Lesion

“ It will be enough for my present purpose to say, in brief, that the lesion consisted of an internal growth which is always dangerous and most often fatal, but which nevertheless is of such a character that, if it be once happily eradicated by supremely good surgery, it never tends to recur, and leaves the patient as strong and well as ever. ”

“ The Primary Lesion.—The incubation period having elapsed, there appears at the site of inoculation a circumscribed area of infiltration which represents the reaction of the tissues to the entrance of the virus. The first appearance is that of a sharply defined papule, rarely larger than a split pea. Its surface is at first smooth and shiny, but as necrosis of the tissue elements takes place in the centre, it becomes concave, and in many cases the epithelium is shed, and an ulcer is formed. ”

“ When the lesion is above the pons and is irritative, as in the early stage of hemorrhage, the deviation is toward the side of the body affected and away from the lesion; when paralysis is established, away from the paralysis and toward the lesion. ”

“ Disease of the bones, whether hereditary or acquired, is an essential descriptive element in reconstituting individuality. Caries and necrosis, rickets, spinal disease, ankylosis, and other external manifestations of bone lesion may furnish pointers of such value as often to be incontestible. They are so evident as not to require detailed mention; but much care in such cases is necessary to distinguish between disease, decay, and violence, and artefacta. ”

“ Perforating Ulcer of the Foot occurs in connection with lowered resisting powers of the tissues, due usually to some lesion of the nerves or vessels. The ulcer is circular in shape, painless, with callous borders, and eats progressively into the deeper tissues and bones, and has little or no tendency to heal. ”

“ It is important to find out the organic lesion which in all probability served as a starting point for the functional disease, and important to remove or abolish this lesion however minute if a complete and lasting cure is to be obtained. ”

“ The lesion consists in an overgrowth of epidermis which often presents an alveolar arrangement. Moles vary greatly in size: some are mere dots, others are as large as the palm of the hand, and occasionally a mole covers half the face. ”

“ The lesions or injuries of the body which form so prominent a part of disease vary in kind, degree and situation, depending upon the character of the injurious agent, the duration of its action and the character of the tissue affected. The most obvious injuries are those produced by violence. By a cut, blood vessels are severed, the relations of tissues disturbed, and at the gaping edges of the wound the tissue usually protected by the skin is exposed to the air, resulting in destruction of the cells contained in a thin layer of the surface. ”

“ The regions commonly invaded are the face, neck, chest, mammæ, back, abdomen, arms, and thighs. The lesions pursue a variable though usually chronic course, lasting, as a rule, years. There is always a marked tendency to varied atrophic changes, which in most cases appear early, the skin becoming thin, shrivelled, or parchment-like, later being bound down to the tissues beneath, forming cicatriform, keloidal lesions, which may cause contraction and deformity, with, in some cases, wasting and general atrophy, more particularly of the extremities. ”

“ They are usually associated with slight fever, considerable malaise, and in some cases with articular pains. Both legs are commonly affected, and rarely are the lesions found elsewhere. In some cases, however, the lesions are numerous and found upon the thighs as well as the legs (Fig. 54) , and in rare instances the forearms may be affected. The lesions are at first of a bright-red hue, but soon become dull red or purplish, and usually disappear in a week or two. New lesions sometimes continue to appear and prolong the duration of the disease. ”

“ Further, that such a lesion in the lower extremity is much more readily recognized than one in the upper extremity, since even slight alterations in the bony tissues of the lower extremity, because of [Pg 59] functional disturbances in walking and running, make themselves manifest. ”

“ The bone lesions usually occur during the seventh or eighth week of the fever, but have been known to occur much later. The chief complaint is of vague pains, at first referred to several bones, later becoming localised in one; they are aggravated by movement, or by handling the bone, and are worst at night. There is redness and œdema of the overlying soft parts, and swelling with vague fluctuation, and on incision there escapes a yellow creamy pus, or a brown syrupy fluid containing the typhoid bacillus in pure culture. Necrosis is exceptional. ”

