Treatment of Local and Constitutional Diseases

Femedies must be chiefly directed to, the removal of that cause, dr te lessen its effects on the constitution; but, on the contrary, when lo- cal disease is either prpmoted or aggravated by constitutional de- Fangement, then your treatment must be directed to the ‘disorder of the system, and as that improves, so will the local affection disappear. Constitutional ireitation must not be too suddenly subdued nor destroyed, #5 9 certain degree of {rritation shows, that nature Is endeavouring to ac- ., INFLAMMATION. b ‘romplich the restorative process: keep it withia bounds, earefally watch ite Progress, and if necessary, ebeck its violence, but do not entirely destroy it. 17. There are two means of reducing irritation -—the frst, by Festoring to the different organs their various secretions, by which the owlets become opened and fever lessened j—and the second, by allaying the excitement of the nervous system, ‘The first indication may be falfilled by producing a determination to the skin, and the administration of aperients; but when the irritation is very. evere indeed, you should give mercurials to act on tbe liver, saline aperi- ents on the intestines and kidneys, and antimonialsonthe skin. The second indication is answered by giviug opium and antimony combined, or calo- ‘mel, antimony, and opium, to act on the skin and liver, as well as on the pervous system. 18, Ta ‘cases of irritation, bleeding must be resorted to for ifit be carried to a great extent, the powers of the com: will be unequal to the reparation ofthe injury. 19> Where there is chronic irritation, the best treatment you can adopt, is to give steadily, those medicines which have the greatest hance of overcoming the complaint. ‘My favourite medicine is the oxy-muriate of mercury combined with rhubarb, bark, or sarsaparilla; Plummer’s pill is also n very fair remedy 5 ‘8s also, the blue pill at night, with saline aperients in the morning. INFLAMMATION. 1. Inflammation is the process by which local injuries are repaired, and it may therefore be considered as the restorative principle. By inflammation, however, is generally understood, the state of a part, In which itis painful, hotter, redder, and somewhat more turgid, than it naturally is; which symptoms, when present in any considerable degree, pr when they affect very sensible parts, are attended with fever, or a gen- ‘eral disturbance of the system, 2, There are four signs that commonly attend its vi pein, increased heat, and swelling. redness, 1 w {iPLAMMATION: 3. Redness :—Arises from an increase of the red particles of blood. in the part. More blood must necessarily be contained there, because the vessels, which previously conveyed the fluid, are preternaturally distentied, dnd thé smafl vessels, which natorally contained only lymph, are now so entat= ged as to be capable of receiving red blood. 4. Pain :—Increased sensibility or pain, is owing to distention of the nerves, hy the greater quantity of blood determined to them. ‘Parts naturally [ttle sensible, are quite the reverse when in a state of Inflammation. Boves, though nearly destitute of sensation in their healthy state, are stmetinies extremely sensitive when inflamed. 5. Increased Heat :-—This is not yet generally allowed to exist: Though no increase of beat is manifested in internal inflammation, yet ‘when it occitrs on the surface of the body, an alteration sométimés, of sev- eral degrees, takes place, It is said néver to éxéeed the héat of the blood at the heart, This in health fs utually about 1000 Fabr.; but sometimes in isease it rises to 1606 or even 170°. . 6. Sicellitig Is. owing iti a mensure tb an increased determing: tion of blood to the part, and also depends on effusion of the fibrin of the blood, which;in coagulating, deposits sertim in the surrodnding cellu: Jar tissue. af ‘That the extravasation of coagulating lymph has a remarkable share in pro= ducing the swelliog of in flamed parts is unquestionable; for it lls up all their interstices, glues their whole structure together, and consolidates {uem into one- mass, Frequently, when its quantity is considerable, it is converted into a true cellular, or membranous texture, or assumes more o less; the peculiar qualities of different organs. This is very evident in the’ bones. By means bf such change, also, several loose parts may acquire the external properties of denser organs. Thus, the lungs are sometimes turn ed into a liver-like suhstance, and hence called Aepatized: 7. Kinds :—Inflammation may be either acute or chronic. 