INFLAMMATION. 



I cal. Inflammation is a local affeiTtion, and ilicrefore muft par- 

 t ticularly require local curative means. OhjciElions have been 

 f urtjcd againll topical blccJina, exrcpt when tlie fkin, over 

 , and near the inflamed part, is itfelf free from the inflammation. 

 I However, mod furgeons in this country think otherwife ; 

 they put leeches on the inflamed fl<in, and even fcarify tiie 

 dilated veffels of the conjunrtiva, in cafes of ophthalmy, as 

 we tliiuk, with dcclJed good effeft. It is alfo an incontro- 

 vertible truth that bleeding is generally more efTedlual, the 

 nearer the evacuation is made to the feat of the inflammation. 

 But it is not always in our power to take away a fufficient 

 quantity of blooil in this manner. Many inflammations muft 

 be immediately checked, or the patient is deftroyed. There- 

 fore, when inflammation affefts a part of f.ich confequence in 

 the animal economy that it caimot undergo much difturbance, 

 without life itfelf being endangered, the furg on is not to he 

 fatisfied with local nieafures. Thus, when the brain, the 

 lungs, the ftom.ach, the bowels, &c. are inflamed, the inflam- 

 mation, unlefs fuddenly arretted, will inevitably end in death. 

 Alfo, when the inflamed parts are endued with inferior 

 powers of recovery, it fs often neccfiary to have recourfe to 

 general as well as topical bleeding ; as in inflammation of a 

 joint. When inflammation is fiiuatcd in an organ, where fup- 

 puration would certainly dellroy its ufes, it is likevvife ad- 

 vifabic to moderate the local afFeftion, even at the expence of 

 the whole fy Hem. Ophthalmy is a cafe of this kind. More- 

 over, it ought to be well underilood that every confiderable 

 andextenfive phlegmonous inflammation, wher'efoerer Ctuat- 

 ed, ought always to be refilled by general bleeding. 



There is no utility in bleeding, when the inflammation and 

 fever are trivial, and the caufe of the dlfordcr can be entirely 

 removed. Such evacuation muft often be hurtful and dan- 

 gerous, when the patient is much debilitated by previous in- 

 difpofition, extreme age, or nnv other circumilance. The 

 fymptomatic fever, attendant on inflammation, can feldom 

 be of itfelf a juft ground for bleedinp-, as it ccnftantly in- 

 creafes and fubfides with the local aflfeftion. We are, there- 

 fore, to be principally guided by the ftate of the inflamma- 

 tion. Bleed with a view of diminifliing this, but never for 

 the folc purpofe of L-flening tlie fever. 



It is a principle very generally acknowledged by fur^rcons, 

 that the efficacy of bleeding is greater the foouer it i? prac- 

 tifed, the nearer it is done to the part affefted, and the more 

 fuddenly the blood is diicharged. Hence, when an organ, 

 like the brain, is inflamed, and it is an objeft of infinite mo- 

 ment to pnt an immediate check to the inflammation, the 

 furgeon fltould take away in the firft inftance fixteen or 

 twenty ounces of blood, if poiTible, from the temporal arte- 

 ries ; but if that quantity cannot be tiius procured, the defi- 

 cient proportion ought to be taken from the arm. 



Another plan, calculated to check and diminifn inflamma- 

 tion, and which is neceflary in almolt all csfes, is to give the 

 patient mild aperient medicines, fuch as Epfom fait, Glau- 

 ber's fait, magnefi3E fulphas, &c. Strong drattic purga- 

 tives, by their irritation on the conftitution, are foldom al- 

 lowable, and almoft always prove hurtful. Gentle purging 

 is even more invariably proper, in all cafes where inflamma- 

 tion already exills, or is to be apprehended, than bleeding ; 

 for this latter evacuation is productive of more lalling 

 weaknefs, and therefore, in flight cafes, and weak habits, 

 is generally difpenfcd with. Purging probably counteracls 

 innammatioii, tirft by increafing the Iccretion of the bowels, 

 fo as to leffen tlic quantity of the circulating fluids ; and fe- 

 condly, by fpecifically diminifliing every operation going on 

 ,in the body, and among others, inflammatory aftion. 

