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INTRODUCTION
To prolong human life and to alleviate suffering are the ultimate objects of scientific medicine. The two great branches of the healing art Medicine and Surgery are so intimately related that it is impossible to draw a hard-and-fast line between them, but for convenience Surgery may be defined as "the art of treating lesions and malformations of the human body by manual operations, mediate and immediate." To apply his art intelligently and successfully, it is essential that the surgeon should be conversant not only with the normal anatomy and physiology of the body and with the various pathological conditions to which it is liable, but also with the nature of the process by which repair of injured or diseased tissues is effected. Without this knowledge he is unable to recognise such deviations from the normal as result from mal-development, injury, or disease, or rationally to direct his efforts towards the correction or removal of these.
PROCESS OF REPAIR
The process of repair in living tissue depends upon an inherent power possessed by vital cells of reacting to the irritation caused by injury or disease. The cells of the damaged tissues, under the influence of this irritation, undergo certain proliferative changes, which are designed to restore the normal structure and configuration of the part. The process by which this restoration is effected is essentially the same in all tissues, but the extent to which different tissues can carry the recuperative process varies. Simple structures, such as skin, cartilage, bone, periosteum, and tendon, for example, have a high power of regeneration, and in them the reparative process may result in almost perfect restitution to the normal. More complex structures, on the other hand, such as secreting glands, muscle, and the tissues of the central nervous system, are but imperfectly restored, simple cicatricial connective tissue taking the place of what has been lost or destroyed. Any given tissue can be replaced only by tissue of a similar kind, and in a damaged part each element takes its share in the reparative process by producing new material which approximates more or less closely to the normal according to the recuperative capacity of the particular tissue. The normal process of repair may be interfered with by various extraneous agencies, the most important of which are infection by disease-producing micro-organisms, the presence of foreign substances, undue movement of the affected part, and improper applications and dressings. The effect of these agencies is to delay repair or to prevent the individual tissues carrying the process to the furthest degree of which they are capable. In the management of wounds and other diseased conditions the main object of the surgeon is to promote the natural reparative process by preventing or eliminating any factor by which it may be disturbed.  Healing by Primary Union.  The most favourable conditions for the progress of the reparative process are to be found in a clean-cut wound of the integument, which is uncomplicated by loss of tissue, by the presence of foreign substances, or by infection with disease-producing micro-organisms, and its edges are in contact. Such a wound in virtue of the absence of infection is said to be  aseptic , and under these conditions healing takes place by what is called "primary union" the "healing by first intention" of the older writers.  Granulation Tissue.  The essential and invariable medium of repair in all structures is an elementary form of new tissue known as  granulation tissue , which is produced in the damaged area in response to the irritation caused by injury or disease. The vital reaction induced by such irritation results in dilatation of the vessels of the part, emigration of leucocytes, transudation of lymph, and certain proliferative changes in the fixed tissue cells. These changes are common to the processes of inflammation and repair; no hard-and-fast line can be drawn between these processes, and the two may go on together. It is, however, only when the proliferative changes have come to predominate that the reparative process is effectively established by the production of healthy granulation tissue.  Formation of Granulation Tissue.  When a wound is made in the integument under aseptic conditions, the passage of the knife through the tissues is immediately followed by an oozing of blood, which soon coagulates on the cut surfaces. In each of the divided vessels a clot forms, and extends as far as the nearest collateral branch; and on the surface of the wound there is a microscopic layer of bruised and devitalised tissue. If the wound is closed, the narrow space between its edges is occupied by blood-clot, which consists of red and white corpuscles mixed with a quantity of fibrin, and this forms a temporary uniting medium between the divided surfaces. During the first twelve hours, the minute vessels in the vicinity of the wound dilate, and from them lymph exudes and leucocytes migrate into the tissues. In from twenty-four to thirty-six hours, the capillaries of the part adjacent to the wound begin to throw out minute buds and fine processes, which bridge the gap and form a firmer, but still temporary, connection between the two sides. Each bud begins in the wall of the capillary as a small accumulation of granular protoplasm, which gradually elongates into a filament containing a nucleus. This filament either joins with a neighbouring capillary or with a similar filament, and in time these become hollow and are filled with blood from the vessels that gave them origin. In this way a series of young  capillary loops  is formed. The spaces between these loops are filled by cells of various kinds, the most important being the  fibroblasts , which are destined to form cicatricial fibrous tissue. These fibroblasts are large irregular nucleated cells derived mainly from the proliferation of the fixed connective-tissue cells of the part, and to a less extent from the lymphocytes and other mononuclear cells which have migrated from the vessels. Among the fibroblasts, larger multi-nucleated cells  giant cells  are sometimes found, particularly when resistant substances, such as silk ligatures or fragments of bone, are embedded in the tissues, and their function seems to be to soften such substances preliminary to their being removed by the phagocytes. Numerous  polymorpho-nuclear leucocytes , which have wandered from the vessels, are also present in the spaces. These act as phagocytes, their function being to remove the red corpuscles and fibrin of the original clot, and this performed, they either pass back into the circulation in virtue of their amœboid movement, or are themselves eaten up by the growing fibroblasts. Beyond this phagocytic action, they do not appear to play any direct part in the reparative process. These young capillary loops, with their supporting cells and fluids, constitute granulation tissue, which is usually fully formed in from three to five days, after which it begins to be replaced by cicatricial or scar tissue.  Formation of Cicatricial Tissue.  The transformation of this temporary granulation tissue into scar tissue is effected by the fibroblasts, which become elongated and spindle-shaped, and produce in and around them a fine fibrillated material which gradually increases in quantity till it replaces the cell protoplasm. In this way white fibrous tissue is formed, the cells of which are arranged in parallel lines and eventually become grouped in bundles, constituting fully formed white fibrous tissue. In its growth it gradually obliterates the capillaries, until at the end of two, three, or four weeks both vessels and cells have almost entirely disappeared, and the original wound is occupied by cicatricial tissue. In course of time this tissue becomes consolidated, and the cicatrix undergoes a certain amount of contraction  cicatricial contraction .  Healing of Epidermis.  While these changes are taking place in the deeper parts of the wound, the surface is being covered over by  epidermis  growing in from the margins. Within twelve hours the cells of the rete Malpighii close to the cut edge begin to sprout on to the surface of the wound, and by their proliferation gradually cover the granulations with a thin pink pellicle. As the epithelium increases in thickness it assumes a bluish hue and eventually the cells become cornified and the epithelium assumes a greyish-white colour.  Clinical Aspects.  So long as the process of repair is not complicated by infection with micro-organisms, there is no interference with the general health of the patient. The temperature remains normal; the circulatory, gastro-intestinal, nervous, and other functions are undisturbed; locally, the part is cool, of natural colour and free from pain.  Modifications of the Process of Repair.  The process of repair by primary union, above described, is to be looked upon as the type of all reparative processes, such modifications as are met with depending merely upon incidental differences in the conditions present, such as loss of tissue, infection by micro-organisms, etc.  Repair after Loss or Destruction of Tissue.  When the edges of a wound cannot be approximated either because tissue has been lost, for example in excising a tumour or because a drainage tube or gauze packing has been necessary, a greater amount of granulation tissue is required to fill the gap, but the process is essentially the same as in the ideal method of repair. The raw surface is first covered by a layer of coagulated blood and fibrin. An extensive new formation of capillary loops and fibroblasts takes place towards the free surface, and goes on until the gap is filled by a fine velvet-like mass of granulation tissue. This granulation tissue is gradually replaced by young cicatricial tissue, and the surface is covered by the ingrowth of epithelium from the edges. This modification of the reparative process can be best studied clinically in a recent wound which has been packed with gauze. When the plug is introduced, the walls of the cavity consist of raw tissue with numerous oozing blood vessels. On removing the packing on the fifth or sixth day, the surface is found to be covered with minute, red, papillary granulations, which are beginning to fill up the cavity. At the edges the epithelium has proliferated and is covering over the newly formed granulation tissue. As lymph and leucocytes escape from the exposed surface there is a certain amount of serous or sero-purulent discharge. On examining the wound at intervals of a few days, it is found that the granulation tissue gradually increases in amount till the gap is completely filled up, and that coincidently the epithelium spreads in and covers over its surface. In course of time the epithelium thickens, and as the granulation tissue is slowly replaced by young cicatricial tissue, which has a peculiar tendency to contract and so to obliterate the blood vessels in it, the scar that is left becomes smooth, pale, and depressed. This method of healing is sometimes spoken of as "healing by granulation" although, as we have seen, it is by granulation that all repair takes place.  Healing by Union of two Granulating Surfaces.  In gaping wounds union is sometimes obtained by bringing the two surfaces into apposition after each has become covered with healthy granulations. The exudate on the surfaces causes them to adhere, capillary loops pass from one to the other, and their final fusion takes place by the further development of granulation and cicatricial tissue.  Reunion of Parts entirely Separated from the Body.  Small portions of tissue, such as the end of a finger, the tip of the nose or a portion of the external ear, accidentally separated from the body, if accurately replaced and fixed in position, occasionally adhere by primary union. In the course of operations also, portions of skin, fascia, or bone, or even a complete joint may be transplanted, and unite by primary union.  Healing under a Scab.  When a small superficial wound is exposed to the air, the blood and serum exuded on its surface may dry and form a hard crust or  scab , which serves to protect the surface from external irritation in the same way as would a dry pad of sterilised gauze. Under this scab the formation of granulation tissue, its transformation into cicatricial tissue, and the growth of epithelium on the surface, go on until in the course of time the crust separates, leaving a scar.  Healing by Blood-clot.  In subcutaneous wounds, for example tenotomy, in amputation wounds, and in wounds made in excising tumours or in operating upon bones, the space left between the divided tissues becomes filled with blood-clot, which acts as a temporary scaffolding in which granulation tissue is built up. Capillary loops grow into the coagulum, and migrated leucocytes from the adjacent blood vessels destroy the red corpuscles, and are in turn disposed of by the developing fibroblasts, which by their growth and proliferation fill up the gap with young connective tissue. It will be evident that this process only differs from healing by primary union in the  amount  of blood-clot that is present.  Presence of a Foreign Body.  When an aseptic foreign body is present in the tissues,  e.g.  a piece of unabsorbable chromicised catgut, the healing process may be modified. After primary union has taken place the scar may broaden, become raised above the surface, and assume a bluish-brown colour; the epidermis gradually thins and gives way, revealing the softened portion of catgut, which can be pulled out in pieces, after which the wound rapidly heals and resumes a normal appearance.
REPAIR IN INDIVIDUAL TISSUES
  Skin and Connective Tissue.  The mode of regeneration of these tissues under aseptic conditions has already been described as the type of ideal repair. In highly vascular parts, such as the face, the reparative process goes on with great rapidity, and even extensive wounds may be firmly united in from three to five days. Where the anastomosis is less free the process is more prolonged. The more highly organised elements of the skin, such as the hair follicles, the sweat and sebaceous glands, are imperfectly reproduced; hence the scar remains smooth, dry, and hairless.  Epithelium.  Epithelium is only reproduced from pre-existing epithelium, and, as a rule, from one of a similar type, although metaplastic transformation of cells of one kind of epithelium into another kind can take place. Thus a granulating surface may be covered entirely by the ingrowing of the cutaneous epithelium from the margins; or islets, originating in surviving cells of sebaceous glands or sweat glands, or of hair follicles, may spring up in the centre of the raw area. Such islets may also be due to the accidental transference of loose epithelial cells from the edges. Even the fluid from a blister, in virtue of the isolated cells of the rete Malpighii which it contains, is capable of starting epithelial growth on a granulating surface. Hairs and nails may be completely regenerated if a sufficient amount of the hair follicles or of the nail matrix has escaped destruction. The epithelium of a mucous membrane is regenerated in the same way as that on a cutaneous surface. Epithelial cells have the power of living for some time after being separated from their normal surroundings, and of growing again when once more placed in favourable circumstances. On this fact the practice of skin grafting is based (p. 11).  Cartilage.  When an articular cartilage is divided by incision or by being implicated in a fracture involving the articular end of a bone, it is repaired by ordinary cicatricial fibrous tissue derived from the proliferating cells of the perichondrium. Cartilage being a non-vascular tissue, the reparative process goes on slowly, and it may be many weeks before it is complete. It is possible for a metaplastic transformation of connective-tissue cells into cartilage cells to take place, the characteristic hyaline matrix being secreted by the new cells. This is sometimes observed as an intermediary stage in the healing of fractures, especially in young bones. It may also take place in the regeneration of lost portions of cartilage, provided the new tissue is so situated as to constitute part of a joint and to be subjected to pressure by an opposing cartilaginous surface. This is illustrated by what takes place after excision of joints where it is desired to restore the function of the articulation. By carrying out movements between the constituent parts, the fibrous tissue covering the ends of the bones becomes moulded into shape, its cells take on the characters of cartilage cells, and, forming a matrix, so develop a new cartilage. Conversely, it is observed that when articular cartilage is no longer subjected to pressure by an opposing cartilage, it tends to be transformed into fibrous tissue, as may be seen in deformities attended with displacement of articular surfaces, such as hallux valgus and club-foot. After fractures of costal cartilage or of the cartilages of the larynx the cicatricial tissue may be ultimately replaced by bone.  Tendons.  When a tendon is divided, for example by subcutaneous tenotomy, the end nearer the muscle fibres is drawn away from the other, leaving a gap which is speedily filled by blood-clot. In the course of a few days this clot becomes permeated by granulation tissue, the fibroblasts of which are derived from the sheath of the tendon, the surrounding connective tissue, and probably also from the divided ends of the tendon itself. These fibroblasts ultimately develop into typical tendon cells, and the fibres which they form constitute the new tendon fibres. Under aseptic conditions repair is complete in from two to three weeks. In the course of the reparative process the tendon and its sheath may become adherent, which leads to impaired movement and stiffness. If the ends of an accidentally divided tendon are at once brought into accurate apposition and secured by sutures, they unite directly with a minimum amount of scar tissue, and function is perfectly restored.  Muscle.  Unstriped muscle does not seem to be capable of being regenerated to any but a moderate degree. If the ends of a divided striped muscle are at once brought into apposition by stitches, primary union takes place with a minimum of intervening fibrous tissue. The nuclei of the muscle fibres in close proximity to this young cicatricial tissue proliferate, and a few new muscle fibres may be developed, but any gross loss of muscular tissue is replaced by a fibrous cicatrix. It would appear that portions of muscle transplanted from animals to fill up gaps in human muscle are similarly replaced by fibrous tissue. When a muscle is paralysed from loss of its nerve supply and undergoes complete degeneration, it is not capable of being regenerated, even should the integrity of the nerve be restored, and so its function is permanently lost.  Secretory Glands.  The regeneration of secretory glands is usually incomplete, cicatricial tissue taking the place of the glandular substance which has been destroyed. In wounds of the liver, for example, the gap is filled by fibrous tissue, but towards the periphery of the wound the liver cells proliferate and a certain amount of regeneration takes place. In the kidney also, repair mainly takes place by cicatricial tissue, and although a few collecting tubules may be reformed, no regeneration of secreting tissue takes place. After the operation of decapsulation of the kidney a new capsule is formed, and during the process young blood vessels permeate the superficial parts of the kidney and temporarily increase its blood supply, but in the consolidation of the new fibrous tissue these vessels are ultimately obliterated. This does not prove that the operation is useless, as the temporary improvement of the circulation in the kidney may serve to tide the patient over a critical period of renal insufficiency.  Stomach and Intestine.  Provided the peritoneal surfaces are accurately apposed, wounds of the stomach and intestine heal with great rapidity. Within a few hours the peritoneal surfaces are glued together by a thin layer of fibrin and leucocytes, which is speedily organised and replaced by fibrous tissue. Fibrous tissue takes the place of the muscular elements, which are not regenerated. The mucous lining is restored by ingrowth from the margins, and there is evidence that some of the secreting glands may be reproduced. Hollow viscera, like the œsophagus and urinary bladder, in so far as they are not covered by peritoneum, heal less rapidly.  Nerve Tissues.  There is no trustworthy evidence that regeneration of the tissues of the brain or spinal cord in man ever takes place. Any loss of substance is replaced by cicatricial tissue. The repair of  Bone ,  Blood Vessels , and  Peripheral Nerves  is more conveniently considered in the chapters dealing with these structures.  Rate of Healing.  While the rate at which wounds heal is remarkably constant there are certain factors that influence it in one direction or the other. Healing is more rapid when the edges are in contact, when there is a minimum amount of blood-clot between them, when the patient is in normal health and the vitality of the tissues has not been impaired. Wounds heal slightly more quickly in the young than in the old, although the difference is so small that it can only be demonstrated by the most careful observations. Certain tissues take longer to heal than others: for example, a fracture of one of the larger long bones takes about six weeks to unite, and divided nerve trunks take much longer about a year. Wounds of certain parts of the body heal more quickly than others: those of the scalp, face, and neck, for example, heal more quickly than those over the buttock or sacrum, probably because of their greater vascularity. The extent of the wound influences the rate of healing; it is only natural that a long and deep wound should take longer to heal than a short and superficial one, because there is so much more work to be done in the conversion of blood-clot into granulation tissue, and this again into scar tissue that will be strong enough to stand the strain on the edges of the wound.
THE TRANSPLANTATION OR GRAFTING OF TISSUES
 Conditions are not infrequently met with in which healing is promoted and restoration of function made possible by the transference of a portion of tissue from one part of the body to another; the tissue transferred is known as the  graft  or the  transplant . The simplest example of grafting is the transplantation of skin. In order that the graft may survive and have a favourable chance of "taking," as it is called, the transplanted tissue must retain its vitality until it has formed an organic connection with the tissue in which it is placed, so that it may derive the necessary nourishment from its new bed. When these conditions are fulfilled the tissues of the graft continue to proliferate, producing new tissue elements to replace those that are lost and making it possible for the graft to become incorporated with the tissue with which it is in contact. Dead tissue, on the other hand, can do neither of these things; it is only capable of acting as a model, or, at the most, as a scaffolding for such mobile tissue elements as may be derived from, the parent tissue with which the graft is in contact: a portion of sterilised marine sponge, for example, may be observed to become permeated with granulation tissue when it is embedded in the tissues. A successful graft of living tissue is not only capable of regeneration, but it acquires a system of lymph and blood vessels, so that in time it bleeds when cut into, and is permeated by new nerve fibres spreading in from the periphery towards the centre. It is instructive to associate the period of survival of the different tissues of the body after death, with their capacity of being used for grafting purposes; the higher tissues such as those of the central nervous system and highly specialised glandular tissues like those of the kidney lose their vitality quickly after death and are therefore useless for grafting; connective tissues, on the other hand, such as fat, cartilage, and bone retain their vitality for several hours after death, so that when they are transplanted, they readily "take" and do all that is required of them: the same is true of the skin and its appendages.  Sources of Grafts.  It is convenient to differentiate between  autoplastic  grafts, that is those derived from the same individual;  homoplastic  grafts, derived from another animal of the same species; and  heteroplastic  grafts, derived from an animal of another species. Other conditions being equal, the prospects of success are greatest with autoplastic grafts, and these are therefore preferred whenever possible. There are certain details making for success that merit attention: the graft must not be roughly handled or allowed to dry, or be subjected to chemical irritation; it must be brought into accurate contact with the new soil, no blood-clot intervening between the two, no movement of the one upon the other should be possible and all infection must be excluded; it will be observed that these are exactly the same conditions that permit of the primary healing of wounds, with which of course the healing of grafts is exactly comparable.  Preservation of Tissues for Grafting.  It was at one time believed that tissues might be taken from the operating theatre and kept in cold storage until they were required. It is now agreed that tissues which have been separated from the body for some time inevitably lose their vitality, become incapable of regeneration, and are therefore unsuited for grafting purposes. If it is intended to preserve a portion of tissue for future grafting, it should be embedded in the subcutaneous tissue of the abdominal wall until it is wanted; this has been carried out with portions of costal cartilage and of bone.
