The principles and practice of surgery / by John Ashhurst ; illustrated with five hundred and thirty-three engravings on wood.
- John Ashhurst
- Date:
- 1871
Licence: Public Domain Mark
Credit: The principles and practice of surgery / by John Ashhurst ; illustrated with five hundred and thirty-three engravings on wood. Source: Wellcome Collection.
Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.
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![with the accompanying vascular and nervous changes, correspond to ■what will be hereafter spoken of as the ^rs^ stage of injiammation. Formative Changes ; Lymph and Pus.—The third series of changes to be noticed as due to inflammation, are the foi'mative, consisting in the formation of the substances known to surgeons as lymph and pus. A microscopic examination of inflamed tissue, made at a period varying from a few to twenty-four hours after the commencement of the inflamma- tion, shows the part to be filled with a large number of cells, about ^/oo of an inch in diameter, spherical or nearly so, pellucid, and colorless or grayish-white. The origin of these cells, which are commonly called lymph cells or corpuscles, and which form the corpuscular element of what is known as injiammatory lymph, cannot be said to be positively deter- mined. The doctrine which was generally received a few years ago, and which taught that the lymph corpuscles resulted from molecular aggre- gation, in a substance exuded from the bloodvessels in a fluid condition and subsequently coagulated, is now almost universally abandoned; and.the two theories which at present chiefly divide the suffrages of pathologists are, (1) that which looks upon the new cellular elements as the result of proliferation^ of pre-existing cells, and (2) that which re- gards the cells of inflammatory lymph as identical with the white blood corpuscles and cells found in the lymphatic vessels, as identical, in fact, with the wandering cells which Recklinghausen has described as exist- ing in connection with the ordinaiy connective tissue corpuscles. These cells, in common with many others, possess a ]30wer of spontaneous movement which, from its resembling that of the amceba, has been called amoeboid or amcehaform; they, probably originate in the lymphatic sys- tem, from which they pass into the bloodvessels, wandering thence into the surrounding tissue, where they may become fixed, or whence they may wander back again and re-enter the circulation. The second theory above mentioned is commonly known as Cohnheim's. Injiammatory lymph, as ordinarily observed by the surgeon, is a yellowish or grayish- white, semi-solid substance, which is somewhat elastic and semi-trans- parent, resembling a good deal the bufiy coat of an inflammatory clot. Chemically, it consists of fibrin with an admixture of oily and saline matters, while, when examined microscopically, it is found to contain fibrils^ and corpuscles (which have already been referred to), in varying proportion. The fihrillous, or as Paget calls it, fibrinous element of lymph, ' It would appear from the observations of Vircliow and otliers, that new may originate from previously existing cells, by one of two processes, viz., (1) division, and (2) endogenous growth or the formation of new cells within the cavity of the old. The first process, or that of simple division, is much the more common, and is that to which the term proliferation is habitually applied. The first thing observed in this process is the enlai'gement of the nucleolus, which subsequently becomes constricted in the middle, and finally divides into two. Afterwards the nucleus, and finally the cell itself, undergo similar changes, and thus from one, two or more new cells are developed. The second process, that of endogenous cell- formation, is extremely seldom met witli, and indeed the possibility of its occur- rence has been doubted by some writers. It is said sometimes to occur normally in cartilage, the supra-renal capsules, the pituitary body (KoUiker), and the thy- mus gland (Virchow); and has, according to Paget, been met with in certain encephaloid and epitheliomatous tumors. 2 Paget speaks of fibrinous and corpuscular lymph, this division corresponding pretty closely to that of Williams and others into plastic and aplastic, and to that of Rokitansky into fibrinous and croupous lymph. Inflammatory lymph is, how- ever, essentially the same under all circumstances, though the relative proportion of its constituents may vary in difierent cases.](https://iiif.wellcomecollection.org/image/b21039094_0039.jp2/full/800%2C/0/default.jpg)
