714 
SURGERY. 
to remove the gangrenous part; care being at the same 
time taken to remove so much of the apparently healthy 
part that no return of the gangrenous action may be in¬ 
dicated. 
With respect to the constitutional treatment of local 
diseases, this is of far more consequence than any topical 
remedies; a fact, which, though so apparently obvious, 
was not clearly observed by any one before the beginning of 
the present century. Mr. Abernethy, in his work on the 
“ Constitutional Origin of Local Diseases,” has put this matter 
in so clear a light, and laid down a line of practice so suc¬ 
cessful, that it has received, for some time, the assent of all 
surgeons and may safely be said to have produced a greater 
revolution in surgical practice than has ever been effected by 
any individual. 
Advancing upon the very evident principles that the repa¬ 
ration of all injured parts must be made from the blood 
which is eliminated by the digestive organs, and must be 
influenced by the irritated or quiescent state of the digestive 
organs, this author proceeded to shew that in all local 
diseases it is of the primest importance to procure healthy 
secretions from the bowels and other viscera of the abdomen, 
and by appropriate diet, and other minor'adj u vants,to tranquil¬ 
lize the inordinate actions of the nervous system. A foolish 
notion has gone abroad that this plan consisted in purging, 
and the name of Dr. Hamilton has been very unjustly asso¬ 
ciated with that of Mr. Abernethy, as if they had each dis¬ 
covered the same principle. The plan, however, of the 
former was to purge, because he found it lower the pulse 
and alleviate some chronic diseases. The practice of the se¬ 
cond arose out of a philosophical consideration of the func¬ 
tions of animal bodies, whereby he saw the dependence of 
one part on another, and the reciprocating action that re¬ 
sulted from the healthy performance of separate functions. 
So that he did not fail to perceive that the due action of the 
skin, the lungs, the stomach, and the liver, were as essential 
to health as the action of the bowels; and if in his practice 
he seemed to pay more especial attention to the alimentary 
canal, it was only because this is the prime recipient of all 
medicine, and the part through which other functions are in¬ 
fluenced in the greatest degree. 
The particular remedies to be used, we need not here de¬ 
tail, after the very full consideration of the influence of the 
digestive system, on the general health, that we indulged in 
under the article Pathology. It is enough to observe 
that, whether inflammation be going on, or any of its con¬ 
sequences, the due action of the alimentary canal is essential 
to their salutary progress. 
The effects of injuries on all parts of the nervous system are 
extremely irregular, but as their consequences are often very 
formidable, they should be diligently noted. Commonly, 
we find so general a prostration of strength, such debility in 
the nerves governing the actions of the respiratory muscles 
of the heart and the- stomach, that no other plan remains 
than to support the patient by stimuli, even though we may 
anticipate a re-action that will require great blood-lettings. 
At times no re-action comes on, or, at least, not for a con¬ 
siderable time; this is especially the case in extensive bums 
or scalds, when it is often necessary to support the patient by 
warm cordials for eight or ten days. The re action that fol¬ 
lows is occasionally succeeded a second time by prostration 
of strength ; but now the stimulating plan must be had re¬ 
course to with less confidence, and endeavours made to 
rouse into action the secernent system. 
With regard to the fever which attendsinflammation.it 
does not appear that we have any reason to interfere with 
this. If, indeed, the theory be true which we have broached 
with regard to the cause of sympathetic fever, it is obvious 
that this is a salutary process. 
It happens to be sure that this action often runs alarmingly 
high, that at other times the patient is sunk into extreme de¬ 
bility ; but in either case, our attention should solely be di¬ 
rected to the original inflammation; if this be found exces¬ 
sive, it must be reduced; if deficient, excited, and thus 
bleeding on the one hand, or stimuli on the other, may be 
indicated; but these not to cure the fever, but its cause. 
Nevertheless, the fever should be carefully noted, because 
it is an indication of the original inflammation, and of 
the strength of the constitution. Thus the fever technically 
called Hectic, which comes on when large quantities of pus 
are formed, or when this matter has been produced for a 
long time, points out a debility of the vital powers, which 
requires continued, but gentle stimulation; or, on the other 
hand, points out the necessity of immediately removing 
the offending part. So, the delirium and the hiccup at¬ 
tending gangrene, point out the dangerous degree of this 
action. 
It has been generally held that the formation of a line of 
separation in gangrene, and of healthy pus in abscess, are 
both much influenced by the administration of bark. Under 
due regulations, and used merely as an adjuvant to remedies 
that excite regular action of the secernents, this drug is valu¬ 
able ; but its administration as a specific, and the practice of 
increasing the dose, when it was found inert, to an extreme 
extent, have now fallen in disuse. 
The treatment of inflammation attacking the mucous 
membranes is best developed in the works of Badham and 
Hastings, and of Broussais and others of the French school. 
We observe in these, however, considerable discrepancies; the 
former laying great stress on bleeding and counter-irritation ; 
the latter considering that mild measures alone are necessary, 
and that phlogoses of these membranes are cured rather by 
time and abstinence, than by any determined practice. 
The inflammation of the serous membranes is for the most 
part characterized by such remarkable lowness of pulse, and 
general depression and weakness of the vital powers, as might 
deter a practitioner, not acting on the result of experience, 
from using the lancet. There is no class of diseases, however, 
which demand larger and more sudden bleedings than this, 
nor any that require a more violent degree of counter-irrita¬ 
tion by purging and blistering. When muscles, or the synovial 
membranes are inflamed, we have these inexplicable forms of 
diseased inflammation, called Gout and Rheumatism. Of 
their treatment little can be said. As they are aggravated by 
disorders in the general health, and ameliorated as this is 
improved, attention to this point is of course indicated. 
Some specific remedies, especially the Colchicum, are also 
occasionally useful ; but upon the whole, the general treat¬ 
ment of inflammation does not apply to them. The inflam¬ 
mation of the joints which occurs from injury, observes the 
same laws, and requires the same treatment as the early stages 
of phlegmon ; namely, depletion generally, and cold lotions 
topically: but the depletion may be carried further. The 
synovial membranes frequently, when the inflammation is 
subdued, continue to secrete inordinate quantities of their na¬ 
tural fluid, by which means great pain and irritation are pro¬ 
duced. Frictions and blistering form the sole local means of 
treating this disorder. 
The phenomena of inflammation attacking arteries, were 
not till lately much investigated. Contrary to what might 
be expected, this is a very rare disease. The causes are hid¬ 
den in obscurity: its characters are remarkable redness of the 
skin and turgescence of the face, with other symptoms of 
vehement general action. This is followed by a typhus fever 
of the gravest description. Great danger results from the 
circumstance that the inflamed artery betrays no tendency to 
unite, by the adhesive inflammation, and that consequently 
the disease spreads rapidly towards the heart. On dissec¬ 
tion, the usual appearances are rough granulations on the 
surface of the artery, separation and erosion of the coats and 
suppuration. It has been conjectured, that though acute 
arteritis be very rare, a chronic kind often exists, which 
gives rise to the several diseases of the inner surface of the 
heart. 
The inflammation of veins is generally brought on by 
bleeding. It exists in various degrees; sometimes being so 
slight, that no further consequences ensue from it than a 
slight thickening of the vein and adhesion of its sides. At 
other 
