Lectures on the principles and practice of physic; delivered at King's College, London / By Thomas Watson.

  • Watson, Thomas, Sir, 1792-1882.
Date:
1844
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Licence: Public Domain Mark

Credit: Lectures on the principles and practice of physic; delivered at King's College, London / By Thomas Watson. Source: Wellcome Collection.

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    place in excess—in a greater degree, that is, and more irregularly than seems to be required. for any useful purpose—-the result is ulceration. This term is, however, commonly re- stricted to those cases. in which the loss of substance occurs upon some suzface internal or external. Many circumstances influence the occurrence and progress of ulceration; and great differences are observable in the different tissues, in respect to the facility with which they severally ulcerate. Ulceration is most common in the tegumentary membranes. It is frequently met with also in the inner coats of the arteries, in cartilages, and in bones. But we are not always sure that it is in these cases an event of inflammation. Ulcera- tion is rare in fibrous tissues of all kinds, in serous membranes, and in the outer coat of arteries. ‘These differences have important pathological bearings. But I may not stop to consider these at present: they will be particularly noticed as the course proceeds. When I state that ulceration may lead to perforations of the alimentary canal——of the air- tubes—of the gall and urinary bladders—of the blood-vessels; and to the fatal escape of the natural contents of these organs; I have said enough to convince you that ulceration, so frequently the object of the surgeon’s care, requires no less attention on the part of the physician. ' There are certain forms of ulceration that are specific in their nature: with these I do not at present meddle. The process of ulceration is very clearly explained in Dr. Alison’s admirable Outlines of Pathology. There are three things generally going on at the same time in an ulcerated surface. First, there is an effusion of plastic lymph, by which what are called granulations are formed. Granulations consist of coagulable lymph which has become organized; furnished with numerous delicate blood-vessels. Secondly, there is suppuration; and, thirdly, there is absorption or the removal of parts. Sometimes, apparently, there is no suppuration-—we see no pus in ulcers of the cornea, nor in certain cases of absorption of articular cartilages. When the first of these three processes gets the better, if I may so speak, of the others, the lymph overspreads the surface of the ulcer, fills up the cavity; and the ulcer heals; cicatrization takes place. When, on the other hand, the absorbing process predominates, the ulcer alt itself —-the excavation grows larger, or deeper--or both larger and deeper: and when this ex- _cess of absorption is great, and the extension of the ulceration rapid, it is called phagedenic ulceration. When a part of the textures perishes during the process of the ulceration, and is separated in entire and sensible masses, the ulcer is said to be a sloughing ulcer. “When the process is slow, the lymph effused at the base and round the edge of the ulcer is hard- ened, and the granulations on its surface are deficient, the ulcer is then said to be callous or indolent: and when the granulations are larger and softer, and more flabby than usual, and require to be repressed before the ulcer will heal; to this variety of ulcer the name of fungous ulcer is given:” and the coarse and too luxuriant granulations are called, by the vulgar, proud flesh. These several terms, in the senses now assigned to them, you will please to remember. It is by regulating the three processes now described—so far as they are capable of being ‘regulated by art—that the surgeon and the physician endeavour to obviate the threatened ill consequences of ulceration, and to promote the repair of the textures which have been destroyed. [explained to you, in a former lecture, that inflammation may Alda to a wasting of parts, although there is no suppuration or ulceration. The testis sometimes withers as a conse- quence of inflammation: interstitial absorption takes place. Atrophy in short.