and cloths dipped in cold water are placed over the wound. The ribbons are not applied till the adhesive substance has partly con gealed and the oozing of blood ceased. The divided margins being approximated by the fingers of an assistant, the ribbons are laid gently over and held for a few seconds. Soon after a sufficient number have been applied the stitches are withdrawn, being no longer necessary.
No other dressing is required, unless suppuration occur ; the ribbons will adhere firmly till the completion of the cure, and thus the pain and irritation caused by frequent dressing is avoided. Even the largest wounds, as after amputation, are treated in this manner with the most satisfactory results. Of late years a plaster, made by coating oiled silk with a solution of isinglass, has been used instead; the glazed surface of the slips is moistened and applied as here directed." Surgery is deeply indebted to Mr. Liston for the bold and fearless manner in which he has carried out a simple and natural treatment of incised wounds.
Wounds, however, under the best of treatment will not always unite by the first intention : the consequence is, that the parts which do not unite at once will suppurate, and granulations will be formed. This is called union by the second intention. [INFLAMMATION.] When this process takes'place, then all applications to procure union by the first intention must be abandoned, and all attention must be given to curing the wound by the process of granulation. Plasters, sutures, and ban dages must be removed ; and where the inflammation is great, every means should be taken to arrest it. Suppuration should be encouraged by warm fomentations, by poultices, and above all by the warm-water dressiug, which consists of nothing more than pledgets of liut dipped in warm water, and then covered over with oiled silk to prevent evapo ration and cooling. When the inflammatory action is subdued and granulations are forming, gentle pressure should be employed for the purpose of avoiding the formation of mere new matter by granulation than is absolutely necessary. The dressings at this period should be light. Some surgeons are fond of ointments, which may always be dispensed with ; but in some cases of languid granulation a stimulating ointment is useful. Lotions are generally better. A weak solution of sulphate of zinc or nitrate of silver may be mostly employed with advantage. The wound itself does not require the washing and sponging and dabbing to which it is so frequently submitted ; but the skin about the wound cannot be kept too clean and free from impurities of every kind.