An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
![Granulation-tissue contains many leucocytes, ])ut they take no active part in the healing process, serving simply as food for the other cells as soon as they have reached a certain stage in their career, known as the polynuclear stage, a point beyond Avhich they are unable to develop. The cells coming from the proliferating tissue-cells are the constructors of the new tissue, and they have in early life amoeboid movements (Ziegler). It is not possible to distinguish the two kinds of cells in granulation-tissue, and Avhen cells of either kind become polynuclear they are no longer able to take an active part in the growth of tissue (Grawitz). It is proposed by Marchand to call the leucocytes found in granulation-tissue exudation-cells, and the proliferating connective- tissue cells the formative cells. Soon after the first day of the healing Fig. 9. \my- -y^Yf^ ■aiiim \>\ i.raiuilaii' ia'ocess new vessels begin to form in loops which develop from the pre-exist- ing vessels. On the surface of a capillary loop a mass of granular protoplasm is seen, which gradually increases in size and grows to an elongated mass of solid nucleated protoplasm which projects toward the edge of the wound. These prolongations either become attached to the wall of another vessel, or unite with similar outgrowths from other vessels or with the cells of the sur- rounding tissue. Later, the central portion of these newly-formed structures melts away, and they become hollow and establish a communication with the vessels from which they spring. The wall of the new vessel is at first homo- geneous, but later becomes nucleated and lined with endothelium. In this w^ay a mass of capillary loops form on either side of the wound, eventually becoming united and forming an exceedingly rich capillary network in the new tissue. As cicatrization completes itself many of the spindle cells and round cells dis- appear. Some undergo granular degeneration and are absorbed; others wander into the adjacent lymph-spaces, and are taken up again into the circulation; many, after reaching a certain stage of development, are destroyed by the more active cells in the reparative process. As the cells vanish new fibers make their appearance, and the wound becomes thus firmly united. In the mean time, on the surface a clot or crust of broken-down blood-corpuscles, epithelial scales, and exudation-material has formed, underneath w^hich new epithelium develops from the deeper layers of the rete mucosum which covers in the sur- face of the wound. When from loss of tissue or other cause it has not been possible to close a wound, and the lips are separated widely from one another, union can only take place by the process of healing by granulation, or second intention (Fig. 9). If we watch such a wound with the naked eye we shall observe, in the course of an hour, that a film has formed upon the surface ; the wound has become glazed by the deposition of a thin layer of coagulated fibrin. This layer, at first trans- parent, soon becomes stained with masses of coagulated blood and fragments of](https://iiif.wellcomecollection.org/image/b21217014_0061.jp2/full/800%2C/0/default.jpg)
