little of the dermis." He said that if the epidermis alone could be transplanted, the same result would be obtained as when a part of the dermis was included.
It is interesting to note that Reverdin developed his method of grafting before the introduction of antisepsis and asepsis in surgery, and that it is probably the only type of graft which could have given satisfactory results under such conditions.
The results obtained by the method of Reverdin were not all that had been anticipated, and although the healing was hastened, it was found, especially in the region of joints, that this method of grafting did not prevent contractures. This fact stimulated investigation and Ollier of Lyon in 1872 grafted much larger areas of skin, 4., 6. and 8. cm. square (13⁄5; 22⁄5, 31⁄5 inches) in extent, using the entire epidermis with a portion of the dermis, instead of the small bits of epidermis 0.3 to 0.4 cm. square (1⁄8 to 3⁄16 inch) as advised by Reverdin. His idea was not to create multiple centers of epidermization, but to substitute for the ordinary healing a surface having the essential elements of the normal skin surrounding it. This conception represented a distinct advance and formed the essential foundation of the method later elaborated by Thiersch. Ollier's work was ignored by his countrymen, as Reverdin's had been.
Thiersch, in 1874, transplanted whole thickness pieces of skin 1. cm. (2⁄5 inch) in diameter, from which the adipose tissue had been carefully removed. He laid great stress upon the following facts: that upon perpendicular sections of the granulation tissue one can easily distinguish upon the deeper part quite dense connective tissue, and a vascular network in a horizontal position. From this horizontal vessel and tissue layer sprouts the much softer and more vascular true granulation tissue, "granulation caruncle," and that unless we render it possible for this soft vascular "granulation caruncle" to change into a firm cicatrix, then the graft over it will sooner or later break down; hence (he argued) that nothing remains but to exclude the superficial part of the granulations from the procedure, and to graft the skin immediately upon the lower horizontal ground. This idea has been proved fallacious.
Thiersch held that the agglutination took place within a layer of subcutaneous cement substance; that the agglutination, if entirely successful, resulted from the inosculation of the vessels which could be seen in 18 hours, in other words, the connection between the vessels of the granulation tissue and the applied skin took place through inter-
