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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    similar to that in the neighbourhood of which it was formed, e.g., in connection with bone and periosteum—a process of change attributable to transformation of these nucleated cells. Be it remembered, that the process of plastic organization is inca- pable of being carried on during occurrence and persistence of the third stage of the inflammatory process; the tendency of this being constantly and surely to the formation of pus (degenerate products of connective tissue proliferation), along with some disintegration of the primary structure. The pus and debris, however, are generally hemmed in and bounded by a margin of this plastic material, the inflammatory process having resulted in this less morbid degree of organization. This marginal new formation assumes, in many chronic abscesses, the form of a limiting membrane ; which is then called “ pyogenic,” as from its surface, after the abscess is opened, pus continues to be formed. When the fibrinous product forms on the free surface of a membrane, it is usually termed False membrane. (b.) Fibrinous product may be produced, as we have seen, in the interior of the part; being mixed with fluid, it insinuates itself so as to fill up every minute space, and, along with the multiplication of cell elements, occasions enlargement. The cohesion of the old textures is, at the same time, generally impaired. If the affection be acute, the part is soft and pulpy, as well as swoln ; a considerable proportion of serum being mingled with the fibrinous product. If the affection be slight and gradual, Induration is found instead of softening; the serum having been absorbed, besides in all probability having been sparingly produced at first; and the connective tissue ele- ments having reached a higher and more permanent organization. The inflammatory process ceasing, so does excess of product; fatty degeneration of the cell elements takes place, and absorption then busies itself in attempts to clear away what has been already heaped up ; and in this it may often be materially assisted from without by the hand of the practitioner. (c.) The new cell formations and collection of fluid may be both on the surface and in the interior ; for instance, into the texture and on the exterior of a serous membrane \ or on the surface of such a membrane, and into the parenchyma which it invests. The result is a combination of the changes described in the two preceding sections of this subject. Thus we see that the hyperplastic change or proliferation of ele- mentary structures, which is the essential characteristic of the inflamma- tory process, varies according to the grade, the site, the extent of the disease, and the state of constitution and circumstances of the patient. (1) Softening and absorption with resolution may occur. (2) Organiza- tion of the nuclear elements—a constructive result—may be attained. (3) Or these may undergo fatty degeneration, with softening of tex- ture. (4) Or imperfect and abortive organization occurring, suppuration follows. To all plastic results, organized under even the lightest degrees of in- flammatory change, a general rule seems to be applicable, viz., that they ai e of an ill matured and imperfect organization, and, by consequence, generally removed in one of two ways ; either by simple decadence and absorption,
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