Surgery : its theory and practice / by William Johnson Walsham.

Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    blood-CTirrent slackens at first in the veins and then in the capillaries and arteries, and leucocytes are seen to drop out here and there from the central stream or axial current, which appears yellowish in colour from the red corpuscles being contained in it. These truant leucocytes first roll lazily along in the pale or circumferential current, and are joined by more and more as the blood- stream further slackens in speed. Now they adhere to the walls of the veins, and to a less extent to the walls of the capillaries and arteries, so that the vessels appear as if lined with them. Soon they begin to pass through the vessel-walls into the tissues around (diapedesis), a process which need not here be described, as it is now fully treated of in works on Physiology. By and by, if the inflammation is very acute, the coloured corpuscles, in groups of two to a dozen, also leave the central stream and pass through the walls of the vessels into the tissues, producing those patches of darker redness and the mottling of the surface alluded to above. The central stream next begins to oscillate, flowing onwards during the systole, and slightly receding during the diastole of the heart; whilst the coloured corpuscles show a tendency to adhere to one another. Finally the stream stops, and stasis is said to have occurred (Fig. 1). In the meantime the liquid contents of the vessels have also been passing through the vessel-walls into the tissues, and together with the escaped leucocytes, account for the swelling and for the serous exudation which can be squeezed out when the parts are cut into. The serum, further, soaks into the neighbouring healthy tissues, thus explaining the surrounding oedema, and is thence, along with some of the leucocytes, taken up by the lymphatics, and so passes back into the circulation, and as we shall presently see, may partly account for the attendant in- flammatory fever. If now the cause of the inflammation ceases to act, and the vitality of the tissues has not been too much lowered to permit of their recovery, the cor- puscles in the middle of the stream in those vessels where stasis has occurred again begin to oscillate and then to move on ; the leucocytes no longer drop out of the axial current, and those that have already escaped into the tissues either break down or pass along with the escaped fluids into the lymphatics, leaving the part apparently uninjured (resolution). If the above favourable termination does not take B 2