In the treatment of such cases, it must be borne in mind, that the secondary inflammations are not the disease, but the effect of a concealed cause, which may develope itself in any part of the system; and that, while the relief of one organ is sought by depletion or mercurial remedies, additional vigour may be given to the latent evil, so as to render it more ready to develope itself in some other part.
When purulent deposits occur, the sudden congestions, which indicate their commencement, are not accompanied by any reparative actions, and the lymph, which is effused in the second stage of their formation, is not so disposed as to circumscribe and limit the inflammation; there is, therefore, no natural process by means of which such collections of fluid can be evacuated; hence, when situated near the surface, they should be opened as soon as they are detected. It will sometimes happen, that, after the symptoms of secondary inflammation of internal organs have commenced, an abscess will present itself near the surface of the body, and relief will be afforded to the part first affected; at other times, an obstinate and violent diarrhœa will precede recovery. Although the mode of treatment adopted may have little influence either in bringing on, or checking, such salutary actions, it is important to watch their occurrence, and perhaps still more important, to be careful not to mistake a remedial action for a symptom of the disease.
"What treatment," says Cruveilhier, "shall we oppose to purulent infection? To this question experience is as yet dumb, while theory would seem to point to diffusible stimuli and tonics; to ammonia, quinine, and sudorifics; to hot external applications, to the vapour baths, to purgatives, and especially to emetics; to tartarized antimony, in large doses; to vesicatories, and to strong diuretics. Calomel has been extensively employed, to create a fluxion from the intestinal mucous membrane; but all these means have failed as signally in my hands as in those of others; yet, when the injection of putrid matters into the veins of living animals has been followed by abundant and very fetid evacuations, they have usually got well. It is a fundamental fact of pathology, that the intestinal canal is chiefly affected in diseases caused by miasmata. I am certain that diseases resulting from purulent infection would not be stamped with the seal of incurability, and that nature, seconded by art, would triumph in the majority of cases, if the pus, which is incessantly renewed, did not incessantly renew the sources of infection. As soon as constitutional symptoms manifest themselves, neither general nor local bleeding affords any advantage. A portion of the materies morbi is, no doubt, abstracted with the blood; but, as it is constantly being reproduced, the constitution is only deprived of the power it would otherwise have of resisting the disease."[43] In accordance with this remark, M. Gaspard found that animals, which recovered after the injection of a certain quantity of pus into their veins, often died when the experiment was repeated. The recovery was usually preceded by black, liquid, and extremely fetid evacuations, which often seemed to afford immediate relief. When such evacuations have taken place in other diseases, the gall-bladder has been found distended with black bile;[44] and it appears probable that the liver, in these cases, is one of the principal organs through which the cleansing of the system is attempted. If the supply of morbid matter to the system could be checked, mercurial action, in this stage of the disease, might be of service, by enabling the liver, or other organs, to throw off their vitiated secretions. When patients recover from purulent deposits (Cases [iii] and [xxvii]), they are often left in a debilitated and languid state, in which ordinary tonics exercise little influence. The consequences of the disease appear to hang about the system, long after the cause which gave rise to it has ceased. The pulse will sometimes continue irritable, and there will be a tendency to derangement of the secretions of the skin, bowels, and other organs, accompanied by occasional slight attacks of fever. In this condition, an alterative course of mercury, combined with sarsaparilla, has been found beneficial. These remedies, by stimulating the activity of the excreting organs, may assist the constitution in throwing off the disease; and their mode of action may be the same as in other cases, where the system has been infected by an animal poison.
APPENDIX OF CASES.
A. CASES OF SECONDARY INFLAMMATION, ACCOMPANIED BY MORTIFICATION OF THE SKIN.
Case i. William Ford, 33, an apparently healthy man, was seized with the symptom of strangulated hernia, at Harrow, December 28th. He was bled in both arms; but, as the hernia remained unreduced, he was sent to town, in a state of considerable restlessness and suffering. During his journey, the hernia returned of its own accord. He left quite relieved, and remained well till the 31st, when he had a rigor. On the 1st of February, there was a considerable degree of febrile excitement, and the anterior part of the left arm was red, swollen, and painful upon pressure. The tenderness and pain soon extended up the arm, in the course of the cephalic vein: the redness assumed the character of erysipelas. On the 3rd, he suffered from sickness, the matter vomited being green and acid. He had two severe rigors, followed by great heat of skin, and a quick full pulse. The orifice in the left arm discharged a thin serous fluid. On the 4th, he complained of stiffness in the right arm; also of being very feeble and faint. 5th. Wandered much during the night. The right arm was a good deal swollen about the end of the elbow-joint, and presented a patch of a bright red colour above the condyle. The pulse was weak and tremulous; motions of the hands were occasionally observed. He complained of pain in the ring-finger of the right hand, and in the ball of the right great toe. The skin, in both these situations, had assumed a red appearance. 6th. Was delirious during the greater part of the night; countenance expressive of much anxiety; pulse very weak; tongue covered by a brown dry fur; profuse perspiration; complained of severe pain in the calves of his legs. He died during the following night.
Post-mortem appearances. A small deposit of thick pus was found on the external surface of the left cephalic vein. The blood was coagulated in its cavity, its coats were thickened, and its lining membrane appeared very red. This redness could be traced, though in a less degree, through the whole extent of the vena innominata. On the right side, the cellular tissue, both above and below the elbow-joint, was greatly distended with serum. The cephalic vein of the right arm presented marks of having been inflamed; but not nearly to the same extent as upon the opposite side. The joints in which pain had been experienced during life, were distended with turbid pus; deposits of pus were also found in the anterior mediastinum, and between the œsophagus and trachea. A large gangrenous spot was observed in the skin of the calf of the right leg. The subjacent cellular tissue was much distended with serum.
Case ii. Richard Mason had a small cancerous tumour removed from the lower lip. The operation was performed in the usual way, and the wound appeared to heal by the first intention; a small abscess, however, followed by some ulceration, subsequently appeared in the neighbourhood of the cicatrix. Nine days after the operation, he complained of sore throat and general uneasiness, and three days afterwards he was seized with rigors, followed by cold perspiration and coma.