602 OF NUTRITION. 







can be filled up. Occasional instances, however, have not been wanting, in 

 which large open wounds have closed up under the dry clot of blood, by which 

 they were at first covered over, without any suppuration, or other symptom 

 of inflammation ; and in these it has been found, that the new surface much 

 more nearly resembles the ordinary one, than does the Cicatrix which follows 

 granulation. To Dr. Macartney, however, is due the merit of explaining the 

 rationale of this action ; which is precisely analogous to that which is con- 

 cerned in the ordinary processes of growth, and to that reproduction of whole 

 parts which takes place in the lower animals without Inflammation. It is 

 termed by him the modelling process ; and he remarks as characteristic of it 

 that, when it goes on perfectly, and without Inflammation, the patients are so 

 completely free from uneasy sensations, as only to be aware of the extent of the 

 injury by their own examination. In this process, the surfaces of the wound 

 do not unite by vascular connection, even when they lie in contact; nor is the 

 space between them filled up with coagulable lymph ; but they are smooth 

 and red, moistened with a fluid, and presenting the appearance of one of fhe 

 natural mucous membranes. " It might be anticipated that, as this mode of 

 reparation bears so strong a resemblance to the natural formation and develop- 

 ment of parts, it is the slowest mode ; but this is of little account, when com- 

 pared with its great advantages in being unattended with pain, inflammation, 

 and constitutional sympathy, and leaving behind it the best description of 

 cicatrix." In the case of large burns on the trunk in children, the difference 

 between the two modes of Reparation will frequently be that of life and death; 

 for it often happens that the patient sinks under the great constitutional dis- 

 turbance occasioned by a large Suppurating surface, although he has survived 

 the immediate shock of the injury. 



798. The most effectual means of promoting this kind of Reparative pro- 

 cess, and of preventing the interference of Inflammation, vary according to 

 the nature of the injury. The exclusion of air from the surface, and the 

 regulation of the temperature, appear the two points of chief importance. By 

 Dr. Macartney, the constant application of moisture is also insisted on.* He 

 states that the immediate effects of injuries, especially of such as act severely 

 upon the sentient extremities of the nerves, are best abated by the action of 

 "steam at a high but comfortable temperature, the influence of which is 

 gently stimulant, and at the same time extremely soothing. After the pain 

 and sense of injury have passed away, the steam, at a lower temperature, 

 may be continued; and, according to Dr. M., no local application can com- 

 pete with this, when the Inflammation is of an active character. For subse- 

 quently restraining this, however, so as to promote the simple Reparative 

 process. Water-dressing will, he considers, answer sufficiently well; its prin- 

 cipal object being the constant production of a moderate degree of Cold, 

 which diminishes, whilst it does not extinguish, sensibility and vascular 

 action, and allows the Reparative process to be carried on as in the inferior 

 tribes of animals. The reduction of the heat in an extreme degree, as by 

 the application of ice or iced water, is not here called for, and would be 

 positively injurious; since it not only renders the existence of Inflammation 

 in the part impossible, but, being a direct sedative to all vital actions, suspends 

 also the process of restoration. The efficacy of Water-dressing in injuries 

 of the severest character, and in those which are most likely to be attended 

 with violent Inflammation (especially wounds of the large joints) has now 

 been established beyond all question; and its employment is continually 

 becoming more general.t Other plans have been proposed, however, which 



Treatise on Inflammation, p. 178. 



j- See an acoount of the results of this treatment by Dr. Gilchrist, in Brit, and For. Med. 

 Rev., July 1846, p. 242. 