8, Acute Inflammation :—Acute inflammation usually goes through its various stages with great rapidity. ‘The adhesive stage is marked by hardness and pain; the suppurative, by ANFLAMMATION. a Urvitative fever, fuctuation, and throbbing or pulsation ; ulceration usually sucreeds in a short space of time, and the matter is discharged. * 9. Chronic Inflammation :—Chronic inflammation is exceedingly slow in its progress, and is either the result of acute inflammation, cor owing to a peculiar state of constitution, occurring in persons who have lived intemperately, or who have been depressed by laborious exertions and disappointments. An instance of chronic inflammation succeeding the acute, may be seen ip gonorrhoea. During the first stages of this complaint, we are obliged tg check the action of the vessels of the aretha, but afterwards to excite it by the balsam of copaiba, and slightly stimulating injections. 10. Inflammation may also be either common or specific. 11, Common Fyflammation :—Common or healthy inflammation is the kind we look to for the reparation of an injured part. Shortly after an injury, if infammmation of this character Is set up,adbesive matter is thrown out apon the edges of the wound, by which they become perfectly united. 12, Specific Inflammation :—In specific or unhealthy inflamma: tion, the vessels have an entirely different action to what happens in the healthy, and thus the fluids and solids which they secrete have @ decidedly opposite character, ‘There are two descriptions of speolfic Inflammation : the first is produced by a pecaliar condition of the constitution, as in the formation of scirrhus, scrofula, gout, ke. and the second, by the application of a poison, as in aypbilis, ke. : ‘The best example of the first kind, is scrofule. Persons attacked by this disease, have generally light batr, fair complexion, and a delicate appear- ance: when inflammation occurs, it is slow in its progress, although ensily ‘excited; and at lastjulceration taking place, the dlacharge consists of curdy matter, or a thin serous fluid, not at all resembling the pus which is formed fn healthy Inflammation. Gonorrhom, variola, &¢. are good illustrations of the second kind of spe- cific inflammation. Thos, in gonorrhoea, the matter secreted is widely dif- ferent from common healthy matter, having in the Brst place a much larger quantity of mucus mixed with it; and, secondly, when applied to a secret- ing surface, ig, capable of exciting in the part, an action by which similar 2 INFLAMMATION. ‘matter and the same effects can be produced. The matter of suinll-pox bc easions the same result, and as {ar as constitutional effects are concerned it does not seem material bow large or bow small a quantity of the poison is applied, the result in each case depending upon the state of the consti: tation. 13. Yrritable Prflammation :—In addition to the kinds of inflamma tion already mentioned, there is another, which I propose to call thé frritable. In this kind, the nerves are more affected than the blood- vessels ; consequently the parts labouring under its influence, are ex- veedingly tender to the touch. ’ ‘The eyes, the breasts of young women, the bladder, and the tésticles aré very disposed to this species of infammation; i 14 Causes :—The true proximate causes of inflammation, ap- pear to be an increase of action in the vessels of the part, and an in: erease in the size of the vessels themselves. g ‘With regard to the proximate cause, there has begs @ great difference of opinion. Galea considered phlegmon to be produced by a superabundance bf the sanguineous humour. Boerhaave referred the proximate cause to an obstruction in the small vessels, occasioned by a lentor of the blood. Cul- Jen and others attributed it rather to an affection of the vessels than a change of the fluids. The question, however, is by ud means satisfactorily explained. 15. Exciting :—The exciting causes of inflammation are whal- ever produces an unnatural state of the parts, calling upon nature for . fits reparation, which she effects by the process of inflathmiation, ds bruises, pressure, extraneous substances, &c. . Mechanical or chemical itritation, changes of temperature; and stimula: ting foods are also exciting causes. Fever wften seems to be a remote cause, the inflammation thus produced is generaify considéred as criticgl: Spontaneous inflammation sometimes occurs Wien wo perceptible cause can, be assigned for its production, ees 16. Inflammation sometimes arises from debility, as is frequently seen in the extremities of old persons, in whom the blood returns to the heart with difficulty, wt From the weakened power in elderly persous, the iirteries are calféd op= _ iy ac aaleateee a INFLAMMATION. 28 - @n for exertion, and tion of the skin succeeds, frequently ‘attended with incrustations, and sometimes witha watery seeretion into the the cellolar tissue. In these eases, bleeding must be resorted to with can- Hon. 17, Irtttable persans are much more predisposed to inflammation ‘than others, and whenit occurs in them, it is ofa more dangerous na tare than in thosa who are not irritable, ‘Thus in fevers, when the constitation has heen much weakened, the parts ‘on which the body has been resting become inflamed, and quickly mortify. Batin feactures,where the systema is healthy and strong, although the pa- tient remain many weeks in bed, no such effects are produced. 