474 WOUNDS. 



" With these exceptions, injuries or losses are capable of no 

 more than repair, in its most limited sense ; that is, in place 

 of what is lost, some lowly organized tissue is formed which 

 fills up the breach, and sufiices for the maintenance of a less 

 perfect life of the part." 



DIFFERENCES BETWEEN THE HEALING OF SUBCUTANEOUS 

 AND OPEN WOUNDS. 



" John Hunter has long ago shown that there is a wide 

 difference between the healing process in injuries which are 

 subcutaneous and those that open to the air. He says — ' The 

 injuries done to sound parts I shall divide into two sorts, 

 according to the effects of the accident. The first kind con- 

 sists of those in which the injured parts do not communicate 

 externally, as concussion of the whole body, or of particular 

 parts — strains, bruises, and simple fractures. The second con- 

 sists of those which have an external opening, comprehending 

 wounds of all kinds and compound fractures.' He then says — 

 ' The injuries of the first division, in which the parts do not 

 communicate externally, seldom inflame ; while those of the 

 second commonly both inflame and suppurate.' It is hardly 

 possible to exaggerate the importance of the principle here laid 

 down, as on it is embodied the whole practice of subcutaneous 

 surgery. Of the two injuries inflicted in a wound — namely, 

 contusion and exposure to the air — exposure is the worse. 

 Both are apt to excite inflammation, but the ex^Dosure excites 

 it most certainly, and in the worst form — that is, in the form 

 which delays the process of repair. Abundant instances are 

 shown of this in simple and compound fractures, and in the 

 injuries of articulations. A simple fracture may have been 

 caused by much greater violence than the compound one, yet 

 the phenomena resulting therefrom are not so tedious nor so 

 dangerous to life ; or a simple fracture extending into a joint, 

 even if caused by great violence, is a very different thing from 

 a wound made into one, though ever so gently made. We 

 have other instances in the rarity of suppurations, even after 

 extensive ecchymoses, and the general occurrence of them wlien 

 wounds are left open. 



" The healing of open wounds, as already stated, may be 

 accomplished by five different modes. 



