FOOTNOTES:

Digitalis, applied either in poultices or infusion, has been said to abate the pain, and meliorate the appearance of the sore; but, in this respect, it seems to be very much on a level with cicuta.

Tar ointment, gastric juice, absorbent powders, and many other applications, which it is unnecessary to enumerate, have been proposed; but as their utility is by no means evinced, I shall not detain the reader with any remarks upon them.

Caustic, and escharotic preparations, have been already considered.

Upon the whole, when the ulcer does not admit of being extirpated, all whichcan be done, is to keep the sore clean, by washing it carefully, and dressing it with some mild ointment, or using some of the poultices or lotions already mentioned, if these do not gall the skin, at the same time that we keep the patient easy by administering opium.

Having now concluded these observations on the cancerous inflammation, I should next proceed to the consideration of the venereal inflammation; but the dissertations on this subject must be reserved for another volume.

END OF VOL. II.

GLASGOW:PRINTED BY JAMES MUNDELL,AYTON COURT.

FOOTNOTES:1Bringing two surfaces in contact, although they naturally were not so, will have the same effect. Thus, if the skin be taken off the edges of our fingers, and the side of the one be applied to the side of the other, adhesion will take place, and no inflammation will be produced. When a part is inflamed, and one portion is brought in contact with another, we uniformly find, that the inflammation is less where the parts were in contact than elsewhere. Thus, when the intestines are inflamed, the parts suffer least which touch other intestines, whilst the angle betwixt the folds is most affected. This fact is observed by Mr. Hunter, but explained upon the principle of contiguous sympathy; or, “a mutual harmony being produced, which prevents their being inflamed.”2If we attempt, without fear, to cure the general disease, why may we not also endeavour to hasten the termination of the local disease?3When we are obliged to stop our bleeding, on account of fainting, before we would otherwise do it, we will find it necessary to repeat the venesection sooner than if this did not happen.4We must distinguish, as has been already mentioned, betwixt a real abatement of the inflammatory action, and a mere temporary suspension of action, or syncope.5Nausea has often been employed with success, in checking active hemorrhage.6This action is, in this respect, similar to that of blisters.7One grain of emetic tartar may be dissolved in five ounces of saline julep, and a table spoonful given every half hour, as long as may be necessary.8Some of these agents might perhaps only change the nature of the inflammation, and render it specific.9Opiates may indeed abate the smarting, or soreness, which is consequent to the immediate mechanical injury of wounds, or operations; but this relief is commonly only temporary; for the general action is very apt to be afterwards increased, and, consequently, union by adhesion is less likely to take place.10There are two general diseases which are connected with local actions, and which opium is supposed to cure, or prevent from taking place; the inflammatory fever, dependent on an wound, and the febrile state, consequent to a temporary increased action, or exertion of a particular part, or the whole of the system; as, for instance, the effect of parturition. The first of these is always aggravated by opium; the second, if it be not increased, cannot possibly be cured by it.11When applied to the skin of the abdomen, it acts chiefly by exciting action, on the principle of the sympathy of equilibrium.12Were this not the case, we should cure pulmonic inflammation, with the greatest certainty, by covering the whole thorax with a blister.13Like other agents of this kind, they may kill speedily, if drunk in too great quantities; and, after death, the vitality, from the previous great action, is found completely destroyed.14Hunter on Inflammation, p. 350.15By peculiar action, I do not here mean what is commonly understood by the term specific, but the action which is proper to the artery, considered as an individual, in opposition to the action of the heart and arteries, considered in general as an entire circulating system; for one part of this system may act less powerfully than another, and may be more dilated, &c.16The distance to which this will extend, depends chiefly upon the quantity of blood which is lost, and the size of the vessel which is affected.17This depends upon the operation of the sympathy of association. Sympathy was, in the preliminary dissertation, divided into that of association, and that of equilibrium; and it was mentioned, that the same parts might be made to exhibit either of these, but that naturally the sympathy of association is chiefly, and most easily exhibited by those parts which are similar in structure, and contiguous to each other; and, in them, the action spreads fastest. At the same time, if the action continues long, or be very strong, it may be propagated to dissimilar parts, and produce either a very extensive, or an universal action, which is just a greater degree of the sympathy of association. In this case, it has, however, been called universal sympathy.18The solution must, upon the principles already laid down, be both weak, and only so cold as to reduce the sensation of the part to its natural condition, that is to say, so as to abate the morbid feeling of heat; because, if we make it otherwise, we may injure the powers of recovery, and perhaps induce gangrene. The application ought not to be so cold as to excite the sensation of coldness, at least in any considerable degree.19Bark is useful and necessary in every case of erysipelas, after the inflammatio valida has abated. Local applications, of a stimulating nature, are also useful at this period, as will afterwards be mentioned, when the inflammatio debilis comes to be considered.20From what has been said in the preliminary dissertation, we may understand how moisture should tend to induce a secretion. Agents frequently excite conditions somewhat similar to their general properties: Thus, putrid matter tends to induce the action of descent, and consequent putrefaction. We likewise experimentally find, that, if moisture be applied during a general increased action, it induces perspiration, unless it be conjoined with cold, which lessens the action.21The proper way to use electricity, in this case, is to draw scintillæ from the part, the patient being insulated.22Fomentations are made, by applying a soft cloth, dipped in any warm fluid, (commonly water) to the part. Sometimes the cloth is wrung hard, in which case it is chiefly steam which is applied.23Poultices may also be made, by boiling pounded linseed-cake, or from potatoes, or mashed vegetable leaves (which are the cheapest for hospitals), such as tussilago, &c.24The inflammatory action, when moderately strong, acts naturally as an exciting cause, inducing the purulent action, which is therefore said to be a termination of inflammation. It is therefore as unnecessary to interfere in the production of this secretion, when the action is of proper strength, &c. as it would be to attempt to increase, by local means, the vesication which is produced by a blister. Poultices are, in this condition, perhaps chiefly useful, by removing the causes which tend to abate the action at an improper time, such as those which produce resolution, as cold, &c.25They keep up the heat of the part, and keep it moist until this happens, and prevent the action from flagging suddenly, which is all that is required of them, when the action is going on of itself in a proper degree.26When two parts are affected at the same time, in consequence of an agent operating quickly on one of them, they commonly exhibit the sympathy of association, which takes place suddenly, but generally at first lasts only for a short time, if the parts be distant; but, if the original disease still continue, it may spread, inch by inch, until it arrives at the part which was formerly affected, and which is again affected more permanently, by the same kind of sympathy taking place, but in a different way. In the first case, we have the sympathia consociationis interrupta; in the second, the sympathia consociationis serpens. It is this last which is the cause of the extension of all action in a part, and which, when strongly excited, overcomes the natural tendency to the exhibition of the sympathy of equilibrium. It is, however, more difficult for local action to spread by degrees to parts which evince the sympathy of equilibrium than other parts; and these, in general, are longer of being affected. Thus, when inflammation begins in the skin, it can much more easily spread along the skin than dip down to the muscles.27In proportion as the action extends outward, it also becomes more concentrated. An abscess is therefore somewhat conical, or at least