A manual of surgery for students and practitioners / by William Rose and Albert Carless.

  • William Rose
Date:
1900
Catalogue details

Licence: Public Domain Mark

Credit: A manual of surgery for students and practitioners / by William Rose and Albert Carless. Source: Wellcome Collection.

    22/1254 (page 4)
    more, it may find its way back into the circulation through the lymphatics, or be transformed into a pus corpuscle ; moreover, prior either to disintegration or transformation into a pus cor¬ puscle, it may attack and assist to remove any dead tissue which exists in the neighbourhood of the inflammatory focus, whilst a phagocytic function (i.e., microbe-destroying, vide p. 16) is also subserved. In fact, the leucocytes may be looked on as the scavengers of the body, or as advanced guards, which, at the onset of mischief, are thrown out from the vessels as Nature’s first line of defence against the invading forces, their chief duty being to remove all damaged and noxious material, and then, having limited the spread of the destructive process, they in turn give place to the larger and more useful fibroblastic cells which are the active agents in the process of repair. The red corpuscles pass through the walls of the capillaries by a process of diapedesis, the result of simple mechanical pressure ; this usually occurs only in very acute attacks. When once external to the vessels they are broken up and their colouring matter diffused through the tissues. The liquor sanguinis is also extravasated. This is merely an exaggeration of a normal process, although in health the lym¬ phatics are capable of removing all the fluid exuded. In patho¬ logical conditions the amount of plasma which passes through the walls is excessive, and although for a time the lymphatics of an inflamed region do increased work, yet the transudation is soon greater than they can deal with. If the fluid escapes into the tissues, it undergoes coagulation by meeting the necessary coagulating media developed from the breaking-down leucocytes ; inflammatory lymph forms locally, whilst the serum collects in the meshes of the tissues, constituting an inflammatory form of oedema; if there is a sufficient breach of surface, the serum drains away. If the exudation takes place from a serous surface -—e.g., pleura, peritoneum, synovial membrane, etc.—the fluid distends the cavity ; it is at first spontaneously coagulable (i.e., consists of plasma) ; if coagulation occurs, the clot or lymph either forms an adherent plastic mass on the surface or floats free in the fluid. Looked at, therefore, simply from a vascular point of view, Inflammation = Hyper cemia + Exudation. In addition, however, to these vascular phenomena, which can be readily seen in a frog’s web, there are others which cannot be so easily observed, and which may be described as II.—The Tissue Changes in Inflammation. Great differences of opinion have been in existence as to the part played by the tissues in inflammation; but although there