176 CHAPTER 18. 



This favorable result, however, does not always ensue. The remedies 

 to which we have had recourse may not succeed in restoring the normal 

 vital functions of the diseased tissue, and the proper flow of the circula- 

 tion ; and we may soon have in the congestion of the blood in the part 

 and neighbouring parts, and in its altered character, a formidable though 

 in reality a secondary disease. 



In cases of Superficial inflammation cold applications will be useful in 

 the primary stage in checking the flow of blood into the part by causing 

 the capillary vessels to contract, also in diminishing the congestion, in 

 giving more tone to the tissue, and in rousing its vital powers to 

 healthier action. In severe cases fomentations will be required in order 

 to allay the irritation. 



359. Treatment of inflammation when established. 



In the treatment of inflammation, when established, we shall have to 

 consider 1st whether the attack is local, diffused, or specific ; 2ndly 

 whether it is acute, subacute, or chronic ; 3rdly whether it is of a sthenic 

 or asthenic type. 



360. Treatment of acute Local inflammation. 



In the treatment of an acute attack of local inflammation our object is 

 to reduce the violence of the disease. 



If the part be superficial and not very extensive, cold water dressings 

 may be applied with the view of reducing the symptoms; but if the 

 attack be severe or deep-seated, it is not probable that we shall be able 

 to effect it sufficiently by such means. Fomentations, which act pri- 

 marily by allaying irritation in the tissues, and secondarily by relaxing 

 the coats of the vessels and thereby allowing an enlarged passage for the 

 blood, will be needed. If by these means the irritation and subsequent 

 congestion and hypersemia can be reduced, the tissue affected will in 

 favorable cases gradually recover its normal tone and vital powers, and 

 the part will be restored to a healthy condition. If this effect cannot be 

 produced, we shall have as a result either effusion of serum through the 

 over-distended coats of the vessels, or one of the other results of inflam- 

 mation mentioned above. 



In the treatment of internal local inflammation, the above local 

 remedies cannot be applied ; and we shall have to consider whether the 

 type of the disease is sthenic or asthenic. The treatment required will 

 be found further on, under" the head of Sthenic and Asthenic inflamma- 

 tion. 



361. Treatment 'of subacute Local inflammation. 



Superficial local inflammation is seldom subacute. It is generally 

 either acute or chronic. Subacute attacks are usually deep seated, as in 

 joints, &c. It is not possible to define any specific treatment for sub- 

 acute cases. The nature and organisation of the parts must be carefully 



