Volume 1

Descriptive catalogue of the pathological specimens contained in the museum of the Royal College of Surgeons of England.

  • Royal College of Surgeons of England. Museum.
Date:
1846-9
Catalogue details

Licence: Public Domain Mark

Credit: Descriptive catalogue of the pathological specimens contained in the museum of the Royal College of Surgeons of England. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    breach in the solids, which had been produced by suppuration and ulceration, and after- wards exposed ; for parts are capable of forming granulations, or what I suppose to be the same thing, new animal matter, where a breach has been made internally, and where it ought to have healed by the first intention ; but the parts being baulked in that operation, often do not reach so far as suppuration, so as to produce the most common cause of granulation. The first instance of the kind that gave me this idea was in a man who died in St. George's Hospital. January, 1777. A man about fifty years of age, fell and broke his thigh-bone nearly across, and about six inches above the lower end. He was taken into St. George's Hospital; the thigh was bound up, and put into splints, &c. The union between tlie two bones did not seem to take place in the usual time. He was taken ill with a com- plaint in his chest, which he had been subject to before, and died between three and four weeks after the accident. On examining the parts after death there were found little or no effects of inflam- mation in the soft parts surrounding the broken bones, except close to the bones where the adhesive inflammation had taken place only in a small degree. The bones were found to ride considerably, viz., near three inches. The cavity made in the soft parts, in consequence of the laceration made by the riding of the bones, had its parietes thickened and pretty solid, by means of the adhesive inflammation, although not so much as would have been the case if the parts had been better disposed for inflammation : and some parts had become bony. There hardly was found within this cavity any extravasated blood or coagulating lymph, except a few pretty loose fibres like strings, which were visibly the remains of the extravasated blood. From these appearances this cavity had evidently lost its first bond of union, viz., the extravasated blood, which took place from the ruptured vessels ; and probably the second had never taken place, viz., the coagulating lympli, in consequence of the adhesive inflammation : however, there was an attempt towards an union, for the sur- rounding soft parts, we have observed, had taken on the adhesive and ossific inflamma- tion, so that in time there might have been formed in the surrounding soft parts a bony case, which wouhl have united the two bones ; but tlie parts being deprived of the two common modes of union, they were led to a third. From the ends of the bones and some parts of tlieir surface, as well as from the inner surface of the soft parts, there was formed new flesli, similar to granulations. The hollow ends of the bones were filled with this matter, which was rising beyond the common surface of the bone, and in some places adiiesion had taken place between it, and the surrounding parts, with which it had come in contact. The same appearance which this new flesh had in this case I have several times seen in joints, both on the ends of the bones and on the inside of the capsular ligament [See 887, 905, 907, &c.], but never before understood how it was formed ; hence we find that granulations can and do arise in parts that are not expot-ed. This is what I have long suspected to be the case in the union of the fractured patella, and this fact confirms me more in that opinion [See 535, 536]. Here then we are shown that the cause of granulation, or the forming of new flesh
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