. The principles of surgery . imatelybecoming more or less confluent. The most frequent sites are theneck, shoulders, arms, hips, lower limbs—especially in the neighbour-hood of the articulations. The sores extend more in surface than indepth; yet their origin is not in the skin, as most other ulcers are, butin the subcutaneous areolar tissue. Commencement is made there bytubercular deposit; causing induration and enlargement, at first pain-less. Then perverted vascular action sets in, of a higher grade thanthe merely nutritive; and the consequences are pain in the infiltratedpart, increase of
. The principles of surgery . imatelybecoming more or less confluent. The most frequent sites are theneck, shoulders, arms, hips, lower limbs—especially in the neighbour-hood of the articulations. The sores extend more in surface than indepth; yet their origin is not in the skin, as most other ulcers are, butin the subcutaneous areolar tissue. Commencement is made there bytubercular deposit; causing induration and enlargement, at first pain-less. Then perverted vascular action sets in, of a higher grade thanthe merely nutritive; and the consequences are pain in the infiltratedpart, increase of swelling, and redness of the superimposed integument,with the other ordinary signs of chronic inflammatory action. Imper-fect suppuration takes place ; and the swelling softens, and pits on pres-sure. By and by fluctuation is felt; and the fluid is seen through theskin, very much attenuated ; but there is no regular pointing. Almostthe whole of the integument over the suppurated and infiltrated part 1 Lancet, 1221, p. 236 THE SCROFULOUS SORE. becomes thin, blue, and translucent; it gives way, partly by Bloughinppartly by ulceration; and through the large, ragged, irregular aperturethus formed, thin pus, with broken-down tubercular matter and por-tions of sloughing areolar tissue, is discharged. For some time, no effort is made towards reparation; on the contrarythe thinned and blue integument still further ulcerates, and the infil-trated tissue beneath oozes away in the discharge. The surface has dogranulations, and is of a dirty gray hue ; surroundedFig. 37. by thin, discoloured skin, undermined, inverted, and floating loosely on the subjacent parts. After atime, some parts of the infiltrated tissue have beencleared away, by disintegration or sloughing; amithere granulations begin to appear. But they areof the weak kind; tall, pale, and exuberant. Aprobe, used even with much gentleness, passes rea-dily through granulations into the boggy texturebeneath; causing little
Size: 1201px × 2081px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1800, booksub, booksubjectsurgicalproceduresoperative
