GRANULATIONS—CICATRICES, 195 
mushrooms. Ordinarily soft, friable and bleeding, they secrete in various 
quantities a thin and serous pus. They are almost always due to local 
causes: sometimes the fungosities conceal or contain foreign bodies 
(granular wounds) ; at others the cutaneous edges are indurated, callous, 
or loosened for some distance; or again the edges are irritating to the 
granulations by their constant motion. In some circumstances, the cause 
of the anomaly cannot be made out. When the cause is established, it 
is simple to obtain the cicatrization by extending to it the treatment 
required by that cause ; but it is necessary sometimes to excise the granu- 
lations or to destroy them, either with caustics (alum, nitrate of silver) or 
with the actual cautery. 
Erethistic granulations are the seat of a well-marked morbid sensibility : 
the slightest touch upon it gives rise to sharp pain, combined sometimes 
with an alteration of the nervous fibers of the edges or of the bottom of 
the wound. Ordinarily, the peritraumatic zone is much inflamed. The 
anomaly may be due to the presence of foreign bodies; and their re- 
moval, the application of warm compresses or balneations, analgesical 
vaseline, iodoform or cauterizations slight and repeated are ordinarily 
successful. In some cases it is necessary to cauterize the entire granular 
layer, or the most painful parts of it. 
_ One observes sometimes, in cicatrizing wounds of all animals, the in- 
fectious complication described under the name of diphtheria of granula- 
tions. It is a mild form of hospital gangrene. From one day to the 
next, the surface of the wound is covered with a diphtheritic yellowish 
gray layer several millimeters thick. Under this false membrane the 
granulations are softish, dark red in some places and yellowish or grayish 
in others. When this complication occurs on recent wounds not entirely 
protected by a granulating layer, it always is complicated with a serious 
lymphangitis of rapid development. Sometimes the granulations disinte- 
grate and ulcerate, and a putrid detritus collects on the wound. We have 
observed this affection in horses and in dogs. Hoffmann has seen it in 
the horse; Miller in dogs and birds; others have mentioned seeing it in 
cattle. Cultures, on gelatine and gelose, of the products taken from the 
surface of the granulations have given us colonies of streptococci. 
This diphtheritic condition of the granulations is treated by a minute 
disinfection of the wound with warm solutions of corrosive sublimate, car- 
bolic acid or chloride of zinc. When it takes place upon an extremity, 
balneation in an antiseptic solution at 45--50° and iodoform dressing are 
very advantageous, especially if there is complication of lymphangitis. 
If the trouble resists, the surface of the granulations must be destroyed 
with the cautery or removed with the curette, and the wound must be 
dressed with iodoform. 
