The principles and practice of modern surgery / by Roswell Park ... with 722 engravings and 60 full-page plates in colors and monochrome.

  • Roswell Park
Date:
1907
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of modern surgery / by Roswell Park ... with 722 engravings and 60 full-page plates in colors and monochrome. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    'I'lic Ix'st cxainitlcs of llic liijj)<r< unit oj pardli/sis jirc pcrliiips to he met with alter (rrtaiii iiijiirit's to nerves, as, for iiistaiiee, (lusliiii<f ol the I'aee and li\ perseerelioii of nasal niui us, tears, etc., aftei-in jnry to the cervical s\ ni])atlielie. Sneh, too, in its essen- tials, is that form of shock known as brain conenssion, which is often followed hv nnlri- tive (listnrl)ances anion<>; the hrain cells, with eonse(|nent ])erversion of brain function. \Vallcr's exjK'rinient of placinff a frcezin<f mixture over the uhuir nerve at the back of the elbow is also significant, the result beinif coiiffcstion and elevation of surface tem- perature of the fintjers supplied by this nerve. ('on<:;esti()n and swellinfj; have also l)een observed after fracture of the internal condyle of the humerus, by which this.nerve was pressed upon; and similar phenomena may be noted in finjjers or toes as the result of injuries of other nerves. Hyperemia due to p(ir<i/i/:<is oj the penr(i.scu/(ir (/(iiu/hii is obsci'vcd sometimes in trans- j)lanti'd flaps, in the suffusion of a limb after I'cmoval of llu- Hsmarch bandai^e, in the congestion of certain sac walls after ta|)pin<i;, in the hyperemia of, ])erhaps even hemor- rhage from, the bladder wall after too (piickly relieving its overdistention, and in the swelling of the extremities when they begin to be first used after having been i)Ut at rest because of injury. The hi/jM'trmin.'i of dilatation are more acute in course and manifestation. Along witii them go sharp pain, hypersecretion of glands, edema, and sometimes desquama- tion of suj)erficial parts. The facial blush due to effusion; the temporary flushing due to indulgence in alcohol; the suffusion of the conjunctiva, perhaj)s the face, with hyj)erlacrymation, accom])anying facial neiu'algia or hemicrania; and the hyperemia eonse(juent upon herpes zoster, urticaria, etc., are illustrative examples of this form. The erythema due to nerve irritation or injury, the swelling of the joints which a])|)ears after similar lesions, and that condition described by Mitchell as n-ijtliroinrlalgia, j)rob- ably also belong here. In fact, almost all the reflex hyperemias are hyperemias of dilatation. The forms of hyperemia considered above belong mainly to the designation of active. Passive Hyperemia.—Passive hyperemia is most often a mechanical consequence of obstruction of the return of blood, which can be imitated at will, and which is not infrequently the result of carelessness, as when an injured limb is bandaged too tightly. Experiment shows that when such mechanical obstruction has taken place there is temporary increase of intravenous pressure, which soon returns to the normal standard, such readjustment meaning that blood has found its way back by collateral circulation. Only when such rearrangement is possible do we have anything like permanent passive hyperemia. In organs with a single vein, such as the kidneys, the question of obstruc- tion may assume a very important aspect. Under these circumstances the appearance of the involved part, when visible, is sj)oken of as cyanotic, while its surface, instead of being abnormally warm, is the reverse, due to impeded access of warm blood and more rapid surface cooling. The blood under such conditions is often darker than natural, because, remaining longer in the part, it absorbs more carbonic dioxide, or at least gives up more of its oxygen. As long as actual gangrene is not threatened, the blood column has a communicated pulsation, at least in the large veins. Escape of corpuscular ele- ments may occur after the phenomena above noted have been present for some time; but the corpuscles rarely, if ever, escape until there has been more or less copious trans- udation of the fluid portion of the blood—i. c, the serum. When anatomical changes can be grossly, yet carefully, observed, as in the fundus of the eye, it is seen that under these circumstances the arteries become smaller, although whether this is a primary or secondary change is not to be determined. Discoloration of the integument is the frequent result of leakage of blood corpuscles and their pigmentary substance into the tissues, and is consequently a frequent accompaniment of chronic passive edema. It is seen often in connection with varicose veins of the legs. Another form of passive congestion or hyperemia is that due to enfeeblement of the heart's action by serious injury or wasting disease. When under these circumstances the lung has become more or less infiltrated with fluid, with hemorrhagic extravasation, the condition is known as hypostatic pneumonia—a misnomer, nevertheless indicating a condition which is only too frequent in the aged and feeble.