hemispherical, the base being turned inward, and the apex outward. When the action reaches the surface, it is first at a single point; but, by degrees, it becomes extended, and the apex becomes broader.28Such as the thorax, trachea, &c. Instances have happened of suffocation being thus produced.29Although, in general, an abscess has little tendency to extend itself deep down, but rather moves toward the surface, although so far from it originally, that, had the action extended equally in all other directions, the size of the abscess must have been immense; yet, when it is situated over a cavity, it may proceed toward that as if to an external surface. Even, however, in this case, the general law, of all actions tending to the skin, obtains; for the progress outward is much quicker than that inward; but, if the action commenced near the surface of the cavity, as is commonly the case, the difference of the distance will compensate for the superior tendency to extend outward; and, therefore, the abscess may burst at the internal surface into the cavity.30In abscesses seated on the thorax, I have known the intercostal muscles and pleura continue the suppurative action, after the external surface had opened, and thus an opening came to be formed into the thorax.31This likewise affects the system, and produces syncope, if the mechanical support be withdrawn suddenly from the parts.32This poultice does not require to be so hot, nor changed so frequently, as before the full formation of matter.33If this produces pain, we may in general conclude that it has been used too soon.34This 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.35If 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.36When 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.37If 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.38There 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.39These sinuses cannot be considered in this dissertation.40This 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.41Mr. 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. 381.42Exercise 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.43Acids are supposed to check it; but they can only act by increasing the strength in a secondary way.44Sweating is perhaps to the general hectic action what the suppuration is to the local one; and, therefore, can only be stopped by influencing this action.45A diet solely animal has been proposed in that peculiar species of hectic which accompanies diabetes; but whether it would be equally useful in other species remains to be determined.46When this disease attacks the lungs, as it too frequently does, then, until a specific remedy for scrophula be discovered, no cure can be obtained. Simple ulceration, or suppuration of the lungs, however, and consequent hectic, may be cured, though not in every instance.47Whenever the discharge does not separate completely from the surface, when it is wiped, but part of it remains, like a film, or jelly, betwixt the granulations, or on particular spots, we may be sure that the action is not healthy.48Simple ointment, rubbed up with a fourth part of its weight of finely levigated calamine, or flowers of zinc, makes a useful application. Mr. Bell recommends, amongst other remedies, a saturnine ointment; but, if this produces any specific operation, it must be a hurtful one, injuring the action.49The circumstance of one part of an ulcer being more affected than another, will be more fully noticed in considering the next genus, in which it is of more practical consequence. Ulcers generally belong to this species, before they assume the characters of the second (for they frequently change from one species, or genus, to another; in which case, the treatment must also be changed).50The cause why these granulations rise, even this trifling height, above the level of the skin, is the indolence of the action, which prevents a cuticle from being formed in due time.51Indolence of the action does not imply that the quantity of a discharge should be lessened, but only that its nature should be changed. In this species, the discharge is much the same in quantity as in a healthy ulcer of the same size, but its perfection is greatly less.52Sometimes the granulating action and the cicatrizing one seems to be confounded, the surface exhibiting a fibrous fleshy appearance. This I have seen most frequently in the calf of the leg; but it may occur in other parts.53These ulcers, after long continuance, frequently induce a disease in the bones or muscles seated below them, as will afterwards be mentioned.54The degree of pressure necessary for producing this effect is proportioned to the susceptibility of the granulations, or organic particles, for receiving the impression of being in contact. When a part is healthy, the mere circumstance of juxtaposition is sufficient for this purpose; and, in a healthy ulcer, the weight of the body applied, such as powdered chalk, or plaster of Paris, or at least the gentle pressure of a stocking, or easy bandage, is all that is necessary. But, when the action is too low, and the granulations are consequently imperfect, both in their structure, power of acting, and capability of receiving impressions, the contact, in order to operate, must be nearer, and more complete; or, in other words, the pressure must be greater. In these cases, bandages not only act on the surface, but also on the parts below, and, therefore, increase the degree of contact of the newly-formed organic particles, and thus strengthen the part.55An ointment composed of these resinous substances is much recommended in the Acta Med. Berolin. Tom. VII. p. 58.56These acids coagulate the pus, and thus afford an artificial covering, or film, which remains in close contact with the granulations, and thus, by producing the natural circumstance of contact and covering, the effects of which have been already mentioned, as well as by creating a more vigorous action by their specific action, they frequently bring those sores into a healthy state.57This operation is performed by making an incision through the skin which covers the vena saphena below the knee; a ligature is then passed under the vessel, by means of a blunt needle, and the vessel is tied. In two or three days the ligature may be removed, its circle being previously divided with a pair of scissars.58By this I mean more perfect in its state of overaction.59In highly overacting ulcers, the granulations seem to possess a middle state, betwixt proper organic particles and the morbid substance, called pus.60This affection of the ulcer, produced by a disease of the parts below, is induced with a frequency nearly proportioned to the aptitude of the part below for becoming diseased, by the continuance of an ulcer over them. Tendons and bones are particularly apt to be injured in this way; and, therefore, ulcers seated over tendinous parts, or bones thinly covered, are more apt to affect these, and to be reacted on themselves, than when seated over fleshy parts. On the same account, ulcers on the foot, or ankle joint, are worse to heal than those a little farther up the leg; and the difference is greater than can be explained wholly, by the circumstance of distance from the heart, and possessing less power of performing action properly. Recent ulcers likewise heal easily on the feet, by proper treatment. It is old ulcers alone which are difficult to manage, and the cause is obvious.61L’eau mercurielle is a solution of mercury in nitrous acid.62In the description of this variety, it was mentioned, that there frequently was a small opening in the surface, which communicated with the bone; but, even where this is not the case, the layer of dead bone, when it exfoliates, comes through the granulations; for the granulations of the sound bone below raise it up, in consequence of which, pressure is made from within outward upon the ulcer, by which absorption is produced at that part, in a greater degree than deposition; and, therefore, a vacuity is produced.63The ammonia hepatizata is prepared by passing a stream of hepatic gas through the aqua ammoniæ.64No external application whatever will produce the same good effect, if used by itself, as when such a general action is induced as shall co-operate with the local remedies. In slight cases, thirty drops of laudanum may be given twice a-day; but, when the overaction is more violent, the dose must be more frequently repeated.65This was probably recommended on account of the sphacelated appearance which these sores sometimes have.66Let two ounces of camomile flowers be boiled in three pounds of water down to two. When this is cold, it ought to be strained, and half a drachm of opium diffused in a pound of the decoction. Of this, a sufficient quantity is to be added to powdered charcoal, in order to form a poultice.67The fermenting poultice is made by adding a spoonful of yest to an oatmeal poultice, and placing it before the fire until it begins to emit air, or rise up in a bubbling way. It