Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

  • John Eric Erichsen
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    198/1274 (page 166)
    microscope shows that this forms an essential part of acute inflammation. Consequently Lister's theory did nob meet with the acceptance it deserved : and until the migration of the white corpuscles was finally establislied by Cohnheim in 18G7, the process of inflammation, according to the Cellular Pathology of Virchow, was regarded as essentially one of increased nutritive and formative activity of the inflamed tissues. All the new cells were supposed to be formed by the rapid proliferation of the original elements of the aflected tissues. The discovery of the migration of the white corpuscles, however, fully accounted for the appearance of the new cells in the inflamed area, without necessitating the improbable assumption, that injury to living tissues imme- diately increases their vital activity. The changes which occur in the tissues as the result of inflammation have been observed both in vascular and non-vascular structures, during life and in preparations made after death. Amongst non-vascular structures the cornea ]nay be taken as the type, and has most frequently been made the subject of investigation. The cornea is composed of a peculiar form of fibrous tissue arrauged in strata, between which lie spaces of an irregular stellate form con- taining corpuscles corresponding with them in shape but not accurately filling them, thus leaving room for the passage of blood plasma and, under certain conditions, of white corpuscles. When the cornea of any animal is irritated by passing a fine silk thread through it, there forms, before many hours are past, an opaque spot extending for a short distance round the part injured. At the same time the vessels of the conjunctiva and of the sclerotic become engorged with blood. If the cornea be cut out and examined about sixteen to twenty-four hours after the injury, in the inflamed area, instead of the single stellate corpuscle naturally seen in each space, there will be found a group of rounded cells having all the appearances of white corpuscles. At one time it was thought that these were produced by proliferation of the corneal corpuscles. It has since been shown clearly that the appearance is really due to an accumu- lation of migTating cells in the space in which the corneal corpuscle lies, so as more or less completely to obscure the original cell. Whenever the original cell can be recognised, it shows no change. The behaviour of the corneal cor- puscles under the influence of irritants was made the subject of a careful investigation by Senftleben. He applied to an extremely limited area in the centre of the cornea a solution of chloride of zinc of sufficient strength to kill the corpuscles with which it came directly in contact, without apparently damaging the fibrous tissue and especially the anterior homogeneous lamina. This was not followed by any dilatation of the peri-corneal vessels, and no cloudiness appeared round the injured area. The microscope showed no alteration in the uninjured corpuscles surrounding the damaged area and no migration of leucocytes into it. The explanation of this is that from the very small amount of the caustic applied, if any found its way by the lymph channels to the neighbourhood of the peri-corneal vessels, it arrived there so greatly diluted as not to produce any injurious efifect on them, and thus no dilatation or migration took place. If the anterior homogeneous lamina was accidentally destroyed, the damaged tissue beneath, being exijoscd to the air. became sc])tic, and the products of the septic change reaching the peri-corneal vessels damaged them, causing dilatation and migration into the cornea. The same effect could be produced by using a larger amount of the caustic or by applying it too near the corneal margin. Senftleben showed, therefore, that