Remarks on the treatment of inflammation, with special reference to pneumonia.

  • Leonidas Merion Lawson
Date:
1860
Catalogue details

Licence: Public Domain Mark

Credit: Remarks on the treatment of inflammation, with special reference to pneumonia. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    of blood, and a very small amount of exudation ; but if the grade of action is high, a large amount of blood will be forced into the diseased part, stasis soon becomes extensive and complete, and the exudation of lymph active and abundant. And who can doubt that the destructive tendencies of inflammation, and the difficulties in securing resolution in ordinary cases, are precisely proportioned to the primary conditions of high action and copious exudation ? For example, a moderate grade of pneumonia, limited in extent and intensity, is far less likely to prove fatal, than where a large amount of blood, in the form of active inflammation, is precipitated upon the pulmonary structures, giving rise to a copious effusion of lymph, block- ing up the air-cells to an extent incompatible with life. Xow, it is precisely in these conditions of active inflammation that we resort, in the early stage of the disease, to bloodletting and other antiphlo- gistics, but not for the purpose, as Dr. Bennett states, of removing stasis and lymph, but to prevent or limit these conditions. Take, again, as an illustration, pneumonia, to which Dr. Bennett so often alludes. In the beginning of the disease we find the patient labouring under inflammatory fever, with a full and strong pulse, hurried breathing, cough, etc.; and a physical exploration of the chest reveals the crepitant rhonchus, with the accompanying signs of pulmonary engorgement and effusion of lymph, but short of consolidation. Under these circumstances, it is abundantly established by clinical experience (even by Dr. Bennett himself, as we shall see hereafter), that bloodletting, general or local, together with other anti- phlogistics, will moderate the fever, reduce the force of cardiac and arterial action, and thereby diminish the flow of blood into the inflamed tissues, and proportionally lessen the exudation of lymph ; and hence, if con- solidation ensues, it will be comparatively limited in extent, and therefore the more readily resolved. But Dr. Bennett's arguments apply to an altogether different stage of disease, and an altered degree of excitement. The cell-transformation, for which Dr. Bennett desires so much blood, and on account of which he objects to depletion, is nothing but resolution, and does not commence until the force of disease has subsided, and consequently the active stage of inflammation has ceased; hence the period when the vital forces are required to assist the changes connected with the absorption of the exuda- tions, the organization of tissues or the formation of pus, is not the stage in which any enlightened practitioner, resorts to depletion. On the con- trary, we deplete in the stage of excitement, and support the strength during the stage of resolution or cell-transformation. Dr. Bennett, there- fore, misrepresents the practice on this subject. No judicious physician would think of depletion in the stage of resolution ; and no sound patho- logist would attempt to increase or sustain the excitement during the forming or active stages of inflammation. But it may be assumed that bloodletting, eve^ '■ ■ Wu ■ ~ m]\ so , uninfluenced by inedicu.