ON THE HEALING OF WOUNDS 107 



The other manners of healing, such as by granulation, 

 may be generally classed as effected by a process of growth 

 from the surface, or surfaces, of the traumatised area, or 

 by what is called "second intention." Granulation may 

 be described as a process of new growth, by which any 

 loss of substance suffered by the traumatised parts is 

 replaced by a cicatricial texture, usually of a lower type 

 than the lost texture, but yet of such an order as to meet 

 the functional requirements of the reunited parts, although, 

 it may be, on a somewhat restricted scale. The process is 

 effected by the reconstructive powers of the sympathetic 

 nervature exercised in arranging and licking into organic 

 form the exuded intra-traumatic plasma by a growth and 

 proliferation of its cell elements with their uniting and 

 anastomosing processes, and secondarily, by the interjec- 

 tion of vascular or blood-vessel agencies and the laying 

 down of a fibrous groundwork of uniting tissue, with the 

 concluding organic act in the regenerative developmental 

 process of a more or less complete renewal of the cutaneous 

 external enveloping texture. 



On closely observing the character and histological 

 elements of cicatricial tissue, it will become apparent that 

 they are composed almost entirely of materials derived 

 from the growth of the sympathetic nerve cellulo-fibrous 

 reticulum into the intra-traumatic plasma by the prolifera- 

 tion of its cell elements and the anastomosis of the pro- 

 cesses thrown out by the evolving cells. This description 

 may be accepted as axiomatic when applied to the cicatricial 

 results of healing by less than first intention, that is, by 

 granulation, but as less axiomatic, or modified, when ap- 

 plied to those of healing by first intention, in which cases 

 the sympathetic cicatricial elements are, to a more or less 

 complete extent, inter-penetrated by the reunited systemic 

 nerve and, it may be, neuro-muscular elements ; functional 

 as well as structural continuity being effected in the latter, 

 while in the former, although structural continuity be 

 effected, it is not followed by renewal of function, on 

 account of the absence in the cicatrix of the systemic nerve 

 elements and related musculature. The sympathetic 

 nervature must, therefore, be recognised as the agent, 

 material and dynamic, in the process of "healing of 



