148 CASE OF COMPOUND DISLOCATION OF THE ANKLE 



cease to discharge ; and they are then at hberty to coalesce. New examples 

 of the same truth present themselves under the antiseptic system of treatment. 

 The wall of an abscess is similar in nature to the granulations of a sore, and is 

 often regarded as essentially ' pyogenic '. But if the abscess is opened anti- 

 septically, the pyogenic membrane, being relieved from the inflammatory 

 stimulus which the tension of the pus before induced, and being at the same 

 time protected from the access of the stimulus of putrefaction, is left free from 

 all disturbance, and never forms another drop of pus. But the most striking 

 illustration I ever saw of the properties of granulations, when not subjected to 

 stimulation, was presented by a case of compound fracture, in which an 

 extensive portion of the shaft of the tibia had lost its vitality, and lay 

 exposed in a large granulating sore. The granulations grew up and enclosed 

 the dead bone, which, being prevented from putrefaction by the treatment 

 employed, was destitute of the usual acrid properties of an exfoliation ; so 

 that the granulations, being not stimulated by it, not only formed no pus from 

 the surface in contact with it, but gradually consumed the dead mass by 

 absorption.^ 



The truth is, that so far from granulations having any inherent tendency 

 to form pus-corpuscles, the imperfect tissue of which they consist is ever disposed 

 to develop into higher forms as soon as it is left free from preternatural excite- 

 ment. This is beautifully illustrated by the familiar phenomena of the healing 

 ulcer. The granulations are still granulations — that is to say, possess still the 

 same pathological structure, when covered by the pellicle of newly formed 

 epidermis at the edge of the sore, as when they were exposed. But no sooner 

 does the film of young epithelium protect the imperfect tissue from the influence 

 of external stimulus than the rudimentary structure of the granulations im- 

 mediately proceeds to develop into the more and more perfect fibrous tissue 

 of the cicatrix. 



It being, then, clearly understood that granulations form pus only when 

 abnormally stimulated, we are in a position to estimate the effects of different ( 

 agents upon them. The simplest case is when an antiseptic substance, like 

 chloride of zinc or carbolic acid, is applied, suitably diluted, to a healthy granu- 

 lating sore. Not the slightest redness of the surrounding skin, or any other 

 indication of inflammatory disturbance, is produced ; yet the granulations, so 

 far as they are exposed to the influence of the stimulating liquid, are excited to 

 superficial suppuration, but form no pus where they are protected from the 

 stimulus by the pellicle of epidermis at the margin. Here, then, we have entire 

 absence of the inflammatory stimulus ; but the chemical stimulus of the pungent 



* See p. 1 6 of this volume. 



