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ERRATUM.

Page 269, line 15. For "Hodgkinson's" read “Hodgkin's.”

X

THE PRACTICE

OF

SURGERY.

SECTION I.

GENERAL PATHOLOGY OF SURGICAL DISEASES.

INFLAMMATION.

"the

INFLAMMATION is defined by Dr. Burdon Sanderson as succession of changes which occur in a living tissue when it is injured, provided that the injury is not of such a degree as at once to destroy its structure and vitality." Inflammation as thus defined may occur in any tissue of the body, and you will do well to impress upon your mind at the outset, that in whatever tissue or organ it occurs, whether superficial or deep, transparent or opaque, vascular or non-vascular, soft or hard, the pathological process is essentially the same.

GENERAL OUTLINE OF THE PROCESS.-Let us first study the process as it may be observed by the naked eye, say, in a portion of inflamed skin. The part is uniformly red, hotter than the surrounding skin, swollen and painful. The redness momentarily disappears on pressure, and gradually fades away into the natural color of the part around, but later it becomes mottled and in places of a deeper hue. There is usually some cedema about the inflamed spot, and the neighboring lymphatic glands may be slightly tender and enlarged. If an incision were now made into the inflamed tissues, they would be found fuller of blood than natural, of a bright red color, and infiltrated with serum; while if the lymphatics leading from the part were opened, as has been done in animals, they would be seen to be transmitting more lymph than under normal conditions. These changes depend, as will be shown presently, upon an increase of blood in the part, the dilatation of the blood

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vessels, and the escape of the corpuscular and fluid elements of the blood through the walls of the vessels into the tissues. The series of changes producing the phenomena above described may now terminate, leaving the tissues apparently normal (resolution); or they may lead to other changes producing irreparable damage to, or total destruction of, the part. Thus, the progress may become chronic and the tissues thickened and indurated (fibroid thickening); or the tissues in the centre of the inflamed spot may soften and break down, forming a creamy fluid called pus (suppuration and abscess); or the more superficial tissues may undergo molecular destruction, leaving a raw surface (ulceration); while again the whole of the tissues in the inflamed area may lose their vitality and die "en masse (gangrene). When the inflammatory process is at all severe, constitutional symptoms will also be present. Thus, the temperature will be more or less raised, the pulse increased in rapidity, the tongue furred, the appetite lost, and the secretions arrested—a condition known as inflammatory fever. Under some circumstances the constitutional symptoms may be of a more serious character, and secondary inflammations may be set up in internal organs, or in other parts of the body: the patient is then said to be suffering from septic or from infective poisoning, conditions which, as will be pointed out hereafter, are probably due to poisonous products entering the general blood-stream at the primary seat of inflammation.

The minute changes which occur in the above described phenomena have of late years been very accurately studied in such transparent parts as the mesentery of the frog, rabbit and dog; and in sections of such structures as the cornea and lip. The following is a brief summary of what is observed. After, in some instances, a momentary contraction, the vessels become dilated and the blood in them flows with greater rapidity, while smaller vessels which were previously invisible are now seen transmitting blood. Hence the redness of the part. Now, after a longer or shorter period, according to the kind of irritant used to set up the inflammation, the blood-current slackens, and leucocytes are seen to drop out here and there from the central stream, which, as you know from your physiological studies, appears yellowish in color from the red corpuscles being contained in it. These truant leucocytes first roll lazily along in the pale or circumferential current, and are joined by more and more as the blood-stream further slackens in speed. Now they adhere to the walls of the veins, and to a less extent to the walls of the capillaries, so that the vessels appear as if lined with them. Soon they begin to pass through

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