ORIGIN OF THE SOLID TISSUES. , 455 



development of parts, it is the slowest mode ; but this is of little account, when 

 compared with its great advantages in being unattended with pain, inflamma- 

 tion, and constitutional sympathy, and leaving behind it the best description 

 of cicatrix." In the case of large burns on the trunk in children, the differ- 

 ence between the two modes of Reparation will frequently be that of life and 

 death ; for it often happens that the patient sinks under the great constitu- 

 tional disturbance occasioned by a large Suppurating surface, although he has 

 survived the immediate shock of the injury. 



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

 and of preventing the interference of Inflammation, vary according to the na- 

 ture of the injury. The exclusion of air from the surface, and the regula- 

 tion of the temperature appear the two points of chief importance. By Dr. 

 Macartney, the constant application of moisture is also insisted on.* He states 

 that the 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 stimu- 

 lant, 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 con- 

 tinued ;" and, according to Dr. M., no local application can compete with this, 

 when the Inflammation is of an active character. For subsequently restraining 

 this, however, so as to promote the simple Reparative process, Water-dressing 

 will, he considers, answer sufficiently well; its principal object being the 

 constant production of a moderate degree of Cold, which diminishes, whilst it 

 does not extinguish, 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 seda- 

 tive 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 employ- 

 ment is continually becoming more general. Other plans have been proposed, 

 however, which seem in particular cases to be equally effectual. To Dr. Green- 

 how, of Newcastle, for instance, it was accidentally suggested, a few years 

 since,tto cover the surface of recent burns with a liquefied resinous ointment; 

 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 occurs even 

 under the best management, subsequently takes place. A plan has, moreover, 

 been proposed for preventing suppuration, and promoting reparation by the 

 modeling process, which consists in the application of warm dry air to the 

 wounded surface. The experiments made on this have not been entirely 

 satisfactory, but they seem to show that though the process of healing is much 

 slower under treatment of this kind, it is attended with less constitutional dis- 

 turbance than is unavoidable in the ordinary method ; and 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 burthen, as 

 after amputation in a strumous subject. But of the superiority of this treat- 

 ment to the water-dressing, no evidence has yet been adduced. 



600. The third method of Reparation that by Granulation appears to be 



* Treatise on Inflammation, p. 178. 

 f Medical Gazette, Oct. 13, 1638. 