INDIVIDUAL TISSUES AS GRAFTS
  The Blood  lends itself in an ideal manner to transplantation, or, as it has long been called,  transfusion . Being always a homoplastic transfer, the new blood is not always tolerated by the old, in which case biochemical changes occur, resulting in hamolysis, which corresponds to the disintegration of other unsuccessful homoplastic grafts. (See article on Transfusion,  Op. Surg. , p. 37.)  The Skin.  The skin was the first tissue to be used for grafting purposes, and it is still employed with greater frequency than any other, as lesions causing defects of skin are extremely common and without the aid of grafts are tedious in healing. Skin grafts may be applied to a raw surface or to one that is covered with granulations.  Skin grafting of raw surfaces  is commonly indicated after operations for malignant disease in which considerable areas of skin must be sacrificed, and after accidents, such as avulsion of the scalp by machinery.  Skin grafting of granulating surfaces  is chiefly employed to promote healing in the large defects of skin caused by severe burns; the grafting is carried out when the surface is covered by a uniform layer of healthy granulations and before the inevitable contraction of scar tissue makes itself manifest. Before applying the grafts it is usual to scrape away the granulations until the young fibrous tissue underneath is exposed, but, if the granulations are healthy and can be rendered aseptic, the grafts may be placed on them directly. If it is decided to scrape away the granulations, the oozing must be arrested by pressure with a pad of gauze, a sheet of dental rubber or green protective is placed next the raw surface to prevent the gauze adhering and starting the bleeding afresh when it is removed.  Methods of Skin-Grafting.  Two methods are employed: one in which the epidermis is mainly or exclusively employed epidermis or epithelial grafting; the other, in which the graft consists of the whole thickness of the true skin cutis-grafting.  Epidermis or Epithelial Grafting.  The method introduced by the late Professor Thiersch of Leipsic is that almost universally practised. It consists in transplanting strips of epidermis shaved from the surface of the skin, the razor passing through the tips of the papilla, which appear as tiny red points yielding a moderate ooze of blood. The strips are obtained from the front and lateral aspects of the thigh or upper arm, the skin in those regions being pliable and comparatively free from hairs. They are cut with a sharp hollow-ground razor or with Thiersch's grafting knife, the blade of which is rinsed in alcohol and kept moistened with warm saline solution. The cutting is made easier if the skin is well stretched and kept flat and perfectly steady, the operator's left hand exerting traction on the skin behind, the hands of the assistant on the skin in front, one above and the other below the seat of operation. To ensure uniform strips being cut, the razor is kept parallel with the surface and used with a short, rapid, sawing movement, so that, with a little practice, grafts six or eight inches long by one or two inches broad can readily be cut. The patient is given a general anasthetic, or regional anasthesia is obtained by injections of a solution of one per cent. novocain into the line of the lateral and middle cutaneous nerves; the disinfection of the skin is carried out on the usual lines, any chemical agent being finally got rid of, however, by means of alcohol followed by saline solution. The strips of epidermis wrinkle up on the knife and are directly transferred to the surface, for which they should be made to form a complete carpet, slightly overlapping the edges of the area and of one another; some blunt instrument is used to straighten out the strips, which are then subjected to firm pressure with a pad of gauze to express blood and air-bells and to ensure accurate contact, for this must be as close as that between a postage stamp and the paper to which it is affixed. As a dressing for the grafted area and of that also from which the grafts have been taken, gauze soaked in  liquid paraffin  the patent variety known as  ambrine  is excellent appears to be the best; the gauze should be moistened every other day or so with fresh paraffin, so that, at the end of a week, when the grafts should have united, the gauze can be removed without risk of detaching them.  Dental wax  is another useful type of dressing; as is also  picric acid  solution. Over the gauze, there is applied a thick layer of cotton wool, and the whole dressing is kept in place by a firmly applied bandage, and in the case of the limbs some form of splint should be added to prevent movement. A dressing may be dispensed with altogether, the grafts being protected by a wire cage such as is used after vaccination, but they tend to dry up and come to resemble a scab. When the grafts have healed, it is well to protect them from injury and to prevent them drying up and cracking by the liberal application of lanoline or vaseline. The new skin is at first insensitive and is fixed to the underlying connective tissue or bone, but in course of time (from six weeks onwards) sensation returns and the formation of elastic tissue beneath renders the skin pliant and movable so that it can be pinched up between the finger and thumb.  Reverdin's  method consists in planting out pieces of skin not bigger than a pin-head over a granulating surface. It is seldom employed.  Grafts of the Cutis Vera.  Grafts consisting of the entire thickness of the true skin were specially advocated by Wolff and are often associated with his name. They should be cut oval or spindle-shaped, to facilitate the approximation of the edges of the resulting wound. The graft should be cut to the exact size of the surface it is to cover; Gillies believes that tension of the graft favours its taking. These grafts may be placed either on a fresh raw surface or on healthy granulations. It is sometimes an advantage to stitch them in position, especially on the face. The dressing and the after-treatment are the same as in epidermis grafting. There is a degree of uncertainty about the graft retaining its vitality long enough to permit of its deriving the necessary nourishment from its new surroundings; in a certain number of cases the flap dies and is thrown off as a slough moist or dry according to the presence or absence of septic infection. The technique for cutis-grafting must be without a flaw, and the asepsis absolute; there must not only be a complete absence of movement, but there must be no traction on the flap that will endanger its blood supply. Owing to the uncertainty in the results of cutis-grafting the  two-stage  or  indirect method  has been introduced, and its almost uniform success has led to its sphere of application being widely extended. The flap is raised as in the direct method but is left attached at one of its margins for a period ranging from 14 to 21 days until its blood supply from its new bed is assured; the detachment is then made complete. The blood supply of the proposed flap may influence its selection and the way in which it is fashioned; for example, a flap cut from the side of the head to fill a defect in the cheek, having in its margin of attachment or pedicle the superficial temporal artery, is more likely to take than a flap cut with its base above. Another modification is to raise the flap but leave it connected at both ends like the piers of a bridge; this method is well suited to defects of skin on the dorsum of the fingers, hand and forearm, the bridge of skin is raised from the abdominal wall and the hand is passed beneath it and securely fixed in position; after an interval of 14 to 21 days, when the flap is assured of its blood supply, the piers of the bridge are divided (Fig. 1). With undermining it is usually easy to bring the edges of the gap in the abdominal wall together, even in children; the skin flap on the dorsum of the hand appears rather thick and prominent almost like the pad of a boxing-glove for some time, but the restoration of function in the capacity to flex the fingers is gratifying in the extreme.  The indirect element of this method of skin-grafting may be carried still further by transferring the flap of skin first to one part of the body and then, after it has taken, transferring it to a third part. Gillies has especially developed this method in the remedying of deformities of the face caused by gunshot wounds and by petrol burns in air-men. A rectangular flap of skin is marked out in the neck and chest, the lateral margins of the flap are raised sufficiently to enable them to be brought together so as to form a tube of skin: after the circulation has been restored, the lower end of the tube is detached and is brought up to the lip or cheek, or eyelid, where it is wanted; when this end has derived its new blood supply, the other end is detached from the neck and brought up to where it is wanted. In this way, skin from the chest may be brought up to form a new forehead and eyelids. Grafts of  mucous membrane  are used to cover defects in the lip, cheek, and conjunctiva. The technique is similar to that employed in skin-grafting; the sources of mucous membrane are limited and the element of septic infection cannot always be excluded.  Fat.  Adipose tissue has a low vitality, but it is easily retained and it readily lends itself to transplantation. Portions of fat are often obtainable at operations from the omentum, for example, otherwise the subcutaneous fat of the buttock is the most accessible; it may be employed to fill up cavities of all kinds in order to obtain more rapid and sounder healing and also to remedy deformity, as in filling up a depression in the cheek or forehead. It is ultimately converted into ordinary connective tissue  pari passu  with the absorption of the fat. The  fascia lata of the thigh  is widely and successfully used as a graft to fill defects in the dura mater, and interposed between the bones of a joint if the articular cartilage has been destroyed to prevent the occurrence of ankylosis. The  peritoneum  of hydrocele and hernial sacs and of the omentum readily lends itself to transplantation.  Cartilage and bone , next to skin, are the tissues most frequently employed for grafting purposes; their sphere of action is so extensive and includes so much of technical detail in their employment, that they will be considered later with the surgery of the bones and joints and with the methods of re-forming the nose.  Tendons and blood vessels  readily lend themselves to transplantation and will also be referred to later.  Muscle and nerve , on the other hand, do not retain their vitality when severed from their surroundings and do not functionate as grafts except for their connective-tissue elements, which it goes without saying are more readily obtainable from other sources. Portions of the  ovary  and of the  thyreoid  have been successfully transplanted into the subcutaneous cellular tissue of the abdominal wall by Tuffier and others. In these new surroundings, the ovary or thyreoid is vascularised and has been shown to functionate, but there is not sufficient regeneration of the essential tissue elements to "carry on"; the secreting tissue is gradually replaced by connective tissue and the special function comes to an end. Even such temporary function may, however, tide a patient over a difficult period.
CHAPTER II
 CONDITIONS WHICH INTERFERE WITH REPAIR
In the management of wounds and other surgical conditions it is necessary to eliminate various extraneous influences which tend to delay or arrest the natural process of repair. Of these, one of the most important is undue movement of the affected part. "The first and great requisite for the restoration of injured parts is  rest ," said John Hunter; and physiological and mechanical rest as the chief of natural therapeutic agents was the theme of John Hilton's classical work  Rest and Pain . In this connection it must be understood that "rest" implies more than the mere state of physical repose: all physiological as well as mechanical function must be prevented as far as is possible. For instance, the constituent bones of a joint affected with tuberculosis must be controlled by splints or other appliances so that no movement can take place between them, and the limb may not be used for any purpose; physiological rest may be secured to an inflamed colon by making an artificial anus in the cacum; the activity of a diseased kidney may be diminished by regulating the quantity and quality of the fluids taken by the patient. Another source of interference with repair in wounds is  irritation , either by mechanical agents such as rough, unsuitable dressings, bandages, or ill-fitting splints; or by chemical agents in the form of strong lotions or other applications. An  unhealthy or devitalised condition of the patient's tissues  also hinders the reparative process. Bruised or lacerated skin heals less kindly than skin cut with a smooth, sharp instrument; and persistent venous congestion of a part, such as occurs, for example, in the leg when the veins are varicose, by preventing the access of healthy blood, tends to delay the healing of open wounds. The existence of grave constitutional disease, such as Bright's disease, diabetes, syphilis, scurvy, or alcoholism, also impedes healing. Infection by disease-producing micro-organisms or  pathogenic bacteria  is, however, the most potent factor in disturbing the natural process of repair in wounds.
SURGICAL BACTERIOLOGY
 The influence of micro-organisms in the causation of disease, and the rôle played by them in interfering with the natural process of repair, are so important that the science of applied bacteriology has now come to dominate every department of surgery, and it is from the standpoint of bacteriology that nearly all surgical questions have to be considered. The term  sepsis  as now used in clinical surgery no longer retains its original meaning as synonymous with "putrefaction," but is employed to denote all conditions in which bacterial infection has taken place, and more particularly those in which pyogenic bacteria are present. In the same way the term  aseptic  conveys the idea of freedom from all forms of bacteria, putrefactive or otherwise; and the term  antiseptic  is used to denote a power of counteracting bacteria and their products.  General Characters of Bacteria.  A  bacterium  consists of a finely granular mass of protoplasm, enclosed in a thin gelatinous envelope. Many forms are motile some in virtue of fine thread-like flagella, and others through contractility of the protoplasm. The great majority multiply by simple fission, each parent cell giving rise to two daughter cells, and this process goes on with extraordinary rapidity. Other varieties, particularly bacilli, are propagated by the formation of  spores . A spore is a minute mass of protoplasm surrounded by a dense, tough membrane, developed in the interior of the parent cell. Spores are remarkable for their tenacity of life, and for the resistance they offer to the action of heat and chemical germicides. Bacteria are most conveniently classified according to their shape. Thus we recognise (1) those that are globular  cocci ; (2) those that resemble a rod  bacilli ; (3) the spiral or wavy forms  spirilla .  Cocci  or  micrococci  are minute round bodies, averaging about 1 µ in diameter. The great majority are non-motile. They multiply by fission; and when they divide in such a way that the resulting cells remain in pairs, are called  diplococci , of which the bacteria of gonorrhœa and pneumonia are examples (Fig. 5). When they divide irregularly, and form grape-like bunches, they are known as  staphylococci , and to this variety the commonest pyogenic or pus-forming organisms belong (Fig. 2). When division takes place only in one axis, so that long chains are formed, the term  streptococcus  is applied (Fig. 3). Streptococci are met with in erysipelas and various other inflammatory and suppurative processes of a spreading character.  Bacilli  are rod-shaped bacteria, usually at least twice as long as they are broad (Fig. 4). Some multiply by fission, others by sporulation. Some forms are motile, others are non-motile. Tuberculosis, tetanus, anthrax, and many other surgical diseases are due to different forms of bacilli.  Spirilla  are long, slender, thread-like cells, more or less spiral or wavy. Some move by a screw-like contraction of the protoplasm, some by flagella. The spirochate associated with syphilis (Fig. 36) is the most important member of this group.  Conditions of Bacterial Life.  Bacteria require for their growth and development a suitable food-supply in the form of proteins, carbohydrates, and salts of calcium and potassium which they break up into simpler elements. An alkaline medium favours bacterial growth; and moisture is a necessary condition; spores, however, can survive the want of water for much longer periods than fully developed bacteria. The necessity for oxygen varies in different species. Those that require oxygen are known as  aërobic bacilli  or  aërobes ; those that cannot live in the presence of oxygen are spoken of as  anaërobes . The great majority of bacteria, however, while they prefer to have oxygen, are able to live without it, and are called  facultative anaërobes . The most suitable temperature for bacterial life is from 95° to 102° F., roughly that of the human body. Extreme or prolonged cold paralyses but does not kill micro-organisms. Few, however, survive being raised to a temperature of 134½° F. Boiling for ten to twenty minutes will kill all bacteria, and the great majority of spores. Steam applied in an autoclave under a pressure of two atmospheres destroys even the most resistant spores in a few minutes. Direct sunlight, electric light, or even diffuse daylight, is inimical to the growth of bacteria, as are also Röntgen rays and radium emanations.  Pathogenic Properties of Bacteria.  We are now only concerned with pathogenic bacteria that is, bacteria capable of producing disease in the human subject. This capacity depends upon two sets of factors (1) certain features peculiar to the invading bacteria, and (2) others peculiar to the host. Many bacteria have only the power of living upon dead matter, and are known as  saphrophytes . Such as do nourish in living tissue are, by distinction, known as  parasites . The power a given parasitic micro-organism has of multiplying in the body and giving rise to disease is spoken of as its  virulence , and this varies not only with different species, but in the same species at different times and under varying circumstances. The actual number of organisms introduced is also an important factor in determining their pathogenic power. Healthy tissues can resist the invasion of a certain number of bacteria of a given species, but when that number is exceeded, the organisms get the upper hand and disease results. When the organisms gain access directly to the blood-stream, as a rule they produce their effects more certainly and with greater intensity than when they are introduced into the tissues. Further, the virulence of an organism is modified by the condition of the patient into whose tissues it is introduced. So long as a person is in good health, the tissues are able to resist the attacks of moderate numbers of most bacteria. Any lowering of the vitality of the individual, however, either locally or generally, at once renders him more susceptible to infection. Thus bruised or torn tissue is much more liable to infection with pus-producing organisms than tissues clean-cut with a knife; also, after certain diseases, the liability to infection by the organisms of diphtheria, pneumonia, or erysipelas is much increased. Even such slight depression of vitality as results from bodily fatigue, or exposure to cold and damp, may be sufficient to turn the scale in the battle between the tissues and the bacteria. Age is an important factor in regard to the action of certain bacteria. Young subjects are attacked by diphtheria, tuberculosis, acute osteomyelitis, and some other diseases with greater frequency and severity than those of more advanced years. In different races, localities, environment, and seasons, the pathogenic powers of certain organisms, such as those of erysipelas, diphtheria, and acute osteomyelitis, vary considerably. There is evidence that a  mixed infection  that is, the introduction of more than one species of organism, for example, the tubercle bacillus and a pyogenic staphylococcus increases the severity of the resulting disease. If one of the varieties gain the ascendancy, the poisons produced by the others so devitalise the tissue cells, and diminish their power of resistance, that the virulence of the most active organisms is increased. On the other hand, there is reason to believe that the products of certain organisms antagonise one another for example, an attack of erysipelas may effect the cure of a patch of tuberculous lupus. Lastly, in patients suffering from chronic wasting diseases, bacteria may invade the internal organs by the blood-stream in enormous numbers and with great rapidity, during the period of extreme debility which shortly precedes death. The discovery of such collections of organisms on post-mortem examination may lead to erroneous conclusions being drawn as to the cause of death.  Results of Bacterial Growth.  Some organisms, such as those of tetanus and erysipelas, and certain of the pyogenic bacteria, show little tendency to pass far beyond the point at which they gain an entrance to the body. Others, on the contrary for example, the tubercle bacillus and the organism of acute osteomyelitis although frequently remaining localised at the seat of inoculation, tend to pass to distant parts, lodging in the capillaries of joints, bones, kidney, or lungs, and there producing their deleterious effects. In the human subject, multiplication in the blood-stream does not occur to any great extent. In some general acute pyogenic infections, such as osteomyelitis, cellulitis, etc., pure cultures of staphylococci or of streptococci may be obtained from the blood. In pneumococcal and typhoid infections, also, the organisms may be found in the blood. It is by the vital changes they bring about in the parts where they settle that micro-organisms disturb the health of the patient. In deriving nourishment from the complex organic compounds in which they nourish, the organisms evolve, probably by means of a ferment, certain chemical products of unknown composition, but probably colloidal in nature, and known as  toxins . When these poisons are absorbed into the general circulation they give rise to certain groups of symptoms such as rise of temperature, associated circulatory and respiratory derangements, interference with the gastro-intestinal functions and also with those of the nervous system which go to make up the condition known as blood-poisoning, toxamia, or  bacterial intoxication . In addition to this, certain bacteria produce toxins that give rise to definite and distinct groups of symptoms such as the convulsions of tetanus, or the paralyses that follow diphtheria.  Death of Bacteria.  Under certain circumstances, it would appear that the accumulation of the toxic products of bacterial action tends to interfere with the continued life and growth of the organisms themselves, and in this way the natural cure of certain diseases is brought about. Outside the body, bacteria may be killed by starvation, by want of moisture, by being subjected to high temperature, or by the action of certain chemical agents of which carbolic acid, the perchloride and biniodide of mercury, and various chlorine preparations are the most powerful.  Immunity.  Some persons are insusceptible to infection by certain diseases, from which they are said to enjoy a  natural immunity . In many acute diseases one attack protects the patient, for a time at least, from a second attack  acquired immunity .  Phagocytosis.  In the production of immunity the leucocytes and certain other cells play an important part in virtue of the power they possess of ingesting bacteria and of destroying them by a process of intra-cellular digestion. To this process Metchnikoff gave the name of  phagocytosis , and he recognised two forms of  phagocytes : (1) the  microphages , which are the polymorpho-nuclear leucocytes of the blood; and (2) the  macrophages , which include the larger hyaline leucocytes, endothelial cells, and connective-tissue corpuscles. During the process of phagocytosis, the polymorpho-nuclear leucocytes in the circulating blood increase greatly in numbers ( leucocytosis ), as well as in their phagocytic action, and in the course of destroying the bacteria they produce certain ferments which enter the blood serum. These are known as  opsonins  or  alexins , and they act on the bacteria by a process comparable to narcotisation, and render them an easy prey for the phagocytes.  Artificial or Passive Immunity.  A form of immunity can be induced by the introduction of protective substances obtained from an animal which has been actively immunised. The process by which passive immunity is acquired depends upon the fact that as a result of the reaction between the specific virus of a particular disease (the  antigen ) and the tissues of the animal attacked, certain substances  antibodies  are produced, which when transferred to the body of a susceptible animal protect it against that disease. The most important of these antibodies are the  antitoxins . From the study of the processes by which immunity is secured against the effects of bacterial action the serum and vaccine methods of treating certain infective diseases have been evolved. The  serum treatment  is designed to furnish the patient with a sufficiency of antibodies to neutralise the infection. The anti-diphtheritic and the anti-tetanic act by neutralising the specific toxins of the disease  antitoxic serums ; the anti-streptcoccic and the serum for anthrax act upon the bacteria  anti-bacterial serums . A  polyvalent  serum, that is, one derived from an animal which has been immunised by numerous strains of the organism derived from various sources, is much more efficacious than when a single strain has been used.  Clinical Use of Serums.  Every precaution must be taken to prevent organismal contamination of the serum or of the apparatus by means of which it is injected. Syringes are so made that they can be sterilised by boiling. The best situations for injection are under the skin of the abdomen, the thorax, or the buttock, and the skin should be purified at the seat of puncture. If the bulk of the full dose is large, it should be divided and injected into different parts of the body, not more than 20 c.c. being injected at one place. The serum may be introduced directly into a vein, or into the spinal canal,  e.g.  anti-tetanic serum. The immunity produced by injections of antitoxic sera lasts only for a comparatively short time, seldom longer than a few weeks.  "Serum Disease" and Anaphylaxis.  It is to be borne in mind that some patients exhibit a supersensitiveness with regard to protective sera, an injection being followed in a few days by the appearance of an urticarial or erythematous rash, pain and swelling of the joints, and a variable degree of fever. These symptoms, to which the name  serum disease  is applied, usually disappear in the course of a few days. The term  anaphylaxis  is applied to an allied condition of supersensitiveness which appears to be induced by the injection of certain substances, including toxins and sera, that are capable of acting as antigens. When a second injection is given after an interval of some days, if anaphylaxis has been established by the first dose, the patient suddenly manifests toxic symptoms of the nature of profound shock which may even prove fatal. The conditions which render a person liable to develop anaphylaxis and the mechanism by which it is established are as yet imperfectly understood.  Vaccine Treatment.  The vaccine treatment elaborated by A. E. Wright consists in injecting, while the disease is still active, specially prepared dead cultures of the causative organisms, and is based on the fact that these "vaccines" render the bacteria in the tissues less able to resist the attacks of the phagocytes. The method is most successful when the vaccine is prepared from organisms isolated from the patient himself,  autogenous vaccine , but when this is impracticable, or takes a considerable time, laboratory-prepared polyvalent  stock vaccines  may be used.  Clinical Use of Vaccines.  Vaccines should not be given while a patient is in a negative phase, as a certain amount of the opsonin in the blood is used up in neutralising the substances injected, and this may reduce the opsonic index to such an extent that the vaccines themselves become dangerous. As a rule, the propriety of using a vaccine can be determined from the general condition of the patient. The initial dose should always be a small one, particularly if the disease is acute, and the subsequent dosage will be regulated by the effect produced. If marked constitutional disturbance with rise of temperature follows the use of a vaccine, it indicates a negative phase, and calls for a diminution in the next dose. If, on the other hand, the local as well as the general condition of the patient improves after the injection, it indicates a positive phase, and the original dose may be repeated or even increased. Vaccines are best introduced subcutaneously, a part being selected which is not liable to pressure, as there is sometimes considerable local reaction. Repeated doses may be necessary at intervals of a few days. The vaccine treatment has been successfully employed in various tuberculous lesions, in pyogenic infections such as acne, boils, sycosis, streptococcal, pneumococcal, and gonococcal conditions, in infections of the accessory air sinuses, and in other diseases caused by bacteria.
