_Of Inflammation_
When either the solids are so injured that they will not transmit the
circulation with their natural freedom; or when the humours are become
so acrimonious, as to constrict the small tubes, that part of the fluids
becomes confined in them, there must then of course be an obstruction of
the circulation of the fluids, thence accumulation must follow and
consequently swell the parts. And this is the nature of an inflammation.
The blood being obstructed, the parts must naturally swell; the blood
being forced into the small lymphatic vessels, thence proceed the
redness; and lastly, from the vessels being distended and irritated by
the stagnated humours, proceeds the pain.
An inflammation terminates three different ways. When the solids relax,
or the fluids become attenuated, so that the accumulated humours
disperse, and are admitted a free circulation again, it is termed
_resolution_; and this is the best and most favourable way for an
inflamed and tumified part to terminate.
When some of the small vessels by the over-stretching of their contained
humours break, together with the lymphatic vessels, and the extravasated
blood intermixed with lymph is converted into matter, it is termed a
_suppuration_; this is also a favourable way of termination, provided
the matter is properly concocted and discharged, and the parts properly
healed up again. And this ought to be the second indication when the
first does not succeed.
When however the imprisoned humours enclosed by their tubulæ are
inspissated, and mix irregularly with the solids that contain them,
obstinate tumours are apt to ensue. This is the third kind of
termination, and should be avoided if possible; for it either becomes
tedious, or occasions malignant ulcers; which in glandulous parts are
the first foundation of cancers.
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.