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Under this scab the formation of granulation tissue, its transformation into cicatricial tissue, and the growth of epithelium on the surface, go on until in the course of time the crust separates, leaving a scar. Healing by Blood-clot.
The base of the ulcer becomes red and angry-looking, the granulations disappear, and a copious discharge of thin yellow pus, mixed with blood, escapes. Sloughs of granulation tissue or of connective tissue may form. The edges become red, ragged, and everted, and the ulcer increases in size by spreading into the inflamed and œdematous surrounding tissues. Such ulcers are frequently multiple.
After the tuberculous granulation tissue erupts through the cortex of the bone, it gives rise to a cold abscess or infects adjacent joints or tendon sheaths. [Illustration: FIG.
Such an ulcer has an elevated border, sharply cut edges, an indurated base, and exudes a scanty serous discharge; its surface is at first occupied by yellow necrosed tissue, but in time this is replaced by smooth, pale-pink granulation tissue; finally, epithelium may spread over the surface, and the ulcer heals.
When the skin is broken and caseous tuberculous tissue is exposed, healing is promoted by cutting away diseased skin, removing the granulation tissue with the spoon, scraping sinuses, and packing the cavity with iodoform worsted and treating it by the open method and secondary suture if necessary. Exposure to the sunshine on the seashore and to the X-rays is often beneficial in these cases.
Some of the poor fellows who were wounded at the battle of Murfreesboro' now began to suffer from gangrene. Tents were pitched outside the hospital for such cases, and it was often my fate to stand beside these sufferers while the surgeon removed unhealthy granulation with instruments or eating acids, or in other ways tortured the poor fellows to save life.
There was little hemorrhage, and the wound was healed by granulation. Avulsion of the male external genitalia is not always accompanied by serious consequences, and even in some cases the sexual power is preserved. Knoll described a case in 1781, occurring in a peasant of thirty-six who fell from a horse under the wheels of a carriage.
It was used like any other commodity, and worn out like leather or cloth. The original cuticle of the continent has disappeared for ever. The task, now is to induce the granulation of a new one. The restorative process may be complete by the time we have four hundred souls to the square mile, like England and Flanders.
This granulation tissue is gradually replaced by young cicatricial tissue, and the surface is covered by the ingrowth of epithelium from the edges. This modification of the reparative process can be best studied clinically in a recent wound which has been packed with gauze. When the plug is introduced, the walls of the cavity consist of raw tissue with numerous oozing blood vessels.
This is a lesion, met with chiefly on the face and in the region of the external genitals, in which the skin becomes infiltrated with granulation tissue so that it is thickened, raised above the surface, and of a brownish-red colour.
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