Surgery : its theory and practice / by William Johnson Walsham.

William Walsham

Date:: 1897

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

108/898 page 92

$have disappeared, a red streak only remaining to mark the line of the wound. This streak grows paler and paler, till ultimately a thin white line, which in course of time may become hardly perceptible, alone indicates the site of the injury. The above- mentioned process, which should be attended by little or no constitutional disturbance, is known as healing by the first intention, and is the one which, other things being equal, is always aimed at by the surgeon in the treatment of wounds. If the wound does not admit of its surfaces being placed wholly in contact, the space left becomes filled with blood, and the wound, if kept perfectly aseptic, unites in a way similar to that above described, without suppuration. This method of healing, which is practically one by the first intention, is known as hmMm^Jni Uood-clot. It is the way in which subcutaneous wounds usually unite. Should, however, the wound, whether its surfaces be in contact or be separated by blood, be not kept aseptic, the inflam- matory redness and swelling of the edges, instead of subsiding and disappearing in a few days, will increase and extend for some distance around ; the parts then become tense, there may be throbbing pain, union fails, and suppuration is set up. In the meantime the patient may have a chill or even a distinct rigor ; the temperature rises; the pulse is increased in frequency; the tongue becomes coated, the skin hot and dry, the urine scanty and high coloured, and the bowels confined; he complains of headache and loss of aj^petite, and there may be restlessness and want of sleep and perhaps slight delirium {septic traumatic fever). If now a free exit is established for the pus, or broken-down blood and pus, and further septic changes are prevented, the constitutional disturbance subsides, and the surface of the wound becomes covered with granulations. The granulations gradually fill up the wound, and when the level of the skin or mucous membrane is reached, epithelium slowly spreads from the edges of the wound over the granulations till they are completely covered in. A red scar is thus left at the seat of the former wound, and though this in the process of time assumes a white colour, and becomes smaller from the contraction of the fibrous tissue into which the granula- tions are at length converted, it is of a permanent character. The above method of repair is known as healing by the second intention, orhj granulation. In wounds where there is loss of substance so that the edges of the skin cannot be brought into contact, the cavity becomes filled with blood-clot, and, if the wound be kept aseptic, repaii- occurs without suppuration, the blood-clot, though passive, forming a nidus in which the process of union takes place. Or, if no blood- clot is present, the surface, after the hemorrhage has been stopped, becomes glazed over, and a reddish serum slowly escapes; granula-$

Surgery : its theory and practice / by William Johnson Walsham.

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