NOTES ON EPIDEMICAL DISEASES
NOTES ON EPIDEMICAL DISEASES
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流行病注意事项
DOI：
10.1136/bmj.s3-2.65.281
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发表时间：
1854
期刊：
影响因子：
--
通讯作者：
W. Addison
中科院分区：
文献类型：
--
作者：
W. Addison
IN epidemical diseases, inflammation is usually present in some part of the body. In eruptive fevers, it is visible on the skin; and in continued fever, dysentery, influenza, etc., there is generally evidence of some degree of iuflammation. Inflammation arises in joints from local injury, a sprain, or contusion. It may arise in the same places from gout. Inflammation follows from injuiry inflicted on the skin, hot water, a blister, or mustard plaster. It 9appears in the same part in measles, scarlet fever, and erysipelas. Pustules arise in the skin from local irritants; also, in the same part, from the poison of small-pox. What are the relations of these varieties of inflammation? and what is the natural history of the process? In the following sketch of inflammation, conclusions derived from original investigations are stated alirmatively. The facts and experiments upon which the conclusions are grounded have been published at different periods; a short account of them will here be given, and full references stated, for those readers who may require their details at greater length. 1. Inflain7natiwn is a preliwinary of repair. Man, placed in the world, is liable to wounds, contusions, and fractures; and properties inherent in the animal economy have been provided for their reparation. Broken bones, 4orn tendons, and other parts separated by wounuds and lacerations, reunite and heal. In these, and in all other instances of iDjury or irritation from injurious agents, a degree of inflammation arises; the blood-vessels of the part are more than usually injected with blood, and there is some effusion or swelling, with heat and paini. The simplest example of inflammation follows the short application of a mustard plaster. The part becomes red, hot, andl painful; but effusion is scarcely to be noticed. Upon the application of a common blister, appearances are somewhat different: there is pain and ,effusion, causing the cuticle to rise, but the redness is less. When an ankle or wrist has been sprained, inflammation arises; there is pain, heat, and swelling; but, as the inflammation is seated internally, in parts around the joint, redness cannot be seen. In fractured bones, ruptured tendons, and lacerations of all kinds, phenomena of inflammation occur. Lastly, in all accidenits, the pain immediately following denotes the injury inflicted upon the part; but that which continues, or arises afterwards with heat and -swelling, is a sign of inflammation. It is admitted by all .surgical writers, that some degree of inflammation is present in all examples of repair of serious injury: and the proposition, that inflammation is a preliminary of repair of injury to the solid textures of the body, may be considered as established. Ir. Inflamatimon alters the structure of blood-vessels, permits effusion of lynmph, and allows the blood itself ai outlet into eww vessels, sustaining necwforms of growth. In natural or original growth, that, for example, of a bone, tendon, .blood-vessel, or any other fibrous texture, preliminary stages are observed. The part is first extremely soft, then firmer, and then fibrous, tendinous, or osseous. If any animal tissue be observed at a very early stage of growth, through a microscope, it is fOUDd composed of cells loosely cohering. The blood-vessels have the same character; they are extremely tender, aud cannot be handled without rupture. As growth advances, the cells are found cohering more firmly, forming a species of cellular texture. At still more advanced periods, this cellular tissue is replaced by on fibrou, din s. and easti' Anlogousy, it a been found, by examinatiou at vious periods after tX accident, that fractured bones, ruptured tendos, aud lacerated wounds, do not unite end to end at once; but that, in all such cases, union is brought about by a pro. liminary soft growth, which follows the course of orig growth: and much evidenoe has been accumulated by microscopical observers, to the effect, that injured textures are disposed or prepared for new growth by ilflamJmation. The summarv of the evidence upon this point may be expressed as follows. Injuries and accidents after birth must happen to parts which are advanced in, or have completed, natural growth. A new growrth is demanded for repair which requires new blood-vessels. And new blood-vessels cannot arise in parts complete in growth, without a previous chauge in their forms and qualities. It is a necessary preliminary of repair, that established blood-vessels assume the disposition and properties favourable to the offset of new vessels; for, without these, new growths cannot be maintained. And it is unquestionably the tendency and effect of inflammation to bring l)arts around an injury to the condition of an anterior form of growth. Blood-vessels and connective tissue recede, until their properties and structure are coincident with those of early growth; whereupon opportunity is afforded for new vessels and new cell-structure, replete with the energies of growth to arise.t CAsE i. Purruntei Ophthcctmia. The eyelids were swollen and closed. Upon separating them, a thick white matter (pus) escaped. The cornea was clear and bright, but surrounded by and almost buried in a red, highly vascular texture, composed of granulations, having a fleshy appearance. A small portion of this was snipped off; and, on submitting it to microscopical examination, the walls or coats of the blood-vessels were found quite altered in structure, greatly thickened, and composed chiefly of colourless cells.+ CASE iI. A man died of consumption and pleurisy. On opeTing the chest, the pleura was found covered with a clear gelatinous matter, traversed by wavy bands of fibres and new blood-vessels. The size, number, and arrangement of these vessels, bore no resemblance to those of the nomal texture. In one place, fifteen large vessels were noted, running, within a very short distance of each other, a parallel course for an inch-a thing never seen in the healthy structure. With the microscope, multitudes of cells were seen in the walls of the vessels, and the smaller branches appeared no more than simple channels in the gelatinous niaterial.§ Inflammation, then, loosens the coherence of existing blood-vessels, cells appearing in their walls; upon which, the colourless elements or lymph of blood first, and afterwards the blood itself, finds outlets into new channels, organising and sustaining new textures. These ends accomplished, if the process be connected with repair, inflaminatory action ceases naturally, just as original growth ceases. And from this point, from the newly formed texture (the granulation texture), as a basis, a series of transformations in the natural order arise for cure,-fibrous, tendinous, or osseous, respectively, as may be required for the restoration of the iinjured structurell.
