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

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.

320/1274 (page 288)

$exudation is perhaps most conveniently applied, is spoken of also as coagulable li/mph,' ^^ inflammatory lymph,''^ ov lymplir After the process has continued for some time, the serum, which was at first almost as red as pure blood, becomes almost colourless, and diminishes greatly in quantity. The two flaps, being now. covered by the adhesive plastic exudation or lymph, adliere to each other readily with a certain degree of firmness if brought together, and thus a temporary union is obtained, which provides for the perfect rest and apposition necessary for the permanent growing-together of the opposed surfaces. The cessation of the exudation occurs as soon as the damaged tissues recover their full vitality. The plastic exudation, just like a blood-clot, becomes gradually firmer as the serum drains completely away fi-om it. The blood-clot and any shreds of tissue which have been killed by the injury are taken up by phagocyte cells, the nature of which has been discussed in the chapter on Inflammation. This process of temporary union should be complete at the end of from twelve to twenty-four hours, the time varying with the size of the wound and the amount of damage done to the tissues in its infliction or in its treatment. If the surface of the wound be washed over with some strong antiseptic solution, such as carbolic acid lotion (1 in 20) or chloride of zinc (20 gr. to 1 oz.), both the quantity and the duration of the exudation will be increased ; but even then it should practically cease at the end of twenty- four hours. In large irregular wounds in which it is impossible to obtain perfect apposition a small quantity of serous discharge will continue to escape from the surfaces not in contact, a condition which must necessarily occur in all surfaces in the living body not provided ^vith an imjDermeable epithelial covering. A wound in which union by first intention is taking place, if removed at the end of twenty-four hours and examined by microscopic sections, presents the following appearances : The vessels on each side, if they have not emptied themselves after the specimen was removed, are seen to be distended with blood, and their actual divided extremities to be filled with small clot-s. Outside the vessels a few wandering cells are recognisable, increasing in number as the actual wound is approached. The original cells of the part show no change. Between the surfaces of the wound, the plastic exudation glueing them together is seen as a closely packed mass of small round cells (leucocytes) between which the coagulated fibrin is not recognisable, as it is concealed by the cells. Here and there are groups of red corpuscles or small patches of blood-clot, varying in amount according to the degree of perfection with which the capillary htemorrhage was arrested before the surfaces of the wound were brought into apposition. The next step in the process is the development of new blood-vessels, which penetrate the plastic exudation and finally communicate with similar ones from the op]Wsite side of the wound. Small lateral dilatations, or pouches, appear at some points on the walls of the nearest old vessels ; these grow out into the plastic mass, bend towards each other, coalesce, and thus form loops. These loops give rise to secondary vascular buds, which follow the same couree of development, and thus thevascularisation of the plastic exudation iscomplcted. These buds are not formed by mere stretching of the wall of the vessel ; they are true growths from its protoplasm. It is not certain by what means the two buds\ve guided towards each other until they meet and unite, but it is not improbable that they follow the processes of a branching cell. This process of$