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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    TREATMENT OF CONGESTION AM) HYPEREMIA with cardiac dchility. While insisting, then, that gangrene shonUl he recognized as a possihh' resuU oi hy|)ereniia, it may he added tiiat it is in eft'ect a tissne death, and that di-ad lissne is always and everywhere practically the same thing, no matter hy what causes hroiight ahout. Conse(|nently, the snl)j<'ct of gangrene will he considered under a separate heading. '). Nutritional Changes will he considered later. 'J'he c(>us((ninicc of prr.sisfnit fii/pcrniii(i /.v trdiisiidation—i. e., cscnpr oj h/ood phisvi frotii thr rrs.sr/.s into hadi/ cainties (ind //.s-.v/zr interspaces. This leads to consideration under a distinct lieading of— TRANSUDATES AND EXUDATES. Exudation may occur in vascular ;nid non-vascular, in firm and soft tissues, in, under, and u|)on nuMuhrancs. With respect to location, exudates are descrihcd as jrcc, when found u|)on free surfaces or within natural cavities; intrr.stitiul, when found between the tissues or j)arts of tissues; and pareneJiijinatoiis, when they are situated within the ti.ssues themselves, particularly in epithelial and glandular cells of any kind. Eixudates are serous, mucous, fibrinous, or mixed, the mixed forms including the so-called seropiirnlent, the mucopurulent, the croupous, and the diphtheritic. When any exudate contains red glohules in sufficient (juantity to stain it, it is called hcniorrhacjic. S(M'()Us transudates from free surfaces are sometimes spoken of as serous catarrhs; when into cavities, as dropsies; when into tissues, as edema; when occurring hcneath the epidermis they form serous vesicles or blebs or bulla'. Fibrinous exudation refers to the fluid which coagulates soon after its exit fi-om the ve.s.sels within those spaces into which it has oozed. When fiocculi of coagula float in serous fluid it is known as a serofibrinous exudate. Pure fihrinous exudate occurs rarely, save in and upon mucous membranes. The extent to which exposure to the air is resj^onsible for the firm coagulation of the fibrin previously held in solution is uncertain. The most potent factors in producing such coagulation are bacteria, but it is not yet dis|)roved that coagulation may occur without their aid. When such coagu- lation occurs U]ion the surface of a mucous membrane it has been spoken of as croupous. When the epithelial covering as well as the basement membrane, and often the sub- mucous tissues, are involvetl, so that the membrane cannot be stripped off without tearing across minute bloodvessels, the exudate has been known as diphtheritic. These terms may possibly be still retained in an adjective sense as implying the exact location of a surface exudate, but are scarcely to be used in any other significance. The following table illustrates significant differences whose full importance cannot be impressed before a study of inflammation has been carefully entered upon: Hyperemic Transudates. Poor in albumin. Rarely coagulate in the tissues. Contain few cells. l/ow specific gravity. Contain no peptone. Inflammatory Exudates. Rich in albumin. Usually coagulate in the ti.ssues. Contain numerous cells. High specific gravity. Contain peptone (product of cell disintegration). TREATMENT OF CONGESTION AND HYPEREMIA. These disturbances are to be combated, first of all, by insisting upon physiological rest. This, perhaps, is the most important measure of all. The profession is indebted to Hilton for the decided advance which he made in the treatment of congestive and inflammatory afTections by insisting upon this principle in his celebrated work on Rest and Pain, which every young practitioner should read. Aside from this first and underlying principle, the treatment must, in some measure at least, be based upon the time at which we are called upon to treat the case. If seen at once, before exudation