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
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.
![what firnier than in the natural state. This is due to the (iistiiiliance in the circulation owing to division of the vessels, and to the injury done to the tissues. There is no redness, as hyperemia is usually absent, ))ut a moderate amount of exudation occurs, which results in the formation of fibrin, by means of which the surfaces brought in contact are tem])orarily glued together. In large wounds the amount of exudation may be considerable, and, unless it be conducted off by a drainage-tube, may accumulate in spaces which have not been accurately brought in contact, and thus separate the o])posing surfaces. In order to avoid this either buried sutures or pressure must be employed to keep the raw surfaces of the wound in contact, or a drainage-tube must be inserted to conduct off the exudation, and thus allow the raw surfaces to adhere. It was at one time thought that the edges of a Avound might unite by what was called immediate union—that is, by an adhesion of the microscoj)ical structures of the part, without any reparative effort. It is now known that such a union is merely the temporary adhesion of fibers to fibers by means of fibrin, which is preliminary to final union l)y the formation of new tissue. In all large wounds, no matter how careful the adjustment of the parts has been, there are always places where the Avails have not come accurately in contact. If we examine under the microscope a wound healing by first inten- tion, we find these small spaces occupied by blood-corpuscles and masses of coagulated fibrin. There will also be found some fragments of bruised and injured tissue, and here and there small portions of tissue which have under- gone a necrosis owing to the impairment of their blood-supply. At the end of the first twenty-four hours there Avill be an accumulation of leucocytes along the line of the wound. The number of these cells is usually small, but when inflammation is present to any extent they may accumulate in sufficient numbers to obscure the pre-existing elements of the tissue. At this period the vessels are not seen near the margins of the Avound, but Thiersch has shoAvn by injection preparations that a system of plasma-canals exists, Avhich com- municate directly Avith the adjacent vessels, and that many of the red blood- corpuscles and masses of fibrin, apparently extravasated in the tissues, lie in these spaces, Avhich thus are able to provide nutriment to the part until new blood-vessels are formed. As the process of repair proceeds the number of cellular elements of the part—indifferent cells, as they are called—increases perceptibly (PI. V). As the cells increase the fibers of the old tissue become more obscure, and many of them, and of other elements Avhich have undergone retrograde changes, disappear, and the cells seem soon to be supported in a ncAv granular or fibril- lated or reticulated intercellular substance, and the so-called granulation or embryonic tissue is formed. At first this is composed of round cells; in the course of a few days, hoAvever, a large number of spindle-shaped cells are found mingled Avith these, and other large cells Avith one or more nuclei, Avhicb are called e])ithelioid cells. A high-poAver microsco))e Avill shoAV, in fact, the greatest variety of shapes at this time. Later the sj^indle-shaped cells become more numerous, and the ncAv tissue begins to present a fibrous appearance. The origin of the cells of the granulation-tissue is a subject about Avliich there has been much dispute. According to Cohnheim, these cells are the emigrated leucocytes, Avhich are able by proliferation to produce other cells like them- selves, and are the active agents in the formation of the ncAv tissue. The vicAV that the fixed cells of the connective tissue and the parenchyma cells of organs are able to proliferate and form ncAV cells during the process of repair has been gradually regaining its lost position, and the very latest views are as folloAA's:](https://iiif.wellcomecollection.org/image/b21217014_0058.jp2/full/800%2C/0/default.jpg)
