Dissertations on Inflammation, Vol. 2

Part 1

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Transcriber’s notes:

Apart from correction of a few typographic errors (intentention → intention, citrinc → citrine, scropulous → scrophulous), the text of this e-book has been preserved in its original form including archaic language and some inconsistent spelling (citrine/cintrine, schirrous/schirrus, exsudation/exudation, eschoritics/escharotics). Footnotes have been numbered and positioned below the relevant paragraphs.

DISSERTATIONS

INFLAMMATION.

VOLUME II.

CONTAINING,

DISSERT. II. continued.--ON THE CURE OF SIMPLE INFLAMMATION, AND ITS CONSEQUENCES.

DISSERT. III.--ON THE PHAGEDENIC, AND SOME OTHER SPECIES OF INFLAMMATION.

DISSERT. IV.--ON THE SPONGOID INFLAMMATION.

DISSERT. V.--ON THE SCROPHULOUS INFLAMMATION.

DISSERT. VI.--ON THE CANCEROUS INFLAMMATION.

BY JOHN BURNS,

SURGEON IN GLASGOW.

GLASGOW: Printed by James Mundell, Aytoun Court, FOR JOHN MURDOCH, TRONGATE; MUNDELL AND SON, AND W. MUDIE, EDINBURGH; AND FOR LONGMAN AND REES, and J. JOHNSON, LONDON.

1800.

DISSERTATIONS

INFLAMMATION.

DISSERTATION II.

CONTINUED.

SIMPLE INFLAMMATION,

And its Consequences.

Of the Cure of Inflammation.

In attempting the cure of inflammation, or its consequences, we must naturally be directed to the means of removal, by the nature of the action itself, and the object which we have in view. The treatment of the inflammatory action may be considered in two points of view; first, as this action consists in peculiar changes of the natural action, which changes we wish to remove; and, secondly, as this action naturally tends to disappear, and produce other actions, which require a peculiar treatment. The observations, therefore, which are to be made upon the method of cure, may be arranged under the heads of the different terminations of inflammation.

Of the Treatment necessary to procure Resolution.

In the treatment of most wounds, our chief intention is to prevent the accession of inflammation, and procure adhesion, which is, in one respect, analogous to resolution. When inflammation has taken place, either in wounds, or in other cases, our great object is, to remove or lessen it as quickly as possible, which we effect, first, by removing the exciting causes of inflammation, or such causes as tend to increase the action; and, secondly, by applying such remedies as tend directly to abate the inflammatory action.

Upon the propriety of removing the exciting causes, and the manner of doing so, very little requires to be said. If any acrid, or stimulating substance, has been applied to the skin, or any extraneous body been forced into it, these must be removed before the inflammation can be resolved; because, if they be allowed to remain, they will keep up the action so long, and to such a degree, that suppuration will be produced, or gangrene, if the part be very sensible, (as, for instance, the cutis) or if the exciting cause be very irritating. Acrid substances are to be removed by ablution with water, which is in general much better than the solutions which are proposed upon the principle of chemically combining with the acrid; because these generally are likewise acrid, or stimulating, and increase still more the inflammation which has taken place, before they can combine with the substance which was formerly applied, and become neutralised. This may be illustrated by the operations of acids and alkalis. If heat have been applied, so as to induce inflammation, we must remove the superabundant quantity of heat, but must not apply cold; because we then do mischief, as will be afterwards mentioned.

When a substance is forced into the skin, so as to stimulate mechanically, we must endeavour to lay hold of it, and pull it out; but if it have penetrated so deep as to make this impracticable, we must then enlarge the wound, and remove it; because we thus may enable the wound to heal by the first intention. If, however, the injury done be great, if the part be much bruised, or the extraneous substances be numerous, we may be less anxious about the extraction of such as require much trouble; because the irritation which is thus given will tend to increase the degree of inflammation, and, very probably, its extent, at the same time, that, from the original injury, there is little prospect of adhesion being procured, or suppuration prevented. We are then chiefly to search after, and extract foreign bodies, when we apprehend that their removal may permit the inflammation to be resolved, and adhesion to take place, and when we expect that their presence will excite a greater action than our endeavours to extract them will do. This is a rule which ought to be carefully remembered by every surgeon, and especially by those whose situation makes them be daily called to take the management of gun-shot wounds. They are not brought to their patient to show how much they can do in the way of cutting and probing; it is their duty to administer relief, and act so as to prevent and abate the inflammatory action, which they will often do most effectually by letting their patient alone, and throwing aside their ball-screws and forceps.

