[34] This is exactly similar to an encysted tumor which has been opened, and requires the same treatment. The internal surface becomes thick and somewhat hard, like that of a cyst. It differs from an encysted tumor only in its cause and origin.
[35] If pressure be employed early, to a considerable degree, the irritation of the means employed produces pain, and a morbid increase of action, unless we keep down the action by cold, as will be explained when considering the treatment of ulcers.
[36] When a bone becomes carious, the periosteum is completely detached, and, therefore, it is felt to be rough by the probe. Its colour becomes first of a dull white, or dirty yellow, which it either preserves, or changes for the intermediate hues betwixt these and black. It is generally more porous than formerly, and lighter; but these qualities vary, from very slight degrees, to the appearance of a light coralline.
[37] If we use the solution, we must, if the bone be very porous, or spongy, apply only a little at once, otherwise it may sink down, and injure a part which we do not wish to act on.
[38] There is a curious case of caries, which is frequently met with: The diseased part, instead of being cast off, is surrounded by a covering of new bone, (except at one portion, where a sinus and ulcer is formed in the soft parts) and may be felt rattling within it. In this case, there is necessarily a permanent enlargement of the part, from the additional bony matter; and this, together with the sinous openings, and the internal caries, being felt with the probe, form the character of the disease, which has been called necrosis, a term which formerly implied merely mortification. The cure of this complaint is to be accomplished by extracting the diseased part, when it becomes loose, if the opening in the case be sufficiently large; if not, it is to be enlarged with the trephine, &c. See the works of Ruysch, Default, &c.; and, more lately, the publication of Mr. Russel.
[39] These sinuses cannot be considered in this dissertation.
[40] This may sometimes be produced by the formation of an abscess, without any evident cause; but at other times it is produced by wounds, &c. in scrophulous habits.
[41] Mr. Hunter supposes that these are useful, “because they endeavour to keep up an universal harmony, by putting the skin in good humour, which quiets every sympathising part, and by counteracting the effects of irritability.” P. 381.
[42] Exercise may be used either on foot, or on horseback, or in a carriage; and its degree must be regulated by the strength. There are few patients who cannot bear moderate exercise (were it no more than walking half a minute in a garden), and who will not be the better of this.
[43] Acids are supposed to check it; but they can only act by increasing the strength in a secondary way.