Surgery, with Special Reference to Podiatry

by Maximilian Stern; Edward Adams

This tendency of the white cells to separate from the others, even when the current is rapid, is partly due to their viscosity and power of ameboid movement, but in the main is a purely mechanical effect of the slower current.

It has been proven that when particles of different density are suspended in a liquid which is circulating through a system of narrow tubes with a very rapid current, there is a clear space next to the wall of the tube where the friction necessarily reduces the speed of the fluid which is free from particles, and, as the current is slowed down, some of the particles of least density, begin to appear in this clear space, their number increasing as the current becomes slower, until even the heavy particles also collect here when it is very slow.

It is known that among the cellular elements of the blood, the leucocytes have the least specific gravity or density, and the blood plaques rank next, while the red blood disks are the heaviest, and these bodies appear in the clear serum near the vessel wall in that order, according to the law just cited. The slow current is associated with an increased intravascular blood pressure, which, in part, is the cause of the phenomena of exudation, emigration and diapedesis.

Exudation. Serum of the blood passes out of the vessels, and collects in the lymphatic spaces in the cellular tissue, and elsewhere, and also exudes from the surface of the mucous membranes or forms vesicles or blisters in the skin by detaching the superficial epithelial layers. Complete stasis, or stoppage of the circulation is seen only when the inflammation is exceedingly intense, and would cause the death of the part if continued long.

Usually the current merely becomes slower than normal. This retarded circulation is followed by the phenomena of emigration.

Emigration. Emigration of the white blood corpuscles consists in the passage of the cells directly through the vessel walls. It is most frequently seen in the capillaries, although it also takes place in the small veins. The white corpuscles, or leucocytes, have the property of ameboid movement, stretching out at will in any direction, long, narrow processes of their protoplasm, called pseudopodia, which may be attached to any object, and having secured such an anchorage, the rest of the protoplasmic body is drawn towards it.

In this way, the leucocytes are able to pass through the interstices between cells, or along narrow channels in the tissues. When the blood current becomes sufficiently slow to enable them to cling to the walls of the vessels, it is then that ameboid movement begins. Sometimes the cells loose their hold and are swept on again, but in other cases a minute bud of protoplasm will appear on the other side of the wall of the vessel, opposite to the spot where the leucocyte is clinging, and as this grows larger, a narrow neck of protoplasm can be traced through the wall directly to the leucocyte, and presently the mass of the leucocyte becomes proportionately smaller as the external bud of protoplasm grows larger. The conditions are gradually reversed, the nuclei of the cells appear outside and only a small mass of protoplasm remains within the vessel until finally the entire leucocyte is in the tissue outside of the vessel and is free to wander in any direction.

The mechanical part of this process is not yet understood. It is claimed by some that small openings exist in the walls of the vessels, between the endothelial cells which line them, to which is given the name of stomata. These openings ordinarily are invisible, but they are said to enlarge under the effect of the dilation of the vessels, and of the alterations in their walls, produced by the inflammatory reaction, and that the leucocytes escape through those openings.

There can be no doubt that the emigration is due to the ameboid motion of the cell, and the discovery of the phenomenon, to which is given the name chemotaxis, affords a sufficient explanation.