Lectures on inflammation : (delivered in the theatre of the Royal College of Surgeons of England) / by James Paget.

  • James Paget
Date:
[1850]
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on inflammation : (delivered in the theatre of the Royal College of Surgeons of England) / by James Paget. Source: Wellcome Collection.

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    granulating wounds, and on mucous sur¬ faces, which have no such ‘ pyogenic ’ membrane. The abscess thus formed has a natural tendency to open, unless all the inflam¬ mation in wdiicli it had its origin subsides. Inflammation appears to be essential to the spontaneous opening of abscesses ; for, where it is absent, the matter of chronic abscesses will remain, like the contents of any cyst, quiet for weeks, or months, or years ; and when in chronic abscesses, or in cysts, inflammation ensues through the whole thickness of their coverings, it is usually certain that their opening is near at hand. This difference between acute and chronic abscesses makes it very doubt¬ ful whether the inflammation of the cover¬ ings of an abscess can be ascribed to any local influence of the pus. But to what¬ ever it may be ascribed, we may refer to this inflammation the comparatively quick absorption of the integuments over the col¬ lection of matter: and thus the fact, how¬ ever we may account for it, that the integu¬ ments are more prone to inflammation, and more actively engaged in it, than the other tissues about an abscess are, may be used to explain the progress of matter towards the surface. Possibly—though this I think is much less probable—the tissues between an abscess and the surface may, after the degeneration which accompanies their de¬ generation, be disintegrated, and may mingle their molecules with the purulent contents of the abscess. But in favour of the be¬ lief that they are absorbed we have the evidence of analogy ; for just the same thinning and removal of integuments takes place when they inflame over a chronic abscess, with a thick impenetrable cyst, or over an encysted or even a solid tumor.* Here absorption alone is possible ; and the cases are so similar to the ordinary pro¬ gress of abscesses, that I think we may assign all the changes of the integuments over these to the same interstitial ab¬ sorption. As the absorption proceeds, the integu¬ ments grow not only thinner, but softer, and more yielding. And this softening is worth notice, because one might sup¬ pose that as pus accumulates, so the in¬ teguments over it would become tenser and more resisting. It is, probably, in great measure, such a softening as I have already spoken of in degenerating inflamed parts ; but it may be also due, in some degree, to such a change as that to which Mr. Hunter refers as “ the relaxing or elongating process.” He used to show this specimenf, and say of it in his lectures, * As in No. 121, College Museum. t College Museum, No. 122; and Catalogue, vol. i., p. 53. “ This preparation represents the front of a chest which contained an aneurism of the aorta; and here, on the right side, you see an instance of the elongating process, the cartilages being bent outwards, or elon¬ gated, to adapt themselves to its figure.” Of the same process he says elsewhere,'* “ Besides these two modes of removing whole parts, singly or together [that is, besides the interstitial and the progressive absorption], there is an operation totally distinct from either; and this is a relaxing and elongating process carried on between the abscess and the skin, and at those parts only where the matter begins to point. It is possible that this relaxing, elongating, and weakening process, may arise in some degree from the absorption of the interior parts ; but there is certainly something more, for the skin that covers an abscess is always looser than a part that gives way from mere mechanical distension, excepting the increase of the abscess is very rapid. “ That parts relax or elongate without mechanical force, but from particular sti¬ muli, is evident in the female parts of gene¬ ration, before the birth of the foetus ; they become relaxed prior to any pressure. The old women in the country can tell when a hen is going to lay from the parts becoming loose about the anus.” I have quoted the whole passage, because I believe that more recent researches have done nothing towards either improving the description or explaining the fact, except in so far as they make it probable that the change is due in a measure to the inflammatory softening of the pointing skin. While these changes of degeneration and removal, of softening and relaxing, are en¬ suing in the cutis over such an abscess as I have described, we commonly notice that the cuticle separates, leaving the very point, or most prominent part, of the abscess bare. The cuticle is not raised as in a blister, but peels-otf like dead cuticle; and we may believe that it is dead, partaking in the failure of nutrition in which all the parts over the abscess are involved, and being removed as a dead, not as a merely degenerated, part: for thus cuticle is always removed. At length, after extreme thinning of the integuments, they perish in the centre of the most prominent part.—Sometimes the perished part becomes dry and parchment¬ like, with a kind of dry gangrene ; but much more commonly a very small ordinary slough is formed, and the detachment of this gives issue to the purulent matter. The discharge is usually followed by a * On the Blood, &c. Works, vol. iii. p. 477.