 , In many inllanccs, the ciTcd of the apcrietit medicines is 



to be promoted with clyfters. Indeed, there are fome ex- 

 amples, where the latter are fafer than purgatives given by 

 the mouth : when the peritoneum and bowels are inflamed, 

 the prudent furgeon is often afraid to prcfcribe any very ac- 

 tive opening medicines. Perliaps he ventures to exhibit half 

 an ounce of the oleum riciui, which frequently does not 

 take eficcl, although the dofe be repeated, until aflllled with 

 a clyfter. 



Antimonial medicines have acquired confiderable reputa- 

 tion in numerous cafes of inflammation, and, as far as we 

 can judge, they are really of eminent lervice. Naufeating 

 dofes of antimonivmi tartarizatum prove advantageous in fe- 

 veral ways ; they reheve that oppreflive dryncfs of the (kin, 

 which accompanies the fever attendant on fevere l«cal inflam- 

 mation ; they promote all the excretions ; and !hey dim-niflx 

 the increafed aftion of the inflamed part. The latter effeft 

 is produced, becaufe, whenever an inclination to ficknefs pre- 

 vails, the fympathy of the whole con(l:tution with the fto- 

 maeh is fo intimate, th:\t the fyltem is immediately thrown 

 into a temporary ilate of debility, every confiderable opera- 

 t/on in the machine becoming lowered, and, among others, 

 the procefs of inflammation. When the inflammatior is dan- 

 gerous, and there is urgent reafon for putting an immediate 

 chock to it, the employment of antimonials ought never to 

 be neglected. Thus, when the brain or its membranes are 

 affected with inflammation, it is ufual to exhibit fmall dofes 

 of antimony. 



Opium is not prefcribedin cafes of common inflammation, 

 unlefsthe feverity of the pain render this medicineindifpenf^ly 

 neceflary ; for it is generally confidcred as a powerful llimulant, 

 and therefore hurtful in regard to the local complaint. In- 

 ftr.nces, however, certainly do prefent themfelves, in which 

 opium is proper. Procuring the patient eafe and fleep, 

 during the violence of many fevere inflammations, is an object 

 of the hsgheft importance ; and, it may be queflioned wiiether 

 the inflammation itfelf would not be aggravated more by 

 leaving the patient to all his pain and relllefsnefs, than by 

 making an attempt to diminifli his fuffcrings, and lull him to 

 Deep by opiates. One thing feems certain, that if opium is 

 to be given in cafes where pain and inflamrmition exift, it 

 fnouid be prefcnbed in an adequate dofe. Thus, after any 

 great operation, fuch as an amputation, the rcmovid of a 

 brealt, S:c. the furgeon fliould give from twenty-five to forty 

 drops of the tinClura opii ; fmall dofes of opium, in fuch 

 cafes, always have the effecl of ferioufly increafing the reft- 

 lefsnefs, fever, &c. inftead of affording eafc, and procuring 

 lleep. 



'i'he patient's regimen and diet arc to be low ; no fpirits 

 nor fermented liquors are allowable ; and .^hen the inflamma- 

 tion is at all extenfive, or fuch as to be of confequence, the 

 patient fliould abftain from eating meat, and hve on thiu 

 broths, barley-water, tea, &c. The pradtitioner would in 

 vain make depletions in order to Hop an inflammation, while 

 his patient was living upon grofs, hot, flimulating difhes. 

 On the contrary, when the regimen and diet are fuch as they 

 ought to be, the patient will do with lefs evacuations, and 

 his health \nll not be fo much injured by the requifite treat- 

 ment. He fhould be advifed to drink plentifully of diluent 

 cooling beverages, hke lemonade and acidulated barley-water. 

 Oranges, llrawberries, fulinc draughts, &c. may be per- 

 mittcd, as being exceedingly grateful to patients, who are 

 feverifii and thinly, from being aflfefled with any ferious 

 degree of inflammation. The patient's chamber fliould be 

 kept cool, nor ought he to be covered witli two much bed- 

 ding. The antiphlogidic regimen, moreover, requires per- 

 fect rcpofe both of bodv and mind. 



With 