“ This ulcer is of the Oriental sore type, and after some months, or even as long as two years, heals up, leaving a thick scar. While the ulcer is open, or more often after it has healed, lesions appear on the mucosa of the mouth and nose. The hard and soft palate, gums and lips all may be attacked. The mucosa of the nose is usually attacked and the cartilages become destroyed, producing great deformity. In bad cases the pharynx and larynx may become infected. ”

“ Lesions: in joints, synovia, serosa, articular cartilage, fibro-cartilage, articular lamella, bone, eburnation, ligaments, joints affected in horse and ox, blood changes, albumen, fibrine, blood globules, pericardium, endocarditis, valvular disease, myocarditis, embolisms in lungs, pleura, nervous lesions, digestive system.
Definition. A constitutional, inflammatory affection, probably toxic, tending to localization in the joints, muscles, tendons, fascia, skin, heart and serous membranes and with a marked disposition to shift from place to place. ”

“ And if at the same time some swelling appears in the vicinity of the eyes, or if a bloody and purulent discharge begins to flow from the nose or the ears, he may not merely entertain a belief that his diagnosis is correct, but may assert with positiveness that the lesions just named really exist. ”

“ Hysterical Cutaneous Conditions.—There are certain cracks of the skin with ulcerative lesions which occur in hysterical patients in the neighborhood of the knuckles that represent a phase of unfavorable influence of the mind. When these patients begin to worry or be anxious they know that these skin lesions will follow. Expectancy seems to make it certain that the lesions will come and attention adds to their chronicity. ”

“ Anomalies, defects, erosions, ulcers, evidences of trauma, inflammations, abscesses, tubercles, gummata, neoplasms, parasites, and all forms of pathologic changes, local or general, must be accurately located and described. The changes [Pg 40] peculiar to certain diseases and infections must always be borne in mind during the examination of any organ in which such conditions are likely to be found. The relationship of lesions in different parts of the body must be recognized. Localized lesions must be described according to position, size, form, color, consistence, etc. ”

“ An acute, subacute or chronic inflammatory disease, characterized in the beginning by the appearance of erythema, papules, vesicles or pustules, or a combination of these lesions, with a variable amount of infiltration and thickening, terminating either in discharge with the formation of crusts, in absorption, or in desquamation, and accompanied by more or less intense itching and a feeling of heat or burning. ”

“ Lesions.—The characteristic lesions of hemorrhagic septicemia consist of hemorrhagic areas in the subcutaneous, subserous, and muscular tissues, the lymph glands, and the viscera; in fact, they are distributed more or less widely throughout the body and vary in size from a mere speck to the diameter of a half dollar or even larger. The superficial form presents itself first as a doughy tumefaction of the skin about the region of the throat, neck, dewlap, or legs, which pits on pressure. ”

“ They are produced by crushing, biting, or tearing forms of violence—such as result from machinery accidents, firearms, or the bites of animals. In addition to the irregular wound of the integument, there is always more or less bruising of the parts beneath and around, and the subcutaneous lesions are much wider than appears on the surface. ”

“ PATHOLOGY.—The alterations in the constitution of the blood are identical with those in anæmia and hydræmia, and produce similar effects. Evidences of fatty degeneration are found in the musculature of the heart, intima of the arteries, and portions of the capillary walls; retinal hemorrhages are constant lesions. The number of white corpuscles is not increased, and signs of leukæmia—splenic tumor, swelling of the lymphatic glands—are wanting. ”

“ The possibility of the foreign body being coughed out after suppurative processes have loosened its impaction is too remote; and the lesions established may result fatally even after the expulsion of the object. ”

