On such an extensive subject it is unnecessary to enter fully; not that
the inquiry is uninteresting, or that a knowledge of the diseases of
the internal cavities, and the mode of treating them, is not required
of the surgical practitioner before he can enter into practice, with
safety to his patients and comfort and satisfaction to himself, but
we have a very important class of diseases to bring under review in
a limited space, and it is properly the province of others to treat
of internal disorders, and to describe the best mode of alleviating
or curing them. It is, however, the duty of the surgeon to treat
the inflammatory affections of some of the serous membranes, and
the consequences of inflammatory action in most of them; and it is
therefore highly necessary that he understand the symptoms, progress,
and consequences of such actions. The affections of the serous
membranes are principally under the management of the physician; but
they not unfrequently follow wounds and surgical operations, and the
diseases of several of them are purely surgical. Inflammation of a
serous membrane is attended with heat and pain, aggravated by motion
of the parts and by pressure; the natural secretion is increased
in quantity, the process of exhalation being incited, and that of
absorption weakened; the serous fluid accumulates. The secretion
becomes altered in quality, and assumes a milky appearance; lymph
is effused, generally mixed with purulent matter, and floats in the
fluid, or adheres to the surface of the membrane, which is rough and
flocculent. The adherent lymph becomes organised, being penetrated
by numerous bloodvessels; and thus the original membrane is, in many
instances, much thickened, chiefly from the addition of new matter,
though also from enlargement of its bloodvessels and opening out
of the primitive tissues, principally the subserous cellular. When
inflamed serous surfaces, which have been altered, both in texture and
function, in consequence of inflammatory action, remain for a short
time in contact with each other, lymph is effused and penetrated by
bloodvessels from each surface; thus the new deposit is organised, and
forms a medium of connection. By this process the parts are intimately
united to each other, and consolidated into one mass; or are merely
approximated, and joined, at one or more points, by portions of lymph,
in some cases thin and narrow, in others extensive and of considerable
thickness; the adhering bands either extend in a straight direction,
from one surface to another, or interlace, forming a sort of network.
After adhesions of various kinds have been formed, they are often
lengthened and attenuated in consequence of the motion of the parts,
as is particularly the case with adhesions between the pleura costalis
and pulmonalis. When they have been of considerable duration, they
often resemble the original membrane from which they were deposited,
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