Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects.

Mansell-Moullin, C. W. (Charles William), 1851-1940

Date:: 1893

Credit: Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects. 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.

54/1262 (page 46)

$this melts away as rapidly as it is produced, the leucocytes perish and drop off as pus, and the debris of the tissues and the plasma (which is prevented from coagu- lating by the ptomaines) add to the amount. By degrees, however, the activity of the germs decreases, the wall of living leucocytes grows thicker, new vessels are developed from the dilated ones around, and at length a pyogenic membrane [limiting fibrine] is formed and the spread of the suppuration is checked. It rarely happens, however, that it is stayed altogether. Owing to the extreme hyperaemia in all the parts near, the tension of the fluid in the interior is unusually high, and, aided by this, the action of the germs remains sufficiently powerful to continue the destruction in the direction of least resistance. Sometimes, owing to the presence of dense sheets of fascia, the pus spreads laterally for immense distances among the tissues; but sooner or later its course turns toward the surface, the skin or mucous membrane, as the case may be, gives way, and the abscess breaks and discharges its contents. [The law in regard to the pointing of an abscess is that pus is forced to the surface in the line of least resistance.] When the nutrition of the tissues is impaired by intemperance or prolonged residence in foul air, in pyjemia, and during convalescence from exhausting illness, suppuration sometimes occurs without local injury. The capillaries are plugged with micro-organisms at some small spot, and the walls of the vessels themselves are the first to perish and melt away. In such cases as these, or when the streptococcus pyogenes gains early access to the lymphatic spaces and spreads through them before the tissues can resist, a pyogenic membrane is never formed; the suppuration is diffuse; the strength of the tissues is so enfeebled that they disappear before the invading germs, unable to protect themselves by a barrier of any kind. Abscess, or Circumscribed Suppuration. Abscesses are acute or chronic, according to the intensity of the symptoms by which they are attended and the rapidity with which they spread. The latter are probably due to the same causes as the former, acting under less favor- able conditions. Those, however, that result from the softening and liquefaction of masses of caseous material must be distinguished ; they are al\\-ays associated with the presence of specific germs, and for a long time, at least so long as they are chronic, do not contain true pus. It must be admitted that it is not always easy to draw a definite line between them. Pus from an acute abscess in an otherwi.se healthy person is a thick, creamy, opaque, yellowish-white, or greenish fluid, with an alkaline reaction and a specific gravity of 1030 to 1035. ^^^ color is due to the presence of small quantities of altered haemoglobin : when it is red and mixed with blood it is known zs sa?iious ; if it is thin and watery it is called ichorous, and curdy when mixed with flakes of caseous material. Sometimes, when it comes from a mucous membrane, it is known as muco-pus; it may be i?ifective from the presence of micro-organisms, and sometimes specific when it conveys the germs that give rise to definite dis- eases. In the neighborhood of the alimentary canal it not unfrequently has a jjeculiarly offensive odor, although there is no direct communication, and the same thing is often noticed in connection with dead bone. In a few rare in- stances its color is blue, owing to the presence of a special organism {bacillus pyocyaneus). [This bacillus resembles the blue-milk bacillus {bacillus cyanogenus) and belongs to the semi-anaerobic species. According to Ernst, there are two varieties of this organism, the second having a green pigment.] Pus consists of pus-corpuscles mixed with germs, floating in a highly albuminous fluid. The corpuscles themselves are, some of them, identical with leucocytes, and these are alive, capable of amoeboid movements, but the vast majority are dead. They are round, slightly irregular on the surface, about ttsimj of an inch in diameter, and granular. The nucleus is generally bifid or trifid. and sometimes$