Imatges de pÓgina
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brief observations follow upon the mechanical injuries of bones, and the different effects resulting from incisions, contusions, or lacerations. The principles of treatment laid down, although concise, are well worth attention.

In conformity with the plan of this Essay, Mr. James passes rapidly over the subject of Inflammation from Eccess or Diminution of Temperature,Inflammation from Poisons," " Inflammation of Vital Organs," “ The Causes

" which produce Inflammation in Vital Organs,' mation of Joints," &c. &c. He conceives that the general principles of Inflammation which it has been his endeavour to support, will find some confirmation in the phenomena exbibited in “ Inflammation of the Eye,” upon which subject he remarks that

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“ In the first place, it is perfectly well known that when ulcera. tion, abscess, or sphacelus, are spreading in the cornea, still more in the globe, the constitutional sympathy is far greater than when the mischief is arrested by the etfusion of organizable lymph, and that if this can be procured by the use of arg. nitrat. remarkable relief is obtained with respect to the general symptoms, while on the other hand those remedies which will correct, subdue, or change, the state of the system, will influence the progress of the disease in a manner no less remarkable ; and as these are processes which we can actually observe and watch, as much as if they were experiments contrived in the most delicate manner, they possess particular value. In the second place, this sympathy is much less when the conjunctiva, or integument, of the eye is alone concerned, than when the more essential parts are so, and there is risk of disorganization. And, in the third place, it may be noticed that each kind of inflammation of the eye has its own peculiar disposition to terminate in one mode or another :-in some this is effusion of puriform mucus ; in others, in vesicle and ulceration ; in others, in adhesion or abscess ; in others, in sphacelus ; in others again, to persist merely as inflammation." P. 163.

The subject of “ Inflammation of the Testis," is dismissed with a few very briet' observations; we notice it merely for the purpose of expressing our regret that a very efficient method of drawing blood from the part affected, by opening the enlarged scrotal veins with a laneet, is not more frequently had recourse to. li is not mentioned by our author, and we believe, indeed, that the practice is seldom adopted. In several cases of inflamed testicles we have drawn blood in this manner with much advantage. A greater quantity may, in some cases, be thus taken, with less trouble to the patient and practitioner than by the application of many leeches, independent of which, it is advantageous in an economical point of view, particularly in hospital practice. We should observe, that it occasionally happens, even when the part is much swoln; that there are no veins sufficiently apparent to allow of the abstraction of blood in the way we have just mentioned. We transcribe the following judicious observations upon “Inflaınınation affecting common or external

parts."

“ It is one principal object of this essay to ground the plan of treatment on the peculiar disposition of the inflammation we have to manage, and one of the most important features in this is, its tendency to one mode of termination rather than another.

« A criterion,' says Dr. Kirkland, (vol. i. p. 317,) ought to Lave been fixed, when to attempt discussion, and when to let it alone. I believe no better can be found than the natural disposition of the inflammation itself ; for, if that is decidedly to suppuration, no attempt, probably, to resolve it will be successful, or, if so, advantageous, with a very few exceptions ; for such a disposition is generally calculated to relieve the constitution.

" When the disposition admits either of resolution or suppuration, then of course the former is to be preferred, but the means of accomplishing this object are by no means the same in all cases ; thus, where there is but little tendency to suppuration, we may employ warm applications without reserve ; whereas, if there is much, they must often be avoided ; while, on the other hand, they are particularly proper where there is no disposition to resolve. There is an avowed difference of opinion with respect to the superiority of warm or cold applications, and some surgeons are almost exclusively addicted to the use of the one or the other; but where there is not such a prejudice existing, it has been confessed that the preference of the one or the other is very often founded rather on empirical than on rational motives. If the principles above stated are true, they may contribute to guide our judgment in this important matter." P. 170. .

Some excellent practical observations are made upon the subject of “ Carbunculous Inflammation.” The peculiar characteristic of inflammations of this genus, is their strong and almost irresistible disposition to terminate in the sloughing process more or less; and in the pus produced, being of

; the worst description and most irritating quality. They occur from the immediate effects of some local injurious cause; in most instances, in persons who have lived freely, grossly, and irregularly, and whose digestive organs are much disordered and loaded.

“The pyrexia, or degree of vascular reaction will greatly depend upon the remaining powers of the constitution, and as the subjects are often people of originally strong stamina, it is often very considerable ; but there is an invariable and strong tendency in all cases to sinking of the nervous powers, which,when sloughs are formed, ofien takes place very suddenly, and to a great degree. A hurried and

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anxious and depressed state of the nervous system are manifested by the tremours, the tendency to low delirium, and the hurried aad anxious countenance. The disordered state of the digestive organs is evinced by the furred and bilious tongue, the nausea, headach, and fuul discharges.

“ The object of medical treatment is to unload the bowels, which generally contain a large quantity of collected fæces, and at the same time procure secretions from the liver; a dose of calomel, followed by a mixture containing the sulphate of magoesia or tartrate of potash, senna in infusion and tincture, and jalap, with a little tartrite of antimony, if the nausea does not forbid it, perhaps afford the best mode of acting upon the bowels with these views; and, indeed, if there is any reason to believe that the stomach is loaded, an emetic is very useful. In the subsequent stages, blue pill, followed by rhubarb and senna, and tartrate of potash, form the best laxative, as I believe. The employment of purgative medicines suited to the case is by no means a light matter; in many instances it forms by far the most important part of the treatment, and if, by injudicious conduct, we leave accumulated faces in the bowels, or fail to excite the secretions from the liver, or if we irritate them too much, and more particularly, if we bring on purging of watery stools, we shall do much harm where we might do much good. The compound extract of colocynth with calomel is often a good medicine in the beginning." P. 181.

