Volume 5

A dictionary of practical medicine, comprising general pathology, the nature and treatment of diseases, morbid structures and the disorders especially incidental to climates, to the sex, and to the different epochs of life. With numerous prescriptions : a classification of diseases a copious bibliography, with references and an appendix of approved formulae / By James Copland.

  • Copland, James, 1791-1870.
Date:
1844-1858
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical medicine, comprising general pathology, the nature and treatment of diseases, morbid structures and the disorders especially incidental to climates, to the sex, and to the different epochs of life. With numerous prescriptions : a classification of diseases a copious bibliography, with references and an appendix of approved formulae / By James Copland. Source: Wellcome Collection.

    38/1000 (page 14)
    not limited to a particular part, or within distinct bounds ; and the fluid which is poured out from the inflamed vessels is not circumscribed, or con- fined to the centre of the inflamed part. The inflammation which produces this unhealthy and imperfect form of abscess is always characterised by that state of asthenic or ataxic action, local and general, which is incapable of producing co- agulable lymph from the blood, that may limit both the morbid action and the effused fluid. (See art. Inrtammarion.) 14. The present kind of abscess not unfre- quently forms in erysipelas; or after wounds, in- juries, and punctures ; and from the inoculation of an animal poison. The character of the suc- cession of morbid actions it presents is want of vital power and resistance, and a speedy solution of the vital cohesion of the affected tissues. It would seem that the influence of the ganglial nerves supplying the capillaries of the part is ra- pidly, or almost instantly, destroyed by the cause of the disease ; and that the vessels, thus deprived of a great proportion or the whole of their vitality, allow the escape of the more fluid parts of the blood, and the infiltration of the tissues. The vessels pass rapidly, and without the previous grades of healthy inflammation, into that state which admits of the effusion of a watery or puri- form sanies. ‘The state of vital energy, and the deficient crasis, or unhealthy condition of the blood itself, probably contributes to this result ; and, with the effect of this effusion on the diseased part, promotes the rapid exhaustion of the remain- ing action of the capillaries. 15. Diffusive abscesses generally commence in, and spread rapidly in the direction of, the cellular tissue. They affect also, in a very marked man- ner, the other structures placed in their way. They seldom commence in the internal viscera, as the liver, lungs, &c.; but when they do thus originate, as is occasionally observed in the latter stages of malignant or ataxic fevers, in exhaust- ed states of the frame, Xc., they nearly approach the characters they assume in the cellular struc- ture. In almost every case of this disease, the constitutional disturbance is .very remarkable ; and the powers of the nervous system, particu- larly that presiding over the organic and assimi- lating functions, uncommonly depressed. Locally, the effusion of a watery, or sero-albuminous, or a sero-sanguineous fluid is nearly coeval with the affection of the cellular tissue and congestion of its capillaries. The vital cohesion of the inflamed texture is rapidly dissolved ; and the fluid, abund- antly poured out in its areole or cellules, distends the part, diminishes its vital functions to the lowest grade, and, at points, lacerates its tissue, thereby partially cutting off its connection with the adjoining structures. Thus the fluid is effused from the congested capillaries of the affected part in numerous places: in some, forming consider- able collections; in others, mere infiltrations. Parts of the cellular tissue itself, and, in rare in- stances, as the mischief proceeds, portions of ad- joining or intermediate textures, are deprived of all vitality, sphacelate, and mix with the fluid effused. 16. In many cases the integuments participate but imperfectly, and often not at all, in the mor- bid actions, whilst the process, as now described, 1s going forward ; and the great effusion into, and . partial destruction of, the cellular tissue, have enormously distended the limb or part in a dif- fused manner and to a great extent, and given it a boggy or imperfectly fluctuating character. At a later period, parts of the more attenuated or dis- coloured integuments vesicate, ultimately burst, and give issue at first to a discoloured puriform secretion, which afterwards becomes offensive and otherwise modified. When the skin is affected, it generally presents a dark or livid hue: its tem- perature is seldom above (excepting, sometimes, at the very commencement of the antecedent in- flammation), and frequently sinks below, the na- tural standard. 17. With respect to the appearance of the se- cretion in this form of abscess, I may state, that it not only varies remarkably in different cases, but also at different stages of the same case. At first, the fluid effused and infiltrating the cellular structure consists chiefly of a limpid, reddened serum, which readily flows from the divided struc- tures ; in a more advanced stage, the effused mat- ter is less fluid, often high-coloured, but without the whiteness and opacity of purulent matter. Afterwards, the cellular membrane is engorged with a white semi-fluid matter, which separates the particles of fat and cellular tissue at an unusual distance from each other. In subsequent stages it continues opaque ; but often becomes reddish, greenish, and more fluid. Ata still more advanced period, the infiltrated cellular and adipose tissue are entirely broken down, and the sphacelated portions hanging into, or mixed with, the puriform matter ; which sometimes now presents the appear- ance of a brownish, purulent sanies, sometimes a greenish pus, and at other times a sero-purulent matter of various shades of colour and degrees of consistence. At no period of the disease is the matter contained in any circumscribed cavity, but is gradually and irregularly lost in the surround- ing cellular tissue ; without any demarcation, or appearance of coagulable lymph about the cir- cumference of the diseased part. In general, the purulent secretion speedily assumes an offensive odour, and its sensible qualities are otherwise altered, and often variously, upon the admission of air to the diseased surface. 18, The muscular structure, and other parts in contact with the puriform matter, and in the way of the spreading disease, is generally much disco- - loured, softened, easily torn, and sometimes par- . tially destroyed. In some cases the muscles are paler; in others, darker, and more livid than na- tural, In rarer instances, the adjoining bones and more resistant structures are also affected. (See Inrrammation, Diffusive.) 19, 3d. Abscesses consequent upon inflammation of lower grades of intensity. — The more slow and obscure the progress of inflammation, the less marked are the signs of irritation preceding and accompanying abscesses. It is not uncommon to observe, in lymphatic and phlegmatic tempera- ments, fluctuating tumours of various sizes, both superficial and deep-seated ; without any consider- able pain or increase of animal heat, either antc- cedent or subsequent to their formation. Purulent collections, of a chronic and indolent character, generally proceed from a low but continued state of irritation, or from reiterated excitation of so low a grade as scarcely to influence the sensibility of the part ; and occur in constitutions of weak vital