METHODS OF HEALING. 477 



The second mode oj repair is that hy primary adhesion, or as 

 it used formerly to be called, by the " adhesive inflammation," 

 and is thus accomplished : — When the divided parts are allowed 

 to remain till the mouths of the divided vessels are entirely 

 shut, inflammation inevitably follows, and will furnish the 

 materials for union by throwing out coagulable lymph ; this is 

 called the adhesive inflammation. The lymph is simply laid 

 on the cut surfaces, and scarcely any is infiltrated into the 

 tissues ; becoming organized and vascular, it connects the two 

 cut edges, aud finally forms between them a thin layer of 

 connective tissue, on the surface of which, if it be exposed, 

 a very delicate layer of cuticle is developed. The smooth 

 shining surface of this cuticle gives the peculiar character to 

 the scar. 



It was thought until very recently that the lymph exuded 

 during the earlier stages of this process developed itself into 

 the tissue by which the repair was effected, but this view is 

 incompatible with the opinions held at the present time ; and 

 it will be seen by reference to the chapter on Inflammation 

 that the formation of the new connective tissue is effected by 

 the cells of the tissues of the part in which the inflammatory 

 process occurs, and not by the organization of exuded lymph, 

 which plays a passive rather than an active part in the process 

 of repair. 



Union by primary adhesion may be accomplished in a very 

 short time. Sir James Paget mentions several instances where 

 the repair has been thus effected in as short a time as seven- 

 teen hours. 



HEALING BY GRANULATIONS. 



Wlien a wound fails to heal by either of the two processes 

 already described, a series of changes take place in it which 

 are termed healing by granulations ; and the simplest case for 

 illustration is that of an open, gaping wound, which from the 

 time of its infliction is only covered with water-dressing. The 

 process is as follows : — Blood gradually ceases to flow from the 

 surface of such a wound; one may, however, still see some 

 blood-tinged, serous-looking fluid oozing from it. Slowly, as 

 this becomes paler, some of it collects, like a whitish film or 



