Pure Pus

Pure Pus we believe to be an albuminous exudate, out of which, like other elementary bodies, the pus-cell becomes developed by virtue of a specific conversion. This process, the so-called development of pus out of fluid blastema, occurs upon surfaces - upon mucous membranes, upon the external skin, upon open wounds, in abscesses. This pus exudate, however, enters frequently into combination with fibrinous exudates of different kinds.

Of these, we could first mention the combination with the fibrino-croup-ous exudate, because this furnishes the base of the so-called development of pus out of solid blastema. Whether, or how far, we participate in this view, will appear in the sequel.

Both upon surfaces and within parenchymata, a solidifying fibrinous blastema is frequently thrown out. A careful inspection will show, imbedded in the solid basement, as also floating in the sero-albuminous fluid, molecular granules and genuine pus-nuclei and pus-cells. Together with these are always found a few nucleus and cell-forms, which vary in their relations, more especially to acetic acid. The solid basement manifests itself as croupous fibrin, which liquefies, incorporates the aforesaid elements, and is distinguished by its great abundance of the most minute molecules. This combination of pus with fibrino-croupous exudate, constitutes the so-called solid pus, or the pus-plug, and is that upon which the breaking down, the softening, of inflammatory induration, abscess, and the like depend. The pus-cell is always developed out of the sero-albuminous moisture pertaining to the fibrin-exudate, never out of or at the expense of the latter itself, the liquefaction of which implies a metamorphosis. This pus, in virtue of its constituent, croupous fibrin, contains pyin.

Another Combination Of The Pus-Exudate

Another Combination Of The Pus-Exudate, is that with plastic fibrin exudate. This frequently, but not invariably, furnishes in pus the basis of new solid textures, of regeneration, of the cicatrix. The fibrin-exudate determines the pus-placenta.

Pus may, without impairment of its primitive character, present various anomalies, for example:

(a.) Watery pus; the pus-cells having become bloated in the preternatu-rally thin medium.

(b.) Preternaturally saturated pus-serum, as containing more saline and albuminous matter. The pus-cells appear less turgescent, smaller, shrivelled, denticulated.

(c.) Pus which has become acid exhibits the nuclei more distinctly, more sharply defined, and, it may be, in a slight measure ruptured, within a transparent membranous sheath.

(d.) Various admixtures, as blood, mucus, epithelial, and other textu-ral debris. It is to be remarked, however, that, by certain admixtures, for instance, of faecal matter, of decomposed urine, and again by its acid conversion, pus may become transformed into a corrosive fluid, and its secreting texture goaded into the production of ichor.

The nearest approach to pus is found in broken-down fibrino-croupous exudates. It has been seen that these frequently enter into a combination with true pus-effusion, and the liquefaction of the fibrino-croupous elements in pus-effusion constitutes what is termed the development of pus out of a solid blastema. Broken-down, pus-like, fibrino-croupous exudate is always marked by its fluid parts holding in suspension a large proportion of the most delicate nebulous molecules, and is distinguished from pus by the relations of the coexistent nuclei and cells. These exudation elements, namely, manifest, as we have stated, on the one hand, an insensibility towards acetic acid, under the influence of which, by an evident condensation and shrinking, the cell-walls and contours of the nuclei are brought more distinctly into relief; or it may be that the cell-walls and cell-contents are rendered clearer, whilst the nucleus becomes condensed and more sharply defined.

On the other hand, these cells approximate to the character of the pus-cell, the nucleus exhibiting, with the disappearance of the cell-wall, to a various extent the phenomena of denticulation and splitting. It is, in our opinion, the broken-down fibrino-croupous exudate, either alone or blended with true pus, that constitutes the pyin-holding pus form. It has been stated that these pus-like exudates frequently manifest a corrosive, deliquescent influence upon the textures. Not being organizable, they are extremely prone to further decomposition, and to assume the nature of ichor. They furnish forth the majority of cases of internal suppuration, of constitutional pus deposits, of abscesses.

Ichor, which, in broken-down croupous exudates, often closely resembles pus in appearance, is distinguished from the bland nature of true pus, by its corroding influence upon the textures, and upon the form-elements developed out of its protein substances. It is only under such a state of things that a fluid can be recognized as ichor. That met with after death varies infinitely. A chemical examination of it embodying what is essential, and simplifying what seems differential, is still wanting. Its degree of corrosiveness varies equally. Ichorous exudates are now thin, serous fluids; now albuminous, viscid, limpid or flocculent, emulsive and fatty, thickish, colorless, or yellowish, yellowish-green, puriform, whitish, creamy. Or, owing to the presence of blood-corpuscles and of blood-pigment, they are of variously shaded red, dingy brown, greenish-brown, chocolate-colored. Again, they are ammoniacal, hydro-sulphuretted, rancid or sour-smelling, acid or alkaline, and apt to produce upon the skin of the dissector a tingling or smarting sensation. These fluids, minutely examined, are found to contain variously sized elementary granules, down to the finest molecular mass, nuclei and cells, of the character of exudation and pus-cells, partly stunted in their development, partly owing to the saline, alkaline, or acid condition of the ichor, shrivelled, jagged, lax, diffluent, the pus-nuclei being in the act of denticula-tion and splitting.

They further contain fibrinous coagula of various kinds, in different grades of spontaneous reduction into pulpy masses, coagula out of casein and pyin substances.

Finally, they yield crystalline salts and textural debris in the act of breaking down, blood-corpuscles, animalcules, etc.

Even ichor enters into combination with fibrinous exudates, especially the fibrino-croupous; and, just as in the case of pus, there is, besides the fluid product ichor, another ichor developed out of consolidated blastema. Having now described both pus and ichor, this appears to us a proper place for the establishment of certain marks necessary for a due discrimination between the two.

The bland properties of normal pus are acknowledged; but how does this characteristic tally with the manifest destruction of tissues implicated in the formation of pus? The following remarks may tend to throw some light upon this point:

(a.) The destruction attendant upon pus-exudation is limited to necrosis of the textural elements involved. But this necrosis is due to the intercepted supply of blood and to forcible disjunction; not to that chemical corrosion and that resolution of the textures which result from ichorous discharge.

(b.) That the bland nature of pus is so frequently questioned, arises from products being so often regarded as pus, which are not so in reality, and which either originally possessed, or have acquired the property of corrosiveness. Such products very commonly form the contents of shut abscesses. Normal pus very often acquires a corroding property through long seclusion within abscesses, which, when opened, forthwith secrete a normal, bland pus.

One of the most remarkable phenomena in the process of suppuration, is the formation of flesh granulations. These granulations present, with reference to their character and further development, two marked distinctions:

(a.) They consist, together with a small proportion of intercellular or bond substance, of primary cells. These cells emerge, together with the pus-cells, from a common albuminous blastema, and out of them are called forth, conformably with the laws of the cell theory, those elementary fibrils which ultimately compose the cicatrix.

(b.) They consist of a fibrinous blastema which, exuding conjointly with the pus, solidifies upon the suppurating surface, and yields, by immediate splitting, the fibrous texture of the cicatrix. Into both these scar-bases enters a new generation of bloodvessels, answering to those of abiding suppuration. They determine the healing of wounds by the second intention.