English
But if it is 334 ANCIENT HINDU MEDICINE strong enough, to destroy a few cells, then I there is a vaso-dilatation, a serous exudation 1 ( edema ) to dilute the toxin and to prevent J its absorption. But if these wounds are not kept in aseptic j condition, the ubiquitous pus coccus {staphy¬ lococcus or streptococcus ), finding favourable medium, starts a colony. It not only multiplies rapidly, but also engenders toxins which cause death of the cells of the region, thus creating a necro-biotic area, surrounded by a prolifera¬ tive zone of the healthy tissues. Struggle now , begins between the invading hosts and the healthy tissues. If the victory is quick with the latter, then the inflammation gradually subsides. But if the tissues lack the resisting power and the bodily defensive mechanism is not powerful or prompt in its response, then leucocytes circumscribe the infection, round the dead cells, so that the general economy can not be affected, and they can fight more conveniently against the microbes and replace the fallen defenders. Coincidentlv the nervous terminations are aroused by the microbic toxins and their excitation gives rise to a series of reflex acts which ending in the active dilatation of the vessels of the invaded area, are follow- DISEASES 335. €(1 by migrations of the leucocytes and the formation of the serous exudate. If the pu.s cocci gain the upper hand, the cells that are killed undergo liquefaction and are converted into the pus^ so that an abscess results. This soon coagulates and a creamy substance is formed which softens towards the centre. And if it be not now evacuated, the softened area increases in size, the skin over it is thinned , and mortified, and a small slough is formed, through which the pus escapes and the tension is relieved. If the pus cavity contains a ropy fibrile core, as in a boil or carbuncle, it indi¬ cates that the cells have been destroyed in mass by a virulent agent, and of the dead cells, the core is composed. After the escape of the pus, a space—the abscess cavity, is left, the walls of which are lined with vascular or granulation tissues, which escaped destruction, and which slowly fill the contracting cavity and obliterate it by forming interstitial scar-tissues. But if the abscess be deeply situated and be not able to open on to a free surface, thus allowing the pus to be drained off, the phago¬ cytes mobilize all their forces, surround the necrotic area and make an advance from all sides. The vanguard of the advancing army is 336 ANCIENT HINDU MEDICINE composed of a more or less compact layer of the mono-nuclear phagocytes (polyblasfs) accom¬ panied by numerous new vessels which bring the food-supply for the phagocytic scavengers who voraciously ingest all the enemy microbes as well as the injured and dead cells, and carry out their removal from the fighting zone. They also drain off the toxie fluid of the disintegra¬ ting cells. Behind the polyhlasts, are seen in mighty battle array, the fibroblasts or connecting . tissue cells in active proliferation, and with their fibrous laminjB shut off the abscess from the healthy tissues, and with the absorption of the pus, encroach on the pus area. With the absorption of the pus, the abscess cavity is replaced by the fibrous tissue, forming the cicatrical scar. But in case the phagocytes lack the necessary vitality for the operation, the abscess burrows through and forms a dangerous fistula ( visarpa na4l ). Tumors are developed in these eight places : skin (pustular inflammations : acne, ecthymoses, variola ; subcutaneous inflammation : erysipelas, Dczema; vesicular lesions (herpes) or bullse varicella, pempigus ), flesh ( 7 nyxoma = tuinov of mucous tissue = tumor of fibi’ous tissue; lipoma =tumor of adipose tissue •. myoma = tumor DISEASES 837 of muscular tissue ), vessels ( angioma —tumor composed of blood vessels ; endothelioma —tumor originating from the endothelium or lining cells of the vascular tissue; hemangioendothelioma = tumor of endothelium of the blood-vessel; lym- phangioendothelioma = txxmov of the endothelium, of the lymphatic vessel; endothelioma = tumor composed of both endothelial and muscular elements; lymphangioma=txxmo'C oi the lymph¬ atic vessels ; aneurism = a blood-containing tumor connecting directly with the lumen of the artery or formed by circumscribed enlargement either axial or lateral, of an artery ) ligament {snayu perhaps included soft cartilage: ehondroma = cartilaginous tumor), bone { osteoma =honj tumor; odontoma = tumor of dental structure), joints {arthromeningitis = inQ.AmradJb{on of the joints; synovitis = inflammation of the synovial membrane, especially that of a joint), nerve' {sndyu-. neuroma ^twcao): in connection with nerves ; glioma = neuroglial tumor ), viscera. (^papilloma, adenoma tumors; carci¬ noma is maligant ) and in vital organs.” Susruta 1 . 