Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    219/976 (page 199)
    pus.* It is mostly, but not always, separated from the venous walls by a layer of still consistent fibrine ; and is generally shut out from the proximal portion of the venous channel in which it lies by a con- tinuation of this layer of fibrine, which forms a kind of septum or diaphragm between them. Generally the rounded extremity of the hollow fibrinous cylinder thus formed has adherent to it and pro- longed from it a process of ordinary coloured clot. Sometimes one, sometimes several veins are found thus affected, and sometimes a con- siderable length of one is converted into an elongated abscess. The ultimate arterial twigs, distributed in the lungs to the masses of diseased lung structure, seem to be invariably occupied, indeed distended, by a soft pulpy yellowish material, or by something more nearly approaching to ordinary coagulum. This material is found to consist mostly of mere disintegrated fibrine presenting the debris only of cells. But sometimes it contains distinct pus f—that is to say cells resembling in all their visible characters pus-corpuscles or the white corpuscles of the blood, but so abundant and so closely aggregated as wholly to negative the notion of their being normal blood-elements. Similar coagula have been detected in the small vessels leading to the diseased patches occurring in other organs besides the lungs—in the vessels for example of the heart, the spleen, the kidneys. (p) Connexion between blocked-up condition of Vessels and Secondary Deposits.—So constantly are these coagula found in the small arteries, if looked for carefully, that the conclusion is forced upon pathologists that there is between them and the patches of diseased tissue a rela- tionship of cause and effect. It might be surmised that the coagula in the blood-vessels are secondary to the local pysemic formations with which they are connected, due to obstruction in the capillaries of the affected part and consequent stagnation of blood in tbe vessels leading to them. The characters of the coagula show however that this cannot be the true explanation of their mode of formation. They are not mere coagulated blood, nor even mere coagulated fibrine ; but, if fibrine at all, are fibrine which has undergone changes, requiring time for their production, and often in point of time clearly in advance of the changes which have taken place in the patches of diseased tissue. There can * The following case bears out the statement in the text. A man died of erysipelas of the face and Pyaemia. “ The brawny tissue of the face was infiltrated with pus, and pus