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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    INCREASED VASCULAR ACTION. cellular substance that adhesions, bands, false membranes, thickenings, and opacities are commonly formed. Plastic matter may also be developed into bone, passing through a fibrous, or fibro-cellular transformation; and, lastly, we see it developed into epithelial scales, such as are commonly found in cutaneous cicatrices. Vascularization of lymph.—In lymph that undergoes development, bloodves- sels are seen to make their appearance at an early period. With regard to the pre- cise time of their formation, Dupuytren and Villerme state, from their_experi- ments on dogs, that twenty-one days are required; and Travers, from his expe- riments on the frog's web, fixed the same period as that in which red blood begins to pass. In the human subject, however, the lymph on the surface of an ulcer or wound certainly appears to become vascular long before this. How are the new vessels formed ?—by development in the lymph ? or by extension from surrounding parts? Hunter and Rokitansky incline to the former opinion. Travers and Queckett, who have recently investigated the matter fully, believe that the vessels are always projected into the lymph from neighboring parts; and Paget agrees with these observers. Travers states dis- tinctly, as the result of his observations, which are borne out by the results of the experiments of the late Dr. Tod, of Brighton, that there is no such thing as independent vascularization, the whole business of organization is of and from the margin of the wound. According to Travers, the following are the periods of development of vessels in a frog's web which had been wounded:— Up to the fourteenth day, there is stasis in the vessels adjoining the wound. From the fourteenth to the twenty-first day, channels are opened in the plastic matter, at first colorless, then admitting single blood-corpuscles; from the twenty- first to the twenty-eighth day, the circulation is more active, the vessels enlarging and anastomosing; in the fifth week, transparent capillaries pass across from the colored arteries to veins; and in the sixth week there is the formation of new vessels in loops, half-circles, &c. The steps by which this interesting process is accomplished, are the following. At first, small lateral dilatations or pouches appear at some points on the walls of the nearest old vessels; these grow out into the plastic mass, bend towards each other, coalesce, and form a loop or fork. These loops give rise to secondary vascular outgrowths; and thus the vascularization of the lymph is completed. Travers states that these vessels are visible, like fine striae, before the circula- tion can be detected in them. A single globule of blood first enters, this is followed by others, which for some time have a see-saw or oscillatory motion, which progresses gradually towards the nearest vessel, and the blood entering this completes the circulation, which becomes continuous and equable. The degeneration of lymph has been especially studied by Paget. He observes that it may wither and harden, forming dry, horny masses or vegetations; that it may undergo fatty degeneration, and become converted into granular matter. These two last forms of degeneration are frequently met with in the coats of diseased arteries. Besides these changes, it may calcify, beino- converted into an inorganic earthy material; it may undergo pigmentary changes j and, lastly, it is very frequently converted into pus. SUPPURATIVE INFLAMMATION. The suppurative is that form of inflammation which gives rise to the pro- duction of pus. And pus never occurs except as the result of this form of in- flammatory action. Pas presents considerable variety in its general character, according to the