What are the ultimate objects of scientific medicine?
To prolong human life and to alleviate suffering are the ultimate objects of scientific medicine.
What is the art of treating lesions and malformations of the human body by manual operations, mediate and immediate?
The two great branches of the healing art Medicine and Surgery are so intimately related that it is impossible to draw a hard-and-fast line between them, but for convenience Surgery may be defined as "the art of treating lesions and malformations of the human body by manual operations, mediate and immediate."
What is the first step in a surgeon's career?
To apply his art intelligently and successfully, it is essential that the surgeon should be conversant not only with the normal anatomy and physiology of the body and with the various pathological conditions to which it is liable, but also with the nature of the process by which repair of injured or diseased tissues is effected.
What is the reason a person is unable to recognize deviations from the normal?
Without this knowledge he is unable to recognise such deviations from the normal as result from mal-development, injury, or disease, or rationally to direct his efforts towards the correction or removal of these.
What is the power of vital cells of reacting to the irritation caused by injury or disease?
PROCESS OF REPAIR The process of repair in living tissue depends upon an inherent power possessed by vital cells of reacting to the irritation caused by injury or disease.
What is the process of repair in living tissue dependent on?
PROCESS OF REPAIR The process of repair in living tissue depends upon an inherent power possessed by vital cells of reacting to the irritation caused by injury or disease.
What are the cells of damaged tissues designed to do?
The cells of the damaged tissues, under the influence of this irritation, undergo certain proliferative changes, which are designed to restore the normal structure and configuration of the part.
What is the extent to which different tissues can carry the recuperative process?
The process by which this restoration is effected is essentially the same in all tissues, but the extent to which different tissues can carry the recuperative process varies.
What is the process of restoration essentially the same in all tissues?
The process by which this restoration is effected is essentially the same in all tissues, but the extent to which different tissues can carry the recuperative process varies.
What can happen to the structures that have a high power of regeneration?
Simple structures, such as skin, cartilage, bone, periosteum, and tendon, for example, have a high power of regeneration, and in them the reparative process may result in almost perfect restitution to the normal.
What are some structures that have a high power of regeneration?
Simple structures, such as skin, cartilage, bone, periosteum, and tendon, for example, have a high power of regeneration, and in them the reparative process may result in almost perfect restitution to the normal.
What is the name of the tissue that takes the place of what has been lost or destroyed?
More complex structures, on the other hand, such as secreting glands, muscle, and the tissues of the central nervous system, are but imperfectly restored, simple cicatricial connective tissue taking the place of what has been lost or destroyed.
What does each element produce in a damaged part?
Any given tissue can be replaced only by tissue of a similar kind, and in a damaged part each element takes its share in the reparative process by producing new material which approximates more or less closely to the normal according to the recuperative capacity of the particular tissue.
What does each element do in a damaged part?
Any given tissue can be replaced only by tissue of a similar kind, and in a damaged part each element takes its share in the reparative process by producing new material which approximates more or less closely to the normal according to the recuperative capacity of the particular tissue.
What can be replaced by tissue of a similar kind?
Any given tissue can be replaced only by tissue of a similar kind, and in a damaged part each element takes its share in the reparative process by producing new material which approximates more or less closely to the normal according to the recuperative capacity of the particular tissue.
What can cause infection by disease-producing micro-organisms?
The normal process of repair may be interfered with by various extraneous agencies, the most important of which are infection by disease-producing micro-organisms, the presence of foreign substances, undue movement of the affected part, and improper applications and dressings.
What can interfere with the normal repair process?
The normal process of repair may be interfered with by various extraneous agencies, the most important of which are infection by disease-producing micro-organisms, the presence of foreign substances, undue movement of the affected part, and improper applications and dressings.
What can cause undue movement of the affected part?
The normal process of repair may be interfered with by various extraneous agencies, the most important of which are infection by disease-producing micro-organisms, the presence of foreign substances, undue movement of the affected part, and improper applications and dressings.
What are the most important factors that can interfere with repair?
The normal process of repair may be interfered with by various extraneous agencies, the most important of which are infection by disease-producing micro-organisms, the presence of foreign substances, undue movement of the affected part, and improper applications and dressings.
What is the effect of the agencies?
The effect of these agencies is to delay repair or to prevent the individual tissues carrying the process to the furthest degree of which they are capable.
What is the main object of a surgeon in the management of wounds and other diseased conditions?
In the management of wounds and other diseased conditions the main object of the surgeon is to promote the natural reparative process by preventing or eliminating any factor by which it may be disturbed.
What is the name of the healing method used by Primary Union?
Healing by Primary Union.
What is uncomplicated by loss of tissue, by the presence of foreign substances, or by infection with disease-producing micro-organisms?
The most favourable conditions for the progress of the reparative process are to be found in a clean-cut wound of the integument, which is uncomplicated by loss of tissue, by the presence of foreign substances, or by infection with disease-producing micro-organisms, and its edges are in contact.
What is the most favourable condition for the progress of the reparative process?
The most favourable conditions for the progress of the reparative process are to be found in a clean-cut wound of the integument, which is uncomplicated by loss of tissue, by the presence of foreign substances, or by infection with disease-producing micro-organisms, and its edges are in contact.
What is the term for a wound that is aseptic?
Such a wound in virtue of the absence of infection is said to be  aseptic , and under these conditions healing takes place by what is called "primary union" the "healing by first intention" of the older writers.
What is the term for the process of healing under aseptic conditions?
Such a wound in virtue of the absence of infection is said to be  aseptic , and under these conditions healing takes place by what is called "primary union" the "healing by first intention" of the older writers.
What is the name of the tissue that is used to make Granulation Tissue?
Granulation Tissue.
What is produced in the damaged area in response to the irritation caused by injury or disease?
The essential and invariable medium of repair in all structures is an elementary form of new tissue known as  granulation tissue , which is produced in the damaged area in response to the irritation caused by injury or disease.
What is the elementary form of new tissue known as?
The essential and invariable medium of repair in all structures is an elementary form of new tissue known as  granulation tissue , which is produced in the damaged area in response to the irritation caused by injury or disease.
What is the essential and invariable medium of repair in all structures?
The essential and invariable medium of repair in all structures is an elementary form of new tissue known as  granulation tissue , which is produced in the damaged area in response to the irritation caused by injury or disease.
What happens to leucocytes?
The vital reaction induced by such irritation results in dilatation of the vessels of the part, emigration of leucocytes, transudation of lymph, and certain proliferative changes in the fixed tissue cells.
What happens to fixed tissue cells?
The vital reaction induced by such irritation results in dilatation of the vessels of the part, emigration of leucocytes, transudation of lymph, and certain proliferative changes in the fixed tissue cells.
What happens to the vessels of the part?
The vital reaction induced by such irritation results in dilatation of the vessels of the part, emigration of leucocytes, transudation of lymph, and certain proliferative changes in the fixed tissue cells.
What happens to lymph?
The vital reaction induced by such irritation results in dilatation of the vessels of the part, emigration of leucocytes, transudation of lymph, and certain proliferative changes in the fixed tissue cells.
What are two processes that are common to inflammation and repair?
These changes are common to the processes of inflammation and repair; no hard-and-fast line can be drawn between these processes, and the two may go on together.
What can no hard and fast line be drawn between?
These changes are common to the processes of inflammation and repair; no hard-and-fast line can be drawn between these processes, and the two may go on together.
What is the only way to establish the reparative process?
It is, however, only when the proliferative changes have come to predominate that the reparative process is effectively established by the production of healthy granulation tissue.
What is produced when the proliferative changes have come to predominate?
It is, however, only when the proliferative changes have come to predominate that the reparative process is effectively established by the production of healthy granulation tissue.
What is the name of the tissue formed by Granulation Tissue?
Formation of Granulation Tissue.
What happens when a wound is made in the integument under aseptic conditions?
When a wound is made in the integument under aseptic conditions, the passage of the knife through the tissues is immediately followed by an oozing of blood, which soon coagulates on the cut surfaces.
What happens when a knife passes through the tissues?
When a wound is made in the integument under aseptic conditions, the passage of the knife through the tissues is immediately followed by an oozing of blood, which soon coagulates on the cut surfaces.
What forms in each of the divided vessels?
In each of the divided vessels a clot forms, and extends as far as the nearest collateral branch; and on the surface of the wound there is a microscopic layer of bruised and devitalised tissue.
What extends as far as the nearest collateral branch?
In each of the divided vessels a clot forms, and extends as far as the nearest collateral branch; and on the surface of the wound there is a microscopic layer of bruised and devitalised tissue.
What is on the surface of the wound?
In each of the divided vessels a clot forms, and extends as far as the nearest collateral branch; and on the surface of the wound there is a microscopic layer of bruised and devitalised tissue.
What is the blood-clot?
If the wound is closed, the narrow space between its edges is occupied by blood-clot, which consists of red and white corpuscles mixed with a quantity of fibrin, and this forms a temporary uniting medium between the divided surfaces.
What happens from the minute vessels in the vicinity of the wound?
During the first twelve hours, the minute vessels in the vicinity of the wound dilate, and from them lymph exudes and leucocytes migrate into the tissues.
What happens during the first twelve hours?
During the first twelve hours, the minute vessels in the vicinity of the wound dilate, and from them lymph exudes and leucocytes migrate into the tissues.
What do the capillaries of the part adjacent to the wound throw out in 24 to 36 hours?
In from twenty-four to thirty-six hours, the capillaries of the part adjacent to the wound begin to throw out minute buds and fine processes, which bridge the gap and form a firmer, but still temporary, connection between the two sides.
What do the capillaries of the part adjacent to the wound begin to throw out in 24 to 36 hours?
In from twenty-four to thirty-six hours, the capillaries of the part adjacent to the wound begin to throw out minute buds and fine processes, which bridge the gap and form a firmer, but still temporary, connection between the two sides.
Where does each bud begin?
Each bud begins in the wall of the capillary as a small accumulation of granular protoplasm, which gradually elongates into a filament containing a nucleus.
What is the first part of a bud?
Each bud begins in the wall of the capillary as a small accumulation of granular protoplasm, which gradually elongates into a filament containing a nucleus.
What happens to the filaments that join with a capillary?
This filament either joins with a neighbouring capillary or with a similar filament, and in time these become hollow and are filled with blood from the vessels that gave them origin.
What is formed in this way?
In this way a series of young  capillary loops  is formed.
What fills the spaces between the loops?
The spaces between these loops are filled by cells of various kinds, the most important being the  fibroblasts , which are destined to form cicatricial fibrous tissue.
What are the most important cells?
The spaces between these loops are filled by cells of various kinds, the most important being the  fibroblasts , which are destined to form cicatricial fibrous tissue.
What do fibroblasts form?
The spaces between these loops are filled by cells of various kinds, the most important being the  fibroblasts , which are destined to form cicatricial fibrous tissue.
What are fibroblasts derived from?
These fibroblasts are large irregular nucleated cells derived mainly from the proliferation of the fixed connective-tissue cells of the part, and to a less extent from the lymphocytes and other mononuclear cells which have migrated from the vessels.
What are fibroblasts?
These fibroblasts are large irregular nucleated cells derived mainly from the proliferation of the fixed connective-tissue cells of the part, and to a less extent from the lymphocytes and other mononuclear cells which have migrated from the vessels.
What does giant cells do?
Among the fibroblasts, larger multi-nucleated cells  giant cells  are sometimes found, particularly when resistant substances, such as silk ligatures or fragments of bone, are embedded in the tissues, and their function seems to be to soften such substances preliminary to their being removed by the phagocytes.
What are giant cells found in fibroblasts?
Among the fibroblasts, larger multi-nucleated cells  giant cells  are sometimes found, particularly when resistant substances, such as silk ligatures or fragments of bone, are embedded in the tissues, and their function seems to be to soften such substances preliminary to their being removed by the phagocytes.
What do giant cells do when resistant substances are embedded in tissues?
Among the fibroblasts, larger multi-nucleated cells  giant cells  are sometimes found, particularly when resistant substances, such as silk ligatures or fragments of bone, are embedded in the tissues, and their function seems to be to soften such substances preliminary to their being removed by the phagocytes.
What are numerous polymorpho-nuclear leucocytes?
Numerous  polymorpho-nuclear leucocytes , which have wandered from the vessels, are also present in the spaces.
What do phagocytes remove from the original clot?
These act as phagocytes, their function being to remove the red corpuscles and fibrin of the original clot, and this performed, they either pass back into the circulation in virtue of their amœboid movement, or are themselves eaten up by the growing fibroblasts.
What do phagocytes do?
These act as phagocytes, their function being to remove the red corpuscles and fibrin of the original clot, and this performed, they either pass back into the circulation in virtue of their amœboid movement, or are themselves eaten up by the growing fibroblasts.
What does the phagocytic action not play a direct part in?
Beyond this phagocytic action, they do not appear to play any direct part in the reparative process.
What is the typical time that granulation tissue is formed?
These young capillary loops, with their supporting cells and fluids, constitute granulation tissue, which is usually fully formed in from three to five days, after which it begins to be replaced by cicatricial or scar tissue.
What do the capillary loops contain?
These young capillary loops, with their supporting cells and fluids, constitute granulation tissue, which is usually fully formed in from three to five days, after which it begins to be replaced by cicatricial or scar tissue.
What is the term for cicatricial tissue?
These young capillary loops, with their supporting cells and fluids, constitute granulation tissue, which is usually fully formed in from three to five days, after which it begins to be replaced by cicatricial or scar tissue.
What is the formation of Cicatricial Tissue?
Formation of Cicatricial Tissue.
What does fibroblasts replace?
The transformation of this temporary granulation tissue into scar tissue is effected by the fibroblasts, which become elongated and spindle-shaped, and produce in and around them a fine fibrillated material which gradually increases in quantity till it replaces the cell protoplasm.
What shape do fibroblasts become?
The transformation of this temporary granulation tissue into scar tissue is effected by the fibroblasts, which become elongated and spindle-shaped, and produce in and around them a fine fibrillated material which gradually increases in quantity till it replaces the cell protoplasm.
What does fibroblasts produce in and around them?
The transformation of this temporary granulation tissue into scar tissue is effected by the fibroblasts, which become elongated and spindle-shaped, and produce in and around them a fine fibrillated material which gradually increases in quantity till it replaces the cell protoplasm.
What is the process of transforming temporary granulation tissue into scar tissue?
The transformation of this temporary granulation tissue into scar tissue is effected by the fibroblasts, which become elongated and spindle-shaped, and produce in and around them a fine fibrillated material which gradually increases in quantity till it replaces the cell protoplasm.
What is formed in this way?
In this way white fibrous tissue is formed, the cells of which are arranged in parallel lines and eventually become grouped in bundles, constituting fully formed white fibrous tissue.
What is the result of the arranged cells?
In this way white fibrous tissue is formed, the cells of which are arranged in parallel lines and eventually become grouped in bundles, constituting fully formed white fibrous tissue.
What do the capillaries of the wound become?
In its growth it gradually obliterates the capillaries, until at the end of two, three, or four weeks both vessels and cells have almost entirely disappeared, and the original wound is occupied by cicatricial tissue.
What is the original wound occupied by?
In its growth it gradually obliterates the capillaries, until at the end of two, three, or four weeks both vessels and cells have almost entirely disappeared, and the original wound is occupied by cicatricial tissue.
What happens to the cicatrix in the course of time?
In course of time this tissue becomes consolidated, and the cicatrix undergoes a certain amount of contraction  cicatricial contraction .
What is the term for the amount of contraction of the cicatrix?
In course of time this tissue becomes consolidated, and the cicatrix undergoes a certain amount of contraction  cicatricial contraction .
What is healing of Epidermis?
Healing of Epidermis.
What is growing in from the margins of the wound?
While these changes are taking place in the deeper parts of the wound, the surface is being covered over by  epidermis  growing in from the margins.
What is covering the surface of the wound?
While these changes are taking place in the deeper parts of the wound, the surface is being covered over by  epidermis  growing in from the margins.
