12 THE TONER LECTURES. 



application of the subcutaneous method advocated by M. Gu4- 

 rin/ and furnished us with a historical resume of the opinions 

 of the older surgeons who have advocated, as well as of those 

 who have denied, the injurious influence of the air upon the 

 healing of wounds. In this resume are included the most 

 interesting points in the historj^ of subcutaneous operations ; 

 but time will not permit me to enter upon this part of our 

 subject. 



With respect to the fourth query, as to the necessity of 

 prolonged exposure to the air, as essential to the production 

 of inflammation, there can be no doubt that the prolonged 

 exposure of a wound to the air is invariably followed by 

 inflammation and generally by suppuration, and there can be 

 as little doubt that this was the condition to which Hunter 

 especially referred ; whilst, on the other hand, open wounds 

 which are quickly closed proceed as favorably in the reparative 

 process in a large majority of cases, as subcutaneous wounds. 

 Prolonged exposure to air cannot, however, be regarded as an 

 essential condition to the production of inflammation in wounds. 



The next subject to which I would direct attention is the 

 pathology, or I might call it the physiological pathology of 

 the reparative process in relation to the subcutaneous method. 

 M. Guerin^ was undoubtedl}-^ the first to call attention to the 

 perfection of the reparative process in subcutaneous operations, 

 and what he called " the immediate organization," i. e., the 

 exudation and development of a reparative material indepen- 

 dently of inflammatory products, which is utilized in the re- 

 generation of tissue, such as tendon, nerve, bone, and cellular 

 tissue, in the most perfect manner. 



We see the reparative process in wounds, under various 

 conditions, proceeding with or without inflammation. The 



» Bulletin de rAcad6mie Imp6riale de M6decine, vol. xxii. pp. 427- 

 724,1857. 



" Essais sur la metliode sous-cutanie ; Paris, 1841. 



