120 INFLAMMATION. 



tially the same processes are involved in all cases, there are yet very 

 marked differences in the degree in which the different factors share. 

 Thus the vascular and exudative phenomena may predominate and very 

 large quantities of serum, fibrin, or pus collect, while the amount of 

 new-formed tissue may be insignificant. The production of a large 

 amount of exudate, particularly of pus cells suppuration usually 

 marks the presence of micro-organisms whose locally elaborated poisons 

 complicate or retard the healing process. In other cases the formation 

 of new tissue is the dominant feature, and the production of exudates 



FIG. 50. CICATRICIAL TISSUE FROM HEALED WorXD. 



seems to be almost entirely subordinated to this end. The process of 

 repair which is complicated by exudative inflammation or effected only 

 by the gradual formation of a considerable amount of new tissue is called 

 by surgeons healing by "second intention." 

 s The distinction between healing by jjrst and second intention, which 



k/A^'-'ra of practical importance in surgery, Ts, Trom the pathological stand - 



M ' point, only a quantitative one: for the restitution of the parts to the 

 ^ l^Jiealthy condition is in both cases brought about by exudation, and 



}J^ ^> proliferation, of cells usually un3er the influence of va^ular"changsg ; 



^s"\ but in one case the latter changes are very slight, in the other more or 

 V less extensive. 



There is much variation in the formation of granulation tissue. Thus 

 sometimes the body cejls respond but feebly to the unusual con- 

 ditions, and neither cell proliferation nor blood-vessel growth is 

 active. On the other hand, the development of blood-vessels may be 

 excessive, while other tissue formation lags. Under these conditions, 

 loops and tangles of thin-walled, contorted new vessels 'may project 

 from the granulating surface, while useful tissue formation remains in 

 abeyance (Fig. 51). The result of this disproportionate growth of ill- 

 formed blood-vessels is the exuberant granulations which the surgeon 

 frequently removes from unhealthy healing surfaces. 1 



Cavities formed by abscesses or by necrosis in any part of the body 

 may be filled up and their sides drawn together in a cicatrix, by the 

 formation of a provisional mass of granulation tissue similar in charac- 

 ter to that which grows in external wounds. So, similarly, cysts may be 



'Fora special study of granulation tissue see Reinbach, Ziegler's Beitr., Bd. 30. 

 p. 102. 



