715 
SURGERY. 
other times the vein bursts on the surface, and exhibits ab¬ 
scesses of various conditions. But instances are not want¬ 
ing, and these are truly dangerous, in which the inflamma¬ 
tion has communicated itself along the parietes of the veins to 
the brain or heart, giving rise to a severe typhoid fever, and 
commonly terminating in death. The treatment is to sub¬ 
due the disease in its earlier stage, by leeching and poul¬ 
tices, and to endeavour to procure adhesion of the sides of 
the vessel by the application of a compress above the wound. 
Some Frenchmen having found inflammation of the veins 
very frequent concomitants of typhus fever, and that the 
latter invariably followed the former, have concluded that 
the two were always related to each other as cause and effect. 
The anatomical characters of phlebitis vary according to the 
violence and the duration of the phlogosis. “ In the early 
stage, we find- the internal membrane of the vessel of a 
brownish-red colour, with or without traces of vascular in¬ 
jection. At a more advanced period, this membrane be¬ 
comes thickened, and easily lacerated. In this condition, 
it is .readily separated from the subjacent tunic, and is often 
covered with purulent matter, or ulcerated in its structure to 
a greater or less extent. It is still more common to find the 
pus, which is the product of the inflammation, mixed with 
a certain quantity of the blood contained in the vein—hence 
the purulent, sanguinolent, or fetid matter which we see in 
the vessels of many of our sick—hence the manifest decom¬ 
position of the blood, with the presence of gas, which we 
occasionally observe. In some cases, the purulent matter 
secreted by the inflamed vein, determines a sort of coagula¬ 
tion of the venous blood, and produces those long fibrinous 
clots, which obstruct the canals of the vessels. Sometimes, 
though rarely, the concretible and organisable matter se¬ 
creted by the vein agglutinates the opposite parietes, and 
the vessel is ultimately converted into a solid cord. This, 
however, is a rare circumstance, because the matter, as it is 
secreted, is hurried along into the general circulation. When 
the inflammation has, at length, invaded all the coats of the 
vein, the vessel becomes thickened in its parietes, and rea¬ 
dily lacerable." 
Inflammation of the absorbents follows nearly the same 
course as phlebitis, except that it is usually attended with 
glandular swellings. These vessels are seen running along 
the limbs, hard, red, and inflamed. Erysipelas generally 
appears on the skin, coagulable lymph is effused around 
them in the cellular tissue, wherein, as well as in the 
glands, abscesses are formed. Inflammation of veins and 
absorbents are, however, rarely if ever seen, except in conse¬ 
quence of the inoculation of poisons, and of these, that of 
putrid bodies is, perhaps, the most frequent. Many have 
been the unfortunate victims who have been carried off by 
this complaint, whilst prosecuting anatomical studies; and 
though of course from many feelings this complaint has 
called forth much attention from pathologists, our practice 
is very unsuccessful. The profession is divided as to whe¬ 
ther this complaint ought to be treated like other inflamma¬ 
tions, by venesection, mercury, purgatives, &c., or by sti¬ 
mulation and a high diet. With regard to the success that 
has followed these two modes of practice, it amounts to 
nearly nothing. Where life has been prolonged by any 
means for some time, the powers of the constitution seem to 
have overcome the virulence of the poison, and the patient 
has slowly recovered: but it is very doubtful whether any 
thing ought to be attributed to the treatment. 
It must be confessed, however, that though the depleting 
system has been adopted in all degrees, and with the most 
obstinate pertinacity, there is no evidence that a plan of 
stimulation, regulated solely by effects and pushed to the 
utmost sufferable degree, has ever been fairly put on trial. 
