How many days does it take for a small wound to heal? What is an infected wound and how to treat it? Healing of sutures after caesarean section

Injuries, often with severe damage to the skin and tissues, are fortunately not an everyday situation, but, alas, not excluded.

Inflammation of the wound, the causes of which can be very diverse, is a natural process in severe wounds.

If you do not respond to wound inflammation in time, the symptoms can intensify significantly and enter a critical phase, leading to serious complications. We invite you to familiarize yourself with the main signs that characterize wound inflammation, the treatment of which, if simple rules are followed, can be quick and effective.

Wound inflammation: causes of the inflammatory process at various stages of healing

Healing of any wound surface occurs in three physiological stages, each of which is characterized by certain visual and symptomatic manifestations. It is worth noting that the healing of damaged tissue is always accompanied by an inflammatory process, the signs of which decrease as the wound heals. In order to promptly identify and prevent atypical inflammation, you need to be well aware of what characterizes each stage of healing.

Stages of healing and external manifestations of wound inflammation

Exudation– local reaction of blood vessels and tissues. It is characterized by slight swelling, as well as slight redness of the tissues surrounding the wound and the release of a specific exudate (liquid part of the blood) from it. Wound exudate at this stage is a clear liquid. Often there are blood clots in it. Over time, the surface of the wound becomes covered with a whitish film - fibrinous plaque. The duration of this period depends on the area and depth of the wound surface and can last up to seven days from the moment of injury. If at this stage the wound becomes infected, the amount of exudate released increases sharply. It becomes cloudy and acquires a characteristic odor.

Regeneration (proliferation)– restoration of damaged tissues. At this stage, tissue granulation occurs. The fibrinous plaque disappears, the tissues are covered with new cells, forming small bright red tubercles (granulations) on the wound surface. There is practically no exudate from the wound; it is still transparent and may contain only a small amount of blood. At the slightest injury, the exudate becomes bloody. Discoloration of granular areas, pallor, indicates re-infection.

Epithelialization– complete healing and scar formation. There is no exudate, the surface of the wound is dry. Inflammation at this stage can only occur due to damage or secondary infection.

With large wounds, healing may occur unevenly. Often the central part of the wound surface is cleaned faster and the edges of the wound do not have time to heal, which slows down its healing.

Sometimes the inflammation of the wound surface increases sharply or its healing proceeds too slowly. There are a number of reasons that can affect the inflammatory process.

Inflammation of the wound: causes affecting slow healing and re-occurring inflammatory process

1. Primary or secondary infection of the wound surface.

Primary – infection directly during injury;

Secondary - can arise as a result of incorrectly performed, in violation of the rules of asepsis, primary wound treatment. As a result of infection due to repeated mechanical trauma to the wound surface or improper local treatment.

2. Weakened immunity and general exhaustion of the body. Chronic infectious diseases (HIV, AIDS, tuberculosis and hepatitis). The presence of chronic diseases that can worsen blood circulation: varicose veins, diabetes mellitus, chronic pathologies of the kidneys, liver, as well as disorders and malfunctions of the cardiovascular system.

3. Deterioration or disruption of diet and rest.

Often, exacerbation of inflammation in a wound is associated with improper treatment, or rather, with self-medication.

Wound inflammation: symptoms of inflammation of the wound and nearby tissues. Possible complications

During primary or secondary infection, anaerobic bacteria, fungi and microorganisms of various origins can enter the wound cavity, which are the root cause of the resulting inflammation.

The main symptoms of wound inflammation and their signs:

Increased temperature in the area of the wound surface;

Sharp hyperemia (redness) of nearby tissues and their swelling;

The released exudate becomes cloudy and viscous - purulent;

Throbbing pain in the wound area;

General malaise: increased body temperature, dizziness, weakness, and in some cases nausea.

Wound healing- a complex process and not only the speed of healing, but also the absence of complications depends on the correctness of the prescription and the accuracy of the treatment. Improper treatment can contribute to the occurrence of sepsis, tetanus, gas gangrene, and rabies. The appearance of purulent and infectious inflammatory processes in the wound area: abscesses, infiltrates, phlegmon or erysipelas.

Wound inflammation: treatment and prevention of possible complications

Wound treatment- a rather lengthy process. The speed of healing depends on the nature of the damage, the degree of infection, the depth and area of the lesion, as well as the general condition of the body. Therefore, first of all, local treatment is carried out aimed at reducing inflammation.