Part 2

The circumstance of being in an unusual situation, in which the natural action cannot possibly be continued, is also a very frequent cause, producing inflammation, and preventing its resolution. We ought, upon this principle, which has been formerly mentioned, to endeavour, in almost every instance, to bring the sides of the wound together, if an wound has been the exciting cause of inflammation, by which we shall much more readily prevent or overcome the inflammatory action; because we thus bring the parts nearly to their natural situation, with respect to interstice, and thus make the organic particles be more readily thrown out. This practice ought to be pushed farther than is often done. Even in many contused wounds it will be useful; because, although union may not be immediately produced, yet, when the contused part is either recovered, or absorbed, the inflammatory action may be prevented, or removed, by the restoration of the natural action, if the part be in absolute contact. It must, however, be remembered, that if much difficulty be experienced in bringing and retaining the parts together, owing to the swelling, from the previous existence of the diseased action, then our endeavour will be hurtful; because the irritation which we thus give, has a greater power to increase the action, than the circumstance of the parts being in contact, has to diminish the inflammation, and restore the natural action.

Bringing two surfaces in contact, although they naturally were not so, will have the same effect. Thus, if the skin be taken off the edges of our fingers, and the side of the one be applied to the side of the other, adhesion will take place, and no inflammation will be produced. When a part is inflamed, and one portion is brought in contact with another, we uniformly find, that the inflammation is less where the parts were in contact than elsewhere. Thus, when the intestines are inflamed, the parts suffer least which touch other intestines, whilst the angle betwixt the folds is most affected. This fact is observed by Mr. Hunter, but explained upon the principle of contiguous sympathy; or, “a mutual harmony being produced, which prevents their being inflamed.”

By removing, then, the exciting causes of inflammation, before the action be induced, we shall frequently prevent it altogether from being formed; but, even although we should be disappointed, we, by this removal, render the disease milder, less extensive, and much more easily overcome; for, as long as the exciting causes continue to operate, it is impossible to procure resolution; but the action will be kept up until some other termination, or consequence, be induced. But, although we thus prevent the action from being raised to so great a degree as it otherwise would be, yet we do not immediately overcome or destroy it; because the action, when once induced, has, like every other action, a tendency to continue for some time after its cause is withdrawn. This continuance may be longer or shorter, according to circumstances, and its termination may be more or less unfavourable. We are, therefore, under the necessity of employing such remedies as have a power of directly diminishing or removing this action. It has, however, been doubted, whether they ought, in every instance, to be employed; or, in other words, whether resolution ought uniformly to be desired. It has, for instance, been deemed unsafe to check those inflammations which depended upon a general or constitutional specific disease, or occurred during its existence. But this opinion, which was evidently founded upon the supposition of the operation of morbid humours, cannot be maintained, now that this is given up. Granting inflammation, in every one of these cases, to be dependent upon the general disease, and to exist as a symptom of it, no harm can accrue from resolving it; because, if the inflammation have once taken place, the full effect of the general disease is produced, which, therefore, cannot be affected by the peculiarity of the termination of this inflammation, unless it be proved, that some humour be sent there to be concocted and thrown out. In many instances, inflammation occurs in a general disease, merely as an accidental circumstance; but, even in those cases where the local inflammation is most decidedly dependent on the general action, and is perhaps essential to it, we find, that no bad effects follow from resolving the inflammation; and, if this be the case with regard to specific inflammation, we may still more certainly extend the principle to the treatment of the simple inflammatory action, with which we have at present a more immediate connection. There are, however, some inflammatory affections which we sometimes cannot put back; such as those tumors which succeed the small-pox; but, when we do succeed, no bad consequence follows; and the failure of some of our attempts can be no argument against the general plan, more than our failure in many other instances.

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