is then fit for applying to the sore.68“Siccitas rubido et phlogosis ulceris facile cognoscuntur; dolore, pruritu, calore stipantur; ca impediunt carnis excrescentiam, adeoque indicant remedia emollientia,” &c. Sauvage Nosol. Meth. Tom. II. p. 613.69See the preliminary dissertation.70It is more rapid in the inflammatio debilis than in the inflammatio valida, and in very delicate parts than in parts which are less so.71The necessity for this, and other remedies, is in general proportioned to the continuance of the disease, and the progress which it has made. In this, as in every other disease, we must be attentive to the effects of our remedies, and consider these in forming our opinion.72The hot, and almost boiling oils, which were poured into these incisions, contributed not a little to increase the disease.73As an illustration of this rule, I may mention the following case: A man, during a voyage to a cold climate, had both his feet frost-bit, in consequence of which mortification ensued. In this state he continued for two or three weeks, during which he received very little medical aid. When I saw him, both his feet were mortified, from the toes to about three inches above the ankle joints, his pulse was feeble, very frequent, and intermittent, the strength was greatly impaired, and the countenance sunk and ghastly. The ulcerative action had been induced for some time, but the want of wine and proper diet had prevented the system from gaining by the cessation of the local disease. He began the use of the bark, opium, wine, and soups, which he took very liberally, in consequence of which his pulse became slower, and his strength increased. In two days, one of the ankle joints was removed by clipping through the tendons, and, in a few days more, the other came away. Amputation was now performed below the knee of the right leg, the constitution, instead of gaining, rather beginning to lose ground. The subsequent affection of the system was by no means great, and, in about a week, he was much stronger; but, as the bones of the ankle joint of the other leg were carious, he again began to sink. Amputation was therefore performed on the left side, in about three weeks after the first. During the cure, the wine, opium, and nourishing diet, were freely prescribed.74It is very seldom that a stump unites at first, if amputation be performed on account of mortification; at least if the operation be not delayed until the health and strength be fully re-established: But this can very seldom be the case; for, in most cases, the state of the bones, and the disease of the part itself, prevents recovery from taking place beyond a certain degree, and also prevents us from delaying beyond a limited time. The system, therefore, is not allowed to recover fully from the tendency to the action of descent, and union does not take place. In the case which was formerly mentioned, the first stump did not adhere fully, but the second succeeded better, because then the system suffered more from the state of the diseased bones, &c. than from the previous mortification, and, therefore, it had not the same inability to undergo the healing action.75In most specific inflammations, if not in every one, the redness is never of the bright scarlet colour, but always more or less purple, or dusky; but this may take place without any specific action. The sensation is also sometimes different.76The neighbouring glands sometimes swell and suppurate, but they heal kindly, and the disease proceeds no farther.77From this, it would appear, that his throat had been at one time healed.78Many of these have been confounded with the venereal disease, and treated accordingly.It were much to be desired that they should be accurately described, and one kind distinguished from another, for there are probably many different species.79Some actions cannot be induced during the continuance of others. Other actions can, in these circumstances, be formed, and displace completely the former action. A third set seem to give a modification to the original disease: They change it to a certain degree; but the change is not salutary, and they never displace it. The mercurial action, when induced during the existence of some of the diseases which I am describing, comes under the last, or third class. At first, during the formation of the mercurial action, the former diseased action is interrupted, in the same way as the natural action is injured during the period of formation of other actions, when no peculiar disease previously existed. On this account, the sore assumes a better appearance; and, if the action be nearly terminating naturally (as some actions do, and as the primary action in these diseases more readily does than the secondary), it quickly heals up; but, if this be not the case, the appearances soon change, and the disease becomes much worse.80There are some cases, described by different authors, of affections of the nipples and breasts, in which the ulcers appear to have been chiefly of the phagedenic kind.81Cases of this kind may be found in Mr. Hunter’s Treatise on the Venereal Disease, and in the third volume of the Medical Transactions.82This disease is communicated even by drinking out of the same vessel with an infected person, even although that person have no sores on the lips, but only in the throat. The contagion then must either be dissolved in the saliva, or remain very powerful, even when reduced to a state of halitus.83There are many different divisions of herpes; as, for instance, into the scurfy, scabby, miliary, &c.; but, for a description of these, I must refer to the writers on the diseases of the skin.84When the conglomerate glands are affected, the tumor is generally hard and firm until matter forms.85Cullen’s First Lines, Vol. IV.86Bell’s Treatise on Ulcers, p. 424.87The morbid condition of the formative action is very frequently manifested in the bones, which are less perfect, that is to say, softer, containing less calcareous earth, and later of being formed. Thus, the teeth are longer of appearing; the bones of the head are soft and yielding, and hence the head is large; the long bones bend and lose their shape, or their extremities swell, and, from being more vascular than their nature is fitted for, inflammation is very apt to be induced. The yielding and increasing of the bones of the cranium is likewise attended with a similar effect, for the brain becomes too large in proportion to the rest of the body, and is very apt to inflame, and have effusions formed into it. At other times, the diseased state of the formative action appears most distinctly at the surface, the skin being rough, and very apt to desquamate.88Some gentlemen have denied that scrophula was a hereditary disease; but it is unnecessary to offer any argument on this subject.89This term is used here in a different sense from its common one, which signifies sensibility, or delicacy with regard to sensation, and capability of being acted on.90Parts which are improperly organised, or which are not in every respect similar, both in their structure and constitution (by which I mean, mode of acting in general), to what naturally they ought to be, are not only less capable of performing their actions aright, but likewise are to be considered as in some respect extraneous to the human body, or, as it were, insulated, and do not correspond exactly to other parts. They therefore receive less support from the neighbouring parts, and, consequently, have their power diminished. The imperfection of action consequent to these causes is proportioned to the morbid condition of the part.91See what has been said on this subject when treating of the cure of mortification.92See the second volume of Medical Communications.93Nosographie Philosophique, Vol. II. p. 238.94When it is wished to prescribe it, the following is a very good formula:R. Terræ Ponder. Salit. Chryst. gr. x.Aq. Font.Aq. Cassiæ utriusque uncias iiiSyrupi Aurent. uncias ii.Half an ounce of this may be given at first, twice or three times a-day, and gradually increased to such quantity as the stomach can bear without sickness.95This metal was one of the principal ingredients in a remedy used by the Marischal de Rougeres, which consisted of filings of iron, sal ammoniac, salt of tartar, &c. Journal de Med. Tom. XL. p. 219.96This is highly recommended by M. Martcau. Journ. de Med. Tom. IV. p. 121.97Practique Moderne de Chirurger, par Ravaton, Tom. II. p. 3.98This ointment may be prepared by macerating one part of recent savine leaves bruised, in four parts of ung. resinos.; it is then to be strained.99The following may be used for this purpose:R. Ceruss. Acetat. drachmam unam.Aq. Rosar. uncias octo. Solve, dein cola.100Keeping this skin dry has a tendency to prevent ulceration, and abate the redness and inflammation. The cerussa may sometimes be advantageously mixed with an eighth part of powdered camphire, which promotes the removal of the superficial inflammation.101Bell on Ulcers, p. 471.102Bell on