712 
SURGERY. 
hough more tardily. On the other hand, where hoemorr- 
hage, or any unusual discharge is taking place, there occurs 
an inordinate afflux of blood. Again, if there be a lentor of 
the blood in inflammation, how happens it that the veins, 
returning from an inflamed part, are also enlarged in calibre, 
and apparently increased in number ? Such are the facts, a3 
any one may satisfy himself by experiment on an animal, 
and they prove that no impediment to the flow of blood 
exists. There may be an error loci, as Boerrhaave called it: 
the passage of blood may be impeded through the smaller 
capillary vessels, and the larger ones may hence be preter- 
naturally distended. Such a supposition, however, by no 
means accords with the appearances on dissection, for the 
sanguineous vessels are found as much increased in number 
as in bulk. 
Inflammations are divided into various kinds, according to 
the appearauces they present. On the surface of the body 
we distinguish phlegmon and erysipelas. The former is 
described in the four words of Celsus, tumor, calor, rubor, 
dolor. The tumour is a regular swelling which gradually 
subsides by a regular circumference into the surrounding 
parts, and loses as it diminishes the other characters. It is 
to be remarked, that the heat, though greater to the feelings 
of the patient, occasions no great rise in the thermometer ; 
that the pain of a dull kind, and indeed there is seldom 
little more felt than the throbbing of the arteries of the part. 
Phlegmon belongs to the skin, cellular tissue, and muscles; 
the constitutional fever it excites, is of that kind usually deno¬ 
minated inflammatory; a pulse full and frequent; a disturb¬ 
ance of the nervous system, varying from a little restless¬ 
ness or disinclination for sleep to actual delirium; a sus¬ 
tained increase of the heat of the skin; all the secretions 
partially stopped and altered, whence result dry furred 
tongue, constipation, high coloured urine, and want of 
perspiration. 
Erysipelas is a form of inflammation confined to the skin 
and cellular tissue. It is just the reverse of phlegmon, in 
regard to its outward appearance; for instead of a regular 
swelling highest in the middle, and imperceptibly sinking 
into the surrounding parts, it has an abrupt edge, ending, as 
it were, all at once; is quite irregular; instead of being hard, 
is boggy; subsides on pressure, but returns; spreads very 
rapidly laterally, and very slowly downwards. It betrays 
little tendency to secrete pus, and none for the deposition 
of coagulating lymph ; and it varies from a slight red blush, 
acquiring in a few days a yellowish hue and ending in des- 
gustion, to a deep red, hot, painful swelling, quickly covered 
with vesiciations, and ultimately terminating in gangrene 
The sympathetic fever varies of course extremely with the 
various appearances of the inflammation; generally speaking, 
however, it may be characterised as of the low nervous 
kind. It is very trifling in common cases, but when erysi¬ 
pelas attacks the face, the constitutional irritation is very 
high, coma and delirium supersede, and the patient is fre¬ 
quently carried off. 
It is difficult to learn the cause of the peculiar appearance 
of this form of inflammation. Some have supposed that it 
arises from the particular structure it affects, but this is as¬ 
suredly not the case, since phlegmon also affects the skin. It 
may perhaps arise from the peculiar matter exuded; but this 
is a mere conjecture. Nor is the reason why sometimes 
erysipelas, and sometimes phlegmon follow the same injury 
at all apparent. This only has been established by repeated ob¬ 
servations, that there is nearly always antecedent to the inflam¬ 
mation something amiss in the constitution of the patient. 
Either he was drunk when he was exposed to the causes of 
erysipelas, or he was an habitual drunkard, or otherwise had 
an impaired constitution. 
The appearances of phlegmon and erysipelas are often 
modified by their being mixed together. Of the union of 
the two inflammations the most remarkable examples are the 
th ^ carbuncle and the boil. These tumours, which vary only 
in degree (the former being small and occurring in healthy 
persons, and the other being large and commonly the sign of 
a broken-down constitution), are remarkable for swelling 
higher than phlegmon and terminating in more irregular 
edges; they are also attended with the hot burning sensation 
of erysipelas; but their most distinctive characters are the 
formation of a gangrenous core at the bases, accompanied 
by the formation of pus in irregular holes, and extreme hard¬ 
ness. 
The fever which accompanies the boil is scarcely perceptible, 
when the patient has a good constitution. But in carbuncle 
there is always much constitutional disturbance—a fever of 
the typhus kind, accompanied often by great depression 
and restlessness. 
Inflammation of the internal organs presents different symp¬ 
toms as it affects the mucous membranes, the serous mem¬ 
branes, or the parenchyma of the viscera. The mucous 
membranes undergo an inflammation so far erysipelatous, 
that it spreads laterally; but here the resemblance, both as to 
appearance and constitutional symptoms, ends. Inflamma¬ 
tions of the parenchyma, indicate most of the characters of 
phlegmon ; there is a sensation of heat and distention in the 
part affected; dissection shews it to have been gorged with 
blood. Making some allowance for the particular parts of 
the nervous system implicated, the fever in these affections is 
of the kind which belongs to the phlegmonous; namely, 
the inflammatory. 
The serous membranes, as well as the cartilages and the 
bones, scarcely undergo any active inflammation without 
sudden and complete disorganization. The pleura is capable 
of intenser inflammation than the peritoneum, without being 
destroyed; nor is there much depression of strength,_a 
phenomenon very remarkable when the latter is affected. 
By an arrangement differing from the one we have chosen, 
inflammations have been divided according to their termina¬ 
tions, as into adhesive, suppurative, and the like; but since 
the circulating vessels are only capable of one kind of action, 
such divisions are not strictly true. These phenomena are' 
rather to be considered as consequential or secondary, and 
should not therefore be confounded with inflammation which 
is simply an affection of the red blood-vessel, and is therefore 
identical in every structure. Proceeding in this view of 
the case, we shall consider the terminations of inflamma¬ 
tion. 
The first and rarest, called resolution, occurs only after 
slight accidents, and consists in the restoration of the pro¬ 
perties of the injured part by a little exaltation in the cir¬ 
culatory and nervous powers. 
In the second, a separation of the blood takes place at the 
extremity of the inflamed vessels; that portion called coagu- 
lable lymph is deposited. This deposition is one of the most 
general and useful of all morbid processes. If a part is 
merely contused, this substance is poured into its insterstices, 
where it serves to supply the place of such parts as having 
lost their vitality, are removed by absorption. Ifacuthas 
been made, it furnishes a cement which by its tenacity 
mechanically unites the divided parts; and this union is 
shortly after rendered permanent by means of vessels that 
shoot through the lymph in every direction. It forms a bed 
for the formation of new bone, or cartilage, when these struc¬ 
tures are broken, and it affords room for adhesions in various 
parts of the viscera, frequently effecting a very remarkable 
preservation of life, but as often producing very dangerous 
effects. 
The effusion of coagulable lymph, though ordinarily, is 
not invariably in direct proportion to the vehemence of the 
attendant inflammation ; and there are many facts which 
warrant the inference that it depends very much on the state 
of the blood. It is generally most copious as the inflamma¬ 
tion subsides, affects the serous membranes more than any 
other part, and rarely attacks the mucous membranes. On 
the former structures, it is found uniting them together in 
various directions, and vascular; the latter coagulable lymph 
does not unite, but is found lining them as with additional 
membranes, sometimes in patches, sometimes assuming very 
accurately their form. The effusion of serum accompanies 
that of lymph; it often occurs likewise alone, but then 
seems peculiar to the unbroken surface of the Dermis, when 
the cuticle is taken off, as in a blister, and to the serous mem¬ 
branes. The inflammation which precedes it is of a milder 
character 