22 . 2 '^® . 148. l: 22 338 ANCIENT HINDU MEDICINE “Now we shall describe the exudation of tumors. If the skin is bruised or lacerated, or in skiu-tumors (varicella, acne, eczema etc.), whether spontaneously or when lanced, an aquatic, slightly acid-smelling and light-yellowish exuda¬ tion (serous fluid mixed with sebaceous secretion) comes out. The evacuation of an abscess in the flesh, is like clarified butter, thick, whitish and slimy {caseous or cheesy pus —a very thick, almost solid pus resulting from the absorption of the liquor puris). In a recent incision of a blood vessel there is an excessive bleeding from the vascular swelling ; if it suppurates, the pus flows from it as from a water-pipe (toya-nadi), thin, unmixed, viscous, flaky (caseous flakes consisting of necrosed or sphacelated cells and fatty acids, floating upon the serous fluid) and has a pale brownish color (serous or curdy pus). The exudation from a *sndyu* ( nerve or ligament tumor ) is creamy, thick, mixed with blood and is like the mucous from the nose (phlegmonous or laudable pus which is a yellowish-white, creamy, thick and odorless liquid ). If a bone is wounded or fractured, a kind of pearly white exudation comes out; but that of an osseous tumor is mixed with bone-marrow, blood and fat (the pus of osseous origin contains fat and often small splinters of DISEASE* 339 l)one ). If an inflammatory joint (tumous joint) is pressed, no exudation comes out; but on contraction, extension,standing on tlie toes, sitting low, pressure sitting, spasmic tension brings out an exudation which is viscous, flaky, foamy and is mixed with blood and pus (suppurated synovia). From the visceral tumors, are evacuated blood, urine, fecal matters, j)us and serous fluid (there may be found in pus foreign bodies, tissue frag¬ ments, elastic fibers, animal or vegetable parasites, hydatids, actinomycets, organic liquids, bile, milk, urine, fecal matters and alimentary fragments. Their finding is of great importance from a semiological standpoint, indicating as to the origin of pus and as to the possibility of organic fistula). As to the exudations of the tumors of the vital organs, nothing is mentioned, for they belong to the same category of tumors of the skin and flesh (mucous membrane and the muscular and adipose tissues). Smruta I. 22. 149. 1 5?^ m 3 firitira: 510^31505 ftftra 'ms ghrrniR, 5;*n^sg:^5rr!r- 340 ANCIENT HINDU MEDICINE The color of the pus is no less variable {Siisruta IV. 1. 8-17 ). Usually yellowish, it may be of orange, brownish red or greenish color. There is no suppuration presenting blue color, but it is- occasionally seen due to the pigment produced by bacillus pyocyaneus which is not pyogenic by itself. However, there is no relation between the color of the pus and the cause which develops it, but on the locality where it is formed and imbibe the coloring matter, with the only exceptioQ of the siippui’ationof the pneumococcie origin, which is thick, greenish and rich in fibrine, often having the aspect of the false membrane. In subcutaneous or pleural collections the pus is phlegmonous, thick ; in meningeal membranes of the bi*ain, it is greenish ; in the- liver, of the chocolate color ; and reddish in the I i awurar- DISEASES 341 lung. When it is of osseous origin, it often contains fat and small splinters of bone. If it takes origin in the glands of the skin, it produces a furuncle or a carbuncle-lesion, remarkable for the presence of sphacelated fragments of the cellular tissue, which constitutes the core. Fyogenic agents : Pyogenic agents which can eause suppuration are numerous. (1) Bacteria habitually pyogenic ; Staphylococcus aureus and albus, streptococcus, pneumococcus, colon bacillus and micrococcus tetragons are normally encountered upon our integuments and though in healthy condition of the tissues they usually live a harmless saprophatic or vegetative life, yet when the tissues are damaged or injured, and therefore are incapable of offering natural resist¬ ance to encroachment, they ai’o particularly apt to provoke suppuration. Of them staphylococci are the most common pathologic agents, but take nearly 250,000,000 to 1,000,000,000 of them to provoke an abscess. (2) Specific pyogenic bacteria are yet reeoguized to be only three, namely : gonoeoccus, the bacillus of soft chancre and the bacillus glanders. (3) Bacteria accidentally pyogenic are those which cause specific and well differentiated lesions of their own, but may, also, cause suppuration under 342 ANCIENT HINDU MEDICINE certain conditions, as the tubercle bacillus causes- cold abscess, and typhoid bacillus pus in the- bone, (4) Pyogenic fungi are the streptothrix,. pergillus and odium.