SURGERY. 713 
character than that which precedes the deposition of solid 
lymph. The third way inflammation terminates is in sup¬ 
puration. In this process the absorption of the affected 
structure is so rapid, that- a considerable cavity is formed. 
This cavity, if the skin is entire, we denominate an abscess; 
if broken, an ulcer. The filling up of this cavity is effected 
by the secretion of a fluid called pus. It is poured forth 
from the sides of the cavity which are always indurated. Its 
composition bears a very near affinity to blood ; its colour, 
however, being a yellow white. In this pus there are soon 
observed red spots which the microscope shows to be blood¬ 
vessels ; these growing up in bundles present a granulated ap¬ 
pearance, and gradually fill up the cavity with flesh of the 
same kind as had been removed. 
Now this process is liable to many irregularities; the ab¬ 
scess frequently burrows into important parts and forms 
dangerous sinuses. The secretion of pus is often incomplete, 
being mixed with too much blood, or presenting a watery 
composition which is called sanies. In this case the ulcer 
assumes every variety of appearance, and requires the inter¬ 
ference of art to bring about the formation of natural pus. 
The granulations are often deficient, and do not fill up the 
vacancy, or they are so redundant as to ascend beyond its 
edge, and form a protrusion, having a fungoid or sprouting 
appearance. 
The last mode in which inflammations terminate, is by 
gangrene. This formidable affection supervenes after any 
species of inflammation, and there is no structure exempt from 
it. It consists in a perfect dissolution of the structure it 
attacks, which is converted into a dark-brown fetid mass, and 
loses all but a mechanical connection with the living parts. 
In the bones, where it is called necrosis, its appearance is 
much varied. If a blow is so severe that it utterly annuls 
the vital action of the vessels and nerves, and destroys the 
natural cohesion of the intimate particles of flesh for each 
other, gangrene ensues. If inflammation be carried on so 
violently at first that it cannot be supported by the powers 
of the part, the same thing occurs. If the disease be so 
extensive or general, that the constitution cannot effect the 
absorption of the old structure without danger, gangrene is 
here met with. 
Though the word gangrene, or mortification, appears at 
first to imply a very formidable disease, it is to be observed, 
that it is only when, from the extent of the injury or the 
feebleness of the constitution, the mortified parts are not 
easily separated from the living, that any danger ensues. 
From sores having but very small dimensions, and pro¬ 
ducing no constitutional disturbance, little black layers are 
often detached, which are called sloughs: these are no other 
than portions of mortified flesh. From the depressions left 
by the small-pox during its decay, similar, but very minute 
pieces of the same substance, are delached. It is only when 
a violent accident or an extensive inflammation causes a very 
large surface to become gangrenous, or when the patient is 
old, or has a feeble constitution, that this disease is terrible 
and perhaps fatal. In such cases the dead parts, instead of 
being detached from, advance upon and convert into their 
own offensive substance, the living structure. 
Having thus given an outline of those diseases of the red- 
blood vessels, which may be said to be primary in regard 
to their simplicity and universal, since they can attack all 
structures, it would now be requisite, if we followed in this 
article any thing like a philosophical arrangement, to 
proceed to the disease of the secreting or white vessels. As, 
however, these diseases are of a chronic character, and are 
very rare, their investigation cannot be reckoned essential 
to the understanding of active diseases. We shall, therefore, 
defer their consideration until we have entered into the 
treatment of inflammation and its consequences. 
Fhlegmonous or pure inflammation, whether it be idiopa¬ 
thic, or the result of injury, is treated locally by means of 
refrigerating lotions. How these act is unknown, but it is 
certain, that by reducing within certain limits the heat of 
inflamed parts, they subside quicker than by any other 
Vot. XXIII. No. 1602. 
mode of treatment. It is, however, curious enough, that if 
the inflammation last a long time, this plan becomes hurtful, 
and warm applications salutary. The time at which a change 
is to be made from one to the other, is chiefly regulated 
by the feelings of the patient. 
The local treatment of erysipelas is a point concerning 
which surgeons are by no means united. Some advising 
cold applications, others warm; some scarifying the erysipe¬ 
latous parts, others applying blisters to them, and others again 
powdering them with flour. Perhaps none of these means 
do any good, and the disease is only to be subdued by con¬ 
stitutional remedies. 
The deposition of coagulable lymph is of course not to 
be interfered with by any topical applications. It is, how¬ 
ever, to be remembered, that the healthy disposition of this 
substance, is chiefly dependant on the degree of phlegmon 
preceding it. 
The formation of pus is facilitated, the attendant in¬ 
flammation rendered milder, and the pain less, by the 
application of warm fomentations and poultices. The 
modus operandi of these matters is quite unknown, but the 
fact of their beneficial tendency is known to every body; and 
to make a smooth poultice has been laid clown by a surgeon 
of the highest eminence, as a most important surgical attain¬ 
ment. When pus is formed, if the abscess does not break, 
some surgeons are in the habit of opening it with the lancet. 
As, however, it generally partially unites and fills again, the 
practice has been much blamed, and indeed we may lay it 
down as a rule, that it is only when an abscess spreads into 
important parts, or when its coverings are so thick as to 
preclude the hope of a natural opening (as when it is under 
fascia, and among tendons) that it should be opened. The 
ulcer which results from the opened abscess, requires no 
other treatment than to be kept moist, and secluded from the 
air. If its granulations are superabundant, it is usual to 
causticate them, and if deficient, to excite inflammation by 
various stimuli. When, however, an ulcer has continued 
long, it is often very troublesome, requiring a multitude of 
various stimuli, and of very opposite characters. In those 
cases where the inveteracy of the disease baffles all these 
attempts, the edge of the ulcer should be swept off with a 
knife, and the cut surfaces drawn together by adhesive 
plaister, and united at once. The chief danger of this pro¬ 
cedure is, that the constitution is liable to suffer from the 
sudden stoppage of the accustomed discharge. 
As to the treatment of boils and carbuncles, the former may 
safely be trusted to nature; occasional poulticing, and, when 
very severe, a little opening medicine, being all that is neces¬ 
sary. The carbuncle, though we may be unwilling to trust it 
to nature, is, nevertheless, a disease in which our interfe- ence 
probably does little good; it is held, however, as established 
practice, to lay open carbuncles very freely, in order to give 
passage to the core or nucleus which forms at their bases. 
This being done, if the patient’s constitution is good, several 
sloughs come out, and the wound heals; if not, these are 
thrown off very tardily, an ichorous discharge follows, the 
ulcer spreads deeply and widely, and the patient, exhausted 
by irritation, dips. Perhaps the only chance of curing bad 
carbuncles, in bad constitutions, would be to endeavour 
to extirpate altogether the diseased structure and unite the 
wound by the first intention. The plan, however, is merely 
a suggestion, and has never been tried. 
The treatment of gangrene is topically by poultices, either 
simply of linseed meal, or of this matter mixed with charcoal, 
or juice of carrots, or yeast. The powers of the part, how¬ 
ever, when they are sufficient to throw off the dead parts, re¬ 
quire no stimulant application, and when they are not, do not 
seem very amenable to external remedies. Indeed, our plan 
should be to prevent such a degree of inflammation as may 
threaten gangrene, for in nine cases out of ten this is a mere 
consequence of previous excitement. No danger is to be 
apprehended from it, if we find a line of separation extending 
between the dead and living parts. When this does not 
take place, and the gangrene spreads, it becomes necessary 
8 T to 