What do the cells of the rete Malpighii cover the granulations with?
Within twelve hours the cells of the rete Malpighii close to the cut edge begin to sprout on to the surface of the wound, and by their proliferation gradually cover the granulations with a thin pink pellicle.
How long do the cells of the rete Malpighii sprout on to the surface of the wound?
Within twelve hours the cells of the rete Malpighii close to the cut edge begin to sprout on to the surface of the wound, and by their proliferation gradually cover the granulations with a thin pink pellicle.
What color does the epithelium become as it enlarges?
As the epithelium increases in thickness it assumes a bluish hue and eventually the cells become cornified and the epithelium assumes a greyish-white colour.
What is the name of the study that is being studied?
Clinical Aspects.
What is the main reason for the absence of infection?
So long as the process of repair is not complicated by infection with micro-organisms, there is no interference with the general health of the patient.
What is the local temperature of the body?
The temperature remains normal; the circulatory, gastro-intestinal, nervous, and other functions are undisturbed; locally, the part is cool, of natural colour and free from pain.
What is the temperature of the body?
The temperature remains normal; the circulatory, gastro-intestinal, nervous, and other functions are undisturbed; locally, the part is cool, of natural colour and free from pain.
What is the part free from?
The temperature remains normal; the circulatory, gastro-intestinal, nervous, and other functions are undisturbed; locally, the part is cool, of natural colour and free from pain.
Modifications of the Process of Repair
Modifications of the Process of Repair.
What is the process of repair by primary union?
The process of repair by primary union, above described, is to be looked upon as the type of all reparative processes, such modifications as are met with depending merely upon incidental differences in the conditions present, such as loss of tissue, infection by micro-organisms, etc.
What are some examples of modifications that are met with depending on incidental differences in the conditions present?
The process of repair by primary union, above described, is to be looked upon as the type of all reparative processes, such modifications as are met with depending merely upon incidental differences in the conditions present, such as loss of tissue, infection by micro-organisms, etc.
What is the name of the repair after loss or destruction of Tissue?
Repair after Loss or Destruction of Tissue.
What is required to fill a gap in a wound?
When the edges of a wound cannot be approximated either because tissue has been lost, for example in excising a tumour or because a drainage tube or gauze packing has been necessary, a greater amount of granulation tissue is required to fill the gap, but the process is essentially the same as in the ideal method of repair.
What is the process similar to in the ideal method of repair?
When the edges of a wound cannot be approximated either because tissue has been lost, for example in excising a tumour or because a drainage tube or gauze packing has been necessary, a greater amount of granulation tissue is required to fill the gap, but the process is essentially the same as in the ideal method of repair.
What is the first layer of the raw surface covered by?
The raw surface is first covered by a layer of coagulated blood and fibrin.
What is the second layer of the raw surface covered by?
The raw surface is first covered by a layer of coagulated blood and fibrin.
What happens to the free surface of the fibroblasts?
An extensive new formation of capillary loops and fibroblasts takes place towards the free surface, and goes on until the gap is filled by a fine velvet-like mass of granulation tissue.
What is the name of the tissue that fills the gap?
An extensive new formation of capillary loops and fibroblasts takes place towards the free surface, and goes on until the gap is filled by a fine velvet-like mass of granulation tissue.
What is replaced by granulation tissue?
This granulation tissue is gradually replaced by young cicatricial tissue, and the surface is covered by the ingrowth of epithelium from the edges.
What is covered by the ingrowth of epithelium from the edges?
This granulation tissue is gradually replaced by young cicatricial tissue, and the surface is covered by the ingrowth of epithelium from the edges.
What is the best place to study the healing process?
This modification of the reparative process can be best studied clinically in a recent wound which has been packed with gauze.
What is the gauze used in?
This modification of the reparative process can be best studied clinically in a recent wound which has been packed with gauze.
What is the wall of the cavity when the plug is introduced?
When the plug is introduced, the walls of the cavity consist of raw tissue with numerous oozing blood vessels.
What is the color of the granulations on the surface of the cavity?
On removing the packing on the fifth or sixth day, the surface is found to be covered with minute, red, papillary granulations, which are beginning to fill up the cavity.
On what day is the cavity found to be covered with papillary granulations?
On removing the packing on the fifth or sixth day, the surface is found to be covered with minute, red, papillary granulations, which are beginning to fill up the cavity.
At the edges of the epithelium is what?
At the edges the epithelium has proliferated and is covering over the newly formed granulation tissue.
What is the name of the discharge that occurs when lymph and leucocytes escape from the exposed surface?
As lymph and leucocytes escape from the exposed surface there is a certain amount of serous or sero-purulent discharge.
What happens to the granulation tissue after a few days?
On examining the wound at intervals of a few days, it is found that the granulation tissue gradually increases in amount till the gap is completely filled up, and that coincidently the epithelium spreads in and covers over its surface.
What spreads in and covers over the wound's surface?
On examining the wound at intervals of a few days, it is found that the granulation tissue gradually increases in amount till the gap is completely filled up, and that coincidently the epithelium spreads in and covers over its surface.
What happens to the epithelium as it thickens?
In course of time the epithelium thickens, and as the granulation tissue is slowly replaced by young cicatricial tissue, which has a peculiar tendency to contract and so to obliterate the blood vessels in it, the scar that is left becomes smooth, pale, and depressed.
What is the result of the cicatricial tissue contracting?
In course of time the epithelium thickens, and as the granulation tissue is slowly replaced by young cicatricial tissue, which has a peculiar tendency to contract and so to obliterate the blood vessels in it, the scar that is left becomes smooth, pale, and depressed.
What is replaced by cicatricial tissue?
In course of time the epithelium thickens, and as the granulation tissue is slowly replaced by young cicatricial tissue, which has a peculiar tendency to contract and so to obliterate the blood vessels in it, the scar that is left becomes smooth, pale, and depressed.
What is the term for the method of healing called?
This method of healing is sometimes spoken of as "healing by granulation" although, as we have seen, it is by granulation that all repair takes place.
What is the method of healing called?
This method of healing is sometimes spoken of as "healing by granulation" although, as we have seen, it is by granulation that all repair takes place.
How many Granulating Surfaces are used for healing?
Healing by Union of two Granulating Surfaces.
What is the process of union in gaping wounds?
In gaping wounds union is sometimes obtained by bringing the two surfaces into apposition after each has become covered with healthy granulations.
What causes capillary loops to adhere?
The exudate on the surfaces causes them to adhere, capillary loops pass from one to the other, and their final fusion takes place by the further development of granulation and cicatricial tissue.
What causes capillary loops to pass from one to the other?
The exudate on the surfaces causes them to adhere, capillary loops pass from one to the other, and their final fusion takes place by the further development of granulation and cicatricial tissue.
What is the name of the group of parts that are completely separated from the body?
Reunion of Parts entirely Separated from the Body.
What happens to small portions of tissue that are accidentally separated from the body?
Small portions of tissue, such as the end of a finger, the tip of the nose or a portion of the external ear, accidentally separated from the body, if accurately replaced and fixed in position, occasionally adhere by primary union.
What can be transplanted in the course of an operation?
In the course of operations also, portions of skin, fascia, or bone, or even a complete joint may be transplanted, and unite by primary union.
What can be unite by primary union?
In the course of operations also, portions of skin, fascia, or bone, or even a complete joint may be transplanted, and unite by primary union.
What is healing under a Scab?
Healing under a Scab.
What can form on a small superficial wound when exposed to the air?
When a small superficial wound is exposed to the air, the blood and serum exuded on its surface may dry and form a hard crust or  scab , which serves to protect the surface from external irritation in the same way as would a dry pad of sterilised gauze.
What does a dry pad of gauze protect from external irritation?
When a small superficial wound is exposed to the air, the blood and serum exuded on its surface may dry and form a hard crust or  scab , which serves to protect the surface from external irritation in the same way as would a dry pad of sterilised gauze.
What can happen to a small superficial wound when exposed to the air?
When a small superficial wound is exposed to the air, the blood and serum exuded on its surface may dry and form a hard crust or  scab , which serves to protect the surface from external irritation in the same way as would a dry pad of sterilised gauze.
What is formed under the scab?
Under this scab the formation of granulation tissue, its transformation into cicatricial tissue, and the growth of epithelium on the surface, go on until in the course of time the crust separates, leaving a scar.
What is transformed into cicatricial tissue?
Under this scab the formation of granulation tissue, its transformation into cicatricial tissue, and the growth of epithelium on the surface, go on until in the course of time the crust separates, leaving a scar.
What is left behind after the crust separates?
Under this scab the formation of granulation tissue, its transformation into cicatricial tissue, and the growth of epithelium on the surface, go on until in the course of time the crust separates, leaving a scar.
What is the name of the drug used for healing?
Healing by Blood-clot.
What is a subcutaneous wound?
In subcutaneous wounds, for example tenotomy, in amputation wounds, and in wounds made in excising tumours or in operating upon bones, the space left between the divided tissues becomes filled with blood-clot, which acts as a temporary scaffolding in which granulation tissue is built up.
What is a temporary scaffolding in which granulation tissue is built up?
In subcutaneous wounds, for example tenotomy, in amputation wounds, and in wounds made in excising tumours or in operating upon bones, the space left between the divided tissues becomes filled with blood-clot, which acts as a temporary scaffolding in which granulation tissue is built up.
What is a wound made in excising tumours or operating upon bones?
In subcutaneous wounds, for example tenotomy, in amputation wounds, and in wounds made in excising tumours or in operating upon bones, the space left between the divided tissues becomes filled with blood-clot, which acts as a temporary scaffolding in which granulation tissue is built up.
What do capillary loops grow into?
Capillary loops grow into the coagulum, and migrated leucocytes from the adjacent blood vessels destroy the red corpuscles, and are in turn disposed of by the developing fibroblasts, which by their growth and proliferation fill up the gap with young connective tissue.
What fills the gap with young connective tissue?
Capillary loops grow into the coagulum, and migrated leucocytes from the adjacent blood vessels destroy the red corpuscles, and are in turn disposed of by the developing fibroblasts, which by their growth and proliferation fill up the gap with young connective tissue.
What destroys the red corpuscles?
Capillary loops grow into the coagulum, and migrated leucocytes from the adjacent blood vessels destroy the red corpuscles, and are in turn disposed of by the developing fibroblasts, which by their growth and proliferation fill up the gap with young connective tissue.
What is the difference between primary union and healing by union?
It will be evident that this process only differs from healing by primary union in the  amount  of blood-clot that is present.
What is the name of the foreign body?
Presence of a Foreign Body.
What is the name of the foreign body that is present in tissues?
When an aseptic foreign body is present in the tissues,  e.g.
What is the healing process of chromicised catgut?
a piece of unabsorbable chromicised catgut, the healing process may be modified.
What is pulled out in pieces after primary union?
After primary union has taken place the scar may broaden, become raised above the surface, and assume a bluish-brown colour; the epidermis gradually thins and gives way, revealing the softened portion of catgut, which can be pulled out in pieces, after which the wound rapidly heals and resumes a normal appearance.
What is the epidermis gradually thinning and giving way to?
After primary union has taken place the scar may broaden, become raised above the surface, and assume a bluish-brown colour; the epidermis gradually thins and gives way, revealing the softened portion of catgut, which can be pulled out in pieces, after which the wound rapidly heals and resumes a normal appearance.
What color does the scar take after primary union?
After primary union has taken place the scar may broaden, become raised above the surface, and assume a bluish-brown colour; the epidermis gradually thins and gives way, revealing the softened portion of catgut, which can be pulled out in pieces, after which the wound rapidly heals and resumes a normal appearance.
What is the name of the two areas of the body that need to be repaired?
REPAIR IN INDIVIDUAL TISSUES  Skin and Connective Tissue.
What is the mode of regeneration of tissues under aseptic conditions described as?
The mode of regeneration of these tissues under aseptic conditions has already been described as the type of ideal repair.
How long does it take for wounds to be firmly united?
In highly vascular parts, such as the face, the reparative process goes on with great rapidity, and even extensive wounds may be firmly united in from three to five days.
Where is the anastomosis less free, the process is more prolonged?
Where the anastomosis is less free the process is more prolonged.
What is the scar left smooth, dry, and hairless?
The more highly organised elements of the skin, such as the hair follicles, the sweat and sebaceous glands, are imperfectly reproduced; hence the scar remains smooth, dry, and hairless.
What are the more highly organized elements of the skin?
The more highly organised elements of the skin, such as the hair follicles, the sweat and sebaceous glands, are imperfectly reproduced; hence the scar remains smooth, dry, and hairless.
What is the name of the tissue that is a part of the body?
Epithelium.
What is the only way that epithelium is reproduced?
Epithelium is only reproduced from pre-existing epithelium, and, as a rule, from one of a similar type, although metaplastic transformation of cells of one kind of epithelium into another kind can take place.
What can happen to cells of one kind of epithelium?
Epithelium is only reproduced from pre-existing epithelium, and, as a rule, from one of a similar type, although metaplastic transformation of cells of one kind of epithelium into another kind can take place.
What may spring up in the centre of the raw area?
Thus a granulating surface may be covered entirely by the ingrowing of the cutaneous epithelium from the margins; or islets, originating in surviving cells of sebaceous glands or sweat glands, or of hair follicles, may spring up in the centre of the raw area.
What may cover a granulating surface entirely?
Thus a granulating surface may be covered entirely by the ingrowing of the cutaneous epithelium from the margins; or islets, originating in surviving cells of sebaceous glands or sweat glands, or of hair follicles, may spring up in the centre of the raw area.
What may cause islets to form?
Such islets may also be due to the accidental transference of loose epithelial cells from the edges.
What may be the cause of islets?
Such islets may also be due to the accidental transference of loose epithelial cells from the edges.
What is a blister capable of starting?
Even the fluid from a blister, in virtue of the isolated cells of the rete Malpighii which it contains, is capable of starting epithelial growth on a granulating surface.
What is the rete Malpighii?
Even the fluid from a blister, in virtue of the isolated cells of the rete Malpighii which it contains, is capable of starting epithelial growth on a granulating surface.
What can be completely regenerated if a sufficient amount of the hair follicles or of the nail matrix has escaped destruction?
Hairs and nails may be completely regenerated if a sufficient amount of the hair follicles or of the nail matrix has escaped destruction.
What is the same as the epithelium on a cutaneous surface?
The epithelium of a mucous membrane is regenerated in the same way as that on a cutaneous surface.
What cells have the power of growing again when placed in favourable circumstances?
Epithelial cells have the power of living for some time after being separated from their normal surroundings, and of growing again when once more placed in favourable circumstances.
What cells have the power of living for some time after being separated from their normal surroundings?
Epithelial cells have the power of living for some time after being separated from their normal surroundings, and of growing again when once more placed in favourable circumstances.
What is the basis of skin grafting?
On this fact the practice of skin grafting is based (p. 11).
What is the name of the material used in the manufacture of the carilage?
Cartilage.
What is the normal cicatricial fibrous tissue derived from?
When an articular cartilage is divided by incision or by being implicated in a fracture involving the articular end of a bone, it is repaired by ordinary cicatricial fibrous tissue derived from the proliferating cells of the perichondrium.
What is used to repair a fracture involving the articular end of a bone?
When an articular cartilage is divided by incision or by being implicated in a fracture involving the articular end of a bone, it is repaired by ordinary cicatricial fibrous tissue derived from the proliferating cells of the perichondrium.
What is the process of repairing cartilage called?
Cartilage being a non-vascular tissue, the reparative process goes on slowly, and it may be many weeks before it is complete.
What is the non-vascular tissue of cartilage?
Cartilage being a non-vascular tissue, the reparative process goes on slowly, and it may be many weeks before it is complete.
What is possible for connective-tissue cells to be transformed into cartilage cells?
It is possible for a metaplastic transformation of connective-tissue cells into cartilage cells to take place, the characteristic hyaline matrix being secreted by the new cells.
What is secreted by the new cells?
It is possible for a metaplastic transformation of connective-tissue cells into cartilage cells to take place, the characteristic hyaline matrix being secreted by the new cells.
What is the term for a stage in the healing of fractures?
This is sometimes observed as an intermediary stage in the healing of fractures, especially in young bones.
What is the new tissue situated to be?
It may also take place in the regeneration of lost portions of cartilage, provided the new tissue is so situated as to constitute part of a joint and to be subjected to pressure by an opposing cartilaginous surface.
What is the new tissue subjected to pressure by?
It may also take place in the regeneration of lost portions of cartilage, provided the new tissue is so situated as to constitute part of a joint and to be subjected to pressure by an opposing cartilaginous surface.
What can happen to lost cartilage?
It may also take place in the regeneration of lost portions of cartilage, provided the new tissue is so situated as to constitute part of a joint and to be subjected to pressure by an opposing cartilaginous surface.
What is the purpose of excision of joints?
This is illustrated by what takes place after excision of joints where it is desired to restore the function of the articulation.
What is formed by the bones' cells?
By carrying out movements between the constituent parts, the fibrous tissue covering the ends of the bones becomes moulded into shape, its cells take on the characters of cartilage cells, and, forming a matrix, so develop a new cartilage.
What is formed by the bones by moving between the parts?
By carrying out movements between the constituent parts, the fibrous tissue covering the ends of the bones becomes moulded into shape, its cells take on the characters of cartilage cells, and, forming a matrix, so develop a new cartilage.
What is the term for deformities that involve displacement of articular surfaces?
Conversely, it is observed that when articular cartilage is no longer subjected to pressure by an opposing cartilage, it tends to be transformed into fibrous tissue, as may be seen in deformities attended with displacement of articular surfaces, such as hallux valgus and club-foot.
What may be replaced by bone after a fracture?
After fractures of costal cartilage or of the cartilages of the larynx the cicatricial tissue may be ultimately replaced by bone.
What is the name of the animal that is a tendon?
Tendons.
What fills the gap left by a blood-clot?
When a tendon is divided, for example by subcutaneous tenotomy, the end nearer the muscle fibres is drawn away from the other, leaving a gap which is speedily filled by blood-clot.
What is done when a tendon is divided?
When a tendon is divided, for example by subcutaneous tenotomy, the end nearer the muscle fibres is drawn away from the other, leaving a gap which is speedily filled by blood-clot.
What is the sheath of the tendon?
In the course of a few days this clot becomes permeated by granulation tissue, the fibroblasts of which are derived from the sheath of the tendon, the surrounding connective tissue, and probably also from the divided ends of the tendon itself.
What is the granulation tissue derived from?
In the course of a few days this clot becomes permeated by granulation tissue, the fibroblasts of which are derived from the sheath of the tendon, the surrounding connective tissue, and probably also from the divided ends of the tendon itself.
What is the surrounding connective tissue derived from?
In the course of a few days this clot becomes permeated by granulation tissue, the fibroblasts of which are derived from the sheath of the tendon, the surrounding connective tissue, and probably also from the divided ends of the tendon itself.
What do fibroblasts eventually develop into?
These fibroblasts ultimately develop into typical tendon cells, and the fibres which they form constitute the new tendon fibres.
What do the fibres that they form constitute?
These fibroblasts ultimately develop into typical tendon cells, and the fibres which they form constitute the new tendon fibres.
In aseptic conditions, how long does it take to complete a repair?
Under aseptic conditions repair is complete in from two to three weeks.
What can happen to the tendon and its sheath during the reparative process?
In the course of the reparative process the tendon and its sheath may become adherent, which leads to impaired movement and stiffness.
What happens when the ends of a tendon are secured by sutures?
If the ends of an accidentally divided tendon are at once brought into accurate apposition and secured by sutures, they unite directly with a minimum amount of scar tissue, and function is perfectly restored.
What type of muscle is not able to be regenerated?
Unstriped muscle does not seem to be capable of being regenerated to any but a moderate degree.
What is the only degree of regenerated muscle?