The wound is cleaned daily using aseptic solutions, anti-inflammatory and antibacterial topical medications: solutions and ointments, drugs that allow you to clean the wound and protect it from secondary infection. In the early stages of healing and further treatment of the wound, aseptic solutions are used: 3% hydrogen peroxide; ready-made solutions “Chlorhexidine”, “Furacillin”, “Fukartsin”; a weak solution of potassium permanganate, etc. They treat the edges and wash the wound cavity, clearing its surface of dirt, specific secretions and foreign bodies that have entered during the wound (splinters, splinters, debris, etc.). Also, bandages are applied with aseptic solutions in the first few days. The use of ointments at this stage is not recommended. Ointment dressings are applied later, depending on the condition of the wound.

In parallel with local treatment, general drug therapy is carried out aimed at suppressing the infection - a course of antibiotics is prescribed, drugs that increase immunity and help reduce the inflammatory process. In more severe cases, infusion therapy (droppers) may be prescribed to reduce intoxication. Along with this, symptomatic therapy is carried out, aimed at suppressing side symptoms and treating chronic diseases.

At the granulation stage, inflammation is treated with ointments, gels or special powders that inhibit the growth of granulations and prevent the wound surface from drying out, which can protect the wound from re-infection. Under no circumstances should Vishnevsky ointment be applied to the wound at this stage. It increases blood flow and circulation in the wound area, thereby stimulating the intensive growth of granulations. The tightening of the edges of the wound during healing may not keep pace with the growth of tissue in the center of the extensive wound surface. The epidermis will not have time to cover the new tissues, and they will remain open, rising significantly above the skin level. The popular name for this unpleasant formation is “wild meat”.

After complete healing and during the period of scarring, the wound site should be properly treated for several days (3-4 days) with a solution of brilliant green (green) or bandages with an alcohol solution of calendula should be applied. This will help relieve inflammation that accompanies the scarring process and speed it up.

Relieving wound inflammation and treating it are directly related. If inflammation is not reduced, wound healing will be delayed, and if the wound is treated incorrectly, inflammation will intensify.

ARGOSULFAN® cream helps speed up the healing of abrasions and small wounds. The combination of the antibacterial component silver sulfathiazole and silver ions provides a wide range of antibacterial effects of the cream. The drug can be applied not only to wounds located on open areas of the body, but also under bandages. The product has not only a wound healing, but also an antimicrobial effect, and in addition, promotes wound healing without a rough scar 1
You need to read the instructions or consult a specialist.

To relieve inflammation and treat wounds, in parallel with drug treatment, traditional medicine means and techniques can be used. Before using them, it is highly recommended to consult a professional doctor, since many remedies involve tightly covering the wound surface with medicinal herbs and applying lotions with infusions and decoctions of herbs to its surface.

To prevent the wound from becoming inflamed and to heal quickly, its surface must “breathe.” Tight covering of the wound surface contributes to the accumulation of exudate in it and, accordingly, additional inflammation. And this is fraught with serious complications.

1 - E.I. Tretyakova. Complex treatment of long-term non-healing wounds of various etiologies. Clinical dermatology and venereology. — 2013.- No. 3

Every person at least once in his life has had to experience what an infected wound is and how long and painstaking the process of its treatment is. According to the classification of injuries, this type of wound is the most dangerous, which, if treated incorrectly and late, can cause enormous harm to health, including amputation of limbs or death.

This form of infection in wounds is caused by an imbalance between the microbes that have entered the wound and the body’s defenses. Infection develops especially often in people suffering from diabetes mellitus and circulatory disorders due to weakened immunity, which cannot fully resist the disease process. Abrasions and bruised knees in children are also a cause for concern.

Signs of purulent wounds

There are times when it is not possible to provide first aid or treat the injury site, and then suppuration begins in the wound. Pyogenic bacteria infect the wound, resulting in general blood poisoning, which can have disastrous consequences for the victim.

A clear sign of an infected wound, that is, the presence of an infection in it, is the accumulation of discharged pus. There are some features of purulent wounds that help to recognize them among other types of damage.

