Scree

“ In chapter xiii., we are told that “if a man has a bright spot deeper than the skin of the flesh, the hair on which has turned white, or the white spot has a raw in it, and the scab be spread in the skin—then shall the priest pronounce him unclean.” But, if he have all the above symptoms, and “the scabs do not spread, or, if he be covered from head to foot—as white as snow—with the disease, then shall the priest pronounce him clean. ”

“ In the case of marked sclerosis, the opening need not be large because, if the bone between the cortex and the antrum be solid, it is hardly probable that infection can spread through it to any outlying cells in the tip of the mastoid or elsewhere. ”

“ Increase of connective tissue is usually found between the fibre bundles and in some cases where the hemorrhages are apparently of long standing, as evidenced by loss of contour of the red cells and pigmentation of the surrounding areas, this scar tissue formation is very marked. ”

“ When the mucous membrane ulcerates the cords grow together, both anteriorly and posteriorly, and when the infiltration disappears there remains a scar tissue, which, by its contraction, reduces the rima to a small slit, a few millimètres wide. ”

“ Diseases of the chest are generally confined to heart, lungs, pleura, the pericardium, mediastium, blood vessels, with nerves and lymphatics. As we open the breast we behold the heart, a very large machine or engine, situated conveniently to throw blood to all parts of the body. To it we see hose or pipes that go to each organ, all muscles, the stomach, bowels, liver, spleen, kidneys, bladder and womb, all bones, fibers, ligaments, membranes, and its body, lungs and brain. ”

“ Every distemper of the body now, is complicated with the spleen, and when we were young men we scarce ever heard of the spleen. In our declinations now, every accident is accompanied with heavy clouds of melancholy; and in our youth we never admitted any. It is the spleen of the minde, and we are affected with vapors from thence; yet truly, even this sadnesse that overtakes us, and this yeelding to the sadnesse, is not so vehement a poison (though it be no Physick neither) as those false waies, in which we sought our comforts in our looser daies. ”

“ The general character of tertiary manifestations may be stated as follows: They attack by preference the tissues derived from the mesoblastic layer of the embryo—the cellular tissue, bones, muscles, and viscera. They are often localised to one particular tissue or organ, such, for example, as the subcutaneous cellular tissue, the bones, or the liver, and they are rarely symmetrical. They are usually aggressive and persistent, with little tendency to natural cure, and they may be dangerous to life, because of the destructive changes produced in such organs as the brain or the larynx. ”

“ A demand for a crucial examination of the skull, the heart, lungs, of the chest, the stomach, liver and other organs of the abdomen is made. The septum of the brain, the pericardium of the chest—the diaphragm of the abdomen which is a dividing septum between the abdomen and chest. In this examination we must know the reasons why any organs, vessel or any other substance is located at a given place. We must run with all the rivers of blood that travel through the system. ”

“ The free surface of the serous system differs essentially from that of the mucous, in this, that it contracts frequent adhesions. The pleura is of all the serous organs, that in which these adhesions are the most evident. We find almost as many dead bodies in which they exist, as we do those in which they do not. Next to the pleura is the peritoneum, then the pericardium, then the tunica vaginalis, then the arachnoides, which is that of all the serous surfaces in which adhesions are the least frequent,139 though I have observed them in it. ”

“ The condition known as arterio-sclerosis, that is, arterial hardening, can be detected by the finger at the wrist, or by the eye in the branch of the temporal artery, which can so frequently be seen to take its sinuous course on the forehead behind and above the eye. ”

“ And hence, when any impurities arise in the region of the liver by reason of disorders of the body, the loose nature of the spleen, which is composed of a hollow and bloodless tissue, receives them all and dears them away, and when filled with the unclean matter, swells and festers, but, again, when the body is purged, settles down into the same place as before, and is humbled. ”

“ They are divisible into the universal and the particular—those which are everywhere present and those which occupy special places. The blood which a scratch brings out shows us that the vascular system sends branches into each spot. The sensation accompanying a scratch proves that the nervous system, too, has there some of its ultimate fibrils. Unobtrusive, and yet to be found at every point, are the ducts of the lymphatic system. And in all parts exists the connective tissue—an inert tough substance which, running through interspaces, wraps up and binds together the other tissues. ”

