An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.

  • William Williams Keen
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. 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.

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    70 .1-v AMi:ni<AX 'iiix'r-!',(>(n< <)isii;(;i:in'. product is calcified. If, however, the process extends, the caseons nodule becomes laro;er, the necrosed material breaks up into a granular d(''bris, and a fluid is produced which in appearance resembles true pus. These products of degeneration frequently contain the bacilli, and when inoculated into animals may re])roduce the disease. This tuherruIouH pus or puruloid material contains the broken-down masses of cells and a certain numl)er of leucocytes and fragnu-nts of the coagulation- necrosis. The contents of cold abscesses arising from tuberculous processes are usually of this character, but occasionally the pyogenic organisms are found in this fluid, in which case true suppuration occurs. The tubercular pus is thin and of a peculiar white or chalk-like color: it contains lumps of cheesy matter the product of tubercular softening, and fragments of sloughs of the connective tissiu'. Crumbs of bone may occasionally be felt in it. If the tubercular nodule is on the surface of the skin or a membrane, such degenerative changes will lead to ulceration. The local spreading of tubercular inflannnation is caused by the growth of the bacilli, Avhich involve new areas of tissue. Adjacent cavities or organs mav thus be invaded. By the breaking down of bone-tissue the bacilli may gain an entrance into a joint, or the peritoneum may become infected from a tuberculosis of the intestine. When the bacilli enter the blood-vessels or lymphatics, they may be transported alone, or in the interior of small emboli, to a distant organ, and a general miliary tuberculosis may be thus produced. Tuberculosis is probably the most common of all diseases, for it is estimated that IS per cent, of all cases of death occur from this cause. According to Baumgarten, it arises more frequently by inheritance than in any other way ; but, although the bacillus may undoubtedly ])e transmitted from parent to off- spring, it is probable that only a predisposition to the disease is the more fre- quent result of heredity. The disease easily arises then in such predisposed persons when the bacillus gains an entrance to the body through the respiratory organs, Avhether inhaled with the air as dust arising from dried sputa and other excretions, or taken into the alimentary canal with food and penetrating the intestinal mucous membrane. It may also be introduced through wounds of the skin, chiefly of a trifling character, such as bruises or scratches. It is undoubtedly an infectious disease, and may be contracted by persons of healthy ancestry by continued exposure to its germs. Tiiherculosis of the skin includes a number of diseases which until recently have been regarded as diff'erent aflcctions. The most frequent form is that known as lupus. This disease is now recognized as a lesion due to the pres- ence of the bacillus of tuberculosis, although it is often extremely difficult to find the organism. The tendency of the disease is to remain local, but it may occasionally lead to a general tuberculosis. Lupus vuJ(/an's is most frequently seen on tlie face, but other portions of the body may be the scat of the affection, particularly the extremities. It is characterized by a chronic inflammatory process, forming brown-red nodules with a tendency to ulceration and sul)se- quent cicatrization. In this way a considerable area gradually may be involved. When the tendency to ulceration is excessive we have the form known as lupus exedens, although this name is often given erroneously to ulcerating forms of cancer of the face. In other cases the amount of granulation-tissue may be a prominent feature, and then we have the form known as Jup}(s hi/pfrfropJu'eus. When there is a tendency to the formation of cicatricial tissue the disease may produce exten- sive superficial alterations in the skin, and give rise to great deformity, the