The main signs of infection in a wound are:

Pain in the wound area, which is throbbing and aching.
There is noticeable swelling around the wound.
Redness around the wound at a distance of 1-2 cm.
An increase in body temperature above 37 ° C indicates that the infection has begun to spread throughout the body.

These symptoms can be supplemented by general disorders throughout the body: dizziness, nausea and weakness.

The period of the first 6-8 hours is especially dangerous for humans and favorable for infection, when the pathogenic properties of microbial contamination are more strongly expressed. The presence of dead tissue is favorable for the development of infection.

In case of severe purulent infection, the body responds with a general reaction according to the nature and scale of the local process. As soon as symptoms appear in the form of edema and phlegmon, this reaction intensifies. Its striking representative is fever, which manifests itself in the deterioration of the patient’s well-being, increasing pain in the wound, changes in the blood (an increase in leukocytes, the appearance of protein and hyaline casts).

Complications when contracting a purulent infection

A serious complication when contracting a purulent infection is sepsis - a general infection of the body by microbes that have entered the blood.

This disease occurs against the background of a violation of protective immunological reactions or during a long, advanced course of a purulent wound process. With sepsis, there is a different incubation period, which can last from two days to several months.

This condition is divided into acute, subacute and chronic sepsis. In severe cases, acute sepsis can result in the death of the patient in a period of 2 days to 2 weeks, subacute - from 16 days to 2 months, chronic - from 2 to 4 months.

Acute sepsis is characterized by high temperature accompanied by fever. The patient's condition is classified as serious. The skin takes on an earthy tint. In patients, the pulse is weakly palpable, tachycardia begins, blood pressure decreases, anemia increases, and signs of leukocytosis appear. The condition of the wound is dry, with pale granulations, it bleeds easily, and a white coating appears. At the slightest suspicion of sepsis, doctors perform immediate surgical intervention. This is the most effective way to save a patient's life.

Treatment of infected wounds

If purulent discharge begins to appear in the wound, this indicates that it has become infected. For the wound to heal quickly, the infection must be suppressed by providing the victim with the necessary assistance. First, you need to ensure the drainage of pus. If it has accumulated under a crust formed on the wound, it is soaked in hydrogen peroxide and removed using a bandage soaked in peroxide or another antiseptic, applied for half an hour. If pus is secreted under the skin, it is squeezed out of the hole, which is made along the edge where the flap of skin has dried.

Mandatory procedures are daily. If necessary, the pus should be squeezed out. Levomekol ointment is a good remedy that promotes the healing of an already cleaned wound. It is recommended to apply a bandage with this ointment to the wound daily.

In case of acute suppuration (phlegmon, abscess), surgical intervention is resorted to. The wound is opened with a scalpel, non-viable tissue is excised, and wound discharge is collected for laboratory testing of the microflora and its sensitivity to antibiotics. The wound is washed and dried several times, then tampons soaked in saline solution are applied to the site of the wound. For some patients with severe pain, saline solution is replaced with novocaine solution. Sutures are placed, which, if healing results are good, are removed on the ninth day.

Doctors very successfully use wipes with immobilized trypsin to heal purulent wounds, thanks to which local manifestations of inflammation disappear after several times of using the solution. On the first day, pain disappears, wound contents peel off, and blood counts improve. The time required for wound cleansing and further treatment after using this medicine is reduced by half. High efficiency, effectiveness and ease of use are the main characteristics of immobilized trypsin preparations.

For certain indications, patients are prescribed analgesics, antihistamines and detoxification agents. Throughout therapy, it is recommended to use immune stimulants. If there is a threat of infection spreading, according to bacteriological tests, doctors prescribe antibiotics. Monitoring the course of the recovery process, treatment and adaptation in the postoperative period is carried out by doctors during dressing procedures.

Much attention is paid to the expressiveness of inflammatory processes on the sides of the wound, studies of wound material and the patient’s blood, as well as studies of the microbial spectrum. Doctors pay special attention to patients with diabetes and people with problems in the circulatory system. Their treatment follows a different scheme and has a number of features due to the complexity of wound healing.

First aid

In the field, treatment of infected wounds consists of several stages. If the victims are on a hike, on vacation in the forest or mountains, where there are no medical facilities, then the entire treatment process lies with the team. To do this, it is worth remembering a few recommendations aimed at providing first aid when receiving a serious wound:

it is necessary to stop the bleeding (apply a bandage or tourniquet);
treat the skin around the wound with a clean swab with an antiseptic (alcohol, iodine, hydrogen peroxide);
treat the wound itself with chlorhexidine, a solution of potassium permanganate or hydrogen peroxide;
apply a sterile bandage.

