TO conceive rightly of the Nature And Treatment of Wounds, under the Variety of Disorders that they are subject to, it will be proper first to learn, what are the Appearances in the Progress of Healing a large Wound, when it is made with a sharp Instrument, and the Constitution is pure.
In this Circumstance, the Blood-Vessels, immediately upon their Division, bleed freely, and continue bleeding till they are either stopp'd by Art, or at length contracting and withdrawing themselves into the Wound, their Extremities are shut up by the coagulated Blood. The Hæmorrhage being stopp'd, the next Occurrence, in about twenty-four Hours, is a thin serous Discharge, and a Day or two after, an Increase of it, tho' somewhat thickened, and stinking. In this State it continues two or three Days without any great Alteration, from which Time the Matter grows thicker and less offensive; and, when the Bottom of the Wound fills up with little Granulations of Flesh, it diminishes in its Quantity, and continues doing so, till the Wound is quite skinned over.
The first Stage of Healing, or the Discharge of Matter, is by Surgeons called Digestion; the Second, or the filling-up with Flesh, Incarnation; and the last, or skinning over, Cicatrization. These are the Technical Terms chiefly in use, and are fully sufficient to describe the State of Wounds, without the farther Subdivisions usually found in Books.
It is worth observing, that the Loss of any particular Part of the Body can only be repaired by the Fluids of that distinct Part; and as in a broken Bone, the Callus is generated from the Ends of the Fracture, so, in a Wound, is the Cicatrix from the Circumference of the Skin only: Hence arises the Necessity of keeping the Surface even, either by Pressure or eating Medicines, that the Eminence of the Flesh may not resist the Fibres of the Skin in their Tendency to cover the Wound. This Eminence is composed of little Points or Granulations called Fungus, or proud Flesh, and is frequently esteemed an Evil, though in Truth, this Species of it be the constant Attendant on healing Wounds; for when they are smooth, and have no Disposition to shoot out above their Lips, there is a Slackness to heal, and a Cure is very difficultly effected: Since then a Fungus prevents healing Only by its Luxuriancy, and all Wounds cicatrise from their Circumference, there will be no Occasion to destroy the whole Fungus every Time it rises, but only the Edges of it near the Lips of the Skin, which may be done by gentle Escharoticks, such as Lint dipt in a mild Solution of Vitriol, or for the most Part only by dry Lint, and a tight Bandage, which will reduce it sufficiently to a Level, if applied before the Fungus have acquired too much Growth. In large Wounds, the Application of corrosive Medicines to the whole Surface, is of no use; because the Fungus will attain but to a certain Height when left to itself, which it will be frequently rising up to, though it be often wasted; and as all the Advantage to be gathered from it, is only from the Evenness of its Margin, the Purpose will be as fully answered by keeping that under only, and an infinite deal of Pain avoided from the continual Repetition of Escharoticks.
When I speak of the Necessity of a Wound being repaired by the same Fluids of which the Part was before composed, I mean, upon the Supposition, that the Renewal be of the same Substance with the Part injured; as Callus is of Bone, and a Cicatrix is of Skin; for a Vacuity is generally filled up with one Species only of Flesh, though it possess the Space, in which were included before the Wound was made, the distinct separate Substances of Membrana Adiposa, Membrana Musculorum, and the Muscle itself; and even if we scratch or perforate a Bone, there are certain wounded Vessels in it that push out Flesh which becomes the Covering of it; and after Fractures of the Skull, when the Surface of the Brain is hurt, and Part of the Membranes and Bones removed, the whole Cavity is filled up by nearly the same uniform Substance, till it arrive even with the Skin, which spreads over it to complete the Cure.
On this account it is, that after the healing of Wounds, where the Surface of the Bone has been bare, the Cicatrix is always adherent to it, and no absolute Distinction of Parts preserved; though if a Wound be made of any certain Magnitude, the Adherence, after healing, will not be so wide as the Wound itself was, but only of the Extent of the Cicatrix, which is always much smaller than the Incision; because Healing does not consist only in the forming of new Matter, but also in the Elongation of the Fibres of the circumjacent Skin and Flesh towards the Center of the Wound; which will cover it in more or less Time, and in greater or less Quantity, in proportion to their Laxness; for the Scar does not begin to form, till they resist any farther Extension; hence arises the Advantage in Amputations, of saving a great deal of Skin.
From what has been said of the Progress of a Wound made by a sharp Instrument, where there is no Indisposition of Body, we see the Cure is performed without any Interruption but from the Fungus; so that the Business of Surgery will consist principally in a proper Regard to that Point, and in Applications that will the least interfere with the ordinary Course of Nature, which in these Cases, will be such as act the least upon the Surface of the Wound; and agreeably to this we find, that dry Lint only is generally the best Remedy through the whole Course of dressing: at first, it stops the Blood with less Injury than any styptick Powders or Waters, and afterwards, by absorbing the Matter, which in the Beginning of Suppuration is thin and acrimonious, it becomes in effect a Digestive: During Incarnation it is the softest Medium that can be applied between the Roller and tender Granulations, and at the same Time, is an easy Compress upon the sprouting Fungus.
Over the dry Lint, may be applied a Pledgit of some soft Ointment spread upon Tow, which must be renewed every Day, and preserved in its Situation by a gentle Bandage; though in all large Wounds, the first Dressing after that of the Accident or Operation, should not be applied in less than three Days, when, the Matter being formed, the Lint separates more easily from the Part; in the Removal of which, no Force should be used, but only so much be taken away as is loose, and comes off without Pain.
Perhaps it may appear surprising that I do not recommend either digestive or incarnative Ointments, which have had such Reputation formerly for their Efficacy in all Species of Wounds; but as the Intent of Medicines is to reduce the Wound to a natural State, or a Propensity to heal, which is what I have already supposed it to be in; the End of such Applications is not wanted, and in other respects dry Lint is more advantageous, as may be learnt from what I have said of its Benefits. There are certainly many Cases in which different Applications will have their several Uses; but these are, when Wounds are attended with a Variety of Circumstances not supposed in that I have been speaking of; though even when these, by the Virtue of Medicines, are reduced to as kind a State, the Method of treating them afterwards should be the same, as will be better understood by the next Chapter, in which I shall treat more particularly of the Dressing of Wounds.