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Class III. been an occasional cause of failure in the usual operation
for this disease *. We even find that if an abscess form Inflamma- in a frontal sinus from an obstruction in its duct, the tions.
matter will rather work its way externally through the frontal bone than descend into the nose. In like manner, if an inflammation attack the cellular membrane on the outside of the rectum near the anus, although the latter be in contact with the inflamed part, the inflammation will extend to the skin of the buttock, while
the gut itself is often but little affected. Farther For the same reason we behold eruptive fevers conby eruptive ducting the specific poisons which excite them, as smallfevers. pox, measles, rosalia, or scarlet fever, and even the plague
itself, to the surface of the body, rather than throwing
them on parts that are deep-seated and vital. The cancer Whether is said to form an exception; but even here the progress cancer forms an
of the disease towards the surface is quicker than its exception : progress towards the centre: while syphilis exhibits whether
something of a similar disposition though not in an equal syphilis.
degree. Hence It appears then that simple or healthy inflammation is healthy in
a remedial process for restoring a part to soundness when flammation a remedial affected by a morbid impression that has a tendency to process : illustrated
injure or destroy it: and that the first stage of this proby a brief cess consists in the effusion of a coagulable lymph, which review of its binds the weakened organization into a closer bond of march.
union, creates new vessels, and consequently introduces new life. If this effort do not succeed, and the morbid action still continues its progress, the affected part dies to a certain extent; but the coagulable lymph which has been thrown out, and introduced new vascularity around it, still sets a boundary to the destructive career, and prevents it from spreading into the neighbourhood, or at least from spreading as far as it otherwise would do. When, however, a part is thus killed or destroyed, it becomes a substance foreign to the body, and must be removed, and have its place supplied by a formation of
• See Hunter on Blood, Inflammation, &c. Part u. Chap. ix..
new living matter. The process of suppuration, which Class III. we shall explain under the genus APOSTEMA, prepares Phlogotica.
ORDER II. equally for the removal of the dead matter and the for- Inflammamation of that which is to fill up its post. This, how- tions. ever, is the progress of healthy inflammation alone; for, as already observed, in unhealthy inflammation the morbid action will often run on to the ulcerative process or last stage at once; or the adhesive, or the suppurative may intermix with it; or all may imperfectly take place together. In attempting the cure of inflammation, our first en- Remedial
treatment. deavour should be to obtain what has been called a re
Resolution: solution of the general enlargement; or, in other words, its import. a restoration of the part to its state of former health, without the necessity of its going through the entire range When to be of the inflammatory process. And in doing this we are attempted. to be guided by the principle of being able to make a new impression upon the part, and to oppose a healthy or remedial to an unhealthy and mischievous action. The nature of the cause must hence be sedulously inquired into, for till this is ascertained and removed, it will be in vain to expect that resolution can take place, and where we can speedily accomplish such removal, resolution will often follow spontaneously; for the animal economy having a disposition in itself to discontinue diseased action, such action will readily subside upon a disappearance of the cause that maintains it. And hence by taking off the venereal action by the use of mercury, in the case of a bubo, the inflammation will gradually cease, provided no other morbid action has already arisen · and united itself with the syphilitic.
Resolution, however, is not always to be atempted; When to be for there are many cases in which the attempt would be from. in vain, and possibly a few in which it would be improper. It is not to be attempted in accidents where there is a considerable exposure of the injured part; and still less in accidents where the part has been killed by their violence: for in these, suppuration is the first natural step to a cure, and we cannot prevent it if we would.
Class III. Where inflammation arises from a morbid predispoORDER II.
sition in the constitution, and belongs to the description Phlogotica. Inflamma- which has been called critical, there is some doubt, and tions.
much demand for circumspection: and in this case resoHow distin- lution is called repulsion. If the inflammation be really from repul- a concentration of the constitutional complaint, which,
by being driven from the part fixed upon, may be again diffused over the entire frame, and in waiting to fasten on some other part, it will often be better to encourage its stay. But the determination even in this case must be subject to the two following conditions: first, that the inflammation so concentrated will readily admit of a cure; and, next, that the part on which it fixes is not of vital importance; for otherwise the remedy may prove worse than the disease.
When resolution is determined upon, independently of removing the cause of the inflammation, we may advantageously follow up its effects by all the common modes employed for this purpose, according to the nature of the particular case. The undue degree of action may be diminished by bleeding and purging; the distention by local applications that tend to contract the diameter of the vessels, as cold, and metallic or other astringents; and if along with the distention there should be great pain, narcotics, and relaxants will generally be found useful auxiliaries. To these in the present day are often added nausea and vomiting, the former of which operates by lowering the action of the vessels; the latter by giving a tendency to a new action. The nature of the case must determine our choice.
LARGE, SUPPURATIVE INFLAMMATION IN A DEEP-SEATED
ORGAN; PUS COPIOUS AND CONFINED.
The term APOSTEMA is Greek, from ápictnu, “ discedo", Gen. I.
Import of « abscedo”, —whence the Latins employed ABSCESSUS, to the generic express the same general idea. Yet they did not, strictly tern among
the Greek speaking, apply either abscessus or apostema to every and Latin suppurative inflammation, but only to those that were writers. deep-seated, and of considerable extent; chiefly indeed to collections of pus consequent upon fevers, or some previous disorder of particular parts, especially abdominal diseases. This limitation is accurately drawn by Celsus immediately after his description of struma, furunculus, and phyma. “ Sed cùm omnes hi nihil nisi minuti abscessus sint, generale nomen trahit latius vitium ad suppurationem spectans. Idque ferè fit aut post febres, aut post dolores partis alicujus, maximèque eos qui ventrem infestarunt.”* The term abscess however, which How differs was colloquially used in a loose sense in the time of Celsus, is used so much more loosely in our own day, that it is impossible to recall it to its precise and original meaning. Yet APOSTEMA has not been thus generalized; Apostema and it is here, therefore, laid hold of and restrained to
to its earlier the signification expressed in the generic definition; af- meaning. ter the authority, indeed, of Sauvages, who has employed it with the same limitation.
The genus apostema in the arrangement before us will be found to include five species: the first of which is com
Lib. v. cap. XXVIII. $ 11.
Apostema. mon to most fleshy parts, and possesses a common chaAposteme.
racter; while the remaining four are distinguished by some peculiarity of character, produced by a peculiarity of situation :
INFLAMMATION COMMON TO THE FLESHY PARTS: PAIN
OBTUSE: TUMOUR SPREADING EXTERNALLY: TENDER
Gen. I. In whatever part an aposteme is seated, it will sometimes
Spec. L spread to a wonderful extent, and be loaded with a protakes a wide digious weight of pus. M. Balme gives us an account range. of an abscess that extended through the whole parietes
of the chest and abdomen on one side, and reached from the scapula to the thigh*; and Hildanus was present, when, upon opening a patient after death, twelve pints of pus were found effused from a visceral aposteme into
the cavity of the abdomen t. Whence this In all such cases the first stage of inflammation, that effect.
of adhesion, must have been overshot in the violence of
• Journal de Médicine, &c. Tom. XVII.
† Cent, 11. Obs. 57.