If the wound is serious, it will become inflamed within a few days. To treat it, you need to urgently consult a doctor in a nearby locality.

When leaving places of civilization for a long time, you need to have a supply of first aid medications with you: antiseptics, Vishnevsky ointment, Streptocide, Syntomethacin. And, of course, it is imperative to remember that active, timely treatment with complex and differentiated therapy, the inclusion of modern methods of rehabilitation measures will help speed up the healing process of wounds complicated by infection. Neglect of health problems can lead to irreparable disaster.

Body tissues can regenerate over time, but this process takes time. How wounds heal and why it can take a long time, we will look at in our article.

How and for how long do wounds heal?

Wound repair occurs in three stages:

Inflammation
Proliferation
Scar formation

At the stage of inflammation, the body fights against the invading infection. A blood clot appears, stopping the bleeding. Swelling also forms. This swelling can put pressure on nerve tissue, causing pain. After a week, the wound cavity begins to fill with tissue called granulation tissue.

At the second stage, the wound is actively filled with epithelial tissue. A scar appears, and then capillaries, which are saturated with blood, and therefore the scar looks scarlet or has a purple tint.

The third stage begins in the fourth week and can last quite a long time, up to a year. The epithelium is formed, the scar turns pale and the primary collagen, which was formed in the second phase, is replaced by secondary collagen. This completes the wound healing process. If you want to learn more about stitches and wounds, you can read the article.

What determines the speed of healing?

The wound can take a very long time to heal. It all depends on a number of factors:

Depth and length of cut
Quality of the applied bandage
Use of drugs
Effects on the wound (movement, pressure).

Complex wounds often require sutures. It would seem that this should speed up healing, but tissue regeneration depends not only on the presence of a suture, but also on the use of drugs. At the same time, even if the patient receives medications and eliminates exposure to the wound, it will still need time to heal. This is primarily due to the genetic characteristics of the human body.

How to heal a wound faster

There are various methods to speed up wound healing. In addition to medications, traditional medicine remains effective. For example:

Bee honey

Thanks to honey, you can eliminate inflammation and improve blood flow. This speeds up the healing process. Honey can be used to treat not only cuts, but also burns, as well as purulent wounds and frostbite. It is best to use a gauze bandage, which you simply need to soak in honey and apply to the wound.

Chamomile

Chamomile also has good properties that can be used to heal wounds. It is enough to prepare a solution of chamomile by mixing it with boiled water. Allow to cool; the resulting tincture should be warm. Next, moisten with cotton wool and apply to the wound. Wrap with gauze. You need to keep this compress for half an hour and apply it twice a day every day.

From this article you will learn:

how gums heal after tooth extraction: photo,
why does white plaque form?
how to speed up wound healing after tooth extraction.

Immediately after the tooth is extracted, the socket is filled with blood, which normally immediately coagulates, forming a blood clot. The latter protects the socket from infection from the oral cavity, and is also the basis for the formation of gums and bone at the site of the extracted tooth. Over time, the surface of the clot epithelializes, becoming indistinguishable from the gum mucosa.

As a rule, it is difficult for patients to understand whether their wound is healing normally after tooth extraction or whether inflammation occurs. The latter can sometimes develop almost asymptomatically, and the white plaque that forms on the surface of the clot or gum after tooth extraction can indicate both normal healing and inflammation.

How gums heal after tooth extraction: photo
(dates are indicated in the photo)

Remember, in order for the gum to heal properly - immediately after removal, the patient must adhere to the rules governing rinsing, oral hygiene and nutritional habits in the first days after removal.

How long does it take for gums to heal after tooth extraction - timing

How long it takes for the gums to heal after tooth extraction depends on many factors: the degree of trauma of the removal, whether sutures were applied, the possible addition of infectious inflammation of the socket, and the age of the patient. Healing of the hole after tooth extraction can be divided into partial and complete.

Partial epithelization of the wound occurs on average in 12 days (Fig. 5), but complete epithelization of the surface of the clot is observed in 20 to 25 days (Fig. 6). However, if inflammation of the socket occurs or after, which is usually accompanied by a major bone injury, the healing time may increase by several days.