18. Treatment :—The treatment or both combined. either constitutional, local, - 19. Constitutional Treatment :—When any important organ is fnjored, or its functions disturbed in consequence of the influence of an injary on the constitution, the treatment mast be invariably con: stitutional. 8 p persons of irritable habit, constitutional treatment is necessary, wheth- er any important part is injured or not ; for in these cases, yery trivial lo- ‘eal damage will speedily affect the entire system. 20. The mast powerful remedy for relieving inflammation, ig the sghstraction of blood : its beneficial effects principally result from pro- ducing a diminution of nervous power, or syncope ;—secondly, by lessening the quantity of bloud ;—and lastly, by facilitating the rex establishment of the secreting functions, ‘Abard, wiry, and quick pulse indicates blood-letting ; bet quickness of Pulse is not in itself a sufficient proofthat bleeding is requisite ; but when wnited with hardness, ne additional evidence of its necessity can be wanted. “* ‘Phe pulse, however, is not always hard when inflammation attacks impor- _ tant parts, for when the stomach or intestines are thus affected, the pulse ia ru 1. ‘ The indfcation for a repetition of blood-letting, is said to be ‘s’bufly state of the blood ; At your decision must not be governed by this appearange, you must still have a hard pulse, bz INFLAMMATION. ‘When b ood is cupped, it is said to be a proof of strength, and, that bleed~ ing should be gepeated ; but experiments Lave shown that even a cupped siate of the blood, and buflinéss conjuined, are vot sufficient evidence to ‘warrant the repetition of blood-letting. 22, The quantity of blood which should be drawn, must depend entirely on the severity of the complaint. Asthe grand object of bleeding in inflammation is to produce syncope, the’ lod should be abstracted rapidly ; therefore, the orifice made Into the vessel should be of considerable size ; for if it be allowed to run slowly, the vessels have time to accommodate themselves to the diminished volume of lrealating fluid; 40 that thesystem scarcely receives any sbock whea blood iy abstracted in this gradual manner. The grand object is always to pro- duce fainting. 23, When you have accidents brought to you, which will require 4 Jong time for their recovery, you must be exceedingly careful how you takeaway blood from the general system; but must adopt, in these cases, local depletion. ‘There are some cases of inflammation, where bleeding will not afford relief: this more frequently bappens in infammation of the testicle than ia ‘any other part. For these affections you must administer the compound ‘powder of ipecacuanha, combined wit calomel. 24. Thesecond mode of relieving inflammation, is by restoring the’ ‘secretions. ‘The most impottant secretions, are those of the liver, intestines, skin, and Kidneys and when these cease to perform their proper functions, from a shock on the nervous system, irritate fever is the consequence. 25. As it is necessary in inflammation, not only to act upom thé intestines, but also to stimulate the liver, the best plan is to give éalomel at night, and a saline aperient in the morning. An éxcellent aperient for adults is one grain of calomel, with four of cathe ‘artic extract ; or two of blue pill, with three of cathartic extract ; castor il, may also be recommended ; and as another safe wpeutag medicitie, you ‘may prescribe infusion of senua with sulphate of magnesia. Ia children, dalomel with rubarb, scammony, or antimony, may be ordevtd as aperients; ind In addition to these means, the use of injections, and the warm bath, are the best means of restoring the secretions of the digestive organs. INFLAMMATION. timonials with colomel ; and that of the kidneys, by the administ tion of diluents, squills, or acetate of potash. Extensive inflammation will not be ovetcome’by restoring this or that #e- ‘eretion, for it cannot be effected but by the complete restoration of them all. 27. Provoking a constant nausea in the stomach, is'another mode of subduing inflammation. ‘For this purpose, the solution of tartar emetie should be given in repeated: sunall doses; it will relieve shat oppressive dryness of the skin which accom~ panies the fever attendant on severe local ioflaramation ; diminish the In- ‘ereased action of the heart and arteries in general tend to restore the secretions; and will be found, more or less, to promote the removal of costiveness. 28. Tho remedies. employed in chronie' inflammation, must have slow and gradual action on the secretions. You cannot take this disease by storm. Calomet and opium compound pills of sub-muriate of mercury ; oxy- muriate of mercury, with the decoction of sarsaparilia; and in children, ‘Yhubarb, with the hydrargyrum cum creta. 