Internally the absorption from ulcers should be promoted first by evacuation, then by opium, bark, mercury, steel.
[3]. Where the inflammation proceeds with greater violence or rapidity, that is, when by the painful sensation a more inordinate activity of the organ is produced, and by this great activity an additional quantity of painful sensation follows in an increasing ratio, till the whole of the sensorial power, or spirit of animation, in the part becomes exhausted, a mortification ensues, as in a carbuncle, in inflammations of the bowels, in the extremities of old people, or in the limbs of those who are brought near a fire after having been much benumbed with cold. And from hence it appears, why weak people are more subject to mortification than strong ones, and why in weak persons less pain will produce mortification, namely, because the sensorial power is sooner exhausted by any excess of activity. I remember seeing a gentleman who had the preceding day travelled two stages in a chaise with what he termed a bearable pain in his bowels; which when I saw him had ceased rather suddenly, and without a passage through him; his pulse was then weak, though not very quick; but as nothing which he swallowed would continue in his stomach many minutes, I concluded that the bowel was mortified; he died on the next day. It is usual for patients sinking under the small-pox with mortified pustules, and with purple spots intermixed, to complain of no pain, but to say they are pretty well to the last moment.
Recapitulation.
[IV]. When the motions of any part of the system, in consequence of previous torpor, are performed with more energy than in the irritative fevers, a disagreeable sensation is produced, and new actions of some part of the system commence in consequence of this sensation conjointly with the irritation: which motions constitute inflammation. If the fever be attended with a strong pulse, as in pleurisy, or rheumatism, it is termed synocha sensitiva, or sensitive fever with strong pulse; which is usually termed inflammatory fever. If it be attended with weak pulse, it is termed typhus sensitivus, or sensitive fever with weak pulse, or typhus gravior, or putrid malignant fever.
The synocha sensitiva, or sensitive fever with strong pulse, is generally attended with some topical inflammation, as in peripneumony, hepatitis, and is accompanied with much coagulable lymph, or size; which rises to the surface of the blood, when taken into a bason, as it cools; and which is believed to be the increased mucous secretion from the coats of the arteries, inspissated by a greater absorption of its aqueous and saline part, and perhaps changed by its delay in the circulation.
The typhus sensitivus, or sensitive fever with weak pulse, is frequently attended with delirium, which is caused by the deficiency of the quantity of sensorial power, and with variety of cutaneous eruptions.
Inflammation is caused by the pains occasioned by excess of action, and not by those pains which are occasioned by defect of action. These morbid actions, which are thus produced by two sensorial powers, viz. by irritation and sensation, secrete new living fibres, which elongate the old vessels, or form new ones, and at the same time much heat is evolved from these combinations. By the rupture of these vessels, or by a new construction of their apertures, purulent matters are secreted of various kinds; which are infectious the first time they are applied to the skin beneath the cuticle, or swallowed with the saliva into the stomach. This contagion acts not by its being absorbed into the circulation, but by the sympathies, or associated actions, between the part first stimulated by the contagious matter and the other parts of the system. Thus in the natural small-pox the contagion is swallowed with the saliva, and by its stimulus inflames the stomach; this variolous inflammation of the stomach increases every day, like the circle round the puncture of an inoculated arm, till it becomes great enough to disorder the circles of irritative and sensitive motions, and thus produces fever-fits, with sickness and vomiting. Lastly, after the cold paroxysm, or fit of torpor, of the stomach has increased for two or three successive days, an inflammation of the skin commences in points; which generally first appear upon the face, as the associated actions between the skin of the face and that of the stomach have been more frequently exerted together than those of any other parts of the external surface.
Contagious matters, as those of the measles and small-pox, do not act upon the system at the same time; but the progress of that which was last received is delayed, till the action of the former infection ceases. All kinds of matter, even that from common ulcers, are probably contagious the first time they are inserted beneath the cuticle or swallowed into the stomach; that is, as they were formed by certain morbid actions of the extremities of the vessels, they have the power to excite similar morbid actions in the extremities of other vessels, to which they are applied; and these by sympathy, or associations of motion, excite similar morbid actions in distant parts of the system, without entering the circulation; and hence the blood of a patient in the small-pox will not give that disease by inoculation to others.
When the new fibres or vessels become again absorbed into the circulation, the inflammation ceases; which is promoted, after sufficient evacuations, by external stimulants and bandages: but where the action of the vessels is very great, a mortification of the part is liable to ensue, owing to the exhaustion of sensorial power; which however occurs in weak people without much pain, and without very violent previous inflammation; and, like partial paralysis, may be esteemed one mode of natural death of old people, a part dying before the whole.