Ulcers, p. 427.103This application forms a very useful remedy for the scrophulous ulceration of the eye-lids, which we so frequently meet with.104This substance is the basis of a celebrated lotion for the face, which is sometimes useful in chronic pustules, which are frequently of a scrophulous nature. It promotes suppuration, the pustule then scabs, and, when this falls off, the part is sometimes found sound below. It is made by dissolving corrosive sublimate in an emulsion of bitter almonds.105Laurent. de Strum. Nat. p. 67.106Although the affected gland becomes rather larger, yet the surrounding cellular substance sometimes diminishes, and the neighbouring glands are rather contracted, in which case the part seems to be shrunk.107This abscess sometimes, though very rarely, occupies the whole of the gland, but oftener only a part of it; and if the gland be large, there are sometimes several abscesses, of considerable size, which form unconnectedly with each other, and burst separately.108It has been said, that genuine cancer is very rare in the uterus, and that the cases which pass for such are phagedenic. But although the uterus may be affected with scrophulous inflammation, and phagedenic, as well as some other specific affections, yet it must be admitted, from an examination of cases, that the uterus is very frequently attacked with true cancer. Its substance is found enlarged, hard, and containing cancerous abscesses in different parts.109To this specific affection, we may give the name of pseudo-cancer, for want of a better designation.110Of this nature was probably the ulcer mentioned by Mr. Wiseman, at least if we may judge from his very short description: “It had eat deep into her left breast, and was fixed to the ribs, but not with much pain. In progress of time, the lips inverted, and united, as it were, and lay covered with a crusty scab; the humour in the mean while spent itself upon the nerves, &c. She lived long, and, in her latter age, tolerably healthful.” Chirurg. Treatises, Vol. I. p. 165.111Extirpation is the only certain cure of this disease; and it is at all times the quickest and the best; but, by eschoritics, we may sometimes procure cicatrization, at least if the gland have shrunk, and most of its substance been destroyed.112It is to be regretted, that some who belong to our profession, reason upon the nature of ulcers, not from appearances and characteristic marks, but from the patients manner of life, or the idea which they have formed of the country whence they come. I remember two instances of people who came from the Hebrides, the one with a cancer of the lip, the other with a cancerous ulcer on the neck, both fungous, and possessing the burning pain, and every character of cancer; but as the sibbens unluckily prevailed in that country, it was thought that the patients might have received this infection, and accordingly were, by a full consultation of surgeons, condemned to undergo a course of mercury. The lip was, in three days, greatly worse; the mercury was omitted, and the patient cured by an operation. The sore on the neck was instantly exasperated, and the patient, to use the words of Hildanus, “had her soul speedily sent to heaven.”113These are sometimes very irregular in their shape, and have their sides very thin; so that, at first sight, they appear like cavities formed by the separation of the fibres of the part.114That is to say, the sore is rather flabby than fungous; for cancerous ulcers which begin superficially, and without previous abscess, remain a considerable time without forming fungus; but when an abscess bursts, and the skin ulcerates in consequence, then the sore is not superficial, but communicates with the abscess, which forms fungus quickly.115Heister’s Institut. Vol. I. p. 229.116Bell on Ulcers, p. 319.117Dioni’s Chir. p. 248.118Does inflammation depend upon the hardness or softness of the inflamed part?119One should expect, that the distension of the vessels would diminish the cause of obstruction, or remove it altogether.It is rather unlucky, that the advocates for obstruction have made it the cause of simple inflammation, scrophula, cancer, &c.; and therefore all these diseases ought to be nearly, if not entirely, similar in their nature, and to require exactly the same means of cure.120Adam’s Observations on Morbid Persons, p. 184.121Idem, p. 185.122Adam’s Observations on Morbid Persons, p. 184.123Idem, p. 161.124Van Swieten’s Commentaries, article Cancer.125Mr. Hunter supposes, that the mere absorption of schirrous substance before matter be formed, will affect the glands; but it is difficult to ascertain the certainty of this, as small abscesses are formed very early. I have formerly mentioned, that every part of the animal is changed in its nature, at the moment of being absorbed: If so, schirrous substances lose all specific property, and cannot affect the glands. Pus, again, being a foreign matter, is absorbed unchanged, and continues so until it reaches the glands.126It may be said, that different parts have different susceptibilities of assuming the morbid condition; that the bones are longer of becoming affected than the soft parts, &c. Admit this, and still it must be explained, why every part of a similar structure, &c. should not be affected at the same moment. All the glands should become diseased at once; all the bones should inflame at the same time; and, instead of finding one or two organs affected, in consequence of the previous existence of a local disease, we should find the whole system rapidly becoming diseased.127It was supposed, that when the menses were obstructed, the impurities were sent by communicating vessels to the breast, where they lodged, and produced cancer. Vide Vesalii Opera, p. 1092. Fabricius de Tum. p. 118.Le Dran observes, that when schirrus, from any cause, takes place in the breast, before the cessation of the menses, it uniformly becomes more painful when any irregularity of that discharge occurs. Vide Memoires de l’Acad. de Chirurg. Tom. III. p. 22.128Warts are, with regard to their power of acting, to be considered in the same light with simple schirri.129See the Note to p.354.130The simple schirrus now assumes that specific mode of inflammatory action which it is to continue, and may now be called the scrophulous or cancerous inflamed schirrus.131Schirrus has generally been enumerated as one of the terminations of inflammation; but it cannot, properly speaking, be considered as such. There are only two kinds of termination, one in death, as, for instance, gangrene; the other in recovery, which is accomplished either directly by resolution, or indirectly by suppuration. Schirrus is not produced by a perfect and complete cessation of inflammation, but by a continuance of a low degree of inflammation, which renders the state of tumefaction which attends it natural to the part, before it goes off. This state, then, is not a termination of inflammation, but a consequence of its continuance.132I have known two cases of this kind; in both the eye was affected. One boy had his eye extirpated; but a small part being left by the surgeon at the angle, the disease returned, and proved fatal. In another, the disease was in its incipient stage; but the relations would not submit to an operation.133Med. Essays, Vol. V. p. 422.134Pract. Obs. on Cancerous Complaints, by Mr. Pearson, p. 50.135Arsenic mixed with sulphur, and powdered crow-foot, and made into a paste with yolk of egg, forms Plunket’s composition. Mixed with forty times its weight of powder of belladona, it forms an application which some time ago was much in repute in North America.136Justamond on Cancers, p. 141. This gentleman relates a case, in which, by destroying the skin with lunar caustic, and then applying arsenic, he removed the gland. The arsenic, in this instance, was fused with antimony, in proportion of two parts of the first to one of the last. This was powdered and mixed with equal parts of powdered opium, and made into a liniment with yolk of egg.137If I am not mistaken, the present Dr. Monro mentions, in his lectures, one instance, in which a small schirrus appeared to be removed by it; but whether this was simple or cancerous, I do not know.138As different parcels of this medicine may not be of the same strength, it is prudent, when we begin a new supply, that we diminish the dose at first, if it have formerly been very considerable. By not attending to this, fatal effects have followed.139I have tried the hepatized ammonia, but without any benefit.140Justamond on Cancers.141Alongst with this, it was customary to prescribe decoctions of guaiac, sarsaparilla, &c.142It likewise continues very long after giving up the use of the mercury.143Some cases of this kind I have already mentioned.144Although the fœtor may depend upon the presence of hepatized ammonia, yet this does no harm to the ulcer. On the contrary, I have sometimes found the application of this fluid, when mixed with water, have the effect of abating the pain.

