SPEC. I. Apostema Common aposteme. the action, or from some other cause, and the suppurative and ulcerative have commenced simultaneously from the first. For otherwise the coagulable, or, as Mr. Hunter commune. prefers to call it, the coagulating lymph thrown forth, as has been already explained, into the cellular membrane in the earliest stage of the inflammation, would have formed a boundary wall by the production of new vessels and reticulations, much nearer to the salient point of the inflammatory action, and confined the secretion of pus to a much narrower limit. inflamma The secretion of coagulable lymph, and the reticu- Adhesive late adhesion and formation of new vessels which issue tion designfrom it, is indeed designed, as has been explained al- ed to narready, to prevent the necessity of the suppurative and limits of ulcerative stages of inflammation; and the natural cure aposteme.` of the adhesive stage is by resolution. row the inflamma where ad a cure; When, therefore, an aposteme takes place in a healthy Suppurative frame, or, in other words, when the inflammation passes tion only into the two ensuing stages of the suppurative and ulcer- follows ative, and pus is formed, and a cavity scooped out for its hesion canreception, we are to take it for granted that the instinc- not produce tive and remedial power of nature is incapable of pro- for the ducing a cure by the first intention; that some dead part purpose of or extrinsic substance is required to be removed, and that removing the two ensuing stages of inflammation are had recourse or foreign to for this purpose. some dead substance. removal is accom actions ne In the formation, then, of an aposteme in a healthy How such constitution, we are to suppose that some part of the organ in which inflammation occurs, as for example, plished. a piece of the muscle of an arm or a leg, is become dead, and an encumbrance to the living parts that surround it, instead of assisting in their office. In effecting, Two distinct therefore, the important object of a cure, it is obvious that two distinct actions are necessary; the dead part must be carried off, and its part must be filled up by substitute of new matter possessing the precise properties of the old. And in the process which takes place to accomplish these two purposes, we meet with another clear and striking instance of that wonderful instinctive a cessary, so as to carry off the dead part and produce a substitute. GEN. I. SPEC. I. Apostema commune. Common aposteme. Striking stinctive power. These effects how accom plished. power which pervades every portion, both of the animal and the vegetable world, and which is perpetually stimulating them to a repair of whatever evils they may encounter, by the most skilful and definite methods. In order to comply with this double demand of carryproof of in- ing off the dead matter, and of providing a substitute of new, the absorbent and the secernent vessels in the living substance that immediately surrounds that which requires to be removed, commence equally, and nearly at the same time, a new mode and a new degree of action. A boundary line is first instinctively drawn between the dead and useless, and the living and active parts; and the latter retract and separate themselves from the former, as though they had been skilfully divided by a knife. This process being completed, the mouths of the surrounding absorbent vessels set to work absorbents. with new and increased power, and imbibe and carry off whatever the material may be of which the dead part consists, whether fat, muscle, ligament, cartilage, or bone; the whole is equally sucked up and taken away, and a hollow is produced where the dead substance existed. Action of the surrounding Action of the surrounding While this is proceeding, the mouths of the correspondent secernent vessels from the first, and perhaps secernents. somewhat antecedently, commence a similar increase and newness of action; and, instead of the usual fluid, pour forth into the hollow a soft, bland, creamy, and inodorous material, which progressively fills up the cavity, presses gradually against the superincumbent skin, in the gentlest manner possible distends and attenuates it, and at length bursts it, and exposes the interior to the operation of the gasses of the atmosphere. From this period the process of incarnation commences: granulations of new living matter pullulate on every side, assimilating themselves to the nature of the different substances that are lost, till the hollowi s sufficiently filled up, and the organization completely regenerated. Sometimes a part of the dead On the bursting of an abscess externally, we occasionally find that a portion of the dead matter still remains, GEN. I. SPEC. I. Apostema which is, afterwards, gradually sloughed away, or is thrown off by a separation at its base. This is particularly the case in furuncles or boils; and still more commune. strikingly so in large abscesses that include bones or the tendinous parts of muscles which are more difficult of absorption, though even these are sometimes absorb- mains after ed, and completely carried off. Common aposteme. matter re the abscess has burst. of dead The attenuation of the superincumbent integuments Process of of an abscess appears to be produced by the stimulus absorption of distention occasioned by the pressure of the accumu- matter. lating pus. And it is to the same stimulus that Mr. Hunter resolves the absorption of the dead matter itself, conceiving that for this purpose the secretion of the pus commences somewhat earlier than the absorbent process. ment of evidenced. The formation of pus, and