Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

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    if the lymphatics leading from the part were opened, as has been done in animals, they would be seen to be transmitting more lymph than under normal conditions. The inflammation may now ter- minate, leaving the tissues apparently normal (resolution), or it may lead to certain changes producing irreparable damage to, or total destruction of the part. Thus, the damaged tissue may be replaced by thickened or indurated tissue, and a condition result which is generally described as one of chronic inflammation {fibroid tMcJienim)-, or the tissues in the centre of the inflamed spot may soften and break down, forming a creamy fluid called pus [su]:)- 2urgtion and abscess); or the more superficial tissues may unde'rgo molecular destruction, leaving a raw surface {ulceration)-, whilst again the whole of the tissues in the inflamed area may lose their vitality and die en masse {gangrene). When the inflammatory process is at all severe, constitutional symptoms will also be present. Thus, the temperature will be more or less raised, the skin dry, the pulse increased in rapidity, the tongue furred, the appetite lost, the bowels confined, and the urine scanty and high- coloured—a condition known as inflammatory fever, and due in almost every case to the absorption of some poison {intoxication). Under some circumstances the constitutional symptoms may be of a more serious character, and secondary inflammations may be set up in internal organs or in other parts of the body: the patient is then said to be suffering from septic or from infective poisoning, conditions which, as will be pointed out hereafter, are due to poisonous bacteria or their products entering the general blood- stream or the lymph-channels at the primary seat of inflammation. The minute changes that occur in the above described pheno- mena have of late years been very accurately studied in the tissues of the frog, rabbit, dog, and other animals, and in sections of the cornea and tongue of the frog. They differ according to whether the inflammation occurs in a vascular or non-vascular area. {a) In a non-rascuJar area_, e.g., the cornea, necrosis followed by Proliferation of the fixed cells may be the only recognizable factor in the process of repair- of injury ; or there may be an immigration of leucocytes, attracted by a process of chemiotaxis to the region of cell destruction. In a more intense inflammation, such as that produced by pyogenic micro-organisms, the cell degeneration is followed by a determination of leucocytes to the seat of injury, the leucocytes travelling along the corneal lymph-channels from the congested vessels at the periphery of the cornea, having been attracted towards the inflammatory focus by some unknown force {chemiotaxis). Many of the leucocytes take up micro-organisms {phagocytosis), others degenerate, and at the same time the destruc- tion of the corneal tissue progresses. An arrest of the process is brought about by the leucocytes massing together in large
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