Unstriped muscle does not seem to be capable of being regenerated to any but a moderate degree.
What happens when the ends of a divided striped muscle are brought into apposition by stitches?
If the ends of a divided striped muscle are at once brought into apposition by stitches, primary union takes place with a minimum of intervening fibrous tissue.
What happens with a minimum of intervening fibrous tissue?
If the ends of a divided striped muscle are at once brought into apposition by stitches, primary union takes place with a minimum of intervening fibrous tissue.
What happens to the nuclei of the muscle fibres in close proximity to the young cicatricial tissue?
The nuclei of the muscle fibres in close proximity to this young cicatricial tissue proliferate, and a few new muscle fibres may be developed, but any gross loss of muscular tissue is replaced by a fibrous cicatrix.
What is replaced by a fibrous cicatrix?
The nuclei of the muscle fibres in close proximity to this young cicatricial tissue proliferate, and a few new muscle fibres may be developed, but any gross loss of muscular tissue is replaced by a fibrous cicatrix.
What is replaced by fibrous tissue?
It would appear that portions of muscle transplanted from animals to fill up gaps in human muscle are similarly replaced by fibrous tissue.
What happens when a muscle is paralysed?
When a muscle is paralysed from loss of its nerve supply and undergoes complete degeneration, it is not capable of being regenerated, even should the integrity of the nerve be restored, and so its function is permanently lost.
What is the name of the secretive land?
Secretory Glands.
What is the most common type of tissue that takes the place of the glandular substance that has been destroyed?
The regeneration of secretory glands is usually incomplete, cicatricial tissue taking the place of the glandular substance which has been destroyed.
Where do liver cells proliferate?
In wounds of the liver, for example, the gap is filled by fibrous tissue, but towards the periphery of the wound the liver cells proliferate and a certain amount of regeneration takes place.
What fills the gap in a liver wound?
In wounds of the liver, for example, the gap is filled by fibrous tissue, but towards the periphery of the wound the liver cells proliferate and a certain amount of regeneration takes place.
What happens to the liver cells near the periphery of the wound?
In wounds of the liver, for example, the gap is filled by fibrous tissue, but towards the periphery of the wound the liver cells proliferate and a certain amount of regeneration takes place.
What tissue is used to repair the kidney?
In the kidney also, repair mainly takes place by cicatricial tissue, and although a few collecting tubules may be reformed, no regeneration of secreting tissue takes place.
What is not used to regenerate the kidney?
In the kidney also, repair mainly takes place by cicatricial tissue, and although a few collecting tubules may be reformed, no regeneration of secreting tissue takes place.
What is used to repair the kidney?
In the kidney also, repair mainly takes place by cicatricial tissue, and although a few collecting tubules may be reformed, no regeneration of secreting tissue takes place.
What is formed after the operation of decapsulation of the kidney?
After the operation of decapsulation of the kidney a new capsule is formed, and during the process young blood vessels permeate the superficial parts of the kidney and temporarily increase its blood supply, but in the consolidation of the new fibrous tissue these vessels are ultimately obliterated.
What is the result of the consolidation of the new fibrous tissue?
After the operation of decapsulation of the kidney a new capsule is formed, and during the process young blood vessels permeate the superficial parts of the kidney and temporarily increase its blood supply, but in the consolidation of the new fibrous tissue these vessels are ultimately obliterated.
What is the purpose of the kidney operation?
This does not prove that the operation is useless, as the temporary improvement of the circulation in the kidney may serve to tide the patient over a critical period of renal insufficiency.
What may be the result of the kidney operation?
This does not prove that the operation is useless, as the temporary improvement of the circulation in the kidney may serve to tide the patient over a critical period of renal insufficiency.
What are the two main parts of the body?
Stomach and Intestine.
What surface of the peritoneal surfaces are properly apposed?
Provided the peritoneal surfaces are accurately apposed, wounds of the stomach and intestine heal with great rapidity.
What kind of wounds of the stomach and intestine heal with great speed?
Provided the peritoneal surfaces are accurately apposed, wounds of the stomach and intestine heal with great rapidity.
What is quickly organised and replaced by fibrous tissue?
Within a few hours the peritoneal surfaces are glued together by a thin layer of fibrin and leucocytes, which is speedily organised and replaced by fibrous tissue.
What is the peritoneal surfaces glued together by?
Within a few hours the peritoneal surfaces are glued together by a thin layer of fibrin and leucocytes, which is speedily organised and replaced by fibrous tissue.
What does fibrous tissue take over?
Fibrous tissue takes the place of the muscular elements, which are not regenerated.
What does fibrous tissue replace?
Fibrous tissue takes the place of the muscular elements, which are not regenerated.
What may be reproduced?
The mucous lining is restored by ingrowth from the margins, and there is evidence that some of the secreting glands may be reproduced.
What is restored by ingrowth from the margins?
The mucous lining is restored by ingrowth from the margins, and there is evidence that some of the secreting glands may be reproduced.
What do hollow viscera heal less quickly?
Hollow viscera, like the œsophagus and urinary bladder, in so far as they are not covered by peritoneum, heal less rapidly.
What are hollow viscera like?
Hollow viscera, like the œsophagus and urinary bladder, in so far as they are not covered by peritoneum, heal less rapidly.
What do hollow viscera not cover?
Hollow viscera, like the œsophagus and urinary bladder, in so far as they are not covered by peritoneum, heal less rapidly.
What are Nerve Tissues?
Nerve Tissues.
What is the only reliable evidence that regeneration of the tissues of the brain or spinal cord takes place in man?
There is no trustworthy evidence that regeneration of the tissues of the brain or spinal cord in man ever takes place.
What is replaced by cicatricial tissue?
Any loss of substance is replaced by cicatricial tissue.
What are the three most commonly addressed structures in the book?
The repair of  Bone ,  Blood Vessels , and  Peripheral Nerves  is more conveniently considered in the chapters dealing with these structures.
What is the rate of healing?
Rate of Healing.
What is the rate at which wounds heal?
While the rate at which wounds heal is remarkably constant there are certain factors that influence it in one direction or the other.
What factors influence the rate at which wounds heal?
While the rate at which wounds heal is remarkably constant there are certain factors that influence it in one direction or the other.
What is more rapid when the edges are in contact?
Healing is more rapid when the edges are in contact, when there is a minimum amount of blood-clot between them, when the patient is in normal health and the vitality of the tissues has not been impaired.
What is the vitality of the tissues not impaired?
Healing is more rapid when the edges are in contact, when there is a minimum amount of blood-clot between them, when the patient is in normal health and the vitality of the tissues has not been impaired.
What is the minimum amount of blood-clot between the edges?
Healing is more rapid when the edges are in contact, when there is a minimum amount of blood-clot between them, when the patient is in normal health and the vitality of the tissues has not been impaired.
What is the difference between the two groups?
Wounds heal slightly more quickly in the young than in the old, although the difference is so small that it can only be demonstrated by the most careful observations.
How long does it take for nerve trunks to split?
Certain tissues take longer to heal than others: for example, a fracture of one of the larger long bones takes about six weeks to unite, and divided nerve trunks take much longer about a year.
What do some tissues take longer to heal than others?
Certain tissues take longer to heal than others: for example, a fracture of one of the larger long bones takes about six weeks to unite, and divided nerve trunks take much longer about a year.
How long does it take for a fracture to unite?
Certain tissues take longer to heal than others: for example, a fracture of one of the larger long bones takes about six weeks to unite, and divided nerve trunks take much longer about a year.
What is the reason for the faster healing of wounds?
Wounds of certain parts of the body heal more quickly than others: those of the scalp, face, and neck, for example, heal more quickly than those over the buttock or sacrum, probably because of their greater vascularity.
What parts of the body heal faster than others?
Wounds of certain parts of the body heal more quickly than others: those of the scalp, face, and neck, for example, heal more quickly than those over the buttock or sacrum, probably because of their greater vascularity.
What is the natural reaction to a long and deep wound?
The extent of the wound influences the rate of healing; it is only natural that a long and deep wound should take longer to heal than a short and superficial one, because there is so much more work to be done in the conversion of blood-clot into granulation tissue, and this again into scar tissue that will be strong enough to stand the strain on the edges of the wound.
What is the result of the conversion of blood-clot into granulation tissue?
The extent of the wound influences the rate of healing; it is only natural that a long and deep wound should take longer to heal than a short and superficial one, because there is so much more work to be done in the conversion of blood-clot into granulation tissue, and this again into scar tissue that will be strong enough to stand the strain on the edges of the wound.
What influences the rate of healing?
The extent of the wound influences the rate of healing; it is only natural that a long and deep wound should take longer to heal than a short and superficial one, because there is so much more work to be done in the conversion of blood-clot into granulation tissue, and this again into scar tissue that will be strong enough to stand the strain on the edges of the wound.
What is the natural reaction to a short and superficial wound?
The extent of the wound influences the rate of healing; it is only natural that a long and deep wound should take longer to heal than a short and superficial one, because there is so much more work to be done in the conversion of blood-clot into granulation tissue, and this again into scar tissue that will be strong enough to stand the strain on the edges of the wound.
What is the term for the transfer of tissue from one part of the body to another?
THE TRANSPLANTATION OR GRAFTING OF TISSUES Conditions are not infrequently met with in which healing is promoted and restoration of function made possible by the transference of a portion of tissue from one part of the body to another; the tissue transferred is known as the  graft  or the  transplant .
What is the term for the tissue transferred?
THE TRANSPLANTATION OR GRAFTING OF TISSUES Conditions are not infrequently met with in which healing is promoted and restoration of function made possible by the transference of a portion of tissue from one part of the body to another; the tissue transferred is known as the  graft  or the  transplant .
What is the simplest example of grafting?
The simplest example of grafting is the transplantation of skin.
What is the process of grafting a tissue into a new bed called?
In order that the graft may survive and have a favourable chance of "taking," as it is called, the transplanted tissue must retain its vitality until it has formed an organic connection with the tissue in which it is placed, so that it may derive the necessary nourishment from its new bed.
What is the term for the process of grafting a tissue into a new bed?
In order that the graft may survive and have a favourable chance of "taking," as it is called, the transplanted tissue must retain its vitality until it has formed an organic connection with the tissue in which it is placed, so that it may derive the necessary nourishment from its new bed.
What happens when the tissues of the graft continue to proliferate?
When these conditions are fulfilled the tissues of the graft continue to proliferate, producing new tissue elements to replace those that are lost and making it possible for the graft to become incorporated with the tissue with which it is in contact.
What does the graft produce to replace those that are lost?
When these conditions are fulfilled the tissues of the graft continue to proliferate, producing new tissue elements to replace those that are lost and making it possible for the graft to become incorporated with the tissue with which it is in contact.
What happens when the conditions are met?
When these conditions are fulfilled the tissues of the graft continue to proliferate, producing new tissue elements to replace those that are lost and making it possible for the graft to become incorporated with the tissue with which it is in contact.
What does the graft become incorporated with?
When these conditions are fulfilled the tissues of the graft continue to proliferate, producing new tissue elements to replace those that are lost and making it possible for the graft to become incorporated with the tissue with which it is in contact.
What is the only way dead tissue can do neither of these things?
Dead tissue, on the other hand, can do neither of these things; it is only capable of acting as a model, or, at the most, as a scaffolding for such mobile tissue elements as may be derived from, the parent tissue with which the graft is in contact: a portion of sterilised marine sponge, for example, may be observed to become permeated with granulation tissue when it is embedded in the tissues.
What is the only way dead tissue can act as a model?
Dead tissue, on the other hand, can do neither of these things; it is only capable of acting as a model, or, at the most, as a scaffolding for such mobile tissue elements as may be derived from, the parent tissue with which the graft is in contact: a portion of sterilised marine sponge, for example, may be observed to become permeated with granulation tissue when it is embedded in the tissues.
What is a portion of a sterilised marine sponge seen to become permeated with when it is embedded in tissues?
Dead tissue, on the other hand, can do neither of these things; it is only capable of acting as a model, or, at the most, as a scaffolding for such mobile tissue elements as may be derived from, the parent tissue with which the graft is in contact: a portion of sterilised marine sponge, for example, may be observed to become permeated with granulation tissue when it is embedded in the tissues.
What is the maximum capacity of dead tissue?
Dead tissue, on the other hand, can do neither of these things; it is only capable of acting as a model, or, at the most, as a scaffolding for such mobile tissue elements as may be derived from, the parent tissue with which the graft is in contact: a portion of sterilised marine sponge, for example, may be observed to become permeated with granulation tissue when it is embedded in the tissues.
What is a graft of living tissue capable of?
A successful graft of living tissue is not only capable of regeneration, but it acquires a system of lymph and blood vessels, so that in time it bleeds when cut into, and is permeated by new nerve fibres spreading in from the periphery towards the centre.
What are the connective tissues that retain their vitality for several hours after death?
It is instructive to associate the period of survival of the different tissues of the body after death, with their capacity of being used for grafting purposes; the higher tissues such as those of the central nervous system and highly specialised glandular tissues like those of the kidney lose their vitality quickly after death and are therefore useless for grafting; connective tissues, on the other hand, such as fat, cartilage, and bone retain their vitality for several hours after death, so that when they are transplanted, they readily "take" and do all that is required of them: the same is true of the skin and its appendages.
What is the same for the skin and its appendages?
It is instructive to associate the period of survival of the different tissues of the body after death, with their capacity of being used for grafting purposes; the higher tissues such as those of the central nervous system and highly specialised glandular tissues like those of the kidney lose their vitality quickly after death and are therefore useless for grafting; connective tissues, on the other hand, such as fat, cartilage, and bone retain their vitality for several hours after death, so that when they are transplanted, they readily "take" and do all that is required of them: the same is true of the skin and its appendages.
What are the higher tissues of the central nervous system useless for?
It is instructive to associate the period of survival of the different tissues of the body after death, with their capacity of being used for grafting purposes; the higher tissues such as those of the central nervous system and highly specialised glandular tissues like those of the kidney lose their vitality quickly after death and are therefore useless for grafting; connective tissues, on the other hand, such as fat, cartilage, and bone retain their vitality for several hours after death, so that when they are transplanted, they readily "take" and do all that is required of them: the same is true of the skin and its appendages.
What is the purpose of the different tissues of the body after death?
It is instructive to associate the period of survival of the different tissues of the body after death, with their capacity of being used for grafting purposes; the higher tissues such as those of the central nervous system and highly specialised glandular tissues like those of the kidney lose their vitality quickly after death and are therefore useless for grafting; connective tissues, on the other hand, such as fat, cartilage, and bone retain their vitality for several hours after death, so that when they are transplanted, they readily "take" and do all that is required of them: the same is true of the skin and its appendages.
What are the sources of Grafts?
Sources of Grafts.
What is heteroplastic grafts derived from?
It is convenient to differentiate between  autoplastic  grafts, that is those derived from the same individual;  homoplastic  grafts, derived from another animal of the same species; and  heteroplastic  grafts, derived from an animal of another species.
What is homoplastic grafts derived from?
It is convenient to differentiate between  autoplastic  grafts, that is those derived from the same individual;  homoplastic  grafts, derived from another animal of the same species; and  heteroplastic  grafts, derived from an animal of another species.
What is convenient to differentiate between autoplastic grafts?
It is convenient to differentiate between  autoplastic  grafts, that is those derived from the same individual;  homoplastic  grafts, derived from another animal of the same species; and  heteroplastic  grafts, derived from an animal of another species.
What is the most likely outcome of autoplastic grafts?
Other conditions being equal, the prospects of success are greatest with autoplastic grafts, and these are therefore preferred whenever possible.
What conditions permit of the primary healing of wounds?
There are certain details making for success that merit attention: the graft must not be roughly handled or allowed to dry, or be subjected to chemical irritation; it must be brought into accurate contact with the new soil, no blood-clot intervening between the two, no movement of the one upon the other should be possible and all infection must be excluded; it will be observed that these are exactly the same conditions that permit of the primary healing of wounds, with which of course the healing of grafts is exactly comparable.
What must be excluded from the graft?
There are certain details making for success that merit attention: the graft must not be roughly handled or allowed to dry, or be subjected to chemical irritation; it must be brought into accurate contact with the new soil, no blood-clot intervening between the two, no movement of the one upon the other should be possible and all infection must be excluded; it will be observed that these are exactly the same conditions that permit of the primary healing of wounds, with which of course the healing of grafts is exactly comparable.
What must not be handled or allowed to dry?
There are certain details making for success that merit attention: the graft must not be roughly handled or allowed to dry, or be subjected to chemical irritation; it must be brought into accurate contact with the new soil, no blood-clot intervening between the two, no movement of the one upon the other should be possible and all infection must be excluded; it will be observed that these are exactly the same conditions that permit of the primary healing of wounds, with which of course the healing of grafts is exactly comparable.
What must not be allowed to intervene between the new soil and the graft?
There are certain details making for success that merit attention: the graft must not be roughly handled or allowed to dry, or be subjected to chemical irritation; it must be brought into accurate contact with the new soil, no blood-clot intervening between the two, no movement of the one upon the other should be possible and all infection must be excluded; it will be observed that these are exactly the same conditions that permit of the primary healing of wounds, with which of course the healing of grafts is exactly comparable.
Preservation of Tissues for Grafting?
Preservation of Tissues for Grafting.
What was the first place that tissues could be taken from the operating theatre and kept in cold storage?
It was at one time believed that tissues might be taken from the operating theatre and kept in cold storage until they were required.
What happens to tissues that have been separated from the body for some time?
It is now agreed that tissues which have been separated from the body for some time inevitably lose their vitality, become incapable of regeneration, and are therefore unsuited for grafting purposes.
What should a patient be embedded in to preserve tissue for future grafting?
If it is intended to preserve a portion of tissue for future grafting, it should be embedded in the subcutaneous tissue of the abdominal wall until it is wanted; this has been carried out with portions of costal cartilage and of bone.
What has been done with portions of costal cartilage and bone?
If it is intended to preserve a portion of tissue for future grafting, it should be embedded in the subcutaneous tissue of the abdominal wall until it is wanted; this has been carried out with portions of costal cartilage and of bone.
What is the term for what type of transplant?
INDIVIDUAL TISSUES AS GRAFTS  The Blood  lends itself in an ideal manner to transplantation, or, as it has long been called,  transfusion .
What happens when the new blood is not always tolerated by the old?
Being always a homoplastic transfer, the new blood is not always tolerated by the old, in which case biochemical changes occur, resulting in hamolysis, which corresponds to the disintegration of other unsuccessful homoplastic grafts.
What is the name of the article that discusses transfusion?
(See article on Transfusion,  Op.
What is the name of the company that is based in the United States?
Surg.
What is the name of the person who is a member of the federation?
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What is the name of the spokesman for the spokesman?
37.)
What is the name of the body part that is responsible for the skin?
The Skin.
What is the most common cause of skin defects?
The skin was the first tissue to be used for grafting purposes, and it is still employed with greater frequency than any other, as lesions causing defects of skin are extremely common and without the aid of grafts are tedious in healing.
What was the first tissue to be used for grafting purposes?
The skin was the first tissue to be used for grafting purposes, and it is still employed with greater frequency than any other, as lesions causing defects of skin are extremely common and without the aid of grafts are tedious in healing.
What is tedious without the aid of grafts?
The skin was the first tissue to be used for grafting purposes, and it is still employed with greater frequency than any other, as lesions causing defects of skin are extremely common and without the aid of grafts are tedious in healing.
What can be applied to a raw surface or to a surface that is covered with granulations?
Skin grafts may be applied to a raw surface or to one that is covered with granulations.
What is often indicated after operations for malignant disease?
Skin grafting of raw surfaces  is commonly indicated after operations for malignant disease in which considerable areas of skin must be sacrificed, and after accidents, such as avulsion of the scalp by machinery.
What is a common accident that causes skin grafting?
