OCR Text |
Show ]U .Enrszrrzms. SUPPURATION. to the neck; the pulse is small and frequent; and if it still. increases, there is a comatose state, and even low delirium. Erysipelas attacking the skin, independent of previous injury, commences its attack with nausea, slight rigor, heat, thirst, and restlessness. At first the quickness of the pulse would indicate the propriety of evacuations : But if the pulse be sunk suddenly by bleeding, or the strength reduced by purging, the worst effects are to be dreaded. And this case may be considered as very desperate, when in a bad habit the skin is of a, dark or dusky red colour, or purplish; has a soft doughy feel, and is little sensible; when the pulse is unequal and faulterlr ing, and there has been rigor, or irregular shiverings, with has 1; bowels in all those apparently local affections, which seem to have some peculiar malignity, or which obstinately resist the common treatment. But more particularly still ought the student to regard the observation of Mr. Abernethy, to whom, on this subject, more than to any other man, we are indebted. He has examined the body, while under the influence of surgical diseases, in the true spirit of medical scrutiny. He has greatly assisted in raising the importance of the art, by giving it principle, and a foundation in science. 0F SUPPURATION'. situdc and feebleness, and an inclint'ition to dose. The phlegmonous inflammation is a symptomatic and necessary action of the living body under injury; the erysipela~ tous is a peculiar disease, and though remotely it may proceed ,_ \ p4 runs-s 4....» 50W" ‘tNDtA ‘- from wounds, yet I believe it is always a direct eil‘ect of the state of the system, either previously existing or consequent upon the injury. The surface in erysipelas, as I have said, has a doughy, soft feel, without tension, as in phlegmon, and it may be distinguished by the want of throbbing, and the redness vanishing on pressure. When it is proceeding to excess, vesications arise. It is still worse when the bases of these become livid. When speaking of the erysipelas of the head and face from wounds, it is impossible to neglect the observations of Dcsault on this subject. But what I would now more particularly notice, is that relation betwixt these injuries of the head and the general system, betwixt the affection of the brain and the ,. tr. fig... __.,_._‘...‘. "~‘-. L" _--...v.-,>r* - .1 s gastric organs, which he points out, and which no surgeo n should for an instant neglect. These affections of the scalp, he observes, are not local diseases; there is betwixt the scalp and brain a sympathy. The stomach and liver is affected; tllC system at large suffers from the disease of these organs ; but the consequence falls with peculiar power on the injure d in» trguments. for understanding this sympathy of parts, and uncle of connexions, our attrution is called to the state of the ScrrunA'ron, the discharge of. pus from inflamed vessels, is preceded by an exacerbation of the symptoms of inflammation, rigors, shooting pain in the part, and increased throbbing. It is followed by a remission of the general tumefaction, and swelling, and redness. In regard to an open wound, as the serous discharge is converted into a thick, white, mild matter, the lips of the wound lose their tension (yet are not loose nor flabby), red and healthy granulations appear; by and bye, this mild discharge continuing, a film of coagulablc lymph is found attached to the surface when the pus is cleaned away ; and this is the second stage preparatory to adhesion-r. When by intempcrance and mismanagement the healthy action is checked, the parts become loose and pale, or hard and irritable, and the discharge grows thin and ichorous. In large extensive wounds, a profuse suppuration often fol» lows the mild secretion of pus. Then there comes a large glecting sore, a declension of the health, and hectic fever, at. tended with diarrhoea and night sweats. * The pus is thrown out from the same vessels from which the serous discharge flowed, and the Change from hxmo: rhagy t0 serous discharge and from that to pus and coaguluble lymph, is gradual. But it is more important to observe at present, that if there arise a new source of irritation, or if the inflammation be increased, the discharge ofpus is again stopped ; and that if the discharge is profuse, with a looseness of the lips, the parts must be stimulated and supported, before they will afl'ord a due discharge of congalable lymph to produce adhesion by the second intuition, |