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annsurg01161-0061 - THE MOTTER LECTURES ON SELECTED TOPICS...

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THE MOTTER LECTURES ON SELECTED TOPICS IN SURGICAL PATHOLOGY. SERIES OF i8go-I.'_ BY ROSWELL PARK, A.M., M.D., OF BUFFALO, PROFESSOR OF SURGERY, MEDICAL DEPARTMENT, UNIVERSITY OF BUFFALO; SUR- GEON ro THE BUFFALO GENERAL HOSPITAL, ETC. LECTURE II. WOUND INFECTION AND SUPPURATION. SYLLABUS.-Predisposition to infection, continued.-Influence of manner of inoculation and arrangement of tissue; of irritating chemical substances. Miscellaneous influences. Variation in susceptibility. Concurrentgrowth of vari- ous bacterial species. Recognition ot pyogenic cocci in the blood as an aid to di- agnosis. A Study of Pus.-What is pus? Different substances to which the name has been applied. Study of its grossand minute appearances, and circumstances under which it is produced. Virchow's views as to physiological and pathological irrita- tions, and his four degrees of the inflammatory process. Old "humoraW theory. Cohnheim's teachings and their influence. Can we have pus without micro-organ- isms? Experiments with cadaverin. Study of the discharge from granulating wounds. Differences between acute and chronic abscesses, and the material they contain. Metastatic abscesses and loci minoris resistentiac. Minute anatomy of abscess. The "pyogenic membrane" should be called "pyophylactic" membrane. Differ- entiation of so-called pus into true pus, ppuruloid and archepyon. Conclusions. POINT OF INOCULATION AND ARRANGEMENT OF TISSUE. BACILLI vary very much in their pathogenic effects, de- pending largely on the point where introduced, and the character of the tissue in which they are placed. Some 'Delivered before the College of Physicians, Philadelphia, December, I890. (284)
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SURGICAL PA THOOLLG Y. organisms will' not grow at large in the body, but nnly in cer- tain tissues, while the character of the lesion may vary within wide limits, according to that of the tissue in which they thrive. The higher fungi act to best advantage within capil- lary blood vessels or large serous sacs. The bacillus of ma- lignant cedema grows only in the cellular tissue, and the cocci of erysipelas thrive best in the lymphatic vessels and cellular tissue. Cheyne had some very suggestive results in experi- menting with the proteus vulgaris, which is a common sapro- phytic organism. Introduced in quantity into subcutaneous tissue it provoked only abscesses, but the same amount intro- duced into the muscles would prove fatal, while a very small dose in the muscles was sufficient to produce abscess. He suggests that possibly some chemical substance in the muscle is split up and gives rise to poisonous compounds. Analogous results have been obtained with other bacteria. Fehleisen states that about one-twelfth of the quantity of staphylococci which is necessary to provoke peritonitis will cause suppuration in and around joints. He thinks also that pus varies in virulence according to its origin, different tissues probably producing different ptomaines. As affording the best illustration of the above statement Cheyne adduces the disease known as the Black-leg in England, Rauschbrand in
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