The treatment of inflammation in special tissues and organs will be considered in the sections devoted to regional surgery.
Chronic Inflammation.—A variety of types of chronic and subacute inflammation are met with which, owing to ignorance of their causations, cannot at present be satisfactorily classified.
The best defined group is that of the granulomata, which includes such important diseases as tuberculosis and syphilis, and in which different types of chronic inflammation are caused by infection with a specific organism, all having the common character, however, that abundant granulation tissue is formed in which cellular changes are more in evidence than changes in the blood vessels, and in which the subsequent degeneration and necrosis of the granulation tissue results in the breaking down and destruction of the tissue in which it is formed. Another group is that in which chronic inflammation is due to mild or attenuated forms of pyogenic infection affecting especially the lymph glands and the bone marrow. In the glands of the groin, for example, associated with various forms of irritation about the external genitals, different types of chronic lymphadenitis are met with; they do not frankly suppurate as do the acute types, but are attended with a hyperplasia of the tissue elements which results in enlargement of the affected glands of a persistent, and sometimes of a relapsing character. Similar varieties of osteomyelitis are met with that do not, like the acute forms, go on to suppuration or to death of bone, but result in thickening of the bone affected, both on the surface and in the interior, resulting in obliteration of the medullary canal.
A third group of chronic inflammations are those that begin as an acute pyogenic inflammation, which, instead of resolving completely, persists in a chronic form. It does so apparently because there is some factor aiding the organisms and handicapping the tissues, such as the presence of a foreign body, a piece of glass or metal, or a piece of dead bone; in these circumstances the inflammation persists in a chronic form, attended with the formation of fibrous tissue, and, in the case of bone, with the formation of new bone in excess. It will be evident that in this group, chronic inflammation and repair are practically interchangeable terms.
There are other groups of chronic inflammation, the origin of which continues to be the subject of controversy. Reference is here made to the chronic inflammations of the synovial membrane of joints, of tendon sheaths and of bursæ—chronic synovitis, teno-synovitis and bursitis; of the fibrous tissues of joints—chronic forms of arthritis; of the blood vessels—chronic forms of endarteritis and of phlebitis and of the peripheral nerves—neuritis. Also in the breast and in the prostate, with the waning of sexual life there may occur a formation of fibrous tissue—chronic interstitial mastitis, chronic prostatitis, having analogies with the chronic interstitial inflammations of internal organs like the kidney—chronic interstitial nephritis; and in the breast and prostate, as in the kidney, the formation of fibrous tissue leads to changes in the secreting epithelium resulting in the formation of cysts.
Lastly, there are still other types of chronic inflammation attended with the formation of fibrous tissue on such a liberal scale as to suggest analogies with new growths. The best known of these are the systematic forms of fibromatosis met with in the central nervous system and in the peripheral nerves—neuro-fibromatosis; in the submucous coat of the stomach—gastric fibromatosis; and in the colon—intestinal fibromatosis.
These conditions will be described with the tissues and organs in which they occur.
In the treatment of chronic inflammations, pending further knowledge as to their causation, and beyond such obvious indications as to help the tissues by removing a foreign body or a piece of dead bone, there are employed—empirically—a number of procedures such as the induction of hyperæmia, exposure to the X-rays, and the employment of blisters, cauteries, and setons. Vaccines may be had recourse to in those of bacterial origin.
CHAPTER IV
SUPPURATION
- [Definition]
- —[Pus]
- —[Varieties]
- —[Acute circumscribed abscess]
- —[Acute suppuration in a wound]
- —[Acute Suppuration in a mucous membrane]
- —[Diffuse cellulitis and diffuse suppuration]
- —[Whitlow]
- —[Suppurative cellulitis in different situations]
- —[Chronic suppuration]
- —[Sinus, Fistula]
- —[Constitutional manifestations of pyogenic infection]
- —[Sapræmia]
- —[Septicæmia]
- —[Pyæmia].