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Updated: May 8, 2025


It was smooth, dark-grey, and clear; free from air, and free from surface lines; very hard, and suggesting the idea of coarse internal granulation.

Even a simple inorganic crystal does not spring ready formed from its solvent, but first passes through phases of granulation and striation comparable with those which characterise the beginnings of vital growth. Metals exhibit in some respects phenomena similar to those possessed by organised beings. Thus, they show fatigue under long continued stress, and they recover their strength with rest.

It is to be understood, however, that operative treatment must always be preceded by and combined with other therapeutic measures. The caseation of tuberculous granulation tissue and its liquefaction is a slow and insidious process, and is unattended with the classical signs of inflammation hence the terms "cold" and "chronic" applied to the tuberculous abscess.

Pain is less severe, and is referred to the parts that have been burned to a less degree. Infection is liable to occur and to lead to wide destruction of the surrounding skin. The amount of granulation tissue necessary to fill the gap is therefore great; and as the epithelial covering can only be derived from the margins the skin glands being completely destroyed the healing process is slow.

In acute arthritis, all the structures of the joint are involved; the articular cartilage is invaded by granulation tissue derived from the synovial membrane, and from the marrow of the subjacent bone; it presents a worm-eaten or ulcerated appearance, or it may undergo necrosis and separate, exposing the subjacent bone and leading to disintegration of the osseous trabeculæ caries.

"For a good many years now a rheumatic right shoulder has made it impossible for me to sleep on my right side and it seriously affected, and increasingly so, the use of my right arm. A masseuse told me she could effect no permanent improvement as there was granulation of the joints and a lesion.

Early tertiary lesions may be infective, and the disease may be transmitted by the discharges from them; but the later the lesions the less is the risk of their containing an infective virus. The most prominent feature of tertiary syphilis consists in the formation of granulation tissue, and this takes place on a scale considerably larger than that observed in lesions of the secondary period.

The clinical features are those of an indolent hydrops, with or without melon-seed bodies, or of uniform thickening of the wall of the bursa; the tuberculous granulation tissue may break down into a cold abscess, and give rise to sinuses.

The dead bone is separated from the living by the agency of granulation tissue with its usual complements of phagocytes and osteoclasts, so that the sequestrum presents along its margins and on its deep surface a pitted, grooved, and worm-eaten appearance, except on the periosteal aspect, which is unaltered.

In subcutaneous wounds, for example tenotomy, in amputation wounds, and in wounds made in excising tumours or in operating upon bones, the space left between the divided tissues becomes filled with blood-clot, which acts as a temporary scaffolding in which granulation tissue is built up.

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