Reasons for slow healing –

significant trauma to the bone and gums during removal (both due to the doctor’s indifference and as a result of sawing out the bone around the tooth with a drill during difficult removal),
when a clot falls out of the socket (empty socket),
development ,
the doctor left fragments or inactive fragments of bone tissue in the socket,
if sharp bone fragments protrude through the mucous membrane,
if the gum mucosa around the hole is very mobile, and the doctor did not apply stitches,
antibiotics were not prescribed after a complex removal,
patient's age.

How to speed up wound healing after tooth extraction -

The best remedy that can speed up the healing of the gums after tooth extraction is the placement of sutures on the socket of the extracted tooth by a surgeon immediately after the tooth is extracted. Moreover, it is necessary that the edges of the gum mucosa be as close to each other as possible. This will speed up healing and reduce the risk of inflammation in the socket of the extracted tooth. But if you have already had a tooth removed without stitches, then topical oral products may help (see below).

Additional topical products –
Patients often ask if there is an ointment for healing wounds after tooth extraction... If you are not satisfied with how long it takes for the gums to heal after tooth extraction, then this process can really be accelerated. Rapid healing of wounds in the oral cavity is possible with the use of agents that accelerate the epithelization of wounds on the mucous membrane. These means include -

It should be noted that these drugs also have a good analgesic effect. You can read about the features of their use after tooth extraction using the links above, but if you are a fan of folk remedies, then ordinary sea buckthorn oil may also come in handy (although its effect will be noticeably more modest).

What does white plaque mean after tooth extraction?

Some patients notice that their gums turn white after tooth extraction. In the normal course of events, a whitish coating is nothing more than an “effusion” of fibrin from the blood, and indicates the beginning of epithelization of the wound. White plaque after tooth extraction usually appears on the surface of a blood clot (Fig. 8), as well as on the surface of a severely injured mucous membrane.

White plaque on the gum after tooth extraction -

In this case, the gum surrounding the socket has a pale pink color; when you press on the gum, there should be no purulent discharge (as in the video below), there should be no unpleasant odor from the socket, constant aching pain or pain in response to cold and hot water.

When whitening of the gums indicates inflammation -

The photos above show what a white or yellowish coating can look like normally. However, very often, necrotic disintegration of a blood clot, or fragments of bone tissue protruding along the edges of the hole or in its depths, covered with a whitish or yellowish coating, can be mistaken for such a plaque.

White gum after tooth extraction due to inflammation (Fig. 10-12) –

Such conditions of the socket after removal are always accompanied by discomfort, constant or periodic aching pain, an unpleasant odor from the socket, and sometimes suppuration from the socket. If there are areas of the bone not covered by a clot, there is almost always pain when cold or hot water comes into contact. In all these situations, an urgent visit to a surgeon is necessary for (alveolitis).

It is not possible to cure alveolitis at home, because... if there is a disintegration of a blood clot, it must first be cleaned from the socket, washed with antiseptics, after which the doctor, during periodic examinations, will initially put anti-inflammatory drugs into the socket, and only after the inflammation has subsided, agents to accelerate epithelization (such as Solcoseryl) are put into the socket.

In video 1 below you can see that the hole is filled in depth with the necrotic decay of a white blood clot. In video 2, the patient had 8 teeth removed from both sides and when you press on the gums, you can see thick pus coming out of the holes.

During the wound process, three main periods are distinguished.

First period characterized by the melting of necrotic tissues, their sequestration into the external environment and cleansing of wound detritus. The duration of this period is determined by the volume of damage, the degree of infection of the wound, the characteristics of the body and averages 3-4 days.

The initial reaction of the body to injury is a spasm of blood vessels in the area of the wound defect, followed by their paralytic expansion, increased permeability of the vascular wall and rapidly increasing edema, which is called traumatic. Acidosis developed as a result of metabolic disorders and changes in the state of colloids contribute to the progression of traumatic edema.

Vasodilation is accompanied by a violation of their permeability and is associated with the release of predominantly histamine and partially serotonin. In response to damage and exposure to microbes, leukocytes migrate from the blood vessels into the wound in large numbers. This applies mainly to neutrophils capable of phagocytosis. Along with other enzymes, they secrete leukoprotease, which is used to destroy cell debris and phagocytosed microorganisms. In addition, a large number of histiocytes, macrophages, lymphocytes and plasma cells accumulate in the tissues. Along with this, normal plasma contains oxins that facilitate phagocytosis, agglutinins that help glue and destroy bacteria, and a factor that stimulates an increase in the release of leukocytes from the blood.