Skin grafting of raw surfaces  is commonly indicated after operations for malignant disease in which considerable areas of skin must be sacrificed, and after accidents, such as avulsion of the scalp by machinery.
What happens when scar tissue contracts?
Skin grafting of granulating surfaces  is chiefly employed to promote healing in the large defects of skin caused by severe burns; the grafting is carried out when the surface is covered by a uniform layer of healthy granulations and before the inevitable contraction of scar tissue makes itself manifest.
What is the main purpose of skin grafting?
Skin grafting of granulating surfaces  is chiefly employed to promote healing in the large defects of skin caused by severe burns; the grafting is carried out when the surface is covered by a uniform layer of healthy granulations and before the inevitable contraction of scar tissue makes itself manifest.
What is the purpose of skin grafting?
Skin grafting of granulating surfaces  is chiefly employed to promote healing in the large defects of skin caused by severe burns; the grafting is carried out when the surface is covered by a uniform layer of healthy granulations and before the inevitable contraction of scar tissue makes itself manifest.
What is the surface covered by?
Skin grafting of granulating surfaces  is chiefly employed to promote healing in the large defects of skin caused by severe burns; the grafting is carried out when the surface is covered by a uniform layer of healthy granulations and before the inevitable contraction of scar tissue makes itself manifest.
If the granulations are healthy and can be rendered aseptic, the grafts may be placed on them directly?
Before applying the grafts it is usual to scrape away the granulations until the young fibrous tissue underneath is exposed, but, if the granulations are healthy and can be rendered aseptic, the grafts may be placed on them directly.
What is the usual procedure for scraping away the granulations before applying the grafts?
Before applying the grafts it is usual to scrape away the granulations until the young fibrous tissue underneath is exposed, but, if the granulations are healthy and can be rendered aseptic, the grafts may be placed on them directly.
What is placed next to the raw surface to prevent the gauze adhesion?
If it is decided to scrape away the granulations, the oozing must be arrested by pressure with a pad of gauze, a sheet of dental rubber or green protective is placed next the raw surface to prevent the gauze adhering and starting the bleeding afresh when it is removed.
What is the green protective?
If it is decided to scrape away the granulations, the oozing must be arrested by pressure with a pad of gauze, a sheet of dental rubber or green protective is placed next the raw surface to prevent the gauze adhering and starting the bleeding afresh when it is removed.
What is used to stop the bleeding when scraping away the granulations?
If it is decided to scrape away the granulations, the oozing must be arrested by pressure with a pad of gauze, a sheet of dental rubber or green protective is placed next the raw surface to prevent the gauze adhering and starting the bleeding afresh when it is removed.
What is the name of the method used to make skin-rafting?
Methods of Skin-Grafting.
What is the graft composed of?
Two methods are employed: one in which the epidermis is mainly or exclusively employed epidermis or epithelial grafting; the other, in which the graft consists of the whole thickness of the true skin cutis-grafting.
What is the other method of grafting?
Two methods are employed: one in which the epidermis is mainly or exclusively employed epidermis or epithelial grafting; the other, in which the graft consists of the whole thickness of the true skin cutis-grafting.
What is the main or exclusively employed method of epidermis grafting?
Two methods are employed: one in which the epidermis is mainly or exclusively employed epidermis or epithelial grafting; the other, in which the graft consists of the whole thickness of the true skin cutis-grafting.
What is the term for Epidermis?
Epidermis or Epithelial Grafting.
Who introduced the method of calculating?
The method introduced by the late Professor Thiersch of Leipsic is that almost universally practised.
What do the strips of epidermis transplant from the surface of the skin do?
It consists in transplanting strips of epidermis shaved from the surface of the skin, the razor passing through the tips of the papilla, which appear as tiny red points yielding a moderate ooze of blood.
What is the procedure called?
It consists in transplanting strips of epidermis shaved from the surface of the skin, the razor passing through the tips of the papilla, which appear as tiny red points yielding a moderate ooze of blood.
What do the strips of epidermis transplant look like?
It consists in transplanting strips of epidermis shaved from the surface of the skin, the razor passing through the tips of the papilla, which appear as tiny red points yielding a moderate ooze of blood.
What is the skin in the lateral aspects of the thigh or upper arm?
The strips are obtained from the front and lateral aspects of the thigh or upper arm, the skin in those regions being pliable and comparatively free from hairs.
Where are the strips obtained?
The strips are obtained from the front and lateral aspects of the thigh or upper arm, the skin in those regions being pliable and comparatively free from hairs.
What is the blade of Thiersch's grafting knife kept moistened with?
They are cut with a sharp hollow-ground razor or with Thiersch's grafting knife, the blade of which is rinsed in alcohol and kept moistened with warm saline solution.
What is the blade of Thiersch's grafting knife rinsed in?
They are cut with a sharp hollow-ground razor or with Thiersch's grafting knife, the blade of which is rinsed in alcohol and kept moistened with warm saline solution.
What is made easier if the skin is well stretched and kept flat and perfectly steady?
The cutting is made easier if the skin is well stretched and kept flat and perfectly steady, the operator's left hand exerting traction on the skin behind, the hands of the assistant on the skin in front, one above and the other below the seat of operation.
What is the operator's left hand exerting traction on?
The cutting is made easier if the skin is well stretched and kept flat and perfectly steady, the operator's left hand exerting traction on the skin behind, the hands of the assistant on the skin in front, one above and the other below the seat of operation.
What is the hands of the assistant on the skin in front?
The cutting is made easier if the skin is well stretched and kept flat and perfectly steady, the operator's left hand exerting traction on the skin behind, the hands of the assistant on the skin in front, one above and the other below the seat of operation.
How wide can grafts be cut?
To ensure uniform strips being cut, the razor is kept parallel with the surface and used with a short, rapid, sawing movement, so that, with a little practice, grafts six or eight inches long by one or two inches broad can readily be cut.
How long can grafts be cut?
To ensure uniform strips being cut, the razor is kept parallel with the surface and used with a short, rapid, sawing movement, so that, with a little practice, grafts six or eight inches long by one or two inches broad can readily be cut.
What is the razor kept parallel with?
To ensure uniform strips being cut, the razor is kept parallel with the surface and used with a short, rapid, sawing movement, so that, with a little practice, grafts six or eight inches long by one or two inches broad can readily be cut.
What is regional anasthesia obtained by?
The patient is given a general anasthetic, or regional anasthesia is obtained by injections of a solution of one per cent.
What is the general anasthetic called?
The patient is given a general anasthetic, or regional anasthesia is obtained by injections of a solution of one per cent.
What is the solution of 1%?
The patient is given a general anasthetic, or regional anasthesia is obtained by injections of a solution of one per cent.
What is the second step in the disinfection of the skin?
novocain into the line of the lateral and middle cutaneous nerves; the disinfection of the skin is carried out on the usual lines, any chemical agent being finally got rid of, however, by means of alcohol followed by saline solution.
What is the usual method of disinfection of the skin?
novocain into the line of the lateral and middle cutaneous nerves; the disinfection of the skin is carried out on the usual lines, any chemical agent being finally got rid of, however, by means of alcohol followed by saline solution.
What is the first step in the disinfection of the skin?
novocain into the line of the lateral and middle cutaneous nerves; the disinfection of the skin is carried out on the usual lines, any chemical agent being finally got rid of, however, by means of alcohol followed by saline solution.
What is used to ensure accurate contact?
The strips of epidermis wrinkle up on the knife and are directly transferred to the surface, for which they should be made to form a complete carpet, slightly overlapping the edges of the area and of one another; some blunt instrument is used to straighten out the strips, which are then subjected to firm pressure with a pad of gauze to express blood and air-bells and to ensure accurate contact, for this must be as close as that between a postage stamp and the paper to which it is affixed.
What is used to straighten out the strips of epidermis?
The strips of epidermis wrinkle up on the knife and are directly transferred to the surface, for which they should be made to form a complete carpet, slightly overlapping the edges of the area and of one another; some blunt instrument is used to straighten out the strips, which are then subjected to firm pressure with a pad of gauze to express blood and air-bells and to ensure accurate contact, for this must be as close as that between a postage stamp and the paper to which it is affixed.
What is used to express blood and air-bells?
The strips of epidermis wrinkle up on the knife and are directly transferred to the surface, for which they should be made to form a complete carpet, slightly overlapping the edges of the area and of one another; some blunt instrument is used to straighten out the strips, which are then subjected to firm pressure with a pad of gauze to express blood and air-bells and to ensure accurate contact, for this must be as close as that between a postage stamp and the paper to which it is affixed.
What is the best dressing for the grafted area?
As a dressing for the grafted area and of that also from which the grafts have been taken, gauze soaked in  liquid paraffin  the patent variety known as  ambrine  is excellent appears to be the best; the gauze should be moistened every other day or so with fresh paraffin, so that, at the end of a week, when the grafts should have united, the gauze can be removed without risk of detaching them.
What should be moistened every other day or so with fresh paraffin?
As a dressing for the grafted area and of that also from which the grafts have been taken, gauze soaked in  liquid paraffin  the patent variety known as  ambrine  is excellent appears to be the best; the gauze should be moistened every other day or so with fresh paraffin, so that, at the end of a week, when the grafts should have united, the gauze can be removed without risk of detaching them.
What is the patent variety known as ambrine?
As a dressing for the grafted area and of that also from which the grafts have been taken, gauze soaked in  liquid paraffin  the patent variety known as  ambrine  is excellent appears to be the best; the gauze should be moistened every other day or so with fresh paraffin, so that, at the end of a week, when the grafts should have united, the gauze can be removed without risk of detaching them.
What is another useful type of dressing?
Dental wax  is another useful type of dressing; as is also  picric acid  solution.
What is kept in place by a firmly applied bandage?
Over the gauze, there is applied a thick layer of cotton wool, and the whole dressing is kept in place by a firmly applied bandage, and in the case of the limbs some form of splint should be added to prevent movement.
What is applied over the gauze?
Over the gauze, there is applied a thick layer of cotton wool, and the whole dressing is kept in place by a firmly applied bandage, and in the case of the limbs some form of splint should be added to prevent movement.
What should be added to the limbs to prevent movement?
Over the gauze, there is applied a thick layer of cotton wool, and the whole dressing is kept in place by a firmly applied bandage, and in the case of the limbs some form of splint should be added to prevent movement.
What is used to protect the grafts after vaccination?
A dressing may be dispensed with altogether, the grafts being protected by a wire cage such as is used after vaccination, but they tend to dry up and come to resemble a scab.
What does the grafts look like after being injected?
A dressing may be dispensed with altogether, the grafts being protected by a wire cage such as is used after vaccination, but they tend to dry up and come to resemble a scab.
What is a good way to protect grafts after they have healed?
When the grafts have healed, it is well to protect them from injury and to prevent them drying up and cracking by the liberal application of lanoline or vaseline.
What is another way to protect grafts after they have healed?
When the grafts have healed, it is well to protect them from injury and to prevent them drying up and cracking by the liberal application of lanoline or vaseline.
What is the first thing that the skin is fixed to?
The new skin is at first insensitive and is fixed to the underlying connective tissue or bone, but in course of time (from six weeks onwards) sensation returns and the formation of elastic tissue beneath renders the skin pliant and movable so that it can be pinched up between the finger and thumb.
What is the second thing that the skin is fixed to?
The new skin is at first insensitive and is fixed to the underlying connective tissue or bone, but in course of time (from six weeks onwards) sensation returns and the formation of elastic tissue beneath renders the skin pliant and movable so that it can be pinched up between the finger and thumb.
What is the size of the skin Reverdin uses?
Reverdin's  method consists in planting out pieces of skin not bigger than a pin-head over a granulating surface.
What is the most common use of the e-mail service?
It is seldom employed.
Grafts of what plant?
Grafts of the Cutis Vera.
Wolff's name is associated with what type of graft?
Grafts consisting of the entire thickness of the true skin were specially advocated by Wolff and are often associated with his name.
Wolff advocated grafts that covered the entire thickness of what?
Grafts consisting of the entire thickness of the true skin were specially advocated by Wolff and are often associated with his name.
What shape should the wounds be?
They should be cut oval or spindle-shaped, to facilitate the approximation of the edges of the resulting wound.
What should be cut to the size of the surface it is to cover?
The graft should be cut to the exact size of the surface it is to cover; Gillies believes that tension of the graft favours its taking.
Gillies believes that tension of the graft favours its taking?
The graft should be cut to the exact size of the surface it is to cover; Gillies believes that tension of the graft favours its taking.
What surface can grafts be placed on?
These grafts may be placed either on a fresh raw surface or on healthy granulations.
What type of surface can grafts be placed on?
These grafts may be placed either on a fresh raw surface or on healthy granulations.
What is an advantage of stitching them in position?
It is sometimes an advantage to stitch them in position, especially on the face.
What is the same as in epidermis grafting?
The dressing and the after-treatment are the same as in epidermis grafting.
In a certain number of cases the flap dies and is thrown off as a slough moist or dry according to the presence or absence of septic infection?
There is a degree of uncertainty about the graft retaining its vitality long enough to permit of its deriving the necessary nourishment from its new surroundings; in a certain number of cases the flap dies and is thrown off as a slough moist or dry according to the presence or absence of septic infection.
What is the degree of uncertainty about the graft retaining its vitality long enough to permit of its deriving the necessary nourishment from its new surroundings?
There is a degree of uncertainty about the graft retaining its vitality long enough to permit of its deriving the necessary nourishment from its new surroundings; in a certain number of cases the flap dies and is thrown off as a slough moist or dry according to the presence or absence of septic infection.
What must not only be a complete absence of movement, but also no traction on the flap that will endanger its blood supply?
The technique for cutis-grafting must be without a flaw, and the asepsis absolute; there must not only be a complete absence of movement, but there must be no traction on the flap that will endanger its blood supply.
What must be the technique for cutis-grafting without?
The technique for cutis-grafting must be without a flaw, and the asepsis absolute; there must not only be a complete absence of movement, but there must be no traction on the flap that will endanger its blood supply.
What has resulted in the widespread application of the indirect method?
Owing to the uncertainty in the results of cutis-grafting the  two-stage  or  indirect method  has been introduced, and its almost uniform success has led to its sphere of application being widely extended.
What method has been introduced to reduce the uncertainty in the results of cutis-grafting?
Owing to the uncertainty in the results of cutis-grafting the  two-stage  or  indirect method  has been introduced, and its almost uniform success has led to its sphere of application being widely extended.
How long is the flap left attached at one of its margins?
The flap is raised as in the direct method but is left attached at one of its margins for a period ranging from 14 to 21 days until its blood supply from its new bed is assured; the detachment is then made complete.
What may influence the selection of a flap?
The blood supply of the proposed flap may influence its selection and the way in which it is fashioned; for example, a flap cut from the side of the head to fill a defect in the cheek, having in its margin of attachment or pedicle the superficial temporal artery, is more likely to take than a flap cut with its base above.
What is more likely to take a flap cut with its base above?
The blood supply of the proposed flap may influence its selection and the way in which it is fashioned; for example, a flap cut from the side of the head to fill a defect in the cheek, having in its margin of attachment or pedicle the superficial temporal artery, is more likely to take than a flap cut with its base above.
What is more likely to take a flap cut from the side of the head to fill a defect in the cheek?
The blood supply of the proposed flap may influence its selection and the way in which it is fashioned; for example, a flap cut from the side of the head to fill a defect in the cheek, having in its margin of attachment or pedicle the superficial temporal artery, is more likely to take than a flap cut with its base above.
What is well suited to defects of skin on the dorsum of the fingers, hand and forearm?
Another modification is to raise the flap but leave it connected at both ends like the piers of a bridge; this method is well suited to defects of skin on the dorsum of the fingers, hand and forearm, the bridge of skin is raised from the abdominal wall and the hand is passed beneath it and securely fixed in position; after an interval of 14 to 21 days, when the flap is assured of its blood supply, the piers of the bridge are divided (Fig.
The bridge of skin is raised from the abdominal wall and the hand is passed beneath it and securely fixed in position?
Another modification is to raise the flap but leave it connected at both ends like the piers of a bridge; this method is well suited to defects of skin on the dorsum of the fingers, hand and forearm, the bridge of skin is raised from the abdominal wall and the hand is passed beneath it and securely fixed in position; after an interval of 14 to 21 days, when the flap is assured of its blood supply, the piers of the bridge are divided (Fig.
What is another modification to raise the flap but leave it connected at both ends like the piers of a bridge?
Another modification is to raise the flap but leave it connected at both ends like the piers of a bridge; this method is well suited to defects of skin on the dorsum of the fingers, hand and forearm, the bridge of skin is raised from the abdominal wall and the hand is passed beneath it and securely fixed in position; after an interval of 14 to 21 days, when the flap is assured of its blood supply, the piers of the bridge are divided (Fig.
After an interval of 14 to 21 days, when the flap is assured of its blood supply, the piers of the bridge are divided?
Another modification is to raise the flap but leave it connected at both ends like the piers of a bridge; this method is well suited to defects of skin on the dorsum of the fingers, hand and forearm, the bridge of skin is raised from the abdominal wall and the hand is passed beneath it and securely fixed in position; after an interval of 14 to 21 days, when the flap is assured of its blood supply, the piers of the bridge are divided (Fig.
What is the name of the spokesman for the spokesman?
1).
What is gratifying in the extreme?
With undermining it is usually easy to bring the edges of the gap in the abdominal wall together, even in children; the skin flap on the dorsum of the hand appears rather thick and prominent almost like the pad of a boxing-glove for some time, but the restoration of function in the capacity to flex the fingers is gratifying in the extreme.
What appears rather thick and prominent like the pad of a boxing glove for some time?
With undermining it is usually easy to bring the edges of the gap in the abdominal wall together, even in children; the skin flap on the dorsum of the hand appears rather thick and prominent almost like the pad of a boxing-glove for some time, but the restoration of function in the capacity to flex the fingers is gratifying in the extreme.
What is it usually easy to bring the edges of the gap in the abdominal wall together?
With undermining it is usually easy to bring the edges of the gap in the abdominal wall together, even in children; the skin flap on the dorsum of the hand appears rather thick and prominent almost like the pad of a boxing-glove for some time, but the restoration of function in the capacity to flex the fingers is gratifying in the extreme.
What is the second part of the body that can be transferred to a third part?
The indirect element of this method of skin-grafting may be carried still further by transferring the flap of skin first to one part of the body and then, after it has taken, transferring it to a third part.
What is the other cause of deformities of the face developed by Gillies?
Gillies has especially developed this method in the remedying of deformities of the face caused by gunshot wounds and by petrol burns in air-men.
What is the main cause of deformities of the face developed by Gillies?
Gillies has especially developed this method in the remedying of deformities of the face caused by gunshot wounds and by petrol burns in air-men.
What is marked out in the neck and chest?
A rectangular flap of skin is marked out in the neck and chest, the lateral margins of the flap are raised sufficiently to enable them to be brought together so as to form a tube of skin: after the circulation has been restored, the lower end of the tube is detached and is brought up to the lip or cheek, or eyelid, where it is wanted; when this end has derived its new blood supply, the other end is detached from the neck and brought up to where it is wanted.
What is the lower end of the tube brought up to?
A rectangular flap of skin is marked out in the neck and chest, the lateral margins of the flap are raised sufficiently to enable them to be brought together so as to form a tube of skin: after the circulation has been restored, the lower end of the tube is detached and is brought up to the lip or cheek, or eyelid, where it is wanted; when this end has derived its new blood supply, the other end is detached from the neck and brought up to where it is wanted.
What can be brought up to form a new forehead and eyelids?
In this way, skin from the chest may be brought up to form a new forehead and eyelids.
What is used to cover defects in the lip, cheek, and conjunctiva?
Grafts of  mucous membrane  are used to cover defects in the lip, cheek, and conjunctiva.
What is the technique similar to?
