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.

    280/1274 (page 248)
    and remaiued sound for some time the capsule is ruptured by pincliing it through the skin and the animal killed a day or two after, and the part carefully examined. In many of these experiments there Avas the obvious fallacy that the substance used was so small in amount and so diffusible that its effect must have been so transient as hardly to be likely to cause suppura- tion. With other substances, especially sterilised cotton oil, turpentine and metallic mercury, pus was frequently produced in which the absence of organisms was proved both by microscopic examination and by cultivation. Aseptic suppuration has also been induced by the injection of sterilized culti- vations of various pyogenic organisms, of putrid fluids, and of some ptomaines derived from them, especially cadaverin and putrescin. Buchner believes that the pyogenic material is often contained in the organisms themselves, and that this may be the case is suggested by the fact that Koch found that the injection of cultures of the tubercle bacillus in which the organism had been destroyed by heat gave rise to suppuration if injected subcutaneously, and that it was necessary therefore to separate the dead organisms in the preparation of the so-called tuberculin. There is, however, one fundamental difference between the suppuration caused by chemical substances and those in which organisms are present. The former are not progressive, as the pyogenic virus does not increase in quantity ; the latter are progressive. Mechanical irritants, such as tension and friction of surfaces against each other, were formerly credited with the power of causing aseptic suppuration, and many cases of the formation of pus in an ill-drained wound were explained in this way, but as our methods of detecting micro-organisms have been per- fected it has been proved that in such conditions micro-organisms are always present. That when suppuration is established these sources of in-itation increase the formation of pus is, however, a fact which few practical Surgeons can doubt. In the extreme tension caused by the subcutaneous rupture of an aneurism or a large vessel inflammation and suppuration not uncommonly occur beneath the unbroken skin, but no case of examination of the pus for micro-organisms seems as yet to have been recorded. The presence of a foreign body in the tissues was at one time considered a sufficient cause of suppuration, but experience in the use of silk ligatures has proved that this is not the case, and that the presence of micro-organisms is the true cause of suppuration in such cases. The influence of chemical substances in the formation of pus is very evident in granulating wounds, as, for instance, a healthy granulating sore of the leg. If the patient be put to bed with the leg elevated, to avoid intravascular tension, and the raw surface be rendered perfectly aseptic, and then covered by a non-irritating substance, and protected from mechanical violence and cold by an application which at the same time absorbs the discharge and prevents its putrefaction, every source of irritation being thus removed, we may succeed in completely preventing any formation of pus. The discharge, such as it is, will be coinposed solely of serous fluid, which necessarily leaks from the surface of the granulations, as they are uncovered by any imper- meable epithelium. Having got the sore into this state, if some mild irritant be now a])plied, as for example, lint soaked in a concentrated solution of boric acid, the discharge will become turbid, the superficial cells perishing and being cast off under the influence of the irritant, while at the same time