The principles of surgery / by James Miller.

  • Miller, James, 1812-1864.
Date:
1853
Catalogue details

Licence: Public Domain Mark

Credit: The principles of surgery / by James Miller. Source: Wellcome Collection.

    111/808 (page 91)
    2. By Contiguity; the texture successively involved not being continuous, but connected by juxta-position; and usually, the more loose the intervening texture, the greater the facility of extension. In neglected phlegmonous erysipelas, the disease commencing in the sur- face may soon reach bone and joint; inflammation in a mucous mem- brane often induces abscess on its exterior, as in the case of the ure- thra ; originating in the envelope of an organ, it may pervade the organ itself. The more I'apid the attainment to the true inflammatory crisis in the part first attacked, the more likely is the disease to extend, and that quickly, to those in the neighbourhood; for its advance is un- opposed by attendant change of structure. In the formation of an ordinary acute abscess, the progress is gradual; and the central por- tion truly inflamed is surrounded not only by serous effusion, but by a mass of dense fibrinous deposit, filling up, and as it were fortifying the previously loose tissue, and exerting a restraining influence on both the extension of the disease and the diffusion of its pro- ductsS. In phlegmonous erysipelas, on the contrary, the crisis is much more speedily attained, there is no such salutary barrier, the surrounding texture remains open both to extension of inflammation and to diffuse infiltration of matter. The consequent mischief is great and often irreparable. The limiting fibrin is either not deposited; or, as more frequently is the case, the exudation is of an aplastic kind. Many other examples might be given of the advantage derived from true inflammation being preceded by active congestion ; suppura- tion being surrounded and limited by plastic fibrinous deposit. Often the texture and efficiency of an internal organ are thus saved; often an irruption of pus into an internal cavity is prevented, which other- wise would have endangered life, either by compression of some neighbouring part, or by violent inflammation of the cavity's lining membrane. 3. Extension of the inflammatory process may be Remote—that is, the part secondarily involved is at a distance from the original site of disease ; and the intervening parts are unaffected. This may be effected by 1. the Blood. This fluid, as formerly seen, emerges from the in- flaming part, changed, as from a laboratory; and circulating thus altered to other and distant parts, may itself become the exciting cause of perverted vascular function there. Purulent formations—in fact, unusually rapid and acute abscesses—occurring in certain forms of phlebitis, at a distance from the affected vein, may be thus satisfac- torily accounted for. 2. By the agency of Absoi'jHion. A part is inocuhitcd by a liurtful virus, and inflammation results in the wound ; besides, a portion of the virus has been carried on by absorption, not