1Bringing two surfaces in contact, although they naturally were not so, will have the same effect. Thus, if the skin be taken off the edges of our fingers, and the side of the one be applied to the side of the other, adhesion will take place, and no inflammation will be produced. When a part is inflamed, and one portion is brought in contact with another, we uniformly find, that the inflammation is less where the parts were in contact than elsewhere. Thus, when the intestines are inflamed, the parts suffer least which touch other intestines, whilst the angle betwixt the folds is most affected. This fact is observed by Mr. Hunter, but explained upon the principle of contiguous sympathy; or, “a mutual harmony being produced, which prevents their being inflamed.”

2If we attempt, without fear, to cure the general disease, why may we not also endeavour to hasten the termination of the local disease?

3When we are obliged to stop our bleeding, on account of fainting, before we would otherwise do it, we will find it necessary to repeat the venesection sooner than if this did not happen.

4We must distinguish, as has been already mentioned, betwixt a real abatement of the inflammatory action, and a mere temporary suspension of action, or syncope.

5Nausea has often been employed with success, in checking active hemorrhage.

6This action is, in this respect, similar to that of blisters.

7One grain of emetic tartar may be dissolved in five ounces of saline julep, and a table spoonful given every half hour, as long as may be necessary.

8Some of these agents might perhaps only change the nature of the inflammation, and render it specific.

9Opiates may indeed abate the smarting, or soreness, which is consequent to the immediate mechanical injury of wounds, or operations; but this relief is commonly only temporary; for the general action is very apt to be afterwards increased, and, consequently, union by adhesion is less likely to take place.

10There are two general diseases which are connected with local actions, and which opium is supposed to cure, or prevent from taking place; the inflammatory fever, dependent on an wound, and the febrile state, consequent to a temporary increased action, or exertion of a particular part, or the whole of the system; as, for instance, the effect of parturition. The first of these is always aggravated by opium; the second, if it be not increased, cannot possibly be cured by it.

11When applied to the skin of the abdomen, it acts chiefly by exciting action, on the principle of the sympathy of equilibrium.

12Were this not the case, we should cure pulmonic inflammation, with the greatest certainty, by covering the whole thorax with a blister.

13Like other agents of this kind, they may kill speedily, if drunk in too great quantities; and, after death, the vitality, from the previous great action, is found completely destroyed.

14Hunter on Inflammation, p. 350.

15By peculiar action, I do not here mean what is commonly understood by the term specific, but the action which is proper to the artery, considered as an individual, in opposition to the action of the heart and arteries, considered in general as an entire circulating system; for one part of this system may act less powerfully than another, and may be more dilated, &c.

16The distance to which this will extend, depends chiefly upon the quantity of blood which is lost, and the size of the vessel which is affected.

17This depends upon the operation of the sympathy of association. Sympathy was, in the preliminary dissertation, divided into that of association, and that of equilibrium; and it was mentioned, that the same parts might be made to exhibit either of these, but that naturally the sympathy of association is chiefly, and most easily exhibited by those parts which are similar in structure, and contiguous to each other; and, in them, the action spreads fastest. At the same time, if the action continues long, or be very strong, it may be propagated to dissimilar parts, and produce either a very extensive, or an universal action, which is just a greater degree of the sympathy of association. In this case, it has, however, been called universal sympathy.

18The solution must, upon the principles already laid down, be both weak, and only so cold as to reduce the sensation of the part to its natural condition, that is to say, so as to abate the morbid feeling of heat; because, if we make it otherwise, we may injure the powers of recovery, and perhaps induce gangrene. The application ought not to be so cold as to excite the sensation of coldness, at least in any considerable degree.

19Bark is useful and necessary in every case of erysipelas, after the inflammatio valida has abated. Local applications, of a stimulating nature, are also useful at this period, as will afterwards be mentioned, when the inflammatio debilis comes to be considered.

20From what has been said in the preliminary dissertation, we may understand how moisture should tend to induce a secretion. Agents frequently excite conditions somewhat similar to their general properties: Thus, putrid matter tends to induce the action of descent, and consequent putrefaction. We likewise experimentally find, that, if moisture be applied during a general increased action, it induces perspiration, unless it be conjoined with cold, which lessens the action.

21The proper way to use electricity, in this case, is to draw scintillæ from the part, the patient being insulated.

22Fomentations are made, by applying a soft cloth, dipped in any warm fluid, (commonly water) to the part. Sometimes the cloth is wrung hard, in which case it is chiefly steam which is applied.

23Poultices may also be made, by boiling pounded linseed-cake, or from potatoes, or mashed vegetable leaves (which are the cheapest for hospitals), such as tussilago, &c.

24The inflammatory action, when moderately strong, acts naturally as an exciting cause, inducing the purulent action, which is therefore said to be a termination of inflammation. It is therefore as unnecessary to interfere in the production of this secretion, when the action is of proper strength, &c. as it would be to attempt to increase, by local means, the vesication which is produced by a blister. Poultices are, in this condition, perhaps chiefly useful, by removing the causes which tend to abate the action at an improper time, such as those which produce resolution, as cold, &c.

25They keep up the heat of the part, and keep it moist until this happens, and prevent the action from flagging suddenly, which is all that is required of them, when the action is going on of itself in a proper degree.

26When two parts are affected at the same time, in consequence of an agent operating quickly on one of them, they commonly exhibit the sympathy of association, which takes place suddenly, but generally at first lasts only for a short time, if the parts be distant; but, if the original disease still continue, it may spread, inch by inch, until it arrives at the part which was formerly affected, and which is again affected more permanently, by the same kind of sympathy taking place, but in a different way. In the first case, we have the sympathia consociationis interrupta; in the second, the sympathia consociationis serpens. It is this last which is the cause of the extension of all action in a part, and which, when strongly excited, overcomes the natural tendency to the exhibition of the sympathy of equilibrium. It is, however, more difficult for local action to spread by degrees to parts which evince the sympathy of equilibrium than other parts; and these, in general, are longer of being affected. Thus, when inflammation begins in the skin, it can much more easily spread along the skin than dip down to the muscles.

27In proportion as the action extends outward, it also becomes more concentrated. An abscess is therefore somewhat conical, or at least hemispherical, the base being turned inward, and the apex outward. When the action reaches the surface, it is first at a single point; but, by degrees, it becomes extended, and the apex becomes broader.

28Such as the thorax, trachea, &c. Instances have happened of suffocation being thus produced.

29Although, in general, an abscess has little tendency to extend itself deep down, but rather moves toward the surface, although so far from it originally, that, had the action extended equally in all other directions, the size of the abscess must have been immense; yet, when it is situated over a cavity, it may proceed toward that as if to an external surface. Even, however, in this case, the general law, of all actions tending to the skin, obtains; for the progress outward is much quicker than that inward; but, if the action commenced near the surface of the cavity, as is commonly the case, the difference of the distance will compensate for the superior tendency to extend outward; and, therefore, the abscess may burst at the internal surface into the cavity.

30In abscesses seated on the thorax, I have known the intercostal muscles and pleura continue the suppurative action, after the external surface had opened, and thus an opening came to be formed into the thorax.

31This likewise affects the system, and produces syncope, if the mechanical support be withdrawn suddenly from the parts.

32This poultice does not require to be so hot, nor changed so frequently, as before the full formation of matter.

33If this produces pain, we may in general conclude that it has been used too soon.

34This 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.

35If 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.

36When 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.

37If 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.

38There 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.

39These sinuses cannot be considered in this dissertation.

