is at first pretty vascular, the vessels running straight; after a time
they contract and become invisible, and scarcely admit fine injections.
Frequently the scar is so far absorbed after some time, as to leave
only a firm line, whiter and more dense than the surrounding integument.
If union by the first intention does not take place, then all the
application to procure it must be abandoned, all sutures, plasters,
compresses, &c., must be dismissed, for they now can do no good, and
may be productive of harm; the attention, on the contrary, must be
directed to effecting union by granulation; with this view, other means
are to be chosen, so that to continue those which were formerly used
to promote adhesion would be absurd, when adhesion can no longer be
expected. The stitches must then be taken out, when inflammation has
gone off, and œdema remains, the parts are to be supported; and by
attention to position, and gentle bandaging, the size of the wound
will be diminished. Inflammation must be subdued by the usual means,
and suppuration encouraged by fomentation and poulticing, or warm
water dressing. After inflammation has subsided, tension disappeared,
purulent discharge occurred, and granulations formed, the edges of the
wound are to be gently brought together, so as to render the quantity
of new matter requisite for filling up the cavity as small as possible.
Nature will then accomplish the union in her own way, and we can only
assist and minister to her; for who thinks now of healing wounds by
pure force of surgery? The dressings ought to be light, the ointment,
if any is used, scanty; in some cases the application may be dry; but
in many cases various lotions will be found of much advantage. These
latter are used of different qualities, according to the nature of the
sore; and these can be of little avail unless evaporation be prevented,
by a piece of oil-silk laid on the outer surface of the dressing. In
most granulating wounds, they require to be of a mildly stimulating
nature, and the one which I have most frequently employed is a weak
solution of the sulphate of zinc. The integuments round the wound may
be occasionally washed, to prevent excoriation, but no good can accrue
from washing the sore; its natural discharge is its best protection,
and if superabundant, it can be removed by means of dry lint or tow
from the surrounding parts.
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