Quarterly report of the Edinburgh Surgical Hospital from August to November 1829 / by James Syme.

  • Syme, James, 1799-1870.
Date:
[1829]
Catalogue details

Licence: Public Domain Mark

Credit: Quarterly report of the Edinburgh Surgical Hospital from August to November 1829 / by James Syme. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the muscle and exposing tlie bone, the cicatrix of which rested directly on the bone without the interposition of any newly formed substance. It was a similar case which led my attention to this subject. M. Bezoet of Rotterdam, who wrote against the doctrine of reproduction, appeals to a case of wound in the head, where a portion of the scalp was removed, and where, not- withstanding the most luxuriant granulations, the cicatrix rest- ed on the bone. I have in my possession several skulls, with the scalps, from which portions of bone had been removed, arti- ficially and naturally. One of these belonged to a gentleman who was attended by myself, and in all of them the cicatrix is but a pellicle resting on the bone or dura mater. When amputation was performed in the old way by cutting directly through all the parts, a very large granulating surface resulted, which ought to have become larger if there really was a growth of new substance, so as to form the stump into a bulbous figure. But it always happened, on the contrary, that the cicatrix was much smaller than the wound, and that the stump, so far from being bulbous, was of a sugar-loaf or conical form. We have frequently an opportunity of dissecting a granu- lating sore after death or amputation. And do we then find any such appearance as the commoti description would lead us to expect ? Do we find successive layers of granulations, or any considerable thickening of newly formed substance ? I have made many such examinations, and could never perceive any thing but a thin layer of organized matter covering the surface. How then are wounds healed by granulation ? Lymph being effused over the surface and organized into a granular pellicle, lymph and serum are effused into the sub- jacent cellular tissue so as to distend it more or less. In what is called a healthy granulating ulcer, the quantity is very small, so as hardly to affect the elevation of the surface, or induration of subjacent parts, but when the process proceeds in a morbid manner, then many remarkable phenomena are thus induced. For instance, when the ulcer is defective from weakness, the oranular surface is distended by serum, effused under it, and ele- vated into soft spongy projections, the proud flesh of the vulgar. This oedematous state of the sore is usually accompanied by a similar condition of the limb or other part in which it is seated, no trace of these fungosities is to be found after death ; pies- sure restrains them as effectually as it does the oedema of the limb; and they suddenly subside under the action of what arc called escharotics without leaving any remains in the jfiace they occupied. These observations afford satisfactoiy evidence of their real nature, which I had lately an opportunity of illus-