Dissertations on Inflammation, Vol. 2

by John Burns

It may also be said, that the wound, after the extirpation, might not heal readily; but the testimony of many writers, as well as what I have observed myself, convince me that this is not the case; for the readiness with which the skin unites and heals, when not previously diseased, produces a speedy cure; whereas, had the diseased gland remained below, and the specific inflammation been propagated to the skin, the ulceration must have been tedious.

Upon the whole, then, in determining on the propriety of extirpation, we must consider whether there be only one gland affected, or an incipient disease in a chain of glands; and, if only one, whether there be a probability of this one suppurating; and whether the advantage of an early removal of the affected part will not be counterbalanced by our losing the chance of restoring the part, and of preserving its functions and utility, as, for instance, in scrophulous inflammation of the breasts, testicle, joints, &c.

Caustics have been proposed with the same view as the incision; but they are more tedious, produce extensive ulceration, greater pain, and are much less certain than the operation.

Issues are recommended as a general remedy, to act as a drain to the constitution, and to render the drying up of the ulcer safe. In this point of view, they appear to be altogether useless and unnecessary; but, when employed as part of the local treatment, they are much more useful. The benefit arising from the use of issues, in the cure of scrophulous inflammation of the bones and joints, is now so fully established, by the practice of every surgeon, that it is useless to insist upon it here. In these cases, it is necessary to insert the issue, which is generally made with caustic, as directly over the affected part as possible; and the size of this issue ought in general to be correspondent to the extent of the disease. There are two circumstances which greatly tend to render this practice efficacious, and which ought to be fully attended to: First, that the disease be allowed to gain as little ground as possible before the insertion of the issue, or that the issue be inserted as early after the disease is observed as the patient will permit. Second, that, during the continuance of the issue, every circumstance be avoided which may counteract its use, such as much use of the joint, or other species of irritation. In diseases of the lower extremities, therefore, whatever exercise produces pain must be carefully avoided; and, for the same reason, in diseases of the spine, proper contrivances to relieve the diseased bone from pressure are necessary to be conjoined with the issue. It sometimes happens, that matter has either formed before the insertion of the peas, or some time afterward. In this case, it either comes to be discharged by an opening through the ulcerated surface, or issue, or it bursts at a more dependent part. In the first situation, no change of treatment is necessary; in the second, it is of service to insert a pea over the mouth of the aperture, which has a tendency to heal the part below, and prevent the formation of a tedious sinus. When the part becomes free from pain, and the soft parts have subsided in their swelling, and matter does not appear to be forming, or does not continue to be formed, if it had already been secreted, we may consider that the effect of the issue is now produced, and may begin gradually to diminish its size.

Issues, employed as a local remedy, have hitherto been chiefly used in diseases of the bones and joints, and sometimes in scrophulous affections of the liver, or lungs; but it is reasonable to suppose that they ought likewise to be useful in the cure of enlargements of the glands, and other scrophulous tumors, if inserted in the immediate vicinity of the part. The only objection to their use is the cicatrix which they leave, and which, in certain situations, we would wish to avoid. When the tumor is thickly covered with the integuments, the issue may be made directly over it, by means of a blister, kept open by savine ointment[98], or any other irritating preparation; but, when the tumor is thinly covered, this will not succeed, as the inflammation consequent to the insertion of the issue will be communicated to the gland which is in immediate contact with the ulcerated surface. In this case, a small pea issue, or seton, may be inserted by the side of the tumor. In scrophulous inflammation of the glands of the neck, this remedy is not adviseable, owing to the scar which it leaves; but, in affections of the mammæ, and some other parts, it may be useful.

Blisters, frequently repeated, are sometimes, in slighter cases of affections of the joints, used in place of issues.

Preparations of lead are frequently employed, and, where the tumor is painful, are often of service. When the lymphatic glands are inflamed, a saturnine solution[99], applied cold to the part, by means of a compress of linen, and frequently renewed, has a tendency to abate the pain and resolve the inflammation. These solutions are sometimes employed warm, particularly in affections of the bones or joints; but they do not, in these cases, seem to have any considerable superiority over fomentations with warm water.

Cloths dipped in cold water, sea water, or weak vegetable acids, have also been used, and have a tendency to abate pain, but are inferior to the saturnine solution.

Ether, applied with a pencil to the part, is also sometimes of service.