“ In long continued cases the skin and subcutaneous tissues become thickened by the formation of scar tissue, due to the presence of the involucrum and the persistence of sinuses, and by thickening of the soft tissues, an affected limb may for years be nearly twice its normal size. ”

“ Less frequently the trabecular framework is added to by the formation of new bone, resulting in a remarkable degree of sclerosis, and if, following upon this, there is caseation of the tubercle and death of the affected portion of bone, there results a sequestrum often of considerable size and characteristic shape, which, because of the sclerosis and surrounding endarteritis, is exceedingly slow in separating. ”

“ The spleen, Gilbert says, is sometimes the name of an organ, sometimes of a disease. As an organ it is spongy and loose in texture, and attracts and retains the superfluities of the black-bile, expelled from the liver for its own cleansing. ”

“ The mucous membrane of the larynx may be the seat of mucous patches or of catarrh, and as a result the child's cry is hoarse.
_Affections of the Bones._--Swellings at the ends of the long bones, due to inflammation at the epiphysial junctions, are most often observed at the upper end of the humerus and in the bones in the region of the elbow. Partial displacement and mobility at the ossifying junction may be observed. The infant cries when the part is touched; and as it does not move the limb voluntarily, the condition is spoken of as _the pseudo-paralysis of syphilis_. ”

“ If the Inflammation that ariseth in the Part be follow'd with Suppuration, it must be dress'd with a small Tent; and if the Suppuration be considerable, it is necessary to dilate the Wound, and to make use of Oil of Eggs and Brandy, or Arcæus's Liniment, with a good Digestive; as also to apply Emplastrum Ceratum; to make an Embrocation on the Arm with Oil of Roses; and to dip the Bolsters in Oxycratum to cover the whole Part.
Is it not to be fear'd that some Nerve may be wounded in letting Blood? ”

“ And this goes on until you have left in the clot very little besides corpuscles entangled in a network of fibrin, and all the rest of the blood has been squeezed outside the clot, and is then called serum. Serum, then, is blood out of which the corpuscles have been strained by the process of clotting.
Now I dare say you are ready to ask the question, If blood clots so readily when it is shed, why does it not clot inside the body? Why is our blood ever{48} fluid? This is rather a difficult question to answer. When blood is shed from the warm body it soon gets cool. ”

“ The diagnosis is not difficult, for an inequality presents itself to the fingers of the examiner, and there is crepitus with derangement at the fractured part. When the fractured parts incline inwards there is a violent pungent pain, more severe than that in pleurisy, from the pleura being wounded as with a sharp instrument; there is difficulty of breathing, cough, and often vomiting of blood. The other modes of displacement, then, may be rectified by the fingers, but in that inwards this cannot be done, owing to the difficulty of applying distension. ”

“ If you fear that any virus has got in where there is any sore, or where the skin is broken, touch it with carbolic acid.
FRACTURES AND DISLOCATIONS. One of the signs of a FRACTURE is crepitus, the sound made by the rubbing of the ends of broken bones together. This sound cannot always be obtained, even when the bone can be moved so that the ends rub each other, and as such motion causes considerable pain the nurse should not seek for it, except as she harkens when the limb is accidentally or necessarily moved. ”

“ When the body was opened, the spleen was in its normal state, with the veins a little livid only, the lungs yellowish in places, and the brain one-sixth larger than is usual in persons of the same age and sex ”

“ What are the Signs of the Fracture of the two Tables of the Skull, and of the overflowing of the Blood upon the Membranes of the Brain?
They are the loss of the Understanding at the very Moment of receiving the Wound; an Hæmorrhage or Flux of Blood thro' the Nose, Mouth, or Ears; drowsiness and heaviness of the Head, and more especially Vomitting of Phlegm; from whence may be inferr'd the necessity of making use of the Trepan. ”

