The principles and practice of medicine / [John Elliotson] ; edited by Nathaniel Rogers and Alexander Cooper Lee.

  • John Elliotson
Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of medicine / [John Elliotson] ; edited by Nathaniel Rogers and Alexander Cooper Lee. Source: Wellcome Collection.

    119/1242 page 99
    it is necessary to remember that the invariable result of' inflammation is— the effusion of liquor sanguinis, differing in its quality, according to the varying condition of the system. When inflammation occurs, therefore, in any given part, circumscribed by defined limits, the cells of the tissue become infiltrated, at the spot in which the action is most intense;—softening of the original structure succeeds; and a more or less perfect solution of the proper tissue takes place, in the inflammatory effusion. This change con- stitutes that condition, which, in scientific medicine, is regarded as an essential preliminary to the process of absorption under every combination of circumstances. The doctrine, first propounded by Hunter, which sup- posed the previous solution of the substance of a part as unnecessary to its absorption, was subverted by the researches of Mr. Key, published in the Transactions of the Medico-Chirurgical Society. The views of Mr. Key have been likewise advocated by Dr. Prout; who puts it forth as a principle of universal application, that the solution of a part is an essential pre-requisite to its absorption. Physiology presents us with numerous instances of in- terest, which might be advanced in confirmation of this view. The yelk, in immediate contact with the beautiful web of the area vasculosa, undergoes liquefaction before it passes into the vessels, to fulfil the purpose of nutri- tion. The lymph is taken up by the absorbents in a perfect state of liquidity. Thus, then, the first steps in the formation of abscesses are rendered intelligible. The disintegration, induced by the softening, soon becomes limited by more active inflammation—a separation is worked out between the disorganized and the surrounding living parts, by the production of a saccular membrane—which in surgery is called pyogenic.a It consists, at the beginning, of the cells of the encircling structure infiltrated with a fibrinous deposit—which subsequently acquires the cha- racters of membrane.—It is supposed to exercise the function of ab- sorption and secretion ;—thus renewing the contents of the abscess.—T. Williams.'] This pyogenic membrane, together with the adjacent soft parts, become gradually absorbed at one particular point of the abscess, nearest to the surface, or some principal outlet of the body; wherever, in fact, the easiest exit for its contents is to he found :—abscess of the liver, for example, may either point outwards towards the surface, or upwards towards the lungs; and, after producing absorption of the intervening diaphragm, discharge its contents. Such, at least, was the opinion of Hunter; it is however certain, that there are other circumstances to be considered ;—such as the structure of the affected part, and the greater or less facility with which it takes on inflammation and ulceration. When there is danger of pus escaping into a cavity, or part of the body where serious consequences would result (as, for instance, into the peritoneum), then a great deal of additional lymph is frequently thrown out for the purpose of glueing the various parts together; —in order to prevent, as much as possible, the escape of the pus in an im- proper direction. Thus nature usually thins the walls of an abscess at that point which is most eligible for the escape of the pus; and thickens them where it would he dangerous for the pus to escape. This extraordinary pro- vision of nature, may truly be considered as one of the most wonderful phenomena which claim the attention of the pathologist. The absorption at the former point, wherever it may be, goes on. If it be near the surface, we see the chief swelling at one particular part; and the collection is said to “ point.” At length a minute opening is formed, a Pus_„£ H 2
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