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.

    270/1274 (page 238)
    CHAPTER V. SUPPURATION AND ABSCESS. Suppuration, or the formation of pus, has ah'eady been described in the ('hapter on Inflammation. It was there j)ointed out that the process consists of a continuance and exaggeration of one of the features of inflammation—the migration of the white corpuscles. The process of suppuration may be diflPuse or circumscribed. When diffuse, the leucocytes and the liquid exudation distend the lymph spaces of the affected part without the formation at first of any dis- tinct cavity containing pus, as in phlegmonous erysipelas or diffuse cellulitis. This, as will be seen afterwards, is due to the rapid diffusion of the irritant causing the suppuration through the lymph spaces. Circumscribed suppuration may occur in two forms, first from a surface, as a granulating wound, and secondly subcutaneously, when the pus accumulates in a newly-formed cavity or abscess. In the formation of an acute abscess the wandering cells accumulate outside the vessels, and possibly multiply by division in their new situation, but this is extremely doubtful; as the accumulation increases, the original tissues, already damaged by the irritant which is causing the inflammation, become pressed upon and absorbed, and the new cells occupy their place : finally, the central cells of the group degenerate from want of nutrition, or perish from the direct action of the irritant, their intercellular substance softens, and the liquid exudation from the surrounding part soaks in amongst them, and thus we get a creamy fluid, or pus. If, as sometimes happens, we have the opportunity of examining microscopi- cally such a small collection of pus in the subcutaneous tissue, the following appearances are observed, proceeding from the circumference to the centre of the affected area. The first sign of deviation from health is that some scattered leucocytes are seen in the spaces between the fibres of the connective tissue, and often evidently in the neighbourhood of a small vessel ; as the centre is approached, the number of these increases, gradually obscuring the connective tissue and its corpuscles, till at last nothing is to be seen but closely-packed small round cells, between which the amount of intercellular substance is too small to be recognised ; in the centre of this group of cells may be a cavity iVom wliich the pus has escaped in preparing the section. Amongst the closely- ])acked cells surrounding the collection of pus, micro-organisms can almost invariably be demonstrated by proper staining and preparation of the specimen 1'he connective tissue, when it is last recognisable before being concealed by tlic infiltrating leucocytes, is seen to have its fibres swollen and vitreous in appearance, while its corpuscles are unchanged or degenerating. They evidently are taking no part in the formation of the new cells which are crowding amongst the fibres. If any blood-vessels are recognisable, it will he seen that, near the point at which everything is concealed by the leucocytes, they are filled with closely packed blood-corpuscles, indicating the presence of a