A system of surgery / by James Miller.

  • James Miller
Date:
1864
Catalogue details

Licence: Public Domain Mark

Credit: A system of surgery / by James Miller. Source: Wellcome Collection.

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    same tissue. Or it may quit an internal part, and shew on the surface. In the one case, probably no harm is done; in the other, a decided ad- vantage accrues from the change. But, on the other hand, delitescence of an erysipelas is often followed by establishment of the inflammatory process in a serous or mucous membrane, or even in the substance of an important internal organ; and such change may be—nay, often has been—fatal. The process which effects subsidence of the original disease, and establishment of the new, is termed Metastasis. Metastasis, however, may be only apparent. Often, disappearance of an external inflammatory process is quickly succeeded by the super- vention of one that is internal ; and the latter is rightly held related to the former, as effect to cause. Yet, not unfrequently, we may have the two circumstances contemporaneous or nearly so, with their relation reversed ; the internal disorder proving the cause of the subsidence of the external—the less becoming merged in the greater malady. Sometimes we find that, as the new inflammatory affection subsides, the old external disease reappears, and cases occur in which fluctua- tions between the external and internal seizures are repeated over and over again. The possible occurrence of an artificial metastasis of the morbid process from internal to external parts leads to the employment of counter-irritation, as it is called, in the treatment of internal inflam- matory disorders. Resolution being about to occur, the part regains its functional activity; the dilated vessels begin to recover their wonted tone and calibre ; and circulation revives from the impending or actual remora. The red corpuscles within the marginal area of stagnation resume their individual distinctness ; and the agglomerate masses, of both red and colourless corpuscles, blocking up the vessels, first oscillate, and then move steadily on into the general circulation. The local determination of blood ceases ; and the inflammatory changes begun in that fluid are recovered from. Absorption comes actively into play ; and the extra- vascular product is more or less rapidly removed—the more rapidly the more serous its character. Ultimately, the balance of healthy nutrition in the part is restored, the supply of blood brought down by the arteries not exceeding the amount required to meet the waste of texture; and normal change and exchange, as well as functional activity, are resumed. Such resolutive change is marked by a corresponding alteration, equally favourable, in the local symptoms. The pain and heat are the first to subside ; then the redness ; ultimately the swelling more or less gradually disappears. Should the constitution have begun to sympathize, the fever will be found to decline \ and critical excretions will probably occur from the skin and kidneys. When the inflammatory process has been slow in its advance to the resolving point, as well as in its subsequent declension, resolution will probably be imperfect. Time has been afforded for the constructive lesults to attain a mature form, and to be less amenable to absorption than when of fluid or semifluid consistence. There is an obvious risk, con- sequently, of a certain change of structure either proving altogether permanent, or long resisting the efforts of absorption.
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