450 OF NUTRITION. 



ment of the nuclei in the subjacent tissue, and there give rise to the forma- 

 tion of islands (Kiiss). The importance of the artificial aid that may be 

 given to the efforts of nature in this direction are sufficiently shown in the 

 remarkable results obtained by Reverdin in his method of treating ulcers by 

 the transplantation of skin. 1 The reparation of somewhat deeper wounds in 

 which there has been so great a loss of substance that neither immediate union 

 nor adhesion by a thin layer of coagulable lymph can take place, is accom- 

 plished by the gradual development of new tissue from the "nucleated 

 blastema" with which the cavity is first filled. But this may take place in 

 different modes, according to the degree in which it is disturbed by the 

 Inflammatory process; and it should be the great object of the Surgeon to 

 procure the most favorable method of its performance. It has been shown 

 by Mr. Paget 3 that the mode in which the process of filling up is accom- 

 plished, differs essentially according as the wound is subcutaneous, or is 

 exposed to air. In the former case, the nucleated blastema is gradually de- 

 veloped into fibrous tissues without any loss, and usually with freedom from 

 local inflammation (beyond what may have been requisite for the production 

 of the plastic fluid"), as well as from constitutional irritation. In the latter 

 case, the nucleated blastema is developed into cells ; and those on its exposed 

 surface are unable, either from degeneration or from imperfect development, 

 to pass on to any higher form of organization, but take on the characters 

 of pus-cells, and are only fit to be cast off. 3 Hence there is a continual 

 loss of plastic material, the amount of which in the case of an extensive 

 suppurating sore, forms a most serious drain upon the system ; whilst, at the 

 same time the local inflammation gives rise to more or less of constitutional 

 disturbance, and the formatinn of new tissue is by no means so perfect as iu 

 the preceding case. In cold-blooded animals, however, the contact of air 

 does not produce this disturbance; and we see wounds with extensive loss of 

 substance gradually filled up in them by the development of new tissue, 

 without any suppuration or other waste of material, very much as in the 

 subcutaneous wounds of warm-blooded animals. This method of healing, 

 which has been termed by Dr. Macartney the "modelling process," is nothing 

 else than healing by granulations under the most favorable circumstances ; 

 and to procure this should be the endeavor of the Surgeon, who too fre- 

 quently considers suppurative granulation as the only means by which an 

 open wound can be filled up. The difference between the two modes of repa- 

 ration is often one of life and death, especially in the case of large burns on 

 the trunk in children; for it frequently happens that the patient sinks under 

 the great constitutional disturbance occasioned by a large suppurating sur- 

 face, although he has survived the immediate shock of the injury. Now the 

 means adopted by Nature to bring this about, in warm-blooded animals, is 

 the formation of a scab ; which reduces the wound more nearly to the 'con- 

 dition of a subcutaneous one, so that the reparative growth and formation 

 of new tissue take place (under favorable circumstances) without any sup- 



1 Eeverdin, Archives Gen. de Mod., 1872, Mars, Juin; Duval, Nouveau Diet, de 

 Mod., 1873, t. xvi, p. 715; Demarquay, De la Regeneration des Organcs et des 

 Tissues, 1874, p. 61. 



* Op. cit. 



3 Tlie organizablc material or lymph containing pus-corpuscles thus thrown out, 

 constitutes ji very favorable bed for the development and multiplication of the various 

 spores which the researches of Tyndall (Nature, vol. i, 18G9-70, p. 339, and vol. iv, 

 p. 124), as well as those of Dr. Cunningham and Lewis (Reports Sanitary Board of 

 Calcutta), have clmwn to be constantly floating in the air. At the temperature of the 

 body, Bacteria, Vibriones, and other organic forms soon make their appearance iu 

 incalculable numbers, and accompany, if they do not produce, the putrefaction which 

 takes place in the fluid. 