The technique is similar to that employed in skin-grafting; the sources of mucous membrane are limited and the element of septic infection cannot always be excluded.
What is the source of mucous membrane?
The technique is similar to that employed in skin-grafting; the sources of mucous membrane are limited and the element of septic infection cannot always be excluded.
What is not always excluded?
The technique is similar to that employed in skin-grafting; the sources of mucous membrane are limited and the element of septic infection cannot always be excluded.
What is the name of the animal that is a part of the body?
Fat.
What is the high vitality of adipose tissue?
Adipose tissue has a low vitality, but it is easily retained and it readily lends itself to transplantation.
What is the low vitality of adipose tissue?
Adipose tissue has a low vitality, but it is easily retained and it readily lends itself to transplantation.
What is fat used to fill cavities?
Portions of fat are often obtainable at operations from the omentum, for example, otherwise the subcutaneous fat of the buttock is the most accessible; it may be employed to fill up cavities of all kinds in order to obtain more rapid and sounder healing and also to remedy deformity, as in filling up a depression in the cheek or forehead.
Where are fats often obtainable?
Portions of fat are often obtainable at operations from the omentum, for example, otherwise the subcutaneous fat of the buttock is the most accessible; it may be employed to fill up cavities of all kinds in order to obtain more rapid and sounder healing and also to remedy deformity, as in filling up a depression in the cheek or forehead.
Where is fat most readily available?
Portions of fat are often obtainable at operations from the omentum, for example, otherwise the subcutaneous fat of the buttock is the most accessible; it may be employed to fill up cavities of all kinds in order to obtain more rapid and sounder healing and also to remedy deformity, as in filling up a depression in the cheek or forehead.
What is converted into ordinary connective tissue pari passu?
It is ultimately converted into ordinary connective tissue  pari passu  with the absorption of the fat.
What is used to fill defects in the dura mater?
The  fascia lata of the thigh  is widely and successfully used as a graft to fill defects in the dura mater, and interposed between the bones of a joint if the articular cartilage has been destroyed to prevent the occurrence of ankylosis.
What is the fascia lata of the thigh used for?
The  fascia lata of the thigh  is widely and successfully used as a graft to fill defects in the dura mater, and interposed between the bones of a joint if the articular cartilage has been destroyed to prevent the occurrence of ankylosis.
What is interposed between the bones of a joint if the articular cartilage has been destroyed?
The  fascia lata of the thigh  is widely and successfully used as a graft to fill defects in the dura mater, and interposed between the bones of a joint if the articular cartilage has been destroyed to prevent the occurrence of ankylosis.
What is readily lendable for transplantation?
The  peritoneum  of hydrocele and hernial sacs and of the omentum readily lends itself to transplantation.
What is the method of re-forming the nose?
Cartilage and bone , next to skin, are the tissues most frequently employed for grafting purposes; their sphere of action is so extensive and includes so much of technical detail in their employment, that they will be considered later with the surgery of the bones and joints and with the methods of re-forming the nose.
What are the two most commonly used for grafting purposes?
Cartilage and bone , next to skin, are the tissues most frequently employed for grafting purposes; their sphere of action is so extensive and includes so much of technical detail in their employment, that they will be considered later with the surgery of the bones and joints and with the methods of re-forming the nose.
What is the sphere of action of cartilage and bone?
Cartilage and bone , next to skin, are the tissues most frequently employed for grafting purposes; their sphere of action is so extensive and includes so much of technical detail in their employment, that they will be considered later with the surgery of the bones and joints and with the methods of re-forming the nose.
What two things are readily available for transplantation?
Tendons and blood vessels  readily lend themselves to transplantation and will also be referred to later.
What do muscle and nerve not retain when they are severed from their surroundings?
Muscle and nerve , on the other hand, do not retain their vitality when severed from their surroundings and do not functionate as grafts except for their connective-tissue elements, which it goes without saying are more readily obtainable from other sources.
What do connective-tissue elements do?
Muscle and nerve , on the other hand, do not retain their vitality when severed from their surroundings and do not functionate as grafts except for their connective-tissue elements, which it goes without saying are more readily obtainable from other sources.
What part of the body has been successfully transplanted into the subcutaneous cellular tissue of the abdominal wall?
Portions of the  ovary  and of the  thyreoid  have been successfully transplanted into the subcutaneous cellular tissue of the abdominal wall by Tuffier and others.
What part of the body has been successfully transplanted into the abdominal wall?
Portions of the  ovary  and of the  thyreoid  have been successfully transplanted into the subcutaneous cellular tissue of the abdominal wall by Tuffier and others.
What is replaced by connective tissue?
In these new surroundings, the ovary or thyreoid is vascularised and has been shown to functionate, but there is not sufficient regeneration of the essential tissue elements to "carry on"; the secreting tissue is gradually replaced by connective tissue and the special function comes to an end.
What is the ovary called?
In these new surroundings, the ovary or thyreoid is vascularised and has been shown to functionate, but there is not sufficient regeneration of the essential tissue elements to "carry on"; the secreting tissue is gradually replaced by connective tissue and the special function comes to an end.
What is the thyreoid?
In these new surroundings, the ovary or thyreoid is vascularised and has been shown to functionate, but there is not sufficient regeneration of the essential tissue elements to "carry on"; the secreting tissue is gradually replaced by connective tissue and the special function comes to an end.
What may tide a patient over a difficult period?
Even such temporary function may, however, tide a patient over a difficult period.
What is the purpose of removing extraneous influences?
CHAPTER II CONDITIONS WHICH INTERFERE WITH REPAIR

In the management of wounds and other surgical conditions it is necessary to eliminate various extraneous influences which tend to delay or arrest the natural process of repair.
What is one of the most important?
Of these, one of the most important is undue movement of the affected part.
What is the chief of natural therapeutic agents?
"The first and great requisite for the restoration of injured parts is  rest ," said John Hunter; and physiological and mechanical rest as the chief of natural therapeutic agents was the theme of John Hilton's classical work  Rest and Pain .
What is the first and great requisite for the restoration of injured parts?
"The first and great requisite for the restoration of injured parts is  rest ," said John Hunter; and physiological and mechanical rest as the chief of natural therapeutic agents was the theme of John Hilton's classical work  Rest and Pain .
What is the theme of John Hilton's classical work Rest and Pain?
"The first and great requisite for the restoration of injured parts is  rest ," said John Hunter; and physiological and mechanical rest as the chief of natural therapeutic agents was the theme of John Hilton's classical work  Rest and Pain .
What must be understood about "rest"?
In this connection it must be understood that "rest" implies more than the mere state of physical repose: all physiological as well as mechanical function must be prevented as far as is possible.
What must be avoided as far as possible?
In this connection it must be understood that "rest" implies more than the mere state of physical repose: all physiological as well as mechanical function must be prevented as far as is possible.
What may be diminished by regulating the quantity and quality of fluids taken by the patient?
For instance, the constituent bones of a joint affected with tuberculosis must be controlled by splints or other appliances so that no movement can take place between them, and the limb may not be used for any purpose; physiological rest may be secured to an inflamed colon by making an artificial anus in the cacum; the activity of a diseased kidney may be diminished by regulating the quantity and quality of the fluids taken by the patient.
What may be secured to an inflamed colon by making an artificial anus in the cacum?
For instance, the constituent bones of a joint affected with tuberculosis must be controlled by splints or other appliances so that no movement can take place between them, and the limb may not be used for any purpose; physiological rest may be secured to an inflamed colon by making an artificial anus in the cacum; the activity of a diseased kidney may be diminished by regulating the quantity and quality of the fluids taken by the patient.
What must be controlled by splints or other appliances?
For instance, the constituent bones of a joint affected with tuberculosis must be controlled by splints or other appliances so that no movement can take place between them, and the limb may not be used for any purpose; physiological rest may be secured to an inflamed colon by making an artificial anus in the cacum; the activity of a diseased kidney may be diminished by regulating the quantity and quality of the fluids taken by the patient.
What is another source of interference with wound repair?
Another source of interference with repair in wounds is  irritation , either by mechanical agents such as rough, unsuitable dressings, bandages, or ill-fitting splints; or by chemical agents in the form of strong lotions or other applications.
What hinders the reparative process?
An  unhealthy or devitalised condition of the patient's tissues  also hinders the reparative process.
What is the most common cause of bruising or lacerated skin?
Bruised or lacerated skin heals less kindly than skin cut with a smooth, sharp instrument; and persistent venous congestion of a part, such as occurs, for example, in the leg when the veins are varicose, by preventing the access of healthy blood, tends to delay the healing of open wounds.
What is the most common cause of venous congestion?
Bruised or lacerated skin heals less kindly than skin cut with a smooth, sharp instrument; and persistent venous congestion of a part, such as occurs, for example, in the leg when the veins are varicose, by preventing the access of healthy blood, tends to delay the healing of open wounds.
What is Bright's disease?
The existence of grave constitutional disease, such as Bright's disease, diabetes, syphilis, scurvy, or alcoholism, also impedes healing.
What impedes healing?
The existence of grave constitutional disease, such as Bright's disease, diabetes, syphilis, scurvy, or alcoholism, also impedes healing.
What is the most potent factor in disturbing the natural process of repair in wounds?
Infection by disease-producing micro-organisms or  pathogenic bacteria  is, however, the most potent factor in disturbing the natural process of repair in wounds.
What is the standpoint of bacteriology that nearly all surgical questions have to be considered?
SURGICAL BACTERIOLOGY The influence of micro-organisms in the causation of disease, and the rôle played by them in interfering with the natural process of repair, are so important that the science of applied bacteriology has now come to dominate every department of surgery, and it is from the standpoint of bacteriology that nearly all surgical questions have to be considered.
What is the science of applied bacteriology now dominated every department of surgery?
SURGICAL BACTERIOLOGY The influence of micro-organisms in the causation of disease, and the rôle played by them in interfering with the natural process of repair, are so important that the science of applied bacteriology has now come to dominate every department of surgery, and it is from the standpoint of bacteriology that nearly all surgical questions have to be considered.
What is the term sepsis now used in clinical surgery?
The term  sepsis  as now used in clinical surgery no longer retains its original meaning as synonymous with "putrefaction," but is employed to denote all conditions in which bacterial infection has taken place, and more particularly those in which pyogenic bacteria are present.
What is the term sepsis now used to denote?
The term  sepsis  as now used in clinical surgery no longer retains its original meaning as synonymous with "putrefaction," but is employed to denote all conditions in which bacterial infection has taken place, and more particularly those in which pyogenic bacteria are present.
What term conveys the idea of freedom from all forms of bacteria?
In the same way the term  aseptic  conveys the idea of freedom from all forms of bacteria, putrefactive or otherwise; and the term  antiseptic  is used to denote a power of counteracting bacteria and their products.
What term is used to denote a power of counteracting bacteria and their products?
In the same way the term  aseptic  conveys the idea of freedom from all forms of bacteria, putrefactive or otherwise; and the term  antiseptic  is used to denote a power of counteracting bacteria and their products.
What are the general characteristics of Bacteria?
General Characters of Bacteria.
What is the bacterium enclosed in?
A  bacterium  consists of a finely granular mass of protoplasm, enclosed in a thin gelatinous envelope.
What is the bacterium composed of?
A  bacterium  consists of a finely granular mass of protoplasm, enclosed in a thin gelatinous envelope.
What is the bacterium?
A  bacterium  consists of a finely granular mass of protoplasm, enclosed in a thin gelatinous envelope.
What is another reason for many forms being motile?
Many forms are motile some in virtue of fine thread-like flagella, and others through contractility of the protoplasm.
What is the reason for many forms being motile?
Many forms are motile some in virtue of fine thread-like flagella, and others through contractility of the protoplasm.
How do the great majority of cells multiply?
The great majority multiply by simple fission, each parent cell giving rise to two daughter cells, and this process goes on with extraordinary rapidity.
How do the cells multiply?
The great majority multiply by simple fission, each parent cell giving rise to two daughter cells, and this process goes on with extraordinary rapidity.
What is another way to propagate bacilli?
Other varieties, particularly bacilli, are propagated by the formation of  spores .
Where is a spore developed?
A spore is a minute mass of protoplasm surrounded by a dense, tough membrane, developed in the interior of the parent cell.
What do Spores resist the action of?
Spores are remarkable for their tenacity of life, and for the resistance they offer to the action of heat and chemical germicides.
What do Spores offer resistance to?
Spores are remarkable for their tenacity of life, and for the resistance they offer to the action of heat and chemical germicides.
What are Spores remarkable for?
Spores are remarkable for their tenacity of life, and for the resistance they offer to the action of heat and chemical germicides.
What is the most convenient way to classify bacteria?
Bacteria are most conveniently classified according to their shape.
What are the wavy forms of spirilla?
Thus we recognise (1) those that are globular  cocci ; (2) those that resemble a rod  bacilli ; (3) the spiral or wavy forms  spirilla .
What are the globular cocci?
Thus we recognise (1) those that are globular  cocci ; (2) those that resemble a rod  bacilli ; (3) the spiral or wavy forms  spirilla .
What is the majority of non-motile animals?
The great majority are non-motile.
What is the name of the bacteria that divide in such a way that the cells remain in pairs?
They multiply by fission; and when they divide in such a way that the resulting cells remain in pairs, are called  diplococci , of which the bacteria of gonorrhœa and pneumonia are examples (Fig.
What is the name of the bacteria that multiply by fission?
They multiply by fission; and when they divide in such a way that the resulting cells remain in pairs, are called  diplococci , of which the bacteria of gonorrhœa and pneumonia are examples (Fig.
What are two examples of diplococci?
They multiply by fission; and when they divide in such a way that the resulting cells remain in pairs, are called  diplococci , of which the bacteria of gonorrhœa and pneumonia are examples (Fig.
What is the name of the systme that is used to determine the number of people in the room?
5).
What are staphylococci called when they divide irregularly?
When they divide irregularly, and form grape-like bunches, they are known as  staphylococci , and to this variety the commonest pyogenic or pus-forming organisms belong (Fig.
What is the name of the spokesman for the spokesman?
2).
What is the term for a chain formed when division takes place only in one axis?
When division takes place only in one axis, so that long chains are formed, the term  streptococcus  is applied (Fig.
What term is used when division takes place only in one axis?
When division takes place only in one axis, so that long chains are formed, the term  streptococcus  is applied (Fig.
How many people are in the house?
3).
Streptococci are met with in what?
Streptococci are met with in erysipelas and various other inflammatory and suppurative processes of a spreading character.
What are rod-shaped bacteria?
Bacilli  are rod-shaped bacteria, usually at least twice as long as they are broad (Fig.
How many people are in the house?
4).
What do some multiply by?
Some multiply by fission, others by sporulation.
What are some forms of a plant called?
Some forms are motile, others are non-motile.
What are some surgical diseases caused by different forms of bacilli?
Tuberculosis, tetanus, anthrax, and many other surgical diseases are due to different forms of bacilli.
What are the cells called that are slender and are spiral or wavy?
Spirilla  are long, slender, thread-like cells, more or less spiral or wavy.
What is the contraction of the protoplasm called?
Some move by a screw-like contraction of the protoplasm, some by flagella.
What is the contraction of the flagella called?
Some move by a screw-like contraction of the protoplasm, some by flagella.
What is the spirochate associated with?
The spirochate associated with syphilis (Fig.
What is the most important member of the group?
36) is the most important member of this group.
What is the name of the organism that is able to survive in the environment?
Conditions of Bacterial Life.
What do bacteria break up into simpler elements?
Bacteria require for their growth and development a suitable food-supply in the form of proteins, carbohydrates, and salts of calcium and potassium which they break up into simpler elements.
What do bacteria need for their growth and development?
Bacteria require for their growth and development a suitable food-supply in the form of proteins, carbohydrates, and salts of calcium and potassium which they break up into simpler elements.
What can spores survive without water for longer periods than fully developed bacteria?
An alkaline medium favours bacterial growth; and moisture is a necessary condition; spores, however, can survive the want of water for much longer periods than fully developed bacteria.
What medium favors bacterial growth?
An alkaline medium favours bacterial growth; and moisture is a necessary condition; spores, however, can survive the want of water for much longer periods than fully developed bacteria.
What is a necessary condition for bacteria to grow?
An alkaline medium favours bacterial growth; and moisture is a necessary condition; spores, however, can survive the want of water for much longer periods than fully developed bacteria.
What is the need for oxygen in different species?
The necessity for oxygen varies in different species.
What are arobic bacilli?
Those that require oxygen are known as  aërobic bacilli  or  aërobes ; those that cannot live in the presence of oxygen are spoken of as  anaërobes .
What are facultative anarobes?
The great majority of bacteria, however, while they prefer to have oxygen, are able to live without it, and are called  facultative anaërobes .
What do bacteria prefer to have?
The great majority of bacteria, however, while they prefer to have oxygen, are able to live without it, and are called  facultative anaërobes .
What is the most suitable temperature for bacteria?
The most suitable temperature for bacterial life is from 95° to 102° F., roughly that of the human body.
What paralyzes but does not kill micro-organisms?
Extreme or prolonged cold paralyses but does not kill micro-organisms.
What does extreme cold do?
Extreme or prolonged cold paralyses but does not kill micro-organisms.
What will kill bacteria?
Few, however, survive being raised to a temperature of 134½° F. Boiling for ten to twenty minutes will kill all bacteria, and the great majority of spores.
How long will boiling for kill bacteria?
Few, however, survive being raised to a temperature of 134½° F. Boiling for ten to twenty minutes will kill all bacteria, and the great majority of spores.
What temperature do bacteria survive being raised to?
Few, however, survive being raised to a temperature of 134½° F. Boiling for ten to twenty minutes will kill all bacteria, and the great majority of spores.
How many atmospheres are needed to destroy even the most resistant spores?
Steam applied in an autoclave under a pressure of two atmospheres destroys even the most resistant spores in a few minutes.
What is inimical to the growth of bacteria?
Direct sunlight, electric light, or even diffuse daylight, is inimical to the growth of bacteria, as are also Röntgen rays and radium emanations.
What are the Pathogenic Properties of Bacteria?
Pathogenic Properties of Bacteria.
What is the term for bacteria capable of producing disease in the human subject?
We are now only concerned with pathogenic bacteria that is, bacteria capable of producing disease in the human subject.
What are the two sets of factors that determine the capacity of bacteria?
This capacity depends upon two sets of factors (1) certain features peculiar to the invading bacteria, and (2) others peculiar to the host.
What are many bacteria known as?
Many bacteria have only the power of living upon dead matter, and are known as  saphrophytes .
What are saphrophytes?
Many bacteria have only the power of living upon dead matter, and are known as  saphrophytes .
What is the power a parasitic micro-organism has of multiplying in the body and giving rise to disease called?
The power a given parasitic micro-organism has of multiplying in the body and giving rise to disease is spoken of as its  virulence , and this varies not only with different species, but in the same species at different times and under varying circumstances.
What is another important factor in determining the pathogenic power of organisms?
The actual number of organisms introduced is also an important factor in determining their pathogenic power.
What can healthy tissues resist?
Healthy tissues can resist the invasion of a certain number of bacteria of a given species, but when that number is exceeded, the organisms get the upper hand and disease results.
What happens when a certain number of bacteria is over the limit?
Healthy tissues can resist the invasion of a certain number of bacteria of a given species, but when that number is exceeded, the organisms get the upper hand and disease results.
What do organisms do when they gain access to the blood-stream?
When the organisms gain access directly to the blood-stream, as a rule they produce their effects more certainly and with greater intensity than when they are introduced into the tissues.
What is the condition of the patient into whose tissues it is introduced?
Further, the virulence of an organism is modified by the condition of the patient into whose tissues it is introduced.
What is the ability of the tissues to resist attacks of bacteria?
So long as a person is in good health, the tissues are able to resist the attacks of moderate numbers of most bacteria.
What is the condition of a person that is in good health?
