Volume 4

A reference handbook of the medical sciences : embracing the entire range of scientific and practical medicine and allied science / by various writers ; edited by Albert H. Buck.

Date:: 1888-1895

Credit: A reference handbook of the medical sciences : embracing the entire range of scientific and practical medicine and allied science / by various writers ; edited by Albert H. Buck. Source: Wellcome Collection.

40/838 (page 28)

$i ii flam idisi t ion. Inflammation. REFERENCE HANDBOOK OF THE MEDICAL SCIENCES. give up this idea when it was found that a watery extract from a lung solidified by croupous pneumonia, in which there is most abundant formation of fibrin, contained a large amount of peptone. The most severe inflammations can be induced without assuming a purulent character. The strong mineral acids and caustic alkalies can be in- jected under the skin, and an inflammation with the most extensive necrosis set up, but there will be no pus. The purulent inflammation is due always to the presence of this chemical compound we have spoken of, and which Weigert has aptly designated the pus-poison (Eitergifi). It has long been known that an inflammation was most apt to become purulent when the air had access to the inflamed part. A simple fracture of a bone never pro- duced a purulent inflammation ; but if a spicula of bone projected through the skin, and the fracture was com- pound, then the pus was formed. A serous inflamma- tion of the pleura too often becomes purulent after the puncture of the trocar. It was soon shown, however, that it was not the entry of the air alone which gave rise to such inflammations. Air was injected into the subcu- taneous cellular tissues of rabbits until they were blown up like balloons, without any inflammation, much less a purulent one, being set up. Everyone knows the risk attending the exposure of serous membranes to the air, yet it was shown that, with certain precautions, air might be passed through the peritoneal cavity for days without any unfavorable results. Other experiments showed that without doubt it was not the air itself, but the lower or- ganisms which it contained, that did the damage, and when these were excluded no harm resulted from the ac- tion of the air. In the great majority of cases a puru- lent inflammation is the result of the action of certain lower organisms, and the pus-poison most probably is a chemical substance produced by them. It is possible, however, to have purulent inflammation entirely inde- pendent of lower organisms ; the pus-poison may have another source. So much as this fact has been denied, it may be regarded to-day as certain. By the injection of petroleum, turpentine, and especially croton-oil, it is al- Fig. 182].—Pus from a Small Abscess. Micrococci are seen both en- closed in pns-corpuscles and lying free. Cover-slip preparation stained with fuchsin. X 600. ways possible to cause a purulent inflammation. Also, if metallic mercury is injected into the knee-joints of rab- bits, a purulent inflammation is caused. Most of these experiments were made by injecting the various sub- stances into the tissues by means of the hypodermic syr- inge. It was claimed by the bacteria believers that, even though the needle and substance injected were thor- oughly disinfected, still away was left open for the entry of organisms by the canal which the needle made. The opponents of the bacteria theory claimed that suppuration could also be produced by the in jection of the most varied substances, such as milk, olive-oil, etc. It needed but a little care and cleanliness in operating to show that these last-named substances had no such action. Some experi- ments have been made by the writer with a view to the absolute exclusion of lower organisms in the suppuration caused by croton-oil. The oil was boiled and enclosed, while still hot, in glass capsules which had previously been heated red-hot. A small opening was made in the skin, and the capsule pushed along a director for some distance into the subcutaneous cellular tissue. After sev- eral days had elapsed, and sifter the skin wound and canal were perfectly healed, the capsules were broken by pinch- ing them, and the result was in every case a suppuration. Control experiments were made in which the capsules were filled with vsirious other substances, and the result was alwsiys negative. Nothing could have shown better the inertness of mechanical irritants to produce inflamma- tion than some experiments made by Dr. Sternberg and the writer in regard to tuberculosis. Large quantities of finely broken glass and Prussian blue were injected, with antiseptic precautions, into the abdominal cavity of rab- bits, and a purulent inflammation was never produced. As regards croton-oil, apart from all experimental evi- dence, we know that its application to the skin of man produces a purulent inflammation. A vesicular inflam- mation is produced, and the vesicles soon change into pustules. As the inflammation takes place, beneath the epidermis, the influence of lower organisms in this case also can be excluded. Apart from such cases as have been mentioned, we can always regard purulent inflammation as due to bacteria. In most cases there is but little difficulty found in trac- ing their entry into the body, and often they enter the tissue at some distance from the point where the abscess has formed. Still there are cases in which there is an abscess formed as the result of violence, and, so far as can be seen, there is no injury to the skin, no way by which bacteria could have entered. Abscesses of the brain in consequence of a blow on the head, or of the subcutaneous cellular tissue in conse- quence of a blow or injury of any sort, are not very un- common in man. On microscopic examination bacteria sire found. How do these organisms get there ? Ordinarily the tissues and blood do not contain any bacteria. More- over, these injuries are followed by suppuration in but a very small percentage of the cases, probably less than one per cent. Experimentally, such suppurations cannot be produced in the lower animals when all chances of infec- tion by bacteria are excluded. It is useless to deny, as has been done, that such cases are seen in man, nor can they be used as proof of the existence of suppuration without the presence of bacteria. Though we know that ordinarily no bacteria are in the normal blood and tissues, still there is the possibility, or even probability, that they may continually enter the blood from the alimentsiry canal, or in some other manner, and be destroyed or re- moved from the blood. It may be, in these cases, that the organisms find in the injured and inflamed area a place of minor resistance, a suitable nidus for their growth ; they develop here and produce a suppuration. In these ab- scesses bacteria are found, but there are certain abscesses which sirise without apparent cause, do not, as a rule, give rise to much constitutional trouble, and in which the ordi- nary bacteria which are found in acute abscesses are never seen. These are the so-called cold abscesses. Since the discovery of the tubercle-bacillus by Koch, it has been found that in most cases these abscesses are tubercular in character, and connected with tubercular caries in bone. The pus is rarely formed at the place where the abscess appears ; in most cases it comes from a distance, travel- ling along the sheaths of muscles or fasciae. The best example of this is the abscess which forms in the groin in consequence of tubercular caries of the vertebrae. The most careful search of the pus in these cases often fails to show the presence of the tubercle-bacillus, but the proof of their tubercular character is found in the fact that the injection of such pus into rabbits or guinea-pigs produces tuberculosis. If the pus is cultivated in suitable media, tubercle-bsicilli will develop. It may be that the organ- isms are present in such small numbers that they elude our search, or they may be present in some form which we cannot recognize. Such abscesses are also found in con- nection with syphilis, farcy, and actinomycosis. Lately,$