452 OF NUTRITION. 



ployment is continually becoming more general. 1 Other plans have been 

 proposed, however, which seem in particular cases to be equally effectual. 

 To Dr. Greenhow, of Newcastle, for instance, it was accidentally suggested, 

 a few years since,' 2 to cover the surface of recent burns with a liquefied 

 resinous ointment, so as to form an artificial scab ; and he states that in this 

 manner suppuration may be prevented, even where large sloughs are formed ; 

 the hollow being gradually filled up by new tissue, which is so like that 

 which has been destroyed, that no change in the surface manifests itself, and 

 none of that contraction, which ordinarily occurs even under the best man- 

 agement, subsequently takes place. A plan has, moreover, been proposed 

 for preventing suppuration 'and promoting reparation by the "modelling" 

 process, which consists in the application of warm dry air to the wounded 

 surface. Although the experiments yet published have not been entirely satis- 

 factory, they seem to show that whilst the process of healing may be slower 

 under treatment of this kind, it is attended with less constitutional disturb- 

 ance than is often unavoidable in the ordinary method ; and that it may, 

 therefore, be advantageously put in practice in those cases in which the 

 condition of the patient requires every precaution against such an additional 

 burden, as after amputation in a strumous subject. 3 



367. When the process of healing of an open wound by Suppurative 

 Granulation is attentively watched, it is seen that the first stage is the for- 

 mation of a "glazing" on the exposed surface, which closely resembles the 

 buffy coat of the blood, being composed of coagulated fibrin and colorless 

 corpuscles; in this manner a sort of imperfect epithelium maybe formed, 

 within half an hour after the surface has been laid bare. The increase of 

 this glazing is the prelude to the formation of granulations; but whilst it is 

 going on, there is, in and about the wound, an appearance of complete inac- 

 tion, a sort of calm, in which scarcely anything appears except a slight ooz- 

 ing of serous fluids from the wound, and which continues from one day to 

 eight, ten, or more, according to the nature and extent of the wounded part, 

 and the general condition of the body. "This calm," says Mr.Paget, "may 

 be the brooding-time for either good or evil ; whilst it lasts, the mode of union 

 of the wound will, in many cases, be determined; the healing may be per- 

 fected, or a slow uncertain process of repair may be but just begun; and the 

 mutual influence which the injury and the patient's constitution are to ex- 

 ercise on one another, appears to be manifested more often at or near the 

 end of this period, than at any other time." The cessation of this period of 

 calm, and the active commencement of the reparative operations, are marked 

 by the restoration of the flow of blood in the vessels of the wounded part; 

 but the current is not altogether normal, being slower but fuller than natu- 

 ral, so that on the whole more blood than usual passes through the capillary 

 plexus. This increased afflux of blood is followed by effusion of plastic mate- 

 rial in increased proportion ; and it is from this effusion that the granulating 

 process properly commences. 



368. The process of Suppurative Granulation, then, appears to differ from 

 the process of granulation as it takes place in closed wounds, or in a warm 

 moist atmosphere (the "modelling process" of Dr. Macartney), essentially 

 in this, that a large part of the corpuscles thrown out on the wounded 

 surface degenerate into pus in the former case, whilst none are thus wasted 

 in the latter; but that the existence of inflammation occasions a more 

 copious supply of fibrin in the former case, and increases its tendency to 



1 See an account of the results of this treatment by Dr. Gilchrist, in Brit, and 

 For. Mccl. Rev., July, 1840, p. 242. 



2 Mcdi.'iil Gazette, Oct. 13th, 1838. 



8 See M. J ules Guyot, De 1'emploi de la Chaleur dans le Traitement des Ulceres, etc. 