In such cases the patient must be supported according to his want of power; if we can keep him up till the sloughs form and separate, he will do well.

According, therefore, to the necessity, it will be our duty to supply him with such articles of drink or food as may to us appear most advantageous, and in the advanced stages it often becomes necessary to push this plan pretty far; and indeed in all instances it is important to remember, that as these inflammations are of the limited kind, there will be less danger in exciting the vascular system than if they were otherwise.

“ But it is of still more consequence to employ suitable local treatment, for upon this the life or death of the patient will generally depend. It is rarely possible to prevent these abscesses from going into suppuration, and therefore it should be our object to promote the process by warm fomentations, and poultices, which in some cases it is serviceable to make with stimulating fluids ; for this kind of inflammation is attended with great want of nervous energy in the part, and for this reason, evaporating lotions or poultices would be highly improper.”. 182.

It is not only the character of such inflammations to form sloughs, but pus of the worst description; healthy pus simply excites a disposition in the part, to discharge it as a foreiga body; but unhealthy, produces excessive irritation, and acts like a poison lowering its powers. There is a strong exertion Vol. II, No. 8.

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made, to wall in matter. so injurious, and this, contrary to the more general tendency, extends to the surface, and hence it is longer confined, a passage being only effected after a long time, by ulceration or mortification of the skin, if the patient lives.

Passing over the brief remarks of our author, upon Furunculus, Carbuncle, and Abscesses in the neighbourhood of the rectum and perineum, we arrive at Class SECOND, the character of which, is a disposition to spread from the failure of the adhesive process, owing to a faulty state of the constitution. It is not asserted that the disposition to limit is entirely absent in this class of inflammations; "on the contrary, there appears to be a struggle in the part and the general system, arising from the endeavour to effect that, which they are either totally, or for a long time, incapable of performing.' Here, then, the difficulty of the task wbich Mr. James has undertaken, is apparent, for he confesses that the inflammation, which at one time belongs to his second Class, may subsequently change its character, and claim a place in the first. Upon inflammation of the absorbent veins and arteries, Mr. James' offers nothing peculiar to himself, in the few remarks he has deemed it necessary to make. Our limits oblige us to refer to the work itself, for the brief sketches which are made upon many of the remaining species of inflammation, which are comprised in the proposed arrangement. Upon the subject of erysipelas, will be found many interesting observations. It is justly observed that there is much difference of opinion, both with respect to the kinds of inflammation which ought to be included under this title :—the nature of true erysipelas, and the proper plan of treatment. It is defined by Mr. James to be,

“ An inflammation of the skin in every case, communicated to the cellular membrane in every species but one, the E. Erraticum; with a disposition to terminate in a few days, probably not exceeding seven or eight, either in resolution, or in suppuration, or sloughing of the cellular membrane, very probably both ; and in vesications of the surface, accompanied with considerable tumefaction, chiefly from the secretion of serous fluids; and ending abruptly in the surrounding skin.” 237

The term erysipelas gangrenosum, as applied to a particular species, is considered objectionable, inasmuch as " it is a termination to which all are liable in a greater or less degree, and, therefore, it is erroneous to bestow this title on one kind only.” It is justly observed, also, that the terms bilious and phlegmonoid ought not to be applied, as they are at present, in contradistinction to each other, for, certainly, the bilious character of constitution is often found combined with the

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phlegmonoid form of local affection. Mr. James does not attempt to reconcile objections to terms, which he looks upon

, as insuperable, but observes,

“ I have taken the liberty of so adapting those we have, as to avoid any very palpable error as I hope ; and have divided the E.

1 phlegmonodes into two kinds, the more purely inflammatory, to which I have added the epithet verum, and the bilious; and to the latter have appended a variety which to me appears sufficiently well marked, in which the absorbents are inflamed, under the title of E. phlegmonodes biliosum complicated with inflammation of the absorbents. The E. ædematodes will constitute another subgenus, of which one principal species will be the E. gangrenosum of authors, which is the bilious erysipelas occurring in shattered constitutions." P. 239,

Having made such alterations in the titles, it necessarily follows, that the descriptions offered" mutato nomine," do not exactly accord with those which have heretofore been given under them.

The treatment of erysipelas recommended, is highly judicious; it does not materially differ from that which is enforced by the best practical authorities of the day. A very perspicuous, yet concise, account of the “Erysipelas Phlegmonodes Biliosum," combined with inflamed absorbents, is given. We are indebted to Mr. Copland Hutchison for the only particular account of this variety of the disease, which has yet been published. Mr. James does not appear to be very sanguine in his expectations of success, from the free use of incisions, which Mr. C. Hutchison bas recommended; he remarks, that those cases which he has treated in this way, have not derived all the advantage from it, which he had been led to expect; but on the other hand, the tendency of the wounds to run into mortification, was not so great as might, by some, have been apprehended. The pain and irritation which almost invariably acconipany cases of this nature, are to be relieved by the free use of opium, the effect of which may be greatly assisted, by applying cold cloths to the forehead and head, which, without preventing its sedative influence, obviates its injurious impression, and often converts a forced sleep into a calm repose. The remaining pages of the work are occupied by a brief, yet correct description of Paronychia Gravis” of “ Inflammations tending to Phagedona," and those which tend to mortification.

From the attentive perusal we have bestowed upon Mr. James's Essay, we are inclined to form a favourable opinion of his talents; he possesses the merit of supporting bis own doctrines with much ingenuity, and is entitled to our commendation, for having honestly forborne to commit a literary

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