“ Some constitutions are incapable of resisting any unusual incitement of the vascular system, or of repairing the consequences of the action, or of any injury, in whatever way inflicted. In such individuals, all the parts of the body are deficient in power—some, however, are more so than others, and, consequently, more readily give way; thus, the lymphatic system, the mucous membranes, the skin, the bones and their coverings, generally suffer in the first instance. ”

“ Collections of matter formed on the membrane lining the heart and covering its valves, are liable to be detached and carried by the circulation to the brain, spleen, or liver, where they plug up some artery, and thus cause death of the parts which it supplies with blood. ”

“ The hair becomes white and woolly, and at length falls off; hard gelatinous swellings are formed in the cellular tissue; the skin gets hard, rough, and seamy, lymph exudes from it, and forms large scabs, which fall off from time to time, and under these there are often offensive running sores. ”

“ During this momentary crush, part of the serum being forced on too fast, oozes through the wall of the over-filled capillaries, as water oozes through the leathern pipes of a fire-engine, and hence probably the appearance of serum or lymph in the organs, where it is immediately sucked up (i. e., absorbed) by the lymphatic vessels. Now, you will easily understand that the larger the proportion of serum in the blood, the greater will be the quantity to be expelled in passing through the capillaries, and the more will the lymphatic vessels swell. ”

“ Examine these surfaces in chronic and acute inflammations, of which they are the seat, in the first especially, they exhibit a vascular net-work, so full of blood, that their redness is often deeper than that of the muscles.
All the organs of which I have spoken above, exhibit the same phenomenon. Observe what takes place in the skin; fine injections show there infinitely more vessels than are filled with blood in a natural state; the face of a child well injected, is wholly black. ”

“ The presence of a ball, a piece of bone, or of any other substance, lying upon or rolling about on the pleura covering the diaphragm, must give rise to more or less irritation and inflammation, and consequently to suppuration, or the formation of matter upon the surface of that membrane in its thickened state, until, in all probability, the foreign substance has been removed or the person has wasted away and perished. ”

“ To let out the Matter, the Patient must be oblig'd to lean on one side, stopping his Mouth and Nose, and puffing up his Cheeks, as if he were to blow vehemently; then if Blood appears, a greater quantity of it may be taken away than if it were Matter, in regard that a Flux of Matter weakens more than that of Blood. ”

“ The principal part of the malarial drama is played out in the spleen, liver, bone marrow, brain, etc., and not in the general circulation. What is seen in finger blood is but an overflow, as it were, of the greater drama going forward in the viscera. ”

“ It is drawn on one side when the menses are hindered from flowing, and the veins and arteries are full, namely, those that go to the womb. If it be a mole on one side, the liver and spleen cause it; by the liver veins on the right side, and the spleen on the left, as they are more or less filled. ”

“ This pulp contains small spherical masses of adenoid tissue, forming the Malpighian corpuscles, situated on the terminal branches of the splenic blood-vessels, together with numerous cells, some of which are red blood corpuscles, others lymph corpuscles, others contain pigment granules or fat, while others have in their interior numerous blood corpuscles. The arteries of the spleen in part end in capillaries from which the veins arise, but more frequently they open into lacunae or blood spaces, which give origin to the veins. ”

“ But you ought first to divide that part of the flesh where no great arteries and veins are situated, cutting them down to the bone, which is to be sawn across as quickly as possible, the fleshy parts in the mean time being retracted with a piece of linen, lest the saw should tear them and occasion bleeding and pain; when the bone is sawn across, whatever portion of the flesh remains undivided is to be cut, and then the veins and arteries are to be burned. When the bleeding is stopped a pledget with suitable bandages is to be applied. ”

“ Bleeding or hemorrhage is the most constant symptom. The degree of hemorrhage depends on the kind, number and size of the blood-vessels severed. In arterial hemorrhage, the blood is bright red and spurts from the mouth of the cut vessel. In venous hemorrhage, the blood is darker and flows in a continuous stream. In abrasions and superficial wounds capillary hemorrhage occurs. Death may follow severe hemorrhage. ”