194 
ON THERAPEUTICS. 
derivative effect upon the nerves, opposing* the morbid stimu¬ 
lus present in the diseased texture. Second, a local excite¬ 
ment of the circulation, resulting in various degrees of 
inflammation, accompanied with deposits occasioning swell¬ 
ing. Third , the extension of the excitement over the whole 
system, when severe pain attends the application of the 
irritant. 
After the immediate effects have subsided, the swelling 
gradually diminishes, and the part recovers nearly its healthy 
form, save that the skin is thickened permanently, and a 
considerable excess of areolar tissue is present beneath it. 
The decrease of any morbid deposit is invariably a very slow 
process; nor do we imagine, in the case of fibrous enlarge¬ 
ment, that the removal is much accelerated by counter¬ 
irritation, excepting in instances where the circulation is de¬ 
fective, when counter-irritants, by altering this condition, 
may facilitate absorption after the excitement has ceased; at 
the same time it is fair to observe that fibrous thickening is 
frequently removed by exercise, with frictions and pressure, 
while in other cases it remains in spite of repeated blisters. 
The general properties of counter-irritants are possessed in 
an eminent degree by the actual cautery. 
Primarily, it causes a powerful derivant impression upon the 
nerves. 
Secondly, it results in active inflammation, followed by effu¬ 
sion, suppuration, and sloughing of the portions of structure 
whose vitality has been destroved by contact with the heated 
body. The subsidence of the inflammation is ordinarily at¬ 
tended with a healthy circulation in the diseased part, and 
frequently with an increased deposit of bone or fibrous tissue. 
Lastly , the cautery leaves the skin thickened, and with a 
diminished elasticity. The question whether firing produces 
a permanent bandage round the part operated on, is still a dis¬ 
puted one, nor is it easy to decide upon it. 
During the swelling which follows the operation and con¬ 
tinues for some weeks afterwards, the subcutaneous textures 
are subjected to a certain amount of pressure, which is to a 
great extent removed as the limb recovers its natural propor¬ 
tions ; still the partial loss of elasticity, and the general 
thickening of the integument, which we have seen some years 
after the operation, necessitate some constriction of the part, 
not unlike the effect of a perfectly adapted bandage. Not, 
however, to this alone do we refer the success attending the 
application of the cautery; we have to take into account the 
immediate influence upon the part, the subsequent formation 
of pus, and the absolute rest necessitated by the amount of 
