Volume 1

The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen.

John Eric Erichsen

Date:: 1895

Credit: The science and art of surgery : a treatise on surgical injuries, diseases, and operations / by John Eric Erichsen. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

235/1274 (page 203)

$pressure ; thirdly, the migratiou of the white corpuscles; fourthly, the complete arrest of the circulation by stasis. The vascular dilatation and exudation cause the inflammatory swelling and give rise to tension, which, acting as a fresh source of irritation, aggravates the. inflammatory process. One of the pi'imary objects in the treatment of inflammation is therefore to limit the exudation lij diminishing the blood-pressure and, fail in// in that, to relieve the tension it gives rise to. The blood-pressure may be limited, first, by general means acting upon the heart, as aconite, antimony, and general blood-letting ; and, secondly, by diminishing the quantity of fluid circulating in the body, as by general blood-letting, saline purgatives, or low diet. The local blood-pressure may be diminished by causing dilatation of the vessels of some other parts—as of the intestines by purgatives in external inflam- mations, or of the skin by diaphoretics in internal affections ; secondly, by causing contraction of the vessels supplying the inflamed area by the direct applicition of cold, belladonna, or astringents, or by employiug a stimulus at a distance, so as to cause a reflex contraction of the vessels of the diseased part, as in counter-irritation by blisters or mustard plasters ; thirdly, by causing a uniform dilatation of all the vessels of the inflamed part and its immediate neighbourhood, so as to lessen local resistance, as in the application of heat ; and, fourthly, by elevation of the affected part of the body, by which the return of blood from the part is favoured, and, as has been shown by Lister, a certain degree of arterial contraction induced. Direct pressure on the main artery of the limb would also come under this heading. When exudation is taking place, elevation of the limb favours its return by the lymphatics, and so lessens swelling. Should the part become so much distended as to threaten gangrene fi'om pressure on the vessels, the exudation may be allowed to escape directly by incisions, punctures or scarifications. The migration of the corpuscles is limited by cold, which ari'ests their amoeboid movements, and by all means which diminish blood-pressure. Heat favours their migration, and also encourages their moving out of the inflamed area into the lymphatics in cases in which resolution is taking place. It is only the return of vitality in the walls of the vessels, however, that can completely arrest the process of migration. The tendency to inflammatory congestion, that is to say, choking of the distended vessels with scarcely moving blood, can be relieved in some cases by drawing blood directly from the part by scarification or puncture, or the force of the heart's action may be stimulated by the administration of alcohol in order to drive the blood past the obstruction. Stasis can be relieved only by the general means above mentioned for favouring the return of vitality in the inflamed area. 4. Pain, which forms so prominent a symptom in many inflammations, will be relieved locally by those means, already mentioned, which tend to diminish tension ; but in addition, local sedatives—as belladonna., opium, or subacetate of lead—are often of great use. If these fail, sedati\^es must be given internally. 5. Lastly, the treatment of inflammation includes that of the febrile dis- turbance which accompanies it. This, as we have seen, may be due chiefly if not entirely to the admixture with the blood of the exudation returning from the inflamed part by the lym])hatics ; in such cases the means adopted to limit the exudation, or to drain it away externally, as in a wound, will limit the fever ; in other cases the stream of lymph bears with it the chemical pro-$