564 OF NUTRITION. 



immediate effects of injuries, especially of such as act severely upon the 

 sentient extremities of the nerves, are best abated by the action of " steam at a 

 high but comfortable temperature, the influence of which is gently stimulant, 

 and at the same time extremely soothing." After the pain and sense of injury 

 have passed away, the steam, at a lower temperature, may be continued; and, 

 according to Dr. M., no local application can compete with this, when the In- 

 flammation is of an active character. For subsequently restraining this, how- 

 ever, so as to promote the simple reparative process, Water-dressing will, he 

 considers, answer sufficiently well; its principal object being the constant pro- 

 duction of a moderate degree of Cold, which diminishes, whilst it does not ex- 

 tinguish, sensibility and vascular action, and allows the Reparative process to 

 be carried on as in the inferior tribes of animals. The reduction of the heat in 

 an extreme degree, as by the application of ice or iced water, is not here called 

 for, and would be positively injurious; since it not only renders the existence of 

 Inflammation in the part impossible, but, being a direct sedative to all vital 

 actions, suspends also the process of restoration. The efficacy of Water-dressing 

 in injuries of the severest character, and in those which are most likely to be 

 attended with violent Inflammation (especially wounds of the large joints) has 

 now been established beyond all question; and its employment 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 New- 

 castle, 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 oc- 

 curs even under the best management, subsequently takes place. f 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 satisfactory, they seem to show that, whilst the process of healing 

 may be slower under treatment of this kind, it is attended with less constitu- 

 tional disturbance 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 



605. When the process of healing of an open wound by Suppurative Granu- 

 lation is attentively watched, it is seen that the first stage is the formation 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 may be 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 inaction, a sort of calm, in which scarcely 

 anything appears except a slight oozing 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, "maybe the brooding-time for either good or evil; 

 whilst it lasts, the mode of union of the wound will, in many cases, be deter- 



1 See an account of the result of this treatment by Dr. Gilchrist, in " Brit, and For. Med. 

 Rev.," July, 1846, p. 242. 



2 "Medical Gazette," Oct. 13, 1838. 



8 See M. Jules Guyot "De 1'emploi de la Chaleur dans le Traitcment des Ulceres, &c." 



