ON SUBCUTANEOUS SURGERY. 13 



relation of the reparative process to that of inflammation has 

 been most carefully studied by Sir James Paget, whose investi- 

 gations, both experimental and clinical, concerning the general 

 pathology of the reparative process in all its phases, are well 

 known. It may, at the pi-esent time, be regarded as an 

 established doctrine, deduced directly from pathological and 

 clinical observation, that the reparative process in wounds, the 

 result either of accident or surgical operations, is more perfect 

 in proportion to the absence of inflammation, and that the 

 danger arising from wounds very much depends upon the 

 extent of the inflammatory complications. 



Microscopical examination of the material effused during 

 the reparative process, in the two great classes of wounds — 

 viz., the open and the subcutaneous — has confirmed the accu- 

 racy of the law, which expresses the difference in the mode of 

 development — perhaps indicating differences in the nature of 

 the material effused for the purpose of repair in these two 

 classes of wounds. The observation of this fact is due to Sir 

 James Paget, wlio states "that the materials produced for the 

 repair of open wounds are not usually the same, or, at least, 

 do not develop themselves in the same manner as those for 

 the repair of closed or subcutaneous ones.'" The general 

 truth appears to be that the material of repair, for subcuta- 

 neous wounds of the soft parts, is developed through the 

 formation of nucleated blastema ; while that for repair by 

 primar}^ adhesion and by granulation, is develojied through 

 nucleated cells. 



I need only observe that the process of development through 

 large nucleated cells, which gradually elongate and form deli- 

 cate filaments, is the process by which cellular adhesions are 

 formed from inflammatory lymph as in inflammation of serous 

 membranes etc., and by which granulation and cicatrization 



' Lectures on Surgical Pathology, vol. i. p. 172. 



