CHAPTER IV. 
GRANULATIONS—CICATRICES. 
In the cicatrization of traumas with loss of substance, as soon as the 
granulations have reached the level of the skin, their growth generally 
ceases; they become even; their structure is more dense ; connective 
structure develops in them ; blood vessels are obliterated ; cellular elements 
disappear by regression ; the purulent secretion diminishes more and more; 
and at the periphery of the wound, at the limit of the cutaneous borders 
and of the newly formed tissue, there appears a slightly projecting circle, 
a kind of reddish band, which progresses slowly toward the center of the 
cicatrix, followed at a short distance by a very thin band of darker color. 
This new layer, which ordinarily spreads evenly on the innodular tissue 
from the periphery to the center of the solution of continuity, is the 
‘regenerated epidermis. Sometimes in large wounds, when small pieces 
of skin with the Malpighian layers have been preserved, the new forma- 
tion of the epidermis takes place at several points. At the same time 
that the cicatrization advances, the tumefaction and the morbid sensibility 
gradually diminish and disappear. = 
But the repairing process does not always follow this normal progress. 
Often, especially with extensive lesions, the cicatrization is disturbed, the 
new tissue assumes a peculiar aspect or character, due to various pathologi- 
cal conditions of the granulations. 
Sometimes, because of some disease or some general cause interfering, 
the granulation relaxes and stops before the wound is entirely filled. It 
must be stimulated by exciting preparations, strong antiseptic solutions or 
superficial cauterization with the nitrate of silver. 
More commonly, the granulations rise quite high above the cutaneous 
layer, and are exuberant. Among horses and cattle, it is quite common 
to observe, especially on wounds of the extremities, cicatrices more or 
less protruding, which in their earlier stages can easily be controlled by the 
use of drying powders, styptic applications, pressure, or dressings with 
astringent preparations (tannin, white lotion). 
Fungous granulations protruding much above the level of the skin, 
and sometimes covering its edges, assume an aspect resembling that of 
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