Volume 1

Cooper's dictionary of practical surgery and encyclopaedia of surgical science.

  • Samuel Cooper
Date:
1861-1872
Catalogue details

Licence: Public Domain Mark

Credit: Cooper's dictionary of practical surgery and encyclopaedia of surgical science. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    29/1104 (page 17)
    lacteal and lymphatic glands is a perfect myster}'. These consist of masses of nucleated cells, eitlier disposed within or around (it is not certain which) a mesh of lacteal or lymphatic vessels. That they are often the seats of inflammatory exudation, in certain individuals when there is any injury, abrasion, ulceration, or other cachectic process at any part whence their radicles are derived, is fa- miliar enough. What their functions are in health, what changes they produce on the liquid that .filters through them, and what it is which makes them talie on inflammation after some injuries, and not after others, are things quite inexplicable. The lymphatic vessels (or ubsorhenis) seem to have the office of absorbing everywhere any excess of liquor sanguinis which may be exuded in the process of nutrition. They may absorb, as we have just intimated, a liquid contaminated by un- healthy exudation ; and such liquid may produce inflammation and abscess at any part of their course up to the nearest lymphatic ganglion, or beyond. They may also absorb, from certain morbid growths, as cancer, and epithelioma, and enchondroma, a liquid containing the germs of those growths, which may be developed at the nearest gland, but why this should be the case with some tumours and not with all, is another mystery. Thus it will be evident, 'that the lymphatic vessels and glands, in their function as absorbents, present many points of interest to the surgeon. But there is one important morbid process which Hunter ascribed to their ngencj-, which modern pathology compels us to deny, and that is ulcer- ation. Not only is there not the shadow of a proof that this process is in any way or in any degree effected by the lymphatic vessels, but the eye affords the clearest evidence that it consists in the piecemeal liquefaction and destruction of the ulcerating tissue, which, before it ulcerates is most probably infiltrated with some imhealthy exudation. Ulceration is, in fact, a variety of mor- tification— a sloughing in detail. It ranks with otiier cases in which an exudation is melted down, and the tissues which are infiltrated share in the destruction. This is the case in every abscess ; and this is the process by which abscesses are brought to the surface, but in this the lymphatics take no share. We will now go on to a fifth class of cases ; which may also, so far as proved, be considered cases of active absorption, and which may be com- prehended under the idea, that rapidly growing cells may take into themselves the solid and liquid substances surrounding them, and grow at their expense. The facts of this class of cases and the history of the opinions which have been founded thereon, may be shortly expressed thus: — During the Iluntcrian era of modern surgery, every morbid process was spoken of as an aclioii of the parts concerned, «nd more especially of their vessels; for the fact was overlooked that many most important steps in organisation occur long previous to the appearance either of blood or blood-vessels. British surgeons considered it orthodox to state that It was the ucliu?i of llic resse/s which was the cause of all growth, all secretion, and all disease; and in particular, as we have repeated in this article, all absorption, wasting, and ulceration whatever, were assumed to be the work of the lymphatic vessels. In 1!)3.'), tlio established doctrines respecting ulceration received a rude shock from Mr. Aston Key (Med. CMr. Trans, vols, xviii. xix.), who as- serted his belief that ulceration in general was a process of liqueliiction, or disintegration, or dis- organisation of the ulcerating tissue; — a pro- cess, he calls it, analogous to the softening at- tending suppuration; it is a degeneration of tissue; a change in the affinities existing between its com- ponent parts, by which it becomes changed from a solid texture into a fluid inorganic mass. But in addition to this form of ulceration, he described another, by which he believed bone and cartilage to be more frequently affected. And this other form of ulceration consists in this ; in the existence of an ahsorhiny tissue which grows upon and eats into the cartilage. This absorbing tissue, in some cases of ulceration of cartilage, he believed to be produced bj' a transformation of the synovial mem- brane, in other cases, to be developed as a fresh morbid production of the scrofulous order, from the articular extremity of the bone. We cannot here enter into any details on the subject of ulceration of cartilage, suffice it to say, that Key looked upon that pulpy and gelatinous membrane so often de- veloped on the surface of diseased cartilages, and apparently fitting into evei'y groove and inequality of the surface, as the agent by which their ab- sorption was effected. In the same manner he believed bone to be absorbed by the agency of granulations, and ligament likewise. In ligamentous fibre, he says, the process of ulceration appears to bo accompanied with some peculiar circumstances. The ligament, instead of preserving its usual form and size, becomes dis- tended and feels pulpy. When cut into, the fibres are found to be separated from each other by a vascular structure, which upon being injected, has a villous appearance. * * It is not improbable that the ligamentous fibres themselves are passive i?i the ulcerative process, which there is some reason for believing is performed entirely by the vascular tis- sue that surrounds them. Thus far then, we have seen Mr. Key main- taining that one tissue can be absorbed by another actively growing tissue, on its surface, or in its interstices. This idea was attempted by the Goodsirs to be elaborated into a general law ; ap- plicable not only to the absorption of chyle by the lacteals (which we have already spoken of) but also to many other cases, including the absorption of nourishment by the placenta and including ul- ceration. An ulcer, according to the Goodsirs, is not a chasm formed by the action of the absorbents, as Hunter said ; nor yet resulting from the liquefaction and dis- integration ]Mre ct simple o{ the diseased structure; but a chasm resulting from the action of a peculiar coll growth, which, as they allege, covers its surface, and grows at the expense of the tissue which it covers, and then immediately decays and disappears. This view of ulceration, presents the strongest analogy to the growth of dri/ rot, and of other destructive fungi upon or within the substance of wood or stone ; producing speedy ruin by first living upon the textures they invade, and then perishing themselves. That it is probable that some tissues do actually' disappear in this manner is shown by what takes place in tiie absorption of bone and teeth. This process was described as to all essential points, by the Goodsirs in their essays before ciuoted; but it was afterwards more fully detailed by Mr. Tomes C