40This 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.

41Mr. 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.

42Exercise 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.

43Acids are supposed to check it; but they can only act by increasing the strength in a secondary way.

44Sweating is perhaps to the general hectic action what the suppuration is to the local one; and, therefore, can only be stopped by influencing this action.

45A diet solely animal has been proposed in that peculiar species of hectic which accompanies diabetes; but whether it would be equally useful in other species remains to be determined.

46When this disease attacks the lungs, as it too frequently does, then, until a specific remedy for scrophula be discovered, no cure can be obtained. Simple ulceration, or suppuration of the lungs, however, and consequent hectic, may be cured, though not in every instance.

47Whenever the discharge does not separate completely from the surface, when it is wiped, but part of it remains, like a film, or jelly, betwixt the granulations, or on particular spots, we may be sure that the action is not healthy.

48Simple ointment, rubbed up with a fourth part of its weight of finely levigated calamine, or flowers of zinc, makes a useful application. Mr. Bell recommends, amongst other remedies, a saturnine ointment; but, if this produces any specific operation, it must be a hurtful one, injuring the action.

49The circumstance of one part of an ulcer being more affected than another, will be more fully noticed in considering the next genus, in which it is of more practical consequence. Ulcers generally belong to this species, before they assume the characters of the second (for they frequently change from one species, or genus, to another; in which case, the treatment must also be changed).

50The cause why these granulations rise, even this trifling height, above the level of the skin, is the indolence of the action, which prevents a cuticle from being formed in due time.

51Indolence of the action does not imply that the quantity of a discharge should be lessened, but only that its nature should be changed. In this species, the discharge is much the same in quantity as in a healthy ulcer of the same size, but its perfection is greatly less.

52Sometimes the granulating action and the cicatrizing one seems to be confounded, the surface exhibiting a fibrous fleshy appearance. This I have seen most frequently in the calf of the leg; but it may occur in other parts.

53These ulcers, after long continuance, frequently induce a disease in the bones or muscles seated below them, as will afterwards be mentioned.

54The degree of pressure necessary for producing this effect is proportioned to the susceptibility of the granulations, or organic particles, for receiving the impression of being in contact. When a part is healthy, the mere circumstance of juxtaposition is sufficient for this purpose; and, in a healthy ulcer, the weight of the body applied, such as powdered chalk, or plaster of Paris, or at least the gentle pressure of a stocking, or easy bandage, is all that is necessary. But, when the action is too low, and the granulations are consequently imperfect, both in their structure, power of acting, and capability of receiving impressions, the contact, in order to operate, must be nearer, and more complete; or, in other words, the pressure must be greater. In these cases, bandages not only act on the surface, but also on the parts below, and, therefore, increase the degree of contact of the newly-formed organic particles, and thus strengthen the part.

55An ointment composed of these resinous substances is much recommended in the Acta Med. Berolin. Tom. VII. p. 58.

56These acids coagulate the pus, and thus afford an artificial covering, or film, which remains in close contact with the granulations, and thus, by producing the natural circumstance of contact and covering, the effects of which have been already mentioned, as well as by creating a more vigorous action by their specific action, they frequently bring those sores into a healthy state.

57This operation is performed by making an incision through the skin which covers the vena saphena below the knee; a ligature is then passed under the vessel, by means of a blunt needle, and the vessel is tied. In two or three days the ligature may be removed, its circle being previously divided with a pair of scissars.

58By this I mean more perfect in its state of overaction.

59In highly overacting ulcers, the granulations seem to possess a middle state, betwixt proper organic particles and the morbid substance, called pus.

60This affection of the ulcer, produced by a disease of the parts below, is induced with a frequency nearly proportioned to the aptitude of the part below for becoming diseased, by the continuance of an ulcer over them. Tendons and bones are particularly apt to be injured in this way; and, therefore, ulcers seated over tendinous parts, or bones thinly covered, are more apt to affect these, and to be reacted on themselves, than when seated over fleshy parts. On the same account, ulcers on the foot, or ankle joint, are worse to heal than those a little farther up the leg; and the difference is greater than can be explained wholly, by the circumstance of distance from the heart, and possessing less power of performing action properly. Recent ulcers likewise heal easily on the feet, by proper treatment. It is old ulcers alone which are difficult to manage, and the cause is obvious.

61L’eau mercurielle is a solution of mercury in nitrous acid.

62In the description of this variety, it was mentioned, that there frequently was a small opening in the surface, which communicated with the bone; but, even where this is not the case, the layer of dead bone, when it exfoliates, comes through the granulations; for the granulations of the sound bone below raise it up, in consequence of which, pressure is made from within outward upon the ulcer, by which absorption is produced at that part, in a greater degree than deposition; and, therefore, a vacuity is produced.

63The ammonia hepatizata is prepared by passing a stream of hepatic gas through the aqua ammoniæ.

64No external application whatever will produce the same good effect, if used by itself, as when such a general action is induced as shall co-operate with the local remedies. In slight cases, thirty drops of laudanum may be given twice a-day; but, when the overaction is more violent, the dose must be more frequently repeated.

65This was probably recommended on account of the sphacelated appearance which these sores sometimes have.

66Let two ounces of camomile flowers be boiled in three pounds of water down to two. When this is cold, it ought to be strained, and half a drachm of opium diffused in a pound of the decoction. Of this, a sufficient quantity is to be added to powdered charcoal, in order to form a poultice.

67The fermenting poultice is made by adding a spoonful of yest to an oatmeal poultice, and placing it before the fire until it begins to emit air, or rise up in a bubbling way. It is then fit for applying to the sore.

68“Siccitas rubido et phlogosis ulceris facile cognoscuntur; dolore, pruritu, calore stipantur; ca impediunt carnis excrescentiam, adeoque indicant remedia emollientia,” &c. Sauvage Nosol. Meth. Tom. II. p. 613.

69See the preliminary dissertation.

70It is more rapid in the inflammatio debilis than in the inflammatio valida, and in very delicate parts than in parts which are less so.

71The necessity for this, and other remedies, is in general proportioned to the continuance of the disease, and the progress which it has made. In this, as in every other disease, we must be attentive to the effects of our remedies, and consider these in forming our opinion.

72The hot, and almost boiling oils, which were poured into these incisions, contributed not a little to increase the disease.

73As an illustration of this rule, I may mention the following case: A man, during a voyage to a cold climate, had both his feet frost-bit, in consequence of which mortification ensued. In this state he continued for two or three weeks, during which he received very little medical aid. When I saw him, both his feet were mortified, from the toes to about three inches above the ankle joints, his pulse was feeble, very frequent, and intermittent, the strength was greatly impaired, and the countenance sunk and ghastly. The ulcerative action had been induced for some time, but the want of wine and proper diet had prevented the system from gaining by the cessation of the local disease. He began the use of the bark, opium, wine, and soups, which he took very liberally, in consequence of which his pulse became slower, and his strength increased. In two days, one of the ankle joints was removed by clipping through the tendons, and, in a few days more, the other came away. Amputation was now performed below the knee of the right leg, the constitution, instead of gaining, rather beginning to lose ground. The subsequent affection of the system was by no means great, and, in about a week, he was much stronger; but, as the bones of the ankle joint of the other leg were carious, he again began to sink. Amputation was therefore performed on the left side, in about three weeks after the first. During the cure, the wine, opium, and nourishing diet, were freely prescribed.

