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41 a "contused wound" till the sloughs separated. A sharp knife does not destroy any part of the tissues, hut it throws them in a microscopically thin layer into a state of intense inflammatory congestion, attended with effusion of coagulable liquor sanguinis. But this noxious agency is only momentary in its operation. It has no time to cause active congestion through the nervous system, but at once leaves the injured tissues free to recover by virtue of their own inherent powers. If the instrument be very sharp the layer of lymph will be very thin, unless some other disturbing cause come into play. But it is. always sufficient in amount to serve the beautiful purpose of adhesion.

It is comparatively rarely that direct inflammation is met with thus pure and simple in practice. The two forms, the direct and indirect, are commonly more or less associated. Thus putrid discharge in a wound is an acrid irritant, as I once experienced personally in the keen smarting of an abrasion on the back of my hand, smeared accidentally with the pus of a stump that I was dressing. Hence during the period that elapses before the divided tissues are clothed with that wonderful protecting layer which we term granulations, such discharge causes direct inflammation in the structures on which it acts immediately, while it also induces in them and in neighbouring parts inflammation through the nervous system.

When Marious [sic] Sims had published his remarkable success with the silver suture in gynaecology, I