600 OF NUTRITION. 



portant confirmation from recent observations, we shall treat of the reparative 

 processes under three distinct heads : First, the adhesion of the sides of a 

 wound by a medium of coagulable lymph, or of a clot of blood. Second, 

 reparation without any medium of lymph or granulations, the cavity of the 

 wound being filled by a natural process of growth from its walls. Third, 

 reparation by means of a new, vascular, and organized substance, termed 

 Granulations. The first of these modes of Reparation, is that which is ordi- 

 narily termed union by the first intention; of this kind of adhesion, the heal- 

 ing of the incision made in venesection, which usually takes place almost 

 without consciousness on the part of the patient, and with scarcely any In- 

 flammation, is a characteristic example: the white line of cicatrix which is 

 left, marks the formation of new substance; and is the result of the want of 

 that perfect approximation of the lips of the wound, which may frequently be 

 obtained in parts, where pressure can be more firmly applied, and where the 

 space to be filled up is proportionably thinner. This mode of union is ordi- 

 narily considered by British Surgeons to be the result of an adhesive inflam- 

 mation. In so regarding it, they conceive that they are following out the 

 views of Hunter ; but he expressly states that wounds may heal without any 

 pain or constitutional disturbance, the reunion proceeding "as if nothing had 

 happened ;" so that he in effect admits, that reparation of this kind may take 

 place without Inflammation. It is well known that if a slight wound, which 

 is thus healing, be provoked to an increased degree of Inflammation, its pro- 

 gress is interrupted ; and all the means which the Surgeon employs to pro- 

 mote union, are such as tend to prevent the accession of this state. The 

 doctrine that the effusion of Lymph for the Reparation of the tissues, is not 

 to be regarded as necessarily a result of the Inflammatory process, is not so 

 novel as its opponents have regarded it; since it has been maintained by many 

 eminent observers, even from the earliest times. The only case in which 

 the occurrence of Inflammation can be regarded as salutary, is that in which 

 there is a deficiency of Fibrine in the blood, causing a deficient organiza- 

 bility of the lymph. It has been seen that the amount of Fibrine is rapidly 

 increased by inflammation; and the Surgeon well knows that a wound with 

 pale flabby edges, in a depressed state of the system, will not heal, until some 

 degree of Inflammation has commenced. 



795. When the Liquor Sanguinis of the Blood, known as Coagulable 

 Lymph, is effused between the two edges of a wound, or upon the surface of 

 a membrane lining a closed sac, the following appears to be the history of its 

 organization. The new matter, which is poured out in a fluid state, and 

 which seems to have been subjected to the peculiar influence of the Colour- 

 less Corpuscles that rapidly collect in large numbers at the injured spot, un- 

 dergoes a Coagulation resembling that of Blood; the Serum, being set free 

 by the concretion of the Fibrine, is absorbed; and the fibrinous coagnlum 

 speedily attains an almost membranous density. If examined with a Micro- 

 scope at the commencement of the process of organization, it is seen to con- 

 tain a large number of cells, which sometimes closely resemble the Colourless 

 Corpuscles of the Blood; and in other instances (especially where there has 

 been active Inflammation) present greater similarity to Pus-corpuscles; these 

 cells, which are known as exudation-corpuscles, probably originate in granules 

 set free from the Colourless Corpuscles of the circulating blood, and exuded 

 with the Liquor Sanguinis. In a short time, these corpuscles present the 

 appearance of regular cells, disposed in layers, and adhering together by an 

 intermediate unorganized substance ; bearing, in fact, a strong resemblance to 

 the cells of tesselated epithelium. Some hours later, the mass exhibits an 

 evidently-fibrous character ; which is probably due to the further elaboration 

 of the plastic material, by the cells just mentioned. Between the fibres, a 



