502 C. M. Child 



tially the same manner whatever parts are concerned. It is not 

 even directly related to the closure of the wound, for under cer- 

 tain conditions it renders closure impossible. 



The process of closure of the wound by new tissue is likewise 

 not related to any ''purpose" such as the return to the normal form 

 but is determined like any other physico-chemical process by con- 

 stitution and conditions. In many cases the process of wound 

 closure renders absolutely impossible any "return" and leads 

 inevitably to death. Whether closure of the wound shall occur 

 in such manner as to render possible continued existence and 

 restitution of the part lost depends very largely upon the anatom- 

 ical structure of the region involved, i.e., the arrangement of mesen- 

 teries, the oesophagus, the enteric organs, etc. It is also depend- 

 ent on the character of the wound contraction, for in many cases 

 this contraction establishes physical conditions which render 

 closure impossible. 



Physiologically the character of the wound reaction complex 

 is apparently much the same in different regions of the body, 

 though its morphological results may be very different, according 

 to the anatomical relations of parts. The only regional physio- 

 logical difference which I have been able to discover is a slight 

 decrease in rapidity of the growth of new tissue with increasing 

 distance from the oral end. 



The closure of the wound, at least a provisional closure or plug- 

 ging, is a necessary condition for the occurrence of anything like 

 normal restitution, for in the absence of distension, atrophy of the 

 body-wall and other parts occurs instead of growth. The growth 

 of new tissue in general occurs only under a certain degree of 

 mechanical tension: restitution proper consists therefore, almost 

 entirely of localized differentiation in a continuous sheet of tissue 

 rather than of outgrowth from a cut surface. 



The regional differences in oral restitution are apparently 

 chiefly difference of quantity. The rapidity of restitution de- 

 creases with increasing distance from the oral end of the body. 

 This difference is apparently physiological in character and 

 independent of the gross anatomical relations of parts. It is, 

 I believe, an expression of a physiological characteristic common 



