Lectures on the principles and practice of physic : delivered at King's College, London / by Thomas Watson.

  • Sir Thomas Watson, 1st Baronet
Date:
1850
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Licence: Public Domain Mark

Credit: Lectures on the principles and practice of physic : delivered at King's College, London / by Thomas Watson. 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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    large cartilage floating about in fluid in one of his knee-joints : but I believe that Mr. Arnott, whom I have consulted on the case, will be very slow to recommend its removal, until the inconvenience produced by it is so great as to incapacitate the patient from pursuing his employment, and until other methods of relief have failed. Suppuration of the joints is also one of the occasional consequences of phlebitis. In- flammation of the synovial membrane speedily leads to a serous effusion into the joint, which often, especially in rheumatism, is as speedily taken up again. Let us next inquire into the modifications which inflammation undergoes when it affects the tegumentary membranes. Considering the skin as one membrane, and neclectintr its subdivisions into epi- dermis, rete mucosum, and cutis vera, we find that inflammation assumes a variety of forms in this external covering of the body. Many of these belong to specific diseases, and do not fall within my present purpose, which is that of noting how common inflammation varies in the different tissues. When the inflammation is superficial, it frequently is denoted by a diffused red blush only, which may be banished for a moment by the pressure of the finger, and which, after a certain time, disappears of its own accord—terminates by resolution ; the only consequence of the inflammation being the separation of the cuticle in small branny fragments ; in one word, desquamation. We call the superficial inflamma- tion, in this case, erythema. If the inflammation has been a little more intense—as in some cases of erysipelas, in scalds, and in that which we are every day exciting by cantharides—a serous fluid is poured out, which elevates the cuticle in larger or smaller patches of vesication. Remove the cuticle and admit air, and the serous effusion becomes purulent effusion: and if the inflammation be pressed beyond a certain point by any other stimulus besides that of air, Ave may have pus poured out. Erysipelatous (which is also a specific) inflammation of the skin, is character- ized by its remarkable tendency to spread ; and a most singular circumstance attends several of the other specific inflammations of the skin, viz.: that having occurred once, they never occur again ; this peculiarity belongs, however, to the great consti- tutional diseases, of which the cutaneous affection forms merely a part. Inflammations of the internal tegumentary membranes—of the three internal sur- faces that communicate with the air, and are clothed with mucous membrane—are very interesting to the physician : and the first thing which strikes our attention in respect to them is the indisposition they manifest to adhesive inflammation : and we are struck at the same time with the beauty of this provision. If the mucous mem- branes were as ready to throw out coagulable lymph, and to adhere to each other as the serous, almost every occurrence of inflammation in them would prove necessa- rily fatal; by closing up the inlets of the air passages; or the outlets of the urinary passages; or any part of that long mucous canal which, passing through the body, requires a free opening at both of its extremities. But the inflamed mucous mem- brane pours out serous fluid, or viscid mucus, or pus, or blood. Inflammation of these membranes is, however, sometimes [in children very frequently] attended with the exudation of something which is very like coagulable lymph, and which has been considered (but in my opinion erroneously considered) to be such lymph. The tracheal, bronchial, and pulmonary mucous membrane, the oesophageal, the intestinal, and that which lines the uterus, are all more or less subject to the forma- tion of adventitious membranes under inflammation. Casts of the smaller branches of the air-tubes have, in rare instances, been repeatedly coughed up in large quan- tity; constituting what have been very inaptly called bronchial polypi. The mem- branous exudation of croup is well known: a tubular substance is formed in the trachea, and, sometimes, fortunately expelled : but too often it suffocates the patient. Similar concrete exudations, broken into irregular shreds, are occasionally voided by stool. It is said that a long membranous mass of the same kind, in size and shape like an earth-worm, has been discharged from the urethra; having formed there in consequence of the injudicious use of stimulating substances, injected with the view of checking the more innocent effusion of pus. The films, or membrane-like flakes which are thus incidental to inflammation of the mucous surfaces, resemble, I say, n their general appearance and disposition, the strata or layers of coagulable lymph L
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