A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases ... with numerous prescriptions ... a classification of diseases ... a copious bibliography, with references; and an appendix of approved formulae / ... By James Copland.

James Copland

Date:: 1844-58

Credit: A dictionary of practical medicine : comprising general pathology, the nature and treatment of diseases ... with numerous prescriptions ... a classification of diseases ... a copious bibliography, with references; and an appendix of approved formulae / ... By James Copland. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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$very quick, and the powers of the latter fail, that much dreaded state of the frame, which is insuf- ficient for the formation of coaguhil)le lymph, may be considered as approaching, if it be not actually present. In all cases where blood-vessels are liable to be inflamed, this state of the consti- tutional powers, owing to the risk of the blood being vitiated, is particularly to be guarded against. Having advanced as much as belongs to my pro- vince lespecting the reparative states of adhesion, I proceed to stale briefly tne doctrine of Murbid adhesions. The particular morbid adhesions are noticed under the articles on the pathology of the parts in which ihey form. 10. Adhesions in some one of the states de- scribed above (§ 1—4.) are liable to occur, as a consequence of certain grades of inflammation, in the following situations: — 1st, In the cellular tissue; 2fi, Between serous surfaces; 3d, Be- tween mucous surfaces; 4th, Between synovial surfaces ; 5th, In the internal surfaces of blood- vessels ; ami, 6ih, Between the surfaces of morbid or accidental formations. 11. A. Adhesions of Cellular Tissue. — The fir-t step of the process is the exhalation of a quantity of yellowish serum and of coagulable lymph into the cellules of this tissue, which ulti- mately agglutinates them together, upon the absorption of the former, and the concrescence of the latter. The consequence of this is, that the piorluct of inflummation formed in the centre of the inflamed cellular tissue, consisting chiefly of the more fluid and least concrescible portion of the exhalation, is prevented from permeating the agglutinated cellules, and a barrier is set up against it. If resolution takes place, and the pu- rulent matter is absorbed, the surfaces of the cavity become united, and the medium of union is changed, as in cases of recent wounds, and in the manner described above (§ 5.). If the parts go on to the evacuation of the matter, adhesion is also effected, as in the case of consecutive re- storative adhesion {§ 7.) ; leaving, however, a cicatrix, which is gradually dimitii-hed, formed of the cellulo-fibrous medium of union. In all cases of indammaiion of cellular tissues adhesion of the cellules, from the exudation of a concres- cible lymph, takes place ; and it is thisadheson which forms the fibrous cysts ti abscesses, isohites their contents from the surrounding structures, and in some respects excludes them from the econoToy. Adiiesions of the cellules of this struc- ture also strengthen the cysts of aneurisms, and form sera fibrous cysts around foreign bodies that are accidentally lodged in it. 12. B. Adhesions between serous surfaces are the next most common; being formed through the medium, either of a more or less thick and firm inorganic albumen, in the form of a false membrane, or of this substance advanced to a more or less organised state, and assuming either the appearance of cellular tissue, with a surface partaking of the serous character, or one of the states about to be noticed. 'Ihe organised nature (if those adhesions has been denied by some ; but the observations of Sioi.i., Hiinti;ii, JJupuy- TuiN. Baii.i.ik, Meckel, Homk, LoiisriiiN, Ciiu- vhiLiiirn, Gendiun', Baiion, and others, who have traced blood-vessels in them, have put the question at rest. Adhesions occur most frequently bet^veen the pleura;, next in the peritoneum, and next Jo these in the pericardium They are com- paratively rare in the tunica vaginalis; and in the arachnoid they are still more rare. 13. It is not necessary to the formation of ad- hesions between opposite serous surfaces, that the pre-existing inflammation shall extend continu- ously to both. VVhen the coagulable lymph is thrown out upon one of the two inflamed surlaces, —as, for instance, on the peritoneal surface of the small intestines, — it seems to act as an irritant to the opposite part of the omentum, with which it is brought in contact, inducing inflammation of that part only, and leaving the intervening surface both above and below it unafteeted. The part thus irritated by the contact of the coagu- lable lymph, poured out by the part primarily afl^ected opposite to it, becomes also inflamed, and exudes this concrescible fluid; and the inflammation thus secondarily induced in a part of the omentum, may advance to the external surface of the omental duplicature, and, by means of the exudation of this product of inflammation in that situation, excite a similar state of action in the directly opposite part of the peritoneum reflected over the abdominal parietes. Thus the inflammation and its consecutive adhesions may proceed, without the disease having affected any of the continuous surfaces intervening between them. A .-imilar circumstance is sometimes ob- served in respect of the convex surface of the liver and peritoneal surface of the diaphragm. Infldmmation, commencing in a part only of the former, will excite it in the part of the latter exactly opposite, and be followed by adhesion ; and the inflammatory action, not infrequently ex- tending upwards through the diaphragm to the dia- phragmatic pleura, will be further followed by the exudation of coaj^ulable lymph on its free surface, which, irritating that portion only of the pulmonic pleura opposite to, or in contact with it, will inflame that part, and form adhesions with it, without afTecting the continuous surface intervening be- tween, and surrounding the adherent parts. The unadhering cavity, however, not infrequently contains a turbid or flaky serum, with patches of false membrane, arising from a less acute state of inflammatory action in those parts of the serous surface immediately adjoining the adhesions. Thus it is not unusual to find, in cases of acute inflam- mation afl^ecting either the peritoneum, pleura, or arachnoid, and limited to a particular part, a similar state of disease, and the same product, formed only, in the parts ojiposite, and most nearly in C(mt!ict ; whilst the continuous surfaces sur- rounding them are either altogether sound, or much less afl'ected ; — most commonly only so far as to give rise to a serous exudation, or slight albuminous coating, in their immediate vicinity. 14. From tliis it will appear, that the near approach, and more especially the immediate contact, of opposite surlaces, and the want of motion between the one surface and the other, will favour the formation of atlhesions : thus they are most fieciuent at the superior parts of the pleura, between the convex suiface of the liver and the dia])hragin, and the serous surfaces of pans included in hernia;. The different species of media, by which adiie-ions of serous surfaces tire affected, are the following, according to M. CiirvMi-nim :—An inorganised false membrnne ; a fihtmentoiis adhesion, and a cellular adhesion.$