SECT. I.
Of Inflammation
When either the solids are so injured that they will not transmit the circulation with their natural freedom; or when the humours are become so acrimonious, as to constrict the small tubes, that part of the fluids becomes confined in them, there must then of course be an obstruction of the circulation of the fluids, thence accumulation must follow and consequently swell the parts. And this is the nature of an inflammation.
The blood being obstructed, the parts must naturally swell; the blood being forced into the small lymphatic vessels, thence proceed the redness; and lastly, from the vessels being distended and irritated by the stagnated humours, proceeds the pain.
An inflammation terminates three different ways. When the solids relax, or the fluids become attenuated, so that the accumulated humours disperse, and are admitted a free circulation again, it is termed resolution; and this is the best and most favourable way for an inflamed and tumified part to terminate.
When some of the small vessels by the over-stretching of their contained humours break, together with the lymphatic vessels, and the extravasated blood intermixed with lymph is converted into matter, it is termed a suppuration; this is also a favourable way of termination, provided the matter is properly concocted and discharged, and the parts properly healed up again. And this ought to be the second indication when the first does not succeed.
When however the imprisoned humours enclosed by their tubulæ are inspissated, and mix irregularly with the solids that contain them, obstinate tumours are apt to ensue. This is the third kind of termination, and should be avoided if possible; for it either becomes tedious, or occasions malignant ulcers; which in glandulous parts are the first foundation of cancers.
But, when the humours that are obstructed get malignantly corrupted into a pernicious acrimony, and stimulate the distended solids, so that they stretch beyond their natural tone, without admitting any circulation, the parts become insufferably painful; the patient is restless, anxious, and attended with an acute fever; the humours become offensive and fœtid, and the parts at length turn of a livid colour, and this is then called a gangrene. Gradually the parts begin to putrefy and grow black, the humours acquire a cadaverous fœtor, the solids lose their natural texture, and die. This is called a sphacelus, or mortification; and unless the mortified parts are removed from the sound, death must inevitably be the consequence.
These are the different terminations of inflammation; and whether the cause is from external injuries, or from internal acrimony, the indication must ever be the same, I shall consider each separately.
Of Resolution.
Inflammation that attends wounds, contusions, &c. should be dispersed by the application I have already mentioned in the foregoing lectures, viz. camphorated spirit (A), or liniment of soap (B), the first suits best the fleshy part, and the latter the inflammation on the joints and tendinous parts. But when with the inflammation a wound is compounded, and is obstructed in its suppuration, recourse should be had to poultices; as thereby the fibres may be the more relaxed, so that the ulcer may the freer discharge the matter, thence drain the inflamed part of the obstructed humour, and consequently remove the cause of the inflammation.
Of Suppuration.
When an inflammation arises from an internal cause, there generally is some acrimonious humour that wants to be discharged; in this case resolvents is not always safe, as it is ever apt to increase the pain and inflammation. Of that kind are the boils and swellings under the armpits, hams, and other parts. In this case, poultices should be applied as warm as possible; the ingredients may be oatmeal, or biscuit powdered, honey and a little butter, warm and largely applied. When the swelling increases, grows red, and acquires a top, together with constant throbbing, it is a sign that matter is forming, which is the more confirmed by its growing soft. When the fluctuation of matter is actually felt, and that the top becomes somewhat of a black and yellow colour, it then is mature for being opened, in order to let out the matter, which is best performed with a lancet: this being done, apply the poultices again. And when the matter is fully discharged, lay on the diachylon plaister, in order to heal up the part. Should however an ulcer be the result, it must then be treated accordingly, as will be directed under that head.
Of Tumours.
When inflammations will neither disperse nor come to suppuration, it is apt to form hard tumours; sometimes they are indolent, at other times very painful. In this case, nothing is better applied, than mercurial plaister (21), and especially if there is any venereal taint in the habit. At the same time, whenever tumours are dispersing, care should be taken to use internal medicines, in order to correct the acrimony, and a purge now and then, in order to incline the humours to be carried off. If, however, they incline to suppuration, poultices should be again applied; and to bring them sooner to a head, purges should be omitted, till after the matter is discharged.
Of Mortification.
A Mortification has two degrees; gangrene, the beginning, and sphacelus the compleated mortification. When an inflammation will neither disperse, suppurate, nor become indurated, but, on the contrary, increase with a burning inflammation, and is prodigious painful; when the swelling continually increases, the parts become uncommonly tender, attended with a numbness; the colour changing from a fiery red into a livid ash colour, and the cuticula seems to separate on the touch, a gangrene has commenced. In this melancholy case there is no time to lose.—Apply the following powerful medicine, which in a gangrene, and even a sphacelus, has proved beneficial to a miracle.
No. VI
Take Mercurial Ointment (P) one ounce; Calomel (N) and Powder’d Precipitate (O) of each one drachm; Oil of Peppermint (U), one drachm; Spread this upon a rag, and apply it to the gangrenous part.
If a sphacelus has commenced, the skin turned livid, attended with a cadaverous fœture, and seems to the touch to be rotten, it must be scarified to the quick with the lancet, and then the above remedy applied. But if it has already reached the bone, (which a mortification soon will) and seems to make a rapid progress, all external remedies are of little avail, and nothing but amputating the limb can save life. But as that operation ought to be performed by a skilful surgeon, I shall therefore omit it here; only observe, that there are very few cases, but that this dreadful catastrophe may be prevented, if timely assistance is given.
To conclude this section, I think it requisite to observe, that a gangrene and sphacelus, or mortification, is far from being so often the case as many from the pain they undergo, are apt to persuade themselves. A common boil, whilst it is in an inflamed state, is sometimes so very painful as to put the patient in a fever, and will be excessively tender. But, notwithstanding, a suppuration is the result.
A gangrene and mortification is only to be dreaded, when a whole limb is inflamed, such as an arm, a leg, &c. When the inflammation is dreadful, that the blood can find no passage at all, but is obstructed on all sides, then the part must naturally die, and become cadaverous. The cause of this misfortune may be either a heavy contusion, a compound fracture, a gun-shot wound, or an internal malignity of the bone itself; and as a caution, I must also add, that pricking a tendon in bleeding may occasion this dreadful malady.
There is another kind of mortification which proceeds from a bad habit of body, a poorness of constitution, or when the whole mass of blood is corrupted by the scurvy. This shall be taken notice of in its proper place.