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
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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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    B. Pathological Hypertrophy.—3, 4. Instances of this are everywhere and every day are met in the results of so-called chronic infiammatinn, a term which is a com[)lete misnomer and should be expunged from text-hook use. So-called chronic inflannnation simply means increase of nutrition owing to a certain degree of hyj:)ereniia, which may have been j)roduced in the first place as the result of traumatism, which may have come from chemical irritants circulating in the fluids of the part—as, for exampl(\ uric acid, etc.—or which is brought about as the result of ])erverted trophic--nerve iiiHuence. Instances of local ])athological hyiHM'trophy may l)e seen in the thickened j)eriosteum after injury, in the enlargement of a phalanx known as the basel)all finger, and in numerous other places; or they may be general, in which case they are brought about mainly by some irritating material in the general circulation. The unknown poison of syphilis generally provokes such nutritive disturbances. 5. Senile liijpcrfrophy is connected with nutritional disturbances characteristic of old age, as to whose remote causes we are still uncertain. Instances of senile hyper- troj)hy, however, are common, particularly in the prostates of elderly men, which are liable to undergo extensive enlargement. C). Of congenital hypertroj^hy and that of unknown origin we se(\ for instance, examples in certain rare cases of hyjiertrojihy of the breast, in leontiasis, jierhaps even in acromegaly, etc.; and these are to be distinguished from gif/(i)iiis-m, because in most instances of the former type the hypertrophic tendency is not manifested until youth or adult life, whereas gigantism is a condition in which the tendency was apparent even before the birth of the individual. ATROPHY. Atrophy implies impaired nutrition, and means diminution in the size of an organ or part, and is the converse of hypertrophy. It is necessary to make plain that in atro])hy nutrition is only impaired and not arrested, since complete arrest of nutrition means necrosis—i. e., gangrene or disappearance of parts. It may be— fl. From disuse without disease; A. Physiological < 2. Biological or developmental; [ 3. Senile. f 4. Result of acute tissue losses; . J 5. Result of phagocvtic activity; B. Pathological j ^. Result of continuous pressure; [ 7. Sjiecific. A. Physiological Atrophy.—1. This is always the result of disuse or impaired function from any cause. Its evidences are generally seen in the fatty structures and muscles—i. e., in the soft parts. It is true, however, even of the bones, or, of greater interest, even in the brain cells. We see evidences of it also in minute organs; as, for example, in the digestive glands in certain cases where diet is restricted. Again, we see it in the diminution of the size of the heart after hip amputation, less being required of that organ, and also in the entire structure of the rectum after colostomy. 2. Examples of the developmental type are best seen in the natural disa)i]icarance of the hypogastric arteries, the ductus arteriosus, the vitelline duct, the Wolffian bodies, and in the various generative ducts (Gartner's, etc.) shortly after the birth of the human individual. We sometimes see it also in the prostate after orchidectomy. P>jually illustrative is the disappearance of the tail and gills of the tadpole, the eyes of animals living in caverns, and, in a general way, of organs which become useless owing to a different environment. 3. Senile atrophy is seen equally well in the hair follicles, the teeth, the bones, and the sexual organs of elderly people—in fact, in all their tissues, even in the brain. B. Pathological Atrophy.—4. Acute atrojihy of surrounding tissues is the necessary accompaniment of destruction by suppurative or other disturbances; that is, parts disappear by absorption which have not been interfered with by pyogenic organisms. So complete may atrophy occur under these circumstances as to cause disablement of an organ or part. This kind of senile disappearance is merely an expression of phagocytic activity, although not now a question of bacteria.