The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen ; edited by John H. Brinton.

  • Erichsen, John Eric, 1818-1896.
Date:
1854
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen ; edited by John H. Brinton. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    clusters by the cohesion of their flat surfaces. This clustering of the red particles, first pointed out by W. Jones, takes place in the vessels as well as out of them, and is considered by its discoverer and by Henle, to be owin°> to in- spiration of the plasma, ° The white corpuscles have excited much attention of late years in connexion with the arrest of circulation in inflammation. Dr. Williams has shown that they appear in increased numbers in the inflamed part, and by their adhesion to the walls of the vessels become one principal source of the arrest of the circulation. There are several questions, however, with reference to the white corpuscles. 1st. As to their actual increase;. 2dly. As to the cause of this increase in their numbers; and 3dly. Their greater disposition to adhere to the vessels. _ Their increase in inflammation is stated by W. Jones to be partly relative, owing to the diminution in the red particles; and Paget, as well as other observers, is of opinion that it is only in sickly and young animals, kept for the purpose of experiment, that this increase has been observed, never being met with in healthy animals, or in the human blood taken from inflamed parts. Hence he infers that they are only met with in large numbers in inflammation, when existing numerously elsewhere. Their appearance in large numbers in the vessels in the inflamed part, and their accumulation here, is ascribed by W. Jones simply to retardation of the circulation ; this condition being consequently the effect, and not the cause of the obstruction, which, however, they may mechanically increase when it has been once induced. The natural adhesiveness of the white corpuscles to the sides of the vessel is such as to require a brisk current to sweep them along, hence when the force of this is lessened, as is the case in an inflamed part, they are not readily de- tached ; but as it has been shown that the tendency to cohesion is increased in the red corpuscles, it is but reasonable to believe, with Dr. Williams, that the adhesiveness of the white ones may also be augmented. The liquor sanguinis undergoes important changes in inflammatory blood. Quesnay, Hey, Thackrah, Babington, and Grainger, have all observed that the quantity of fibrine in it increases, and Andral and G-avarret have shown that it may rise from 2£ per 1000 as high as 10 per 1000. This superfibrination of the blood probably results from waste or oxidation of the tissues, and its aug- mentation must not be looked upon as an increased development of nutritive power. It is in fact the consequence of changes taking place in the blood and parenchyma of the diseased part. The proportion of albumen and of saline matter is somewhat below the natural standard, whilst that of the water is increased above it. When inflammatory blood is drawn from the body it coagulates more slowly than healthy blood; the coagulum also is harder and smaller, and the quantity of serum apparently greater. The surface of the coagulum is commonly covered by a tough layer of yellow fibrinous matter, the huffy coat; and its upper surface is depressed in the centre, having elevated edges, being ctipped, as it is usually termed. By this buff and cup the practitioner commonly estimates the intensity of the inflammation; but it must be borne in mind that buff may occur in certain conditions of the system, as in plethora, pregnancy, or after exercise, without the occurrence of inflammation ; and that the tissue affected, rather than the severity of the inflammation, influences its quantity: thus, it is greatest if the fibrous or serous tissues, and least when the mucous or tegumentary are inflamed. The cupped shape of the clot may likewise be owing, in some degree, to the kind of vessel in which the blood is received, being most evident in those which are rather narrow and deep. These are the principal changes met with in the vessels and blood of the af- fected part, but it must not be supposed that the inflammatory process consists simply in these changes; the nerves and parenchyma doubtless exercise an im-