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.

    231/1274 (page 199)
    take part in tlie preparation of the blood, or to eliminate from it the products tif tissue-change, its composition must be materially altered ; but it is at pre- sent impossible to state with any definiteness the exact nature of the changes that take place. In simple inflammations, the fluid draining away from the inflamed area contains, as before stated, an excess of the so-called fibrin- ferment, and it is possibly due to this tliat the amount of coagulated hbrin which can be obtained from a given quantity of blood is increased in some inflammatory affections. In inflammations accompanied by putrefaction of the discharges, the products of decomposition are added to the fluids entering the circulation by means of the lymph-stream, and with these, microscopic organisms often find their way into the blood. The bacteria which accom- pany ordinary putrefaction soon perish in healthy blood, being apparently incapable of finding nutriment amongst living tissues. In true infective inflammations, the inflammatory products which entqr the blood-stream may in some cases bear with them organisms capable of multiplying amongst the living tissue and giving rise to secondary local mischief or ftital general disease. The corpuscles of the blood, both white and red, may show considerable deviation from the normal standard in number during inflammation. There is no reason to believe that in simple inflammations there is any material change in the number of red corpuscles ; but in infective inflammations with high fever and in those accompanied by the absorption of the products of putrefaction, there is undoubtedly a rapid destruction of the red corpuscles. In those cases they often show a tendency to aggregation iu irregular clusters instead of the well-formed rouleaux seen in normal blood. The number of white corpuscles in the blood during inflammation has been said by Virchow, Gulliver, and others, to be increased. T. P. Gostling has made a series of observations on this point in the wards of University College Hos- ]:)ital. The corpuscles were counted by means of Gowers's hDsmocytoraeter, The conclusions arrived at were briefly as follow : The white corpuscles are increased in the blood in all inflammations reaching the stage of suppuration, especially if the pus is pent up in a cavity ; they are also slightly increased in parenchymatous inflammations such as acute pneumonia. They are not increased in inflammations accompanied only by serous or sero-fibrinous exudations. According to Virchow, the increase in the white corpuscles is due to stimulation of the lymphatic glands, through which the excessive lymph-stream passes from the area of inflammation. Varieties of Acute Surgical Pever.—Acute inflammatory fever presents an infinite vai-iety of form ; the type which it assumes being dependent, fii'st on the nature of the pyrogenic substance the admixture of which with the blood is the cause of the disturbance ; secondly, on the previous health and strength of the patient : and thii-dly, on the occurrence of certain local symptoms determined by the scat of the inflammation. These varieties in the type of the fever arrange themselves practically into two classes—1, sthenic, and 2, asthenic. The terms sthenic and asthenic are not used at the present day with reference to varieties of infiammation as they wei'c in former times ; but for the designation of the dilferent forms of febrile disturbance, as observed clinically, wo have no better names, and it is convenient to continue to employ them. ,■ . ]. SUimic Inf/ammalor// Fever occura in young or middle-aged individuals