REPARATIVE PROCESS. 563 



inflammation (beyond what may have been requisite for the production of the 

 plastic fluid), as well as from constitutional irritation. In the latter case, the 

 nucleated blastema is developed into cells; and those on its exposed surface are 

 unable, either from degeneration or from imperfect development, to pass on to 

 any higher form of organization, but take on the characters of pus-cells, and 

 are only fit to be cast off. Hence there is a continual loss of plastic material, 

 the amount of which, in the case of an extensive suppurating sore, forms a most 

 serious drain upon the system; whilst, at the same time, the local inflammation 

 gives rise to more or less of constitutional disturbance, and the formation of 

 new tissue is by no means so perfect as in the preceding case. In cold-blooded 

 animals, however, the contact of air does not produce this disturbance ; and we 

 see wounds with extensive loss of substance gradually filled up in them by the 

 development of new tissue, without any suppuration or other waste of material, 

 very much as in the subcutaneous wounds of warm-blooded animals. This 

 method of healing, which has been termed by Dr. Macartney the "modelling 

 process/' is nothing else than healing by granulations under the most favorable 

 circumstances; and to procure this should be the endeavor of the Surgeon, who 

 too frequently considers suppurative granulation as the only means by which an 

 open wound can be filled up. The difference between the two modes of repara- 

 tion is often one of life and death, especially in the case of large burns on the 

 trunk in children; for it frequently happens that the patient sinks under the 

 great constitutional disturbance occasioned by a large suppurating surface, 

 although he has survived the immediate shock of the injury. Now the means 

 adopted by Nature to bring this about, in warm-blooded animals, is the forma- 

 tion of a scab; which reduces the wound more nearly to the condition of a sub- 

 cutaneous one, so that the reparative growth and formation of new tissue take 

 place (under favorable circumstances) without any suppuration, 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 process is far less certain than it is 

 among the lower animals, owing to the liability 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 desira- 

 ble mode, beneath a clot of inspissated blood. In fact, among " uncivilized" 

 nations, whose habits of life are favorable to health their bodies being con- 

 tinually 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 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 frequently 

 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. 



604. The most effectual means of promoting this kind of Reparative process, 

 and of preventing the interference of Inflammation, vary according to the nature 

 of the injury. The exclusion of air from the surface, and the regulation of the 

 temperature, appear the two points of chief importance. By Dr. Macartney, 

 the constant application of moisture is also insisted on. 1 He states that the 



1 "Treatise on Inflammation," p. 178. 