Regarding the mechanism of lysis of non-viable tissue and wound cleansing, the role of the microbial factor in this process should also be emphasized.

The inflammatory reaction can grow rapidly and within the first day a so-called leukocyte wall is formed, which develops at the border of viable and dead tissue, being a demarcation zone. All these processes lead to the preparation of damaged tissues for the healing process. In particular, fibrin deposited in the wound undergoes local fibrinolysis of plasmin, which appears due to activation of plasmin by kinase. This leads to the unblocking of lymphatic gaps and vessels, and inflammatory swelling disappears. Starting from the third day, along with the previously predominant catabolic processes, anabolic ones come into play, the synthesis of the main substance and collagen fibers by fibroblasts increases and capillaries are formed.

An increase in blood supply to the area of injury causes a decrease in local acidosis.

Second period - the period of regeneration, fibroplasia, begins 3-4 days after injury. The shorter it is, the less cells and tissue were injured when injured. A distinctive feature of this period is the development of granulation tissue, which gradually fills the wound defect. At the same time, the number of leukocytes sharply decreases. Macrophages continue to play an important role, but capillary endothelium and fibroblasts become of great importance during the regeneration period.

Granulation tissue begins to form in the form of separate foci at the bottom of the wound. These lesions are characterized by intense new formation of capillaries as a result of the secretion of biologically active substances by mast cells. Granulation tissue, due to its richness in blood vessels and cells, looks juicy, bleeds easily and has a pinkish-red color. Based on the appearance of granulations, one can judge the state of wound healing. Typically, healthy granulations have a granular appearance, a bright red color, and their surface is moist and shiny. Pathological granulations are characterized by a smoother surface; they look pale, flaccid, glassy-edematous, and covered with a layer of fibrin. Their cyanotic tint indicates a deterioration in venous outflow, which determines this color. In sepsis, granulations are dark red and appear dry.

The causes of poor granulation formation can be both general and local. After their elimination, the appearance of granulations quickly changes and the process of filling the wound with scar tissue is restored.

Thanks to the large number of fibroblasts that form collagen fibers and interstitial substance, the wound cavity is filled and at the same time the epithelium begins to creep from the edges due to the migration of cells to the newly formed granulations. The second fibroplastic period lasts from 2 to 4 weeks, depending on the location and size of the wound.

Third period- the period of scar reorganization and epithelization begins without any transition on the 12-30th day from the moment of injury and is characterized by a progressive decrease in the number of vessels, they become empty. the number of macrophages and mast cells of fibroblasts decreases. In parallel with the maturation of granulation tissue, epithelization of the wound occurs. Excessively formed scar tissue rich in collagen fibers undergoes restructuring. These processes are characteristic of all tissues; they differ only in time. For example, skin heals much faster than fascia and tendons, which take 3-6 months to heal. At the same time, restoration of the skin begins after 24-48 hours and is determined by the migration, division and differentiation of epithelial cells. During primary wound healing, epithelization occurs on days 4-6.

Phases of wound healing (according to M.I. Kuzin, 1977) The first phase is inflammation. The initial period of this phase in the wound is characterized by vasodilation, exudation, hydration and migration of leukocytes. Then phagocytosis and autolysis increase, which helps cleanse the wound of necrotic tissue. The duration of this phase is 1-5 days. In this phase, the wound experiences pain, increased temperature, infiltration and swelling.

The second phase is regeneration. During this period, recovery processes predominate in the wound. Tissue exudation decreases. The synthesis of collagen and elastic fibers increases, which fill the tissue defect. The wound is cleaned and granulation tissue appears in it. Signs of local inflammation are reduced - pain, temperature, infiltration. The duration of this phase is about a week (from 6 to 14 days from the onset of injury).

The third phase is the formation and reorganization of the scar. There is no clear boundary between the second and third phases. During this period, the scar thickens and contracts. The duration of this phase is up to 6 months.

Each anatomical region has its own characteristics of wounds. This determines the tactics of performing surgical operations, pain relief, etc.