consequently the existence Commenceof an aposteme, is evidenced by a cessation of the pain suppuraof distention, which gives way to a throbbing pain, tion how synchronous with the dilation of the arteries; and by irregular shiverings, and sometimes rigor. After a few days a weight is felt in the part, the throbbing pain itself subsides, the tumour becomes soft, and, if it point sufficiently towards the surface, fluctuates to the touch. Economy of suppuration, chiefly due There is some doubt to whom we are indebted for the first insight into this wonderful process; for it was by whom taught at the same time, or nearly so, on the continent discovered. by De Haen, Plenciz, and Schroeder, and in our own country by Hewson, Hunter, Home, Cruikshank, and Professor Morgan; but upon the whole, Mr. Hewson Explanation appears to have taken the lead, and the rest to have to Hewson. followed closely in his steps. Antecedently to which How acperiod, pus, instead of being a peculiar secretion, was antecedentsupposed to consist in a dissolution of the blood-vessels, ly. nerves, muscles, and other solids, in the ordinary exhaling fluid when augmented by effusion; or in a conversion of the serum, thrown forth, on the occasion, into the new matter, by a change effected in its gluten during its state of stagnation: the first of which hypotheses was that of counted for GEN. I. SPEC. I. Boerhaave*, Platner †, and almost all who practised an Apostema tecedently to their time: and the second that of M. Gaber, and Sir John Pringle §. commune. Common aposteme. Pus proved by Hewson to be a secretion. His view of in one 6 These conjectures were ingenious, but they were nothing more; and their errors are sufficiently pointed out in the Experimental Inquiries' of Mr. Hewson, to whom physiology, and especially the science of morbid anatomy, is almost as much indebted as to any person whatever. He travelled with a comprehensive mind, and a zealous and indefatigable step, in what was at that time new and untried ground; and though he was mistaken in a few points, he correctly explored much, and, by the course he laid down, indicated to his successors the truest methods both of confirming his facts and correcting his misconceptions. He proved decidedly that pus is a peculiar secretion, and that it is often, indeed, secreted where there is no abscess or breach of surface: and he ingeniously accounted for its production by supposing it to be formed out of the coagulable lymph by a new power given to the secernent vessels in consequence of the inflammatory action. "And if pus", says he, "in these cases, is produced merely by a secretion, so likewise it would seem probable that even in abscesses, where there is a loss of substance, it is not the melting down of the solids that gives rise to the pus, but the pus being secreted into the cellular membrane from its pressure, and from other causes, deadens the solids, and then dissolves ||| them." The idea of the solids contained in an abscess being the subject deadened and dissolved by the pus which surrounds them, in the ordinary sense of the expression (for in one sense, as will appear hereafter, they may be said to be dissolved), was one of the erroneous opinions of Mr. point er roneous. Aphor. 387. + Instit. Chirurg. Sect. LIV. Acta Taurinensia, Vol. 11. S Treat. on the Diseases of the Army, App. Hewson to which I have just alluded; and originated from too close an adherence to the earlier, and still more mistaken hypotheses we have just noticed. GEN. I. SPEC. I. Apostema commune. Common aposteme. and the Hunter. Ulceration as well as suppuration a link in the And hence, with all his ingenuity, Mr. Hewson advanced not much more than half way in explaining the entire economy of suppurative inflammation. It re- corrected mained for the exploring eye and commanding genius of whole exMr. Hunter to penetrate through a considerable portion planation of the remaining half of this curious process, and to improved by prove that the solid parts contained in the area of an abscess, instead of being deadened by the pressure of the surrounding pus, are dead before-hand, destroyed indeed by the violence of the accident, or of the inflammation; and that, instead of being merely dissolved in the circumambient pus, they are absorbed and carried off by a new and increased action of the circumambient absorbents; thus showing that even ulceration itself, when of a healthy kind, is only another link in the restorative chain of nature made use of on this occasion. The greater part of this nice fabrication is rendered restorative so clear in Mr. Hunter's admirable work on inflammation, and his arguments and his facts have been so fully confirmed, and so abundantly exemplified by later physiologists, and particularly by Mr. Cruikshank in his Confirmed by the obvaluable treatise on the absorbents, as to remove every servations of doubt upon the subject in the minds of the great body Cruikshank. of the profession. And it is hence not a little surprising, that Dr. Cullen's Practice of Physic should be still printed and circulated, and more than this, be still employed as a text-book (as I am told it is), in many of the most celebrated schools of the present day, with the old, mis- The old and taken, and exploded hypothesis of the formation of pus hypotheses out of secreted serum, advanced as a true and genuine doctrine*, without the slightest hint of any newer or modern more satisfactory explanation of the subject. It is still more surprising, that the same antiquated doctrine should be taught in the latest editions of Mr. Book 11. Ch. 1. Sect. CCL. chain. erroneous still current in several works. ( |