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.