474 WODNDS 



"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 suffices for the maintenance of a lesa 

 perfect life of the part." 



DIFFERENCES BETWEEN THE HEALING OF SUBCUTANEOUa 

 AND OPEN WOUNDS. 



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

 aifference between the healing process in injuries which aro 

 subcutaneous and those tliat open to the air. lie 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 tlie importance of the princi])le 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 exposure 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 diflerent 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 wheu 

 wounds are left open. 



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

 accomplished by five different modes. 



I. 



