REPARATIVE PROCESS. 451 



puration, and with scarcely any irritation ; the subsequent cicatrix, too, 

 being much more like the natural parts, than are any scars formed in wounds 

 that remain exposed to the air. In the Human subject, however, the pro- 

 cess is far less certain than it is among the lower animals, owing to the lia- 

 bility to inflammation in the wounded part, and the consequent effusion of 

 fluid, which produces pain, compresses the wounded surface, or forces off the 

 scab, with great discomfort to the patient, and retardation of the healing. 

 Small wounds, however, in persons of good habit of body, and in parts which 

 can be completely kept at rest, readily heal in this manner ; and large 

 wounds have been known to close, in the same desirable mode, beneath a 

 clot of inspissated blood. In fact, among "uncivilized" nations whose habits 

 of life are favorable to health their bodies being continually exposed to 

 fresh air, their food wholesome and taken in moderation, and their drink 

 water or other unstimulating liquids there seems to be as great a tendency 

 to this method of reparation, as exists among the lower animals ; and the 

 difficulty of procuring it among the members of "civilized" communities, is 

 owing, without doubt, to the unnatural conditions under which they too fre- 

 quently live. Seeing as we continually do, the effects of foul air, of habitual 

 excess in diet, and of the constant abuse of stimulants, in impairing that 

 form of the reparative process which must be regarded as the least favorable, 

 namely, the closure of a wound by suppurating granulations, it is very 

 easy to comprehend, that, to induce the most favorable method, the most 

 perfect freedom from all pernicious agencies should be required. 



366. 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 which almost invariably 

 contains the germs of low organisms from the surface, and the regulation of 

 the temperature, appear the two points of chief importance. The value of 

 the former is well shown by the favorable results obtained by the plan sug- 

 gested by Prof. Lister, 1 of dressing wounds in an atmosphere saturated with 

 carbolic acid spray and of the free application of carbolic acid to wounds, 

 fistulous passages, etc., and by covering them with a paste formed of whiting, 

 boiled linseed oil, and carbolic acid. By Dr. Macartney, the constant ap- 

 plication of moisture is also insisted on. 2 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 comfort- 

 able 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 compete with this, when the Inflammation 

 is of an active character. For subsequently restraining this, however, so as 

 to promote the simple reparative process, Water-dressing will, he considers, 

 answer sufficiently well ; its principal 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 car- 

 ried 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 exist- 

 ence of Inflammation in the part impossible, but being a direct sedative to 

 all vital activity, 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 em- 



1 Lancet, 1867, pp. 326, 357, etc. . 2 Treatise on Inflammation, p. 178. 