74It is very seldom that a stump unites at first, if amputation be performed on account of mortification; at least if the operation be not delayed until the health and strength be fully re-established: But this can very seldom be the case; for, in most cases, the state of the bones, and the disease of the part itself, prevents recovery from taking place beyond a certain degree, and also prevents us from delaying beyond a limited time. The system, therefore, is not allowed to recover fully from the tendency to the action of descent, and union does not take place. In the case which was formerly mentioned, the first stump did not adhere fully, but the second succeeded better, because then the system suffered more from the state of the diseased bones, &c. than from the previous mortification, and, therefore, it had not the same inability to undergo the healing action.

75In most specific inflammations, if not in every one, the redness is never of the bright scarlet colour, but always more or less purple, or dusky; but this may take place without any specific action. The sensation is also sometimes different.

76The neighbouring glands sometimes swell and suppurate, but they heal kindly, and the disease proceeds no farther.

77From this, it would appear, that his throat had been at one time healed.

78Many of these have been confounded with the venereal disease, and treated accordingly.It were much to be desired that they should be accurately described, and one kind distinguished from another, for there are probably many different species.

78Many of these have been confounded with the venereal disease, and treated accordingly.

It were much to be desired that they should be accurately described, and one kind distinguished from another, for there are probably many different species.

79Some actions cannot be induced during the continuance of others. Other actions can, in these circumstances, be formed, and displace completely the former action. A third set seem to give a modification to the original disease: They change it to a certain degree; but the change is not salutary, and they never displace it. The mercurial action, when induced during the existence of some of the diseases which I am describing, comes under the last, or third class. At first, during the formation of the mercurial action, the former diseased action is interrupted, in the same way as the natural action is injured during the period of formation of other actions, when no peculiar disease previously existed. On this account, the sore assumes a better appearance; and, if the action be nearly terminating naturally (as some actions do, and as the primary action in these diseases more readily does than the secondary), it quickly heals up; but, if this be not the case, the appearances soon change, and the disease becomes much worse.

80There are some cases, described by different authors, of affections of the nipples and breasts, in which the ulcers appear to have been chiefly of the phagedenic kind.

81Cases of this kind may be found in Mr. Hunter’s Treatise on the Venereal Disease, and in the third volume of the Medical Transactions.

82This disease is communicated even by drinking out of the same vessel with an infected person, even although that person have no sores on the lips, but only in the throat. The contagion then must either be dissolved in the saliva, or remain very powerful, even when reduced to a state of halitus.

83There are many different divisions of herpes; as, for instance, into the scurfy, scabby, miliary, &c.; but, for a description of these, I must refer to the writers on the diseases of the skin.

84When the conglomerate glands are affected, the tumor is generally hard and firm until matter forms.

85Cullen’s First Lines, Vol. IV.

86Bell’s Treatise on Ulcers, p. 424.

87The morbid condition of the formative action is very frequently manifested in the bones, which are less perfect, that is to say, softer, containing less calcareous earth, and later of being formed. Thus, the teeth are longer of appearing; the bones of the head are soft and yielding, and hence the head is large; the long bones bend and lose their shape, or their extremities swell, and, from being more vascular than their nature is fitted for, inflammation is very apt to be induced. The yielding and increasing of the bones of the cranium is likewise attended with a similar effect, for the brain becomes too large in proportion to the rest of the body, and is very apt to inflame, and have effusions formed into it. At other times, the diseased state of the formative action appears most distinctly at the surface, the skin being rough, and very apt to desquamate.

88Some gentlemen have denied that scrophula was a hereditary disease; but it is unnecessary to offer any argument on this subject.

89This term is used here in a different sense from its common one, which signifies sensibility, or delicacy with regard to sensation, and capability of being acted on.

90Parts which are improperly organised, or which are not in every respect similar, both in their structure and constitution (by which I mean, mode of acting in general), to what naturally they ought to be, are not only less capable of performing their actions aright, but likewise are to be considered as in some respect extraneous to the human body, or, as it were, insulated, and do not correspond exactly to other parts. They therefore receive less support from the neighbouring parts, and, consequently, have their power diminished. The imperfection of action consequent to these causes is proportioned to the morbid condition of the part.

91See what has been said on this subject when treating of the cure of mortification.

92See the second volume of Medical Communications.

93Nosographie Philosophique, Vol. II. p. 238.

94When it is wished to prescribe it, the following is a very good formula:R. Terræ Ponder. Salit. Chryst. gr. x.Aq. Font.Aq. Cassiæ utriusque uncias iiiSyrupi Aurent. uncias ii.Half an ounce of this may be given at first, twice or three times a-day, and gradually increased to such quantity as the stomach can bear without sickness.

94When it is wished to prescribe it, the following is a very good formula:

R. Terræ Ponder. Salit. Chryst. gr. x.Aq. Font.Aq. Cassiæ utriusque uncias iiiSyrupi Aurent. uncias ii.

Half an ounce of this may be given at first, twice or three times a-day, and gradually increased to such quantity as the stomach can bear without sickness.

95This metal was one of the principal ingredients in a remedy used by the Marischal de Rougeres, which consisted of filings of iron, sal ammoniac, salt of tartar, &c. Journal de Med. Tom. XL. p. 219.

96This is highly recommended by M. Martcau. Journ. de Med. Tom. IV. p. 121.

97Practique Moderne de Chirurger, par Ravaton, Tom. II. p. 3.

98This ointment may be prepared by macerating one part of recent savine leaves bruised, in four parts of ung. resinos.; it is then to be strained.

99The following may be used for this purpose:R. Ceruss. Acetat. drachmam unam.Aq. Rosar. uncias octo. Solve, dein cola.

99The following may be used for this purpose:

R. Ceruss. Acetat. drachmam unam.Aq. Rosar. uncias octo. Solve, dein cola.

100Keeping this skin dry has a tendency to prevent ulceration, and abate the redness and inflammation. The cerussa may sometimes be advantageously mixed with an eighth part of powdered camphire, which promotes the removal of the superficial inflammation.

101Bell on Ulcers, p. 471.

102Bell on Ulcers, p. 427.

103This application forms a very useful remedy for the scrophulous ulceration of the eye-lids, which we so frequently meet with.

104This substance is the basis of a celebrated lotion for the face, which is sometimes useful in chronic pustules, which are frequently of a scrophulous nature. It promotes suppuration, the pustule then scabs, and, when this falls off, the part is sometimes found sound below. It is made by dissolving corrosive sublimate in an emulsion of bitter almonds.

105Laurent. de Strum. Nat. p. 67.

106Although the affected gland becomes rather larger, yet the surrounding cellular substance sometimes diminishes, and the neighbouring glands are rather contracted, in which case the part seems to be shrunk.

107This abscess sometimes, though very rarely, occupies the whole of the gland, but oftener only a part of it; and if the gland be large, there are sometimes several abscesses, of considerable size, which form unconnectedly with each other, and burst separately.

