Surgery, with Special Reference to PodiatryStern, Maximilian
Science
Surgery, with Special Reference to Podiatry
Stern, Maximilian
Foot -- Surgery; Surgery
+Suppuration.+ Pus consists of a serum containing little or no fibrin
and large numbers of leucocytes. There are also many cells, either
dead or dying, which represent the waste thrown off from the tissues
as a result of the inflammatory reaction. A purulent inflammation or
suppurative inflammation, is one in which there is pus formation.
When suppuration occurs, the pus may make its way to a free surface,
such as a mucous membrane, or may form an abscess, or may cause
sloughing of the skin over the seat of inflammation, and so escape
from the cellular spaces in the tissues.
Pus may be thrown off by a mucous membrane, without any actual breach
of continuity. Diffuse infiltration of the tissues is the most
dangerous form of suppuration.
In this variety of inflammation the exudate is brought into contact
with the greatest possible extent of absorbent vessels, for as a
surface of a sponge is greater than that of a bag, which would contain
it, so the surface of these intercellular spaces is much greater than
that of an abscess cavity filled by the same amount of pus. In this
form the bands of cellular tissue, lying between and forming the
boundaries of these spaces, remain intact, and the exudate is either
absorbed into the circulation, or seeks escape through many punctate
openings in the skin.
The entire skin of the part is frequently detached from the fascia by
the sloughing of the subcutaneous tissues, before it gives way, and
even when it finally yields to the necrotic process, the openings
formed will be altogether too small in proportion to the extent of the
disease beneath, so that healing is still further delayed.
+Sloughing.+ Inflammation may be accompanied by sloughing or death of
tissues. Gangrene, mortification or necrosis is a death of the tissue
from any cause. The part which has died is designated as a _slough_.
When inflammation has subsided, granulation tissue forms on the living
tissue, exerting pressure upon the slough, thus hastening its
absorption or separation.
+Chronic Inflammation.+ An interruption at some stage of resolution or
suppuration and the continuance of mild symptoms constitutes a chronic
state.
By chronic inflammation, we understand a long continuance of some or
all of the changes seen in acute inflammation, but less in intensity,
and an abnormal tendency to the production of new tissue.
+Treatment.+ The general indications to be observed in the treatment of
inflammation are: (1) to combat the congestion of the parts; (2) to
relieve tension; (3) to give free issue to the products of
inflammation; (4) to produce early separation of sloughs.
Very hot or very cold applications exert a beneficial and soothing
effect upon inflamed areas.
Cold has the tendency to reduce tension by constricting the blood
vessels thus diminishing the amount of blood supplied. In an infected
area the reproduction and development of bacteria are checked, and
suppuration is frequently aborted.
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