Viewing the matter on theoretical grounds, (and it is to 
theory we must resort when experience shews no certain 
way), we should be inclined to fhink that the stimulating 
plan is the only one likely to be attended with success, and 
that the measures adopted by those who preferred antiphlo¬ 
gistic measures, were calculated on all accounts to be pro¬ 
ductive of injury. In the first place, we suppose it will be 
allowed on all hands, that a specific poison is absorbed into 
the blood either through the veins or absorbents. What is 
the process nature adopts in ordinary cases to prevent the 
ingress of morbid matter into the system ? Why first, the 
part affected inflames, coagulating lymph is thrown out, a 
cyst is formed by it round the inflamed part, into this cyst 
pus is secreted, and the poison is probably thrown off; at 
all events no ill consequences result, and though the sore 
long remains open, and is very troublesome, no dangers are 
threatened. It appears here that the indurated cyst which 
is formed round the wound, or the adhesion that closes the 
inflamed vein afford a powerful opposition to the transmis¬ 
sion of poison into the system. Yet we do every thing to 
prevent this consolidation. We bleed, which is the very 
treatment we adopt when we wish to prevent adhesive in¬ 
flammation from taking place. We give mercury in large 
doses; a medicine of the utmost efficacy in checking the de¬ 
position of lymph, and which has moreover the reputation of 
promoting absorption. It would be more consonant with 
reason, and not at all opposed by experience, to tie a liga¬ 
ture round the poisoned limb, so as to retard the flow of 
blood, and thus favour deposition, and to give the sulphate 
of quinine, or other medicine of a stimulating nature, in such 
doses as might keep up a strong action of the heart and 
arteries. 
Having thus given a general account of the varieties of 
active inflammation, we shall proceed to some account of 
those sudden injuries or accidents which call this action 
into play. These may naturally be divided in wounds, 
contusions, burns, scalds, dislocations, and fractures. 
Wounds are of three kinds—cuts, stabs, and rents: words 
with the meaning of which every one is so familiar, that 
they require no definition. They are dangerous nearly in 
the order set down; the first being the least so. The effect of 
an incision through the flesh is to cause haemorrhage from 
all the blood-vessels divided; if any of them are of large size, 
(say the size of the third string of a fiddle,) and it is not com¬ 
pressed, the patient commonly bleeds to death. Arteries of 
smaller dimensions, however, having bled a little, have 
an inflammation set up in their vasa vasorum, which causes 
them to swell, and obliterates them. Though the blood is 
by this means stopped, the orifices pour forth a lymph 
which, coagulating, forms a cement to unite the divided sur¬ 
faces. This deposition of coagulation has of course the 
greater effect the nearer the respective sides of the wounds 
are approached to each other, and thus it happens that 
if the wound be very deep, the lower not being brought into 
opposition by an unskilful surgeon, the exterior part unites 
while suppuration takes place below. The accurate union of 
all the wound is therefore our first duty. This is for the most 
part easily effected by adhesive plaister laid over the wound 
in strips, so as to bring the edges of the wound in contact, 
while the bottom of the wound may be closed by means of 
compresses laid on the sides of the limb and fixed by 
bandages. There is considerable tact required in this as 
well as in the removal and re-application of dressings. The 
following rules are extracted from a very useful book, “ Coo¬ 
per’s Surgery— 
“The strips of adhesive plaister should be removed by 
taking hold of iheir ends, and drawing them always in a 
direction towards the wound. Were the plaisters pulled off 
in the contrary direction, the edges of the wound would be 
separated, and perhaps torn asunder again, and the process 
of reunion at all events disturbed. The plaister should not 
be pulled up, as by this proceeding the edges of the wound 
would be torn from the subjacent parts. 
“In large wounds, especially, only one strip, or at most 
two, should be off the injury at a time ; and the part from 
which the plaister has been removed, having been carefully 
wiped with a sponge and dried, is then to be supported with 
a fresh strip, before any more strips are taken off. 
“ The edges of the wound, particularly if it be large and 
deep, should always be held together by an assistant at the 
time of changing the dressings. 
“ The frequency of dressing must be regulated by the 
quantity 