108It has been said, that genuine cancer is very rare in the uterus, and that the cases which pass for such are phagedenic. But although the uterus may be affected with scrophulous inflammation, and phagedenic, as well as some other specific affections, yet it must be admitted, from an examination of cases, that the uterus is very frequently attacked with true cancer. Its substance is found enlarged, hard, and containing cancerous abscesses in different parts.

109To this specific affection, we may give the name of pseudo-cancer, for want of a better designation.

110Of this nature was probably the ulcer mentioned by Mr. Wiseman, at least if we may judge from his very short description: “It had eat deep into her left breast, and was fixed to the ribs, but not with much pain. In progress of time, the lips inverted, and united, as it were, and lay covered with a crusty scab; the humour in the mean while spent itself upon the nerves, &c. She lived long, and, in her latter age, tolerably healthful.” Chirurg. Treatises, Vol. I. p. 165.

111Extirpation is the only certain cure of this disease; and it is at all times the quickest and the best; but, by eschoritics, we may sometimes procure cicatrization, at least if the gland have shrunk, and most of its substance been destroyed.

112It is to be regretted, that some who belong to our profession, reason upon the nature of ulcers, not from appearances and characteristic marks, but from the patients manner of life, or the idea which they have formed of the country whence they come. I remember two instances of people who came from the Hebrides, the one with a cancer of the lip, the other with a cancerous ulcer on the neck, both fungous, and possessing the burning pain, and every character of cancer; but as the sibbens unluckily prevailed in that country, it was thought that the patients might have received this infection, and accordingly were, by a full consultation of surgeons, condemned to undergo a course of mercury. The lip was, in three days, greatly worse; the mercury was omitted, and the patient cured by an operation. The sore on the neck was instantly exasperated, and the patient, to use the words of Hildanus, “had her soul speedily sent to heaven.”

113These are sometimes very irregular in their shape, and have their sides very thin; so that, at first sight, they appear like cavities formed by the separation of the fibres of the part.

114That is to say, the sore is rather flabby than fungous; for cancerous ulcers which begin superficially, and without previous abscess, remain a considerable time without forming fungus; but when an abscess bursts, and the skin ulcerates in consequence, then the sore is not superficial, but communicates with the abscess, which forms fungus quickly.

115Heister’s Institut. Vol. I. p. 229.

116Bell on Ulcers, p. 319.

117Dioni’s Chir. p. 248.

118Does inflammation depend upon the hardness or softness of the inflamed part?

119One should expect, that the distension of the vessels would diminish the cause of obstruction, or remove it altogether.It is rather unlucky, that the advocates for obstruction have made it the cause of simple inflammation, scrophula, cancer, &c.; and therefore all these diseases ought to be nearly, if not entirely, similar in their nature, and to require exactly the same means of cure.

119One should expect, that the distension of the vessels would diminish the cause of obstruction, or remove it altogether.

It is rather unlucky, that the advocates for obstruction have made it the cause of simple inflammation, scrophula, cancer, &c.; and therefore all these diseases ought to be nearly, if not entirely, similar in their nature, and to require exactly the same means of cure.

120Adam’s Observations on Morbid Persons, p. 184.

121Idem, p. 185.

122Adam’s Observations on Morbid Persons, p. 184.

123Idem, p. 161.

124Van Swieten’s Commentaries, article Cancer.

125Mr. Hunter supposes, that the mere absorption of schirrous substance before matter be formed, will affect the glands; but it is difficult to ascertain the certainty of this, as small abscesses are formed very early. I have formerly mentioned, that every part of the animal is changed in its nature, at the moment of being absorbed: If so, schirrous substances lose all specific property, and cannot affect the glands. Pus, again, being a foreign matter, is absorbed unchanged, and continues so until it reaches the glands.

126It may be said, that different parts have different susceptibilities of assuming the morbid condition; that the bones are longer of becoming affected than the soft parts, &c. Admit this, and still it must be explained, why every part of a similar structure, &c. should not be affected at the same moment. All the glands should become diseased at once; all the bones should inflame at the same time; and, instead of finding one or two organs affected, in consequence of the previous existence of a local disease, we should find the whole system rapidly becoming diseased.

127It was supposed, that when the menses were obstructed, the impurities were sent by communicating vessels to the breast, where they lodged, and produced cancer. Vide Vesalii Opera, p. 1092. Fabricius de Tum. p. 118.Le Dran observes, that when schirrus, from any cause, takes place in the breast, before the cessation of the menses, it uniformly becomes more painful when any irregularity of that discharge occurs. Vide Memoires de l’Acad. de Chirurg. Tom. III. p. 22.

Le Dran observes, that when schirrus, from any cause, takes place in the breast, before the cessation of the menses, it uniformly becomes more painful when any irregularity of that discharge occurs. Vide Memoires de l’Acad. de Chirurg. Tom. III. p. 22.

128Warts are, with regard to their power of acting, to be considered in the same light with simple schirri.

129See the Note to p.354.

130The simple schirrus now assumes that specific mode of inflammatory action which it is to continue, and may now be called the scrophulous or cancerous inflamed schirrus.

131Schirrus has generally been enumerated as one of the terminations of inflammation; but it cannot, properly speaking, be considered as such. There are only two kinds of termination, one in death, as, for instance, gangrene; the other in recovery, which is accomplished either directly by resolution, or indirectly by suppuration. Schirrus is not produced by a perfect and complete cessation of inflammation, but by a continuance of a low degree of inflammation, which renders the state of tumefaction which attends it natural to the part, before it goes off. This state, then, is not a termination of inflammation, but a consequence of its continuance.

132I have known two cases of this kind; in both the eye was affected. One boy had his eye extirpated; but a small part being left by the surgeon at the angle, the disease returned, and proved fatal. In another, the disease was in its incipient stage; but the relations would not submit to an operation.

133Med. Essays, Vol. V. p. 422.

134Pract. Obs. on Cancerous Complaints, by Mr. Pearson, p. 50.

135Arsenic mixed with sulphur, and powdered crow-foot, and made into a paste with yolk of egg, forms Plunket’s composition. Mixed with forty times its weight of powder of belladona, it forms an application which some time ago was much in repute in North America.

136Justamond on Cancers, p. 141. This gentleman relates a case, in which, by destroying the skin with lunar caustic, and then applying arsenic, he removed the gland. The arsenic, in this instance, was fused with antimony, in proportion of two parts of the first to one of the last. This was powdered and mixed with equal parts of powdered opium, and made into a liniment with yolk of egg.

137If I am not mistaken, the present Dr. Monro mentions, in his lectures, one instance, in which a small schirrus appeared to be removed by it; but whether this was simple or cancerous, I do not know.

138As different parcels of this medicine may not be of the same strength, it is prudent, when we begin a new supply, that we diminish the dose at first, if it have formerly been very considerable. By not attending to this, fatal effects have followed.

139I have tried the hepatized ammonia, but without any benefit.

140Justamond on Cancers.

141Alongst with this, it was customary to prescribe decoctions of guaiac, sarsaparilla, &c.

142It likewise continues very long after giving up the use of the mercury.

143Some cases of this kind I have already mentioned.

144Although the fœtor may depend upon the presence of hepatized ammonia, yet this does no harm to the ulcer. On the contrary, I have sometimes found the application of this fluid, when mixed with water, have the effect of abating the pain.

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