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.
![CHAPTER V. SUPPURATION AND ABSCESS. SECTION I—SUPPURATION. Suppuration is due to the action of the pyogenic cocci upon the tissues, •ind is the usual termination of infective infianiniation. It is the process by means of which the exudate and the tissues involved become liquefied and con- verted into pus. The organisms most frequently found in pus are the staphylo- coccus pyogenes aureus and albus. They have a tendency to accumulate in clusters, and when growing in the tissues produce circumscribed forms of sup];uration. The streptococcus, which is sometiuies present, on the other hand, shows less tendency to cause local suppuration, but spreads rapidly through the tissues by the lymphatics, and eventually gives rise to a diffused form of suppuration. When grown on beef gelatin the staphylococcus causes a liquefaction of the culture medium in virtue of its peptonizing action, which is due to the presence of a soluble peptonizing ferment, and it is in consequence of this action that the fibrinous exudate and the inflamed tissues become converted into pus. That the pyogenic cocci are the cause of suppuration has been abundantly shown by microscopical investigation and experiment. They are found in the pus of all acute abscesses, and sometimes in cold abscesses. The failure to find them in the latter class of abscess has been explained in various ways. By some these abscesses are supposed to be caused by the bacillus of tuberculosis alone, but the most probable explanation is the dying out of the organisms and the deposition of their remains as a sediment. Experiments on animals show that these organisms when injected in sufficient quantity under the skin will produce suppuration. When absorption takes place rapidly, however, a larger (juantity can be injected without producing suppuration. In man inoculation through abrasions or Avounds, and even through the uninjured skin, will cause suppu- ration. Garre produced furuncles of the forearm by rubbing in a culture of the aureus. The question of suppuration without the agency of bacteria has been carefully studied recently. Ex})criments on animals with the injection of calomel, mercury, turpentine, and croton oil show that certain drugs can produce in certain animals pus, or, as it would be better called, puruloid material, containing no bacteria. Non-bacterial pus can also be produced by introducing cultures of cocci which have been sterilized by heat. In this case the organ- isms have been removed, but their chemical products still remain, and are undoubtedly important factors in the production of inflammation and suppu- ration. Practically, however, the surgeon never has to deal with non-bacterial suppuration. Among the predisposing causes of suppuration may be mentioned diminished vitality of the tissues. The healthy body is intolerant of bacteria, and will resist the invasion of a mass of organisms which an inflamed or diseased part may be unable to withstand. The milder types of inflammation seem partic- ularly well adapted to encourage bacterial growth. Some of the severest types of suppuration, such as acute osteo-myelitis, follow often slight blows or inju- ries. The delicate reticulum of blood-vessels found in the medullary cavities of bones furnishes a convenient lodging-place for swarms of bacteria, owing to the slowness of the blood-current and tlie tortuous course of the blood-channels. When the circulation has been impaired or arrested by an extravasation of blood or a congestion of the part, the conditions are favorable for an intravas-](https://iiif.wellcomecollection.org/image/b21217014_0074.jp2/full/800%2C/0/default.jpg)
