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Updated: June 28, 2025
Hence it is easy to understand how, when a wound is very large, the crust beneath the rag may prove here and there insufficient to protect the raw surface from the stimulating influence of the carbolic acid in the putty; and the result will be first the conversion of the tissues so acted on into granulations, and subsequently the formation of more or less pus.
Great nations replaced little states. Had the South prevailed in the Civil War, there would have been a distinct and calamitous set-back in the world movement. It would have been a reaction toward particularism, and how far might it not have gone? Into what granulations might not our society have crumbled?
On healing, they usually leave a depressed and adherent cicatrix. The scorbutic ulcer occurs in patients suffering from scurvy, and is characterised by its prominent granulations, which show a marked tendency to bleed, with the formation of clots, which dry and form a spongy crust on the surface. In gouty patients small ulcers which are exceedingly irritable and painful are liable to occur.
It may be a foreign body, such as a piece of dead bone, an infected ligature, or a bullet, acting mechanically or by keeping up discharge, and if the body is removed the sinus usually heals. The presence of a foreign body is often suggested by a mass of redundant granulations at the mouth of the sinus.
The occurrence of pathological dislocation is due to softening and stretching of the ligaments which normally retain the bones in position, and to some factor causing displacement, which may be the accumulation of fluid or of granulations in the joint, the involuntary contraction of muscles, or some movement or twist of the limb.
When I first saw this ulcer it was about two inches in diameter and nearly circular, with high edges, a surface of a greenish colour, and without any healthy granulations. I applied the lunar caustic to form an eschar. The pain from the caustic was severe for several hours.
On removing the packing on the fifth or sixth day, the surface is found to be covered with minute, red, papillary granulations, which are beginning to fill up the cavity. At the edges the epithelium has proliferated and is covering over the newly formed granulation tissue. As lymph and leucocytes escape from the exposed surface there is a certain amount of serous or sero-purulent discharge.
Sometimes, again, even when the tints had not changed, after the pricked and labored surface had seemed about to quicken in the heat, to assume the vibratility of living skin, even at the last hour all the labor of the workers proved to have been wasted; for the fickle substance rebelled against their efforts, producing only crinklings grotesque as those upon the rind of a withered fruit, or granulations like those upon the skin of a dead bird from which the feathers have been rudely plucked.
At the seventeenth year the patient began to have a left-sided headache and increased sweating of the right half of the body. In 1892 the periodically-appearing skin-affection became worse. Instead of healing, the broken vessels became blackish and healed slowly, leaving ulcers, granulations, and scars, and the gangrenous tendency of the skin increased.
When these little excrescences appear on the external or internal portions of the flap, they may be taken off with the knife, and caustic applied to the wound, to induce them to heal, and keep down further granulations.
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