29, From what has been said on the treatment of inflammation, it appears that, by vensesection, we diminish the quantity of circula- fing fluid, and assisted by the restoration of the secretions, we pre- Yent the heart from propelling a great quantity of blood with vio- ence to any particular part of the body. 90. Local Treatment :—-Cold applications will relieve, by abstract- [ing heat, by lessening the size of the vessels, and by diminishing the’ ‘action of the part, through lessening its nervous irritability. A lotion of sp. vinl rect. 4. with aque: $v. is thebest local remedy. Ice Is not recommended in the inflammatory stage, it irritates and sometimes prodaces gangrene. Io'applying spirits of wine, let your cloth be very ‘thin, that evaporation may freely take place. 31. In contrh-nse'to cold applications, heat and mbisture are very Yalueble, for the two produce relaxation, epen the pores, give rise 16” perspiration, and-thereby remove congestion, 3 INFLAMMATION. tpoultices are the general forms. Leeches are used with poultices or fomentations ; and also in some cases, panc- (the part witb a lancet. 32. Asin the acute inflammation, our object is to diminish vaseu- lar action ; s0 in the chronic, we endeavour to increase it, by the use of stimulants. ‘Thus in long-continued discharges arising from relaxation, we employ stimulating lotions, for the purpose of restoring to the vessels their healthy power of contraction. Again, in sloggi alcers, it Is 7 necessary to excite action. 33. Counter-irritation :—Is a very powerful remedy in inflamma- tion, and its advantages numerous ; but the chief benefit arises from iis drawing off the blood from the neighbouring inflamed parts, where- by itchecks the course of the disease in important organs. Thus a blister at the nape of the neck, if early applied, will arrest an, Soflammation of the brain, and so on io other parts of the body. Blisters, Iasues, setons, and ointment of tartarized antimony, are the usual counter- Irritants. 34, Counter-irritation, if carried to too great an extent, will ag- gravate the original disease. 35. Position and rest must be particularly attended to, in the treatment of inflammation, 36. Indurations frequently remain after inflammation has entirely ceased. These are to be got rid of by diminishing the circulation of the part, and producing absorption, Pressure with rollers or strapping, electricity, mercury, and friction, are ‘the usual means resorted to. ‘37. Effects :—In inflammation, the vessels of the part are in a dilated state, and the surrounding ones have an increased action. 38. The local effects of inflammation, are either adhesion, euppu ration, absorption, or gangrene ; the constitutional symptoms are sim- iar fo those of irritation. INFLAMMATION. Pf $9. Inflammation produces different results in different parts, 40. When seated in the skin, it usually becomes extensive, be- cause the surface is unbroken. Its covkir is very Gorid; It separates the cuticle in the form of vesiea- tlons, which usually contain seram, but also in some cases, fibrin; a serous effusion is also produced by it into the subjacent cellular tissue In some’ instances it is preceded by fever, in others followed by it. 41. In the cellular membrane, inflammation produces an effusion which obliterates or fills its cells; if it proceed, it occasious suppu- ration, and produces an abscess. 42. In debilitated irritable constitutions, inflammation destroys the cellular tissue, and produces carbuncle ; but if the inflammation is of a chronic nature, it occasions tumours of various kinds, as the steatomatous or adipose ; or under peculiar circumstances, those of a malignant nature, as the schirrhous, fungous, &c, 43. Loflammation of fascice is generally extensive, from the large surfaces they present. ‘When matter is produced by inflammation of this texture, and is seated under it, great irvitative fever succeeds until itis discharged, as for exam ple, in the palms of the hands, or soles of the feet. 44. When inflammation attacks muscles, itis known by the spas- modic twitchings which attend it. It is from this cause, in fractures, that patients are restless for the two or three first nights. 45. Tendons are not very susceptible of inflammation, but they sometimes become inflamed to a considerable extent. Punetured wounds of tendons are apt to produce tetanus more than’ ‘wounds of other parts of the body. Matter formed under tendons, burrows 6. great extent, and produces violent irritation. 46. Inflammation in the absorbent vessels, is marked by red lines on the skin, in the course of these vessels. ‘These form hard knots, from the skin participating in the inflammation: 2B INFLAMMATION. Their glans beeome also inflamed, and both glands and vessels occadlon- ‘ally soppurate. Absorbents mere frequently inflame from common irrita- tion than from the absorption of polson. Arteries are rarely inflamed, excepting after wounds, or the n of ligatures. Inflammation of the arteries is, however, sometimes very extensive, even going as far as the heart itself. This T have frequently observed in patients. who