“ Book I. is devoted to affections of the cranium, eruptions on the head, eye diseases, ear diseases (snaring of ear polypi) , nasal polypi, abscesses in the axilla, affections of the mammary gland, tumors in different parts of the body, venereal lesions in the groin, and a long list of other surgical maladies. Book II. describes wounds of all sorts, including those produced by arrows (with reports of cases) , penetrating wounds of the chest and abdomen (with instructions about sewing both longitudinal and transverse wounds of the intestine) , etc. ”

“ The upper part of the body is covered with frequent spots and tumours, the redness gradually changes to black, the skin is thickened, and covered with hard asperities like scales; the body wastes, but the face, legs, and feet swell; and when the disease is protracted, the fingers and toes become buried in the swelling, and a slight fever comes on, which finishes the patient’s sufferings. Such is his description of the disease. His treatment consists in bleeding at the commencement, abstinence, then supporting the strength, purging, exercise, sudorifics, and friction. ”

“ For example, the pain caused by an inflammation of the skin is usually described as of a burning or itching character; that of inflammation in dense tissues like periosteum or bone, or in encapsuled organs, as dull, boring, or aching. When inflammation is passing on to suppuration the pain assumes a throbbing character, and as the pus reaches the surface, or “points,” as it is called, sharp, darting, or lancinating pains are experienced. Inflammation involving a nerve-trunk may cause a boring or a tingling pain ”

“ As the disease proceeds, matter forms in the joint, and is often attended with great pain and fever; or the pus is effused into the bursæ, into the surrounding cellular tissue, or into the filamentous tissue amongst the tendinous sheaths of the muscles in the neighbourhood; being allowed to remain without an outlet, it at length communicates with the cavity of the joint. Portions of the cartilages are absorbed, though this, as already noticed, may occur at the very commencement of the disease; the subjacent bone becomes affected by ulceration, or perhaps its vitality is partially destroyed. ”

“ There are in my private collection a few specimens of necrosis, in which matter found its way into the neighbouring joint, leading to disease of the tissues composing it, and rendering amputation necessary for the preservation of the patient’s existence. External injury may produce this disease by causing a violent increase of action, or it may be so severe as at once to deprive part of the bone of its vitality. Destruction of the periosteum, and of the vessels which enter the surface of the bone, frequently gives rise to superficial necrosis or exfoliation. ”

“ Sloughing. Inflammation may be accompanied by sloughing or death of tissues. Gangrene, mortification or [Pg 34] necrosis is a death of the tissue from any cause. The part which has died is designated as a slough.
When inflammation has subsided, granulation tissue forms on the living tissue, exerting pressure upon the slough, thus hastening its absorption or separation.
Chronic Inflammation. An interruption at some stage of resolution or suppuration and the continuance of mild symptoms constitutes a chronic state. ”

“ As the result, then, of lowered vitality, a certain area becomes congested and effusion takes place into the tissues. This effusion coagulates and a hard, brawny mass is formed which softens towards the centre. If nothing is done the softened area increases in size, the skin over it becomes thinned, loses its vitality (mortifies) and a small ``slough'' is formed. When the slough gives way the pus escapes and, tension being relieved, pain ceases. A local necrosis or death of tissue takes place at that part of the inflammatory swelling farthest from the healthy circulation. ”

“ Different parts of the cut surface of the same organ should be compared as to color, moisture and dryness. (Areas of suppuration, congestion, œdema, inflammation, recent hemorrhage, hydropic degeneration, liquefaction necrosis, etc., are more moist than normal; old thrombi, fibrinous exudates, old hemorrhages, simple, coagulation, caseous and Zenker’s necrosis, dry gangrene, anæmic and hemorrhagic infarctions, amyloid, concretions of cholesterin, bile-pigment, lime-salts, urates, etc., contents of dermoid cysts and cholesteatomata, etc., are dry.) ”

“ Observe the difference that there is between a gangrene of the soft parts, in which death takes place in a short time, with caries and necrosis of the bones, in which a long period elapses between disease and death of the part. In general we can say, when inflammation exists in a bone, that it is chronic. ”