So long as a person is in good health, the tissues are able to resist the attacks of moderate numbers of most bacteria.
What makes an individual more susceptible to infection?
Any lowering of the vitality of the individual, however, either locally or generally, at once renders him more susceptible to infection.
What is more liable to pus-producing organisms in bruised or torn tissue than tissues clean-cut with a knife?
Thus bruised or torn tissue is much more liable to infection with pus-producing organisms than tissues clean-cut with a knife; also, after certain diseases, the liability to infection by the organisms of diphtheria, pneumonia, or erysipelas is much increased.
What can be enough to turn the scale in the battle between the tissues and bacteria?
Even such slight depression of vitality as results from bodily fatigue, or exposure to cold and damp, may be sufficient to turn the scale in the battle between the tissues and the bacteria.
What can cause a slight depressed state of vitality?
Even such slight depression of vitality as results from bodily fatigue, or exposure to cold and damp, may be sufficient to turn the scale in the battle between the tissues and the bacteria.
What is an important factor in regard to the action of certain bacteria?
Age is an important factor in regard to the action of certain bacteria.
What is the most common disease that young people are exposed to?
Young subjects are attacked by diphtheria, tuberculosis, acute osteomyelitis, and some other diseases with greater frequency and severity than those of more advanced years.
What are some of the pathogenic powers of certain organisms?
In different races, localities, environment, and seasons, the pathogenic powers of certain organisms, such as those of erysipelas, diphtheria, and acute osteomyelitis, vary considerably.
What is the term for a mixed infection?
There is evidence that a  mixed infection  that is, the introduction of more than one species of organism, for example, the tubercle bacillus and a pyogenic staphylococcus increases the severity of the resulting disease.
What happens if one of the varieties gain the ascendancy?
If one of the varieties gain the ascendancy, the poisons produced by the others so devitalise the tissue cells, and diminish their power of resistance, that the virulence of the most active organisms is increased.
What increases the virulence of the most active organisms?
If one of the varieties gain the ascendancy, the poisons produced by the others so devitalise the tissue cells, and diminish their power of resistance, that the virulence of the most active organisms is increased.
What does the poisons produced by the others do?
If one of the varieties gain the ascendancy, the poisons produced by the others so devitalise the tissue cells, and diminish their power of resistance, that the virulence of the most active organisms is increased.
What is an example of an organism that can cause a patch of tblupus to be cured?
On the other hand, there is reason to believe that the products of certain organisms antagonise one another for example, an attack of erysipelas may effect the cure of a patch of tuberculous lupus.
What period precedes death?
Lastly, in patients suffering from chronic wasting diseases, bacteria may invade the internal organs by the blood-stream in enormous numbers and with great rapidity, during the period of extreme debility which shortly precedes death.
What can bacteria invade the internal organs of chronic wasting diseases?
Lastly, in patients suffering from chronic wasting diseases, bacteria may invade the internal organs by the blood-stream in enormous numbers and with great rapidity, during the period of extreme debility which shortly precedes death.
What can be erroneous conclusions drawn from the discovery of such collections of organisms?
The discovery of such collections of organisms on post-mortem examination may lead to erroneous conclusions being drawn as to the cause of death.
What is the name of the process that produces the results of Bacterial Growth?
Results of Bacterial Growth.
What organisms show little tendency to pass far beyond the point at which they gain an entrance to the body?
Some organisms, such as those of tetanus and erysipelas, and certain of the pyogenic bacteria, show little tendency to pass far beyond the point at which they gain an entrance to the body.
What organisms tend to pass to distant parts?
Others, on the contrary for example, the tubercle bacillus and the organism of acute osteomyelitis although frequently remaining localised at the seat of inoculation, tend to pass to distant parts, lodging in the capillaries of joints, bones, kidney, or lungs, and there producing their deleterious effects.
Where do the organisms of acute osteomyelitis often stay?
Others, on the contrary for example, the tubercle bacillus and the organism of acute osteomyelitis although frequently remaining localised at the seat of inoculation, tend to pass to distant parts, lodging in the capillaries of joints, bones, kidney, or lungs, and there producing their deleterious effects.
Where do the organisms of acute osteomyelitis often remain?
Others, on the contrary for example, the tubercle bacillus and the organism of acute osteomyelitis although frequently remaining localised at the seat of inoculation, tend to pass to distant parts, lodging in the capillaries of joints, bones, kidney, or lungs, and there producing their deleterious effects.
In the human subject, what does not occur to a great extent?
In the human subject, multiplication in the blood-stream does not occur to any great extent.
What can be obtained from the blood in some general acute pyogenic infections?
In some general acute pyogenic infections, such as osteomyelitis, cellulitis, etc., pure cultures of staphylococci or of streptococci may be obtained from the blood.
What can be found in pneumococcal and typhoid infections?
In pneumococcal and typhoid infections, also, the organisms may be found in the blood.
What is the cause of the changes that micro-organisms bring about in the parts where they settle?
It is by the vital changes they bring about in the parts where they settle that micro-organisms disturb the health of the patient.
What do micro-organisms disturb in the parts where they settle?
It is by the vital changes they bring about in the parts where they settle that micro-organisms disturb the health of the patient.
What are the chemical products of unknown composition known as?
In deriving nourishment from the complex organic compounds in which they nourish, the organisms evolve, probably by means of a ferment, certain chemical products of unknown composition, but probably colloidal in nature, and known as  toxins .
What is the process by which organisms evolve?
In deriving nourishment from the complex organic compounds in which they nourish, the organisms evolve, probably by means of a ferment, certain chemical products of unknown composition, but probably colloidal in nature, and known as  toxins .
What are some symptoms of blood poisoning?
When these poisons are absorbed into the general circulation they give rise to certain groups of symptoms such as rise of temperature, associated circulatory and respiratory derangements, interference with the gastro-intestinal functions and also with those of the nervous system which go to make up the condition known as blood-poisoning, toxamia, or  bacterial intoxication .
What bacteria produce toxins that give rise to definite and distinct groups of symptoms?
In addition to this, certain bacteria produce toxins that give rise to definite and distinct groups of symptoms such as the convulsions of tetanus, or the paralyses that follow diphtheria.
What are the convulsions of tetanus?
In addition to this, certain bacteria produce toxins that give rise to definite and distinct groups of symptoms such as the convulsions of tetanus, or the paralyses that follow diphtheria.
What are the paralyses that follow diphtheria?
In addition to this, certain bacteria produce toxins that give rise to definite and distinct groups of symptoms such as the convulsions of tetanus, or the paralyses that follow diphtheria.
What is the name of the bacteria that dies?
Death of Bacteria.
What is the result of the accumulation of toxic products of bacteria?
Under certain circumstances, it would appear that the accumulation of the toxic products of bacterial action tends to interfere with the continued life and growth of the organisms themselves, and in this way the natural cure of certain diseases is brought about.
What is the effect of the accumulation of toxic products of bacteria on the organisms?
Under certain circumstances, it would appear that the accumulation of the toxic products of bacterial action tends to interfere with the continued life and growth of the organisms themselves, and in this way the natural cure of certain diseases is brought about.
What is the most powerful agent that can kill bacteria?
Outside the body, bacteria may be killed by starvation, by want of moisture, by being subjected to high temperature, or by the action of certain chemical agents of which carbolic acid, the perchloride and biniodide of mercury, and various chlorine preparations are the most powerful.
What is the name of the disease that is immune?
Immunity.
Some people are insusceptible to what?
Some persons are insusceptible to infection by certain diseases, from which they are said to enjoy a  natural immunity .
What does one attack protect from?
In many acute diseases one attack protects the patient, for a time at least, from a second attack  acquired immunity .
What is the name of the second attack?
In many acute diseases one attack protects the patient, for a time at least, from a second attack  acquired immunity .
What is the name of the disease that causes phagocytosis?
Phagocytosis.
What is the process of ingesting bacteria and destroying them?
In the production of immunity the leucocytes and certain other cells play an important part in virtue of the power they possess of ingesting bacteria and of destroying them by a process of intra-cellular digestion.
What is the process of destroying bacteria called?
In the production of immunity the leucocytes and certain other cells play an important part in virtue of the power they possess of ingesting bacteria and of destroying them by a process of intra-cellular digestion.
What are macrophages?
To this process Metchnikoff gave the name of  phagocytosis , and he recognised two forms of  phagocytes : (1) the  microphages , which are the polymorpho-nuclear leucocytes of the blood; and (2) the  macrophages , which include the larger hyaline leucocytes, endothelial cells, and connective-tissue corpuscles.
What is phagocytosis?
To this process Metchnikoff gave the name of  phagocytosis , and he recognised two forms of  phagocytes : (1) the  microphages , which are the polymorpho-nuclear leucocytes of the blood; and (2) the  macrophages , which include the larger hyaline leucocytes, endothelial cells, and connective-tissue corpuscles.
What are microphages?
To this process Metchnikoff gave the name of  phagocytosis , and he recognised two forms of  phagocytes : (1) the  microphages , which are the polymorpho-nuclear leucocytes of the blood; and (2) the  macrophages , which include the larger hyaline leucocytes, endothelial cells, and connective-tissue corpuscles.
What are hyaline leucocytes?
To this process Metchnikoff gave the name of  phagocytosis , and he recognised two forms of  phagocytes : (1) the  microphages , which are the polymorpho-nuclear leucocytes of the blood; and (2) the  macrophages , which include the larger hyaline leucocytes, endothelial cells, and connective-tissue corpuscles.
What is the process of phagocytosis?
During the process of phagocytosis, the polymorpho-nuclear leucocytes in the circulating blood increase greatly in numbers ( leucocytosis ), as well as in their phagocytic action, and in the course of destroying the bacteria they produce certain ferments which enter the blood serum.
What do the leucocytes produce in the blood?
During the process of phagocytosis, the polymorpho-nuclear leucocytes in the circulating blood increase greatly in numbers ( leucocytosis ), as well as in their phagocytic action, and in the course of destroying the bacteria they produce certain ferments which enter the blood serum.
What do the leucocytes destroy?
During the process of phagocytosis, the polymorpho-nuclear leucocytes in the circulating blood increase greatly in numbers ( leucocytosis ), as well as in their phagocytic action, and in the course of destroying the bacteria they produce certain ferments which enter the blood serum.
What are the two names for opsonins?
These are known as  opsonins  or  alexins , and they act on the bacteria by a process comparable to narcotisation, and render them an easy prey for the phagocytes.
What is the process of alexins similar to?
These are known as  opsonins  or  alexins , and they act on the bacteria by a process comparable to narcotisation, and render them an easy prey for the phagocytes.
What is the process of opsonins similar to?
These are known as  opsonins  or  alexins , and they act on the bacteria by a process comparable to narcotisation, and render them an easy prey for the phagocytes.
What is the term for Artificial Immunity?
Artificial or Passive Immunity.
What can induce an animal to become immune?
A form of immunity can be induced by the introduction of protective substances obtained from an animal which has been actively immunised.
What protects an animal against a disease when transferred to the body of a susceptible animal?
The process by which passive immunity is acquired depends upon the fact that as a result of the reaction between the specific virus of a particular disease (the  antigen ) and the tissues of the animal attacked, certain substances  antibodies  are produced, which when transferred to the body of a susceptible animal protect it against that disease.
What is produced as a result of the reaction between the specific virus of a particular disease and the tissues of the animal attacked?
The process by which passive immunity is acquired depends upon the fact that as a result of the reaction between the specific virus of a particular disease (the  antigen ) and the tissues of the animal attacked, certain substances  antibodies  are produced, which when transferred to the body of a susceptible animal protect it against that disease.
What is the process by which passive immunity is acquired?
The process by which passive immunity is acquired depends upon the fact that as a result of the reaction between the specific virus of a particular disease (the  antigen ) and the tissues of the animal attacked, certain substances  antibodies  are produced, which when transferred to the body of a susceptible animal protect it against that disease.
What are the most important of these antibodies?
The most important of these antibodies are the  antitoxins .
What are the two main methods of treating certain infective diseases?
From the study of the processes by which immunity is secured against the effects of bacterial action the serum and vaccine methods of treating certain infective diseases have been evolved.
What is the purpose of the serum treatment?
The  serum treatment  is designed to furnish the patient with a sufficiency of antibodies to neutralise the infection.
What act by neutralising the specific toxins of the disease antitoxic serums?
The anti-diphtheritic and the anti-tetanic act by neutralising the specific toxins of the disease  antitoxic serums ; the anti-streptcoccic and the serum for anthrax act upon the bacteria  anti-bacterial serums .
What act upon the bacteria anti-bacterial serums?
The anti-diphtheritic and the anti-tetanic act by neutralising the specific toxins of the disease  antitoxic serums ; the anti-streptcoccic and the serum for anthrax act upon the bacteria  anti-bacterial serums .
What is a polyvalent serum?
A  polyvalent  serum, that is, one derived from an animal which has been immunised by numerous strains of the organism derived from various sources, is much more efficacious than when a single strain has been used.
What is the name of the product that is used for clinical use?
Clinical Use of Serums.
What must be taken to prevent contamination of the serum or of the apparatus by which it is injected?
Every precaution must be taken to prevent organismal contamination of the serum or of the apparatus by means of which it is injected.
What is the process of making syringes?
Syringes are so made that they can be sterilised by boiling.
How can syringes be sterilised?
Syringes are so made that they can be sterilised by boiling.
Where should the skin be purified?
The best situations for injection are under the skin of the abdomen, the thorax, or the buttock, and the skin should be purified at the seat of puncture.
What is the best place for injection?
The best situations for injection are under the skin of the abdomen, the thorax, or the buttock, and the skin should be purified at the seat of puncture.
How much of the full dose should be divided and injected into different parts of the body?
If the bulk of the full dose is large, it should be divided and injected into different parts of the body, not more than 20 c.c.
What should be injected into different parts of the body?
If the bulk of the full dose is large, it should be divided and injected into different parts of the body, not more than 20 c.c.
At what place is the injection of the drug?
being injected at one place.
What is the most common place that serum is introduced into a vein?
The serum may be introduced directly into a vein, or into the spinal canal,  e.g.
What is another way that serum is introduced into a spinal canal?
The serum may be introduced directly into a vein, or into the spinal canal,  e.g.
What is the duration of the immunity produced by injections of antitoxic sera?
The immunity produced by injections of antitoxic sera lasts only for a comparatively short time, seldom longer than a few weeks.
What is the name of the disease that causes anaphylaxis?
"Serum Disease" and Anaphylaxis.
What is the name of the rash that may occur after an injection?
It is to be borne in mind that some patients exhibit a supersensitiveness with regard to protective sera, an injection being followed in a few days by the appearance of an urticarial or erythematous rash, pain and swelling of the joints, and a variable degree of fever.
What is the name of the disease that causes the symptoms of serum disease?
These symptoms, to which the name  serum disease  is applied, usually disappear in the course of a few days.
What is the nature of profound shock?
When a second injection is given after an interval of some days, if anaphylaxis has been established by the first dose, the patient suddenly manifests toxic symptoms of the nature of profound shock which may even prove fatal.
What may even prove fatal when a second injection is given?
When a second injection is given after an interval of some days, if anaphylaxis has been established by the first dose, the patient suddenly manifests toxic symptoms of the nature of profound shock which may even prove fatal.
What happens when a second injection is given after an interval of some days?
When a second injection is given after an interval of some days, if anaphylaxis has been established by the first dose, the patient suddenly manifests toxic symptoms of the nature of profound shock which may even prove fatal.
What is the condition that makes a person liable to develop anaphylaxis?
The conditions which render a person liable to develop anaphylaxis and the mechanism by which it is established are as yet imperfectly understood.
What is the mechanism by which anaphylaxis is established?
The conditions which render a person liable to develop anaphylaxis and the mechanism by which it is established are as yet imperfectly understood.
What is the name of the vaccine that is used to treat HIV?
Vaccine Treatment.
What does the vaccine treatment render the bacteria in the tissues less able to resist?
The vaccine treatment elaborated by A. E. Wright consists in injecting, while the disease is still active, specially prepared dead cultures of the causative organisms, and is based on the fact that these "vaccines" render the bacteria in the tissues less able to resist the attacks of the phagocytes.
Who developed the vaccine treatment?
The vaccine treatment elaborated by A. E. Wright consists in injecting, while the disease is still active, specially prepared dead cultures of the causative organisms, and is based on the fact that these "vaccines" render the bacteria in the tissues less able to resist the attacks of the phagocytes.
What is the most successful method of vaccine preparation?
The method is most successful when the vaccine is prepared from organisms isolated from the patient himself,  autogenous vaccine , but when this is impracticable, or takes a considerable time, laboratory-prepared polyvalent  stock vaccines  may be used.
What is the clinical use of vaccines?
Clinical Use of Vaccines.
What is the effect of a certain amount of opsonin in the blood on the opsonic index?
Vaccines should not be given while a patient is in a negative phase, as a certain amount of the opsonin in the blood is used up in neutralising the substances injected, and this may reduce the opsonic index to such an extent that the vaccines themselves become dangerous.
What is used up in the blood to neutralise the injections?
Vaccines should not be given while a patient is in a negative phase, as a certain amount of the opsonin in the blood is used up in neutralising the substances injected, and this may reduce the opsonic index to such an extent that the vaccines themselves become dangerous.
What can determine the propriety of using a vaccine?
As a rule, the propriety of using a vaccine can be determined from the general condition of the patient.
What should the initial dose be?
The initial dose should always be a small one, particularly if the disease is acute, and the subsequent dosage will be regulated by the effect produced.
What will determine the subsequent dosage?
The initial dose should always be a small one, particularly if the disease is acute, and the subsequent dosage will be regulated by the effect produced.
What indicates a negative phase of a vaccine?
If marked constitutional disturbance with rise of temperature follows the use of a vaccine, it indicates a negative phase, and calls for a diminution in the next dose.
What indicates a positive phase?
If, on the other hand, the local as well as the general condition of the patient improves after the injection, it indicates a positive phase, and the original dose may be repeated or even increased.
What may be repeated or increased if the local and general condition of the patient improves after the injection?
If, on the other hand, the local as well as the general condition of the patient improves after the injection, it indicates a positive phase, and the original dose may be repeated or even increased.
What is the reason for a local reaction?
Vaccines are best introduced subcutaneously, a part being selected which is not liable to pressure, as there is sometimes considerable local reaction.
What is the best way to introduce a vaccine?
Vaccines are best introduced subcutaneously, a part being selected which is not liable to pressure, as there is sometimes considerable local reaction.
What is the part of the vaccine that is not liable to pressure?
Vaccines are best introduced subcutaneously, a part being selected which is not liable to pressure, as there is sometimes considerable local reaction.
What may be necessary at intervals of a few days?
Repeated doses may be necessary at intervals of a few days.
What has been successfully employed in various lesions caused by bacteria?
The vaccine treatment has been successfully employed in various tuberculous lesions, in pyogenic infections such as acne, boils, sycosis, streptococcal, pneumococcal, and gonococcal conditions, in infections of the accessory air sinuses, and in other diseases caused by bacteria.
What is a gonococcal condition?
The vaccine treatment has been successfully employed in various tuberculous lesions, in pyogenic infections such as acne, boils, sycosis, streptococcal, pneumococcal, and gonococcal conditions, in infections of the accessory air sinuses, and in other diseases caused by bacteria.
What is a pyogenic infection?
The vaccine treatment has been successfully employed in various tuberculous lesions, in pyogenic infections such as acne, boils, sycosis, streptococcal, pneumococcal, and gonococcal conditions, in infections of the accessory air sinuses, and in other diseases caused by bacteria.
What is an accessory air sinus infection?
The vaccine treatment has been successfully employed in various tuberculous lesions, in pyogenic infections such as acne, boils, sycosis, streptococcal, pneumococcal, and gonococcal conditions, in infections of the accessory air sinuses, and in other diseases caused by bacteria.