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Updated: June 28, 2025
Granulations spring up to fill the gap, and are rapidly covered by epithelium, derived partly from the margins and partly from the remains of skin glands which have not been completely destroyed. These latter appear on the surface of the granulations as small bluish islets which gradually increase in size, become of a greyish-white colour, and ultimately blend with one another and with the edges.
The tuberculous ulcer, so often seen in the neck, in the vicinity of joints, or over the ribs and sternum, usually results from the bursting through the skin of a tuberculous abscess. The base is soft, pale, and covered with feeble granulations and grey shreddy sloughs.
Where the soft tissues are pressed against the edge of the nail, the skin gives way and there is the formation of exuberant granulations and of discharge which is sometimes fœtid. The affection is a painful one and may unfit the patient for work.
In extensive ulcers resulting from recent burns, if the granulations are healthy and aseptic, skin-grafts may safely be placed on them directly. If, however, their asepticity cannot be relied upon, it is necessary to scrape away the superficial layer of the granulations, the young fibrous tissue underneath being conserved, as it is sufficiently vascular to nourish the grafts placed on it.
I have sometimes witnessed an angry word spoken to a healthy dog produce instant convulsions in a distempered one that happened to be near; and the fits that come on spontaneously in distemper, almost instantly leave the dog by soothing notice of him. A little of the acid should be dropped on the part and bound tightly down. The protuberance will slough off and healthy granulations will spring up.
When a joint has been opened into, the difficulty of thoroughly getting rid of all unhealthy and infected granulations is so great that amputation may be advisable, but it is to be remembered that ulceration may recur in the stump if pressure is put upon it. The treatment of any nervous disease or glycosuria which may coexist is, of course, indicated.
In abscesses treated by the open method, when the cavity has become lined with healthy granulations, it may be closed by secondary suture, or, if the granulating surface is flush with the skin, healing may be hastened by skin-grafting.
However violent may be the inflammation, and by whatever disorganization it may be accompanied, if we can cure the distemper, the granulations will disappear, the ulcer will heal, the opacity will clear away, and the eye will not eventually suffer in the slightest degree.
The dead bone having been removed, the lining granulations are scraped away with a spoon, and the cavity is disinfected.
As the disease proceeds, and even at a very early period of its progress, an ulcer appears on the centre; at first superficial, but enlarging and deepening until it has penetrated the cornea, and the aqueous humour has escaped. Granulations then spring from the edges of the ulcer, rapidly enlarge, and protrude through the lids.
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