348 MORBID ANATOMY OF THE SKIN. 



analogy may be extended to its mode of healing, which closel}' 

 resembles that of repair by the second intention. The phe- 

 nomena exhibited by the cutis must be viewed as analogous to 

 that '' cicatrisation from helow^^ which, as the reader may re- 

 collect, plays so momentous a part in repair by the second inten- 

 tion (cf. fig. 39, c, § 104). These phenomena consist of a very 

 curious combination of two processes which act in opposition to 

 each other, viz. the production of cicatricial tissue, and an in- 

 crease instead of a diminution in volume. We shall have to 

 return to the consideration of this point under the head of 

 Elephantiasis. It cannot be doubted that these phenomena 

 react upon the state of the surface ; on examining vertical sec- 

 tions (fig. 110) we often find the remains of obliterated vessels, 

 recognisable as pigmented striae, mounting obliquely towards the 

 dermal surface ; we may legitimately infer that their obliteration 

 must have hindered the supply of blood to the papillary body. 

 It would however be a great mistake to ground any hopes of the 

 healing of the affected surface on these processes in the cutis, as 

 in the case of repair by the second intention. On the contrary, 

 everything depends on the treatment to which the diseased part 

 is subjected. Nature must be helped by astringent and sicca- 

 tive remedies, but chiefly by a systematic application of pressure. 

 Under such conditions recovery takes place by a gradual reces- 

 sion of the proliferated papillae, and a skinning over of the entire 

 surface. The diminution in size of the papillae is operated partly 

 by the return of the infiltrated fluid into the blood, partly by the 

 fatty degeneration and absorption of large numbers of corpus- 

 cular elements. Intercellular substance appears between the 

 cells ; hairs, glands, and nerve-fibres are no longer to be found : 

 they have obviously perished in the stormy activity wdiich pre- 

 vailed in the connective tissue around them : but nothing is 

 known about the way in which they are destroyed. The papilla3 

 never reach their normal height ; in fact it is only the shallow 

 undulations of the l^oundary-line between connective tissue and 

 epidermis which indicate their existence (fig. 110). 



In marked contrast to a granulating sore, the skinning-over 

 of the surface starts from several centres at once ; it proceeds 

 from within outwards as well as from without inwards ; this 

 anomaly is due to the presence everywhere of remnants of the 

 old rete Malpighii, which may proceed directly to the formation 



