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.

    256/1274 (page 224)
    is of low vitality and readily degenerates, and the chronic, process may often be intensified to the acute from a comparatively slight increase in the local irritation. Widely, therefore, as chronic inflammation may differ from the acute process, there are points in which an analogy may be traced betAveen them. In acute inflammation the essential features are a diminution of the vital activity of the tissues, and of the walls of the vessels consequent upon some injurious influence acting upon them. This is followed by dilatation of the vessels with exudation of almost pure blood-plasma, and migration of leucocytes which infiltrate the damaged area, while at the same time changes of a degenerative or destructive character take place in the original tissues of the part. In chronic inflamma- tion all these phenomena ]nay occur, but they are less strongly marked. They nray conveniently be considered in the same order as in the acute process. The dilatation of the vessels and afflux of blood are much less. The chronic distension, however, lasting as it may do for an indefinite period, leads to a permanent loss of tone and dilatation, especially in the small veins, which, in chronically inflamed parts, can often be seen clearly with the naked eye. The relaxation of the arteries is less complete, and there is often a tendency to slackened circulation. The redness, when present in chronic inflammation, is therefore as a rule more dusky than in the acute form. The whole process being due to a slighter degree of damage to the tissues, there is not the same impairment of vitality in the walls of the vessels, and consequently the tendency of the corpuscles to adhere to the vessels and retard the flow is little marked. Migration when it does occur is usually less abundant, and probably is influenced by the conditions described on p. 161. The vessels in most cases still retain to some extent their selective influence on what passes through their walls, and the exudation in chronic inflammations is less rich in albumen and often not spontaneously coagulable. Thus in chronic inflammations of serous or synovial cavities, we frequently find them distended with a fluid of considerably lower specific gravity than that of the liquor sanguinis, and not possessing the power of spontaneous coagulation. In those chronic inflammations which are partly caused by prolonged passive congestion, red corpuscles are frequently found outside the vessels. The tissues of a part afl'ected by chronic inflammation become, as in the acute process, crowded with new cells, the probable origin of which has already been mentioned. These new cells show the same phagocytic properties as those met with in acute inflammation. They take an active part in the desti-uction and absorption of dead or degenerating tissues, as, for example, the osteoblasts in chronic inflammation of bone, and in infective inflammations caused by invading organisms they are often found to liave surrounded the pathogenic fungi, or to have taken them into their substance, as is seen in the giant cells of tubercle. The new cells produced in chronic inflammation undergo a variety of changes according to circumstances. If the part recovers, they may, as in acute inflammation, disappear, probably disintegrating or being absorbed, or possibly, if still possessing amoeboid properties, wandering away into the lym- phatics. It is rare, however, for ]ierfect recovery to follow chronic inflam- mation ; most commonly some thickening or induration from newly-formed fibrous tissue is left behind. In other cases the cells may go on proliferating, slowly destroying or dis-