406 HEALTH AND DISEASE 



sistence, and are finally resolved into a tough connective tissue, as indicated 

 by the white, glistening scar which remains on the site of the wound. 



As to the nature and source of granulations, they are made up of little 

 heaps of closely-packed cells permeated by minute blood-vessels. The 

 former are derived from connective tissue cells which previously existed in 

 the injured structures, and which, under the influence of irritation excited 

 in the part as a result of the injury, have been caused to multiply, while the 

 new vessels with which they are supplied are offshoots from the old ones. 

 In this mode of healing, many of the cells intended for the purpose of 

 tissue-formation die and are cast off as pus cells, and constitute the white, 

 creamy discharge commonly termed " matter". 



When, in the course of healing, granulations are in excess, and project 

 beyond the wound as a fleshy excrescence, they are usually spoken of as 

 " proud flesh ". 



The three forms of healing first referred to are unattended with danger 

 or suffering to the patient; but in the more prolonged process of suppu- 

 ration and granulation involved in the fourth, various complications may 

 arise by which the general health is more or less seriously impaired, or 

 life imperilled. These untoward results occur for the most part before 

 the surface of the wound is completely covered with granulations, and are 

 brought about by the entrance of bacteria into the wound, and their repro- 

 duction there, giving rise to what is commonly termed "blood-poisoning". 



Besides contaminating the blood, bacteria also operate prejudicially 

 against the healing of wounds. The chemical products they give out 

 irritate and inflame the injured part, and produce a more or less copious 

 outflow of pus, and delay the healing process. 



Blood-poisoning presents several forms and degrees of severity, from 

 a slight traumatic fever to a fatal collapse, or the development of a suc- 

 cession of abscesses in different parts of the body, extending over a more or 

 less protracted period. 



The fluids contained in and upon the surface of a wound serve as a 

 suitable habitat or breeding-ground for a variety of micro-organisms, which 

 not only undergo rapid multiplication, but in the course of their growth 

 and development give off chemical products which in certain conditions of 

 the wound become absorbed into the system, and produce that form of 

 blood-poisoning known as septic intoxication. Large wounds are the more 

 dangerous because of the large supply of this septic product they yield, and 

 the greater extent of absorbing surface they present. The period of 

 greatest danger is during the first six or seven days, or until the wound 

 becomes covered with granulations, which form a barrier against the absorp- 

 tion of the poisonous bacterial products. 



