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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    RESULTS OF HYPEREMIA AND CONGESTION. These may be— 1. Speedy subsidence of all hyperemic phenomena—resolution. 2. Ac-ute swelling. 3. Chronic swelling. 4. (Jangrcne. 5. Xutritinnal changes—atrophy and hypertrophy. 1. Resolution.—The speedy subsidence of hy|)eremic phenomena is known as resolution—a term which has also been applied to the retrograde jjhenoraena after a genuine inflammation. For present purposes it implies, first, the subsidence into inactivity of the exciting cause or its complete removal. This may include the passing of an emotion, the removal of an irritant, the loosening of a bandage, the resort to cer- tain applications or to constringing or astringing measures by which the effect is counter- acted. A particle of dust in the conjunctiva may within a few moments produce an active congestion of the conjunctival vessels, which, ordinarily scarcely visible, becomes prominent and easily noted. The removal of the offending substance permits a return to their original size in perhaps a half-hour. This is an example of the speedy subsidence of the hyperemia of dilatation after removal of the cause. Should the hyperemia not subside promptly, it is well to use cold ap])lications, or in this instance an astringent coUyrium, or some agent whose physiological effect it is to produce vascular contraction, as cocjtine, adrenal extract, etc. 2. Acute Swelling.—When the effusion above referred to takes place into loose con- nective tissues tlie condition is spoken of technically as edema, while when it occurs into a previously existing cavity, such as that of a joint, it is known as an efjiiaion. The amount of blood thus effused will be influenced by the anatomical and mechanical conditions existing al^out the part. It may be presumed, as a general rule, that when the extravascular pressure equals the intravascular pressure little or no more fluid may escape. As a matter of fact, it is seldom that the former rises to the degree of the latter. Conversely, one method of treating such edemas and effusions is by some device which shall make the extravascular pressure exceed the intravascular, when the fluid is, as it were, forced back into the vessels, and is made to resume its proper place within the same. This is often done by taking advantage of elastic compression, as when a rubber bandage is applied about the part. In certain parts of the body it may be done by pressure brought about by some other device. Pressure may be used for two purposes: .1. To so increase extravascular pressure as to limit the possible amount of an effusion, as when it is put on early after an injury; or, B. When it is used as a later resort for the purpose of reducing swelling which has already occurred, 3. Chronic Swelling.—This is something more than the swelling alluded to under Acute Sirelling. Chronic swelling implies either a continuous passive hyperemia, or, what is more common, a positive increase in tissue elements as the result of an oversupplv of nutrition brought by the blood, which itself was furnished to the part in a degree far in excess of its needs. The result is a more rapid reproduction of cell elements, with result in the shape of ti.ssue thickenings or tissue enlargements, known as hypertrophy, or, more properly speaking, hj/perplasia, of a part, and to the laity as overgrowth. This chronic swelling or chronic enlargement is in some degree also connected with the phenomena of escape of white corpuscles from the bloodvessels and mitotic division of certain tissue cells, which have up to this time been usually regarded as a feature of the true inflammatory process. 4. Gangrene.—This may be the result of hyperemia—for the most part the passive forms—though most instances of gangrene due to intrinsic cau.ses are inseparable from the presence of infectious microorganisms. The gangrene which is spoken of here includes that due to the pressure of tumors, tight dressings, or any natural or intrinsic agency, and that due to pressure from without when not so pronounced as to produce immediate and total loss of circulation in a part. It includes the forma- tion of manv bed-sores and sf)-calle(l pressure-sores, which may be due to an enfeebled heart, to an obstructed pulmonary circulation, or to external pressure in conjunction