480 WOUNDS, 



selves beyond one or other of their lower forms. In other 

 cases, the cells not only do not develop themselves, but they 

 degenerate, becoming merely granular, losing the well-marked 

 character of their nuclei, and acquiring all the structure of the 

 pus cell ; thus they are found in the walls of fistuloe and 

 sinuses. Or, more than this, the granulation cells may lose all 

 structure, and degenerate into a mere mass of delris and 

 molecular substance. They are so found on the surface of a 

 wound a day or two before death from exhaustion, as in fatal 

 cases of punctured foot ; and in this state they are found, and 

 are commonly ejected when a granulating wound ulcerates or 

 sloughs. "With more active disease they become tinged with 

 blood, or oedematous ; such are the spongy masses that protrude 

 under the name of proud- flesh or fungus in wounds, and in 

 that disease of the foot termed canker. " All these are 

 hindrances to healing; these are the dangers to which the 

 healing by granulations is obnoxious; it is the proneness to 

 these things that makes it even slower and more insecure than 

 in its proper course it might be." — (Paget.) 



The treatment for granulation is that calculated to repress 

 undue inflammation, in fulfilment of which all sources of irrita- 

 tion must be removed. Sutures, if present, should be removed, 

 warm w^ater dressings or irrigations applied, cleanliness en- 

 joined, and to prevent putrescence and fcetor, weak carbolic acid 

 or other antiseptics. If the discharge be excessive, weak astrin- 

 gents, as the white lotion, are usefid adjuncts; and lastly, it 

 must be remembered that aU. pieces of pulpified tissues, lacerated 

 ligaments, thecse, or skin, ought to be clipped off, and partially 

 divided nerves cut across, and the torn portions taken away. 

 Without these precautions sloughing ensues, and the process of 

 repair will be greatly retarded. 



HEALING BY SECONDARY ADHESION, OR UNION OF 

 GRANULATIONS, 



Occurs when even surfaces of granulations, well developed, but 

 not covered with cuticle, are brought into contact, and so re- 

 tained at rest. As often as this happens, the cells of which the 

 surfaces are composed adhere together; vessels are develoj)ed 

 which pass through them, forming mutual communications, and 



