Alexander Miles

“ The malignancy of cancer depends on the tendency which the epithelium has of invading the tissues in its neighbourhood, and on the capacity of the cells, when transported elsewhere by the lymph or blood-stream, of giving rise to secondary growths.
Cancer may arise on any surface covered by epithelium or in any of the secreting glands of the body, but it is much more common in some situations than in others. It is frequently met with, for example, in the skin, in the stomach and large intestine, in the breast, the uterus, and the external genitals ”

“ Cellulitis is an acute affection resulting from the introduction of some organism—commonly the streptococcus pyogenes—into the cellular connective tissue of the integument, intermuscular septa, tendon sheaths, or other structures. Infection always takes place through a breach of the surface, although this may be superficial and insignificant, such as a pin-prick, a scratch, or a crack under a nail, and the wound may have been healed for some time before the inflammation becomes manifest. ”

“ An ulcer is an open wound or sore in which there are present certain conditions tending to prevent it undergoing the natural process of repair. Of these, one of the most important is the presence of pathogenic bacteria, which by their action not only prevent healing, but so irritate and destroy the tissues as to lead to an actual increase in the size of the sore. Interference with the nutrition of a part by œdema or chronic venous congestion may impede healing; as may also induration of the surrounding area, by preventing the contraction which is such an important factor in repair. ”

“ He is roused from his condition of indifference with difficulty, but answers questions intelligently, if only in a whisper. The face is pale, beads of sweat stand out on the brow, the features are drawn, the eyes sunken, and the cheeks hollow. ”

“ 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. ”

“ Clinical Aspects of Inflammation.—It must clearly be understood that inflammation is not to be looked upon as a disease in itself, but rather as an evidence of some infective process going on in the tissues in which it occurs, and of an effort on the part of these tissues to overcome the invading organisms and their products. The chief danger to the patient lies, not in the reactive changes that constitute the inflammatory process, but in the fact that he is liable to be poisoned by the toxins of the bacteria at work in the inflamed area. ”

“ Treatment of Ulcers.—An ulcer is not only an immediate cause of suffering to the patient, crippling and incapacitating him for his work, but is a distinct and constant menace to his health: the prolonged discharge reduces his strength; the open sore is a possible source of infection by the organisms of suppuration, erysipelas, or other specific diseases; phlebitis, with formation of septic emboli, leading to pyæmia, is liable to occur; and in old persons it is not uncommon for ulcers of long standing to become the seat of cancer. ”

“ Regeneration of Bone.—When bone has been lost or destroyed as a result of injury or disease, it is capable of being reproduced, the extent to which regeneration takes place varying under different conditions. The chief part in the regeneration of bone is played by the osteoblasts in the adjacent marrow and in the deeper layer of the periosteum. The shaft of a long bone may be reproduced after having been destroyed by disease or removed by operation. The flat bones of the skull and the bones of the face, which are primarily developed in membrane, have little capacity of regeneration ”

“ Stripping of large areas of skin is not in itself a reason for removing a limb, as much can be done by skin grafting, but when it is associated with other lesions it favours amputation. In considering these points, it must be borne in mind that the damage to the deeper tissues is always more extensive than appears on the surface, and that in many cases it is only possible to estimate the real extent of the injury by administering an anæsthetic and exploring the wound. ”

“ Sometimes the blood persists as a collection of fluid with a newly formed connective-tissue capsule, constituting a hæmatoma or blood cyst, more often met with in the scalp than in other parts.
The impairment of the blood supply of the skin may lead to the formation of blisters, or to necrosis. Death of skin is more liable to occur in bleeders, and when the slough separates the blood-clot is exposed and the reparative changes go on extremely slowly. Suppuration may occur and lead to the formation of an abscess as a result of direct infection from the skin or through the circulation. ”

“ The patient complains of increasing disability of the limb, movements of the joint becoming more and more restricted and painful. There is swelling corresponding to the distended capsule of the joint, and on palpation the bodies moving under the fingers yield a sensation as of grains of rice shifting in a bag. If the bodies are so numerous as to be tightly packed together, the impression is that of a plastic mass having the shape of the synovial sac. The stiffness and the cracking on movement may suggest arthritis deformans, but the X-ray appearances make the diagnosis an easy one. ”

“ When syphilis is communicated from one individual to another by contact infection, the condition is spoken of as acquired syphilis, and the first visible sign of the disease appears at the site of inoculation, and is known as the primary lesion. Those who have thus acquired the disease may transmit it to their offspring, who are then said to suffer from inherited syphilis. ”

“ If the case is left to nature, the discharge of pus continues, and the track opening on the skin remains as a sinus. The persistence of suppuration is due to the presence in the wall of the abscess and of the sinus, of tuberculous granulation tissue, which, so long as it remains, continues to furnish discharge, and so prevents healing. Sooner or later pyogenic organisms gain access to the sinus, and through it to the wall of the abscess. They tend further to depress the resisting power of the tissues, and thereby aggravate and perpetuate the tuberculous disease. ”

“ The most common exciting cause is increased pressure within the veins, and this may be produced in a variety of ways. In certain diseases of the heart, lungs, and liver, for example, the venous pressure may be so raised as to cause a localised dilatation of such veins as are congenitally weak. The direct pressure of a tumour, or of the gravid uterus on the large venous trunks in the pelvis, may so obstruct the flow as to distend the veins of the lower extremity. It is a common experience in women that the signs of varix date from an antecedent pregnancy. ”

“ 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. ”

“ 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. ”

“ The transference of cancer from one human being to another, whether by accident, as in the case of a surgeon wounding his finger while operating for cancer, or by the deliberate introduction of a portion of cancerous tumour into the tissues, has never been known to occur. It is by no means infrequent, however, that when recurrence takes place after an operation for the removal of cancer, the recurrent nodules make their appearance in the main scar or in the scars of stitches in its neighbourhood. In the lower animals the grafting of cancer only succeeds in animals of the same species ”

“ The raw surface is absolutely insensitive, so that the probe can be freely employed without the patient even being aware of it or suffering the least discomfort—a significant fact in diagnosis. The cavity is filled with effete and decomposing epidermis, which has a most offensive odour. The chronic and intractable character of the ulcer is due to interference with the trophic nerve-supply of the parts, and to the fact that the epithelium of the skin grows in and lines the track leading down to the deepest part of the ulcer and so prevents closure. ”

“ The disease is not attended with any disturbance of the general health; the pathological changes are the same as in infantile rickets, but are for the most part confined to the ossifying junctions, especially those which are most active during adolescence, for example at the knee-joint. The patient is easily tired, complains of pain in the bones, and, unless care is taken, deformity is liable to ensue. There can be no doubt that adolescent rickets plays an important part in the production of the deformities which occur at or near puberty, especially knock-knee and bow-knee. ”

“ 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. ”

“ When the infection becomes active, the contents of the cavity are transformed into a greenish-yellow pus from which the staphylococcus can be isolated, and the cavity is lined by a thin film of granulation tissue which erodes the surrounding bone and so causes the abscess to increase in size. If the erosion proceeds uniformly, the cavity is spherical or oval; if it is more active at some points than others, diverticula or tunnels are formed, and one of these may finally erupt through the shell of the bone or into an adjacent joint. ”