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It will not be difficult to understand how these remote causes, singly, or in concurrence, produce the proximate cause of inflammation.
263. It does not appear that, in different cases of inflammation, there is any difference in the state of the proximate cause, except in the degree of it; and, though some difference of inflammation may arise from the difference of the remote causes, yet this is not necessary to be taken notice of here ; because the different appearances which attend different inflammations may be referred, for the most part, to the difference of the part affected, as will appear when we shall consider the several genera and species marked in the nosology. When I come to treat of these, I shall find a more proper occasion for taking notice of the different states of the proximate, or of the differences of the remote cause, than by treating of them in general here.
Of the cure of inflammation. . 264. The indications of cure in inflammation are different, according as it may still be capable of resolution, or may have taken a tendency to the several other terminations above mentioned. As the tendency to these terminations is not always immediately evident, it is always proper, upon the first appearance of inflammation, to attempt the cure of it by resolution. For this purpose, the indications of cure are;
1, To remove the remote causes, when they are evident, and continue to operate ;
2, To take off the phlogistic diathesis affecting either the whole system, or the particular part;
3, To take off the spasm of the particular part, by remedies applied either to the whole system, or to the part itself.
265. The means of removing the remote causes will readily occur, from considering the particular nature and circumstances of the different kinds. Acrid matters must be removed, or their action must be prevented, by the application of correctors or demulcents. Compressing and overstretching powers must be taken away; and, from their several circumstances, the means of doing so will be obvious.
266. The means of taking off the phlogistic diathesis of the system, are the same with those for moderating the violence of reaction in fever, which are mentioned and treated of from 127 to 149, and therefore need not be repeated here. I only observe, that, in the use of those remedies, there is less occasion for any reserve than in many cases of fever; and, more particularly, that topi
cal bleedings are here particularly indicated and proper.
267. The means of taking off the spasm of the particular part are nearly the same as those mentioned above, for taking off the spasm of the extreme vessels in the case of fever, and which are treated of from 150 to 200. Only it is observed here, that some of these are here especially indi. cated, and that some of them are to be directed more particularly to the part especially affected : the management of which will be more properly considered when we shall treat of particular inflammations.
.268. When a tendency to suppuration (251) is distinctly perceived, as we suppose it to depend upon the effusion of a fluid which cannot be easily reabsorbed, so it becomes necessary that this fluid be converted into pus, as the only natural means of obtaining its evacuation : and, as the effusion is, perhaps, seldom made without some rupture of the vessels, to the healing of which a pus is absolutely necessary; so, in the case of a tendency to suppuration, the indication of cure always is, to promote the production of a perfect pus as quickly as possible.
269. For this purpose, various remedies, supposed to posses a specific power, have been pro-,
posed; but I can perceive no such power in any of them; and, in my opinion, all that can be done is, to favour the suppuration by such applications as may support a proper heat in the part, as, by some tenacity, may confine the perspiration of the part, and as, by an emollient quality, may weaken the cohesion of the teguments, and favour their erosion.
270. As, in the case of certain effusions, a suppuration is not only unavoidable, but desirable, it may be supposed, that most of the means of resolution formerly mentioned should be avoided ; and accordingly our practice is commonly so directed. But, as we observe, on the one hand, that a certain degree of increased impetus, or of the original circumstances of inflammation, is requisite to produce a proper suppuration ; so it is then especially necessary to avoid those means of resolution that may diminish too much the force of the circulation. And as, on the other hand, the impetus of the blood, when violent, is found to prevent the proper suppuration ; so, in such cases, although a tendency to suppuration may have begun, it may be proper to continue those means of resolution which moderate the force of the circulation. „ With respect to the opening of abscesses, when completely formed, I refer to the writings on surgery.
271. When an inflammation has taken a tendency to gangrene, that event is to be prevented by every possible means; and these must be difa ferent, according to the nature of the several causes occasioning that tendency, as may be understood from what has been already said of them. After a gangrene has, in some degree, taken place, it can be cured only by the separation of the dead from the living parts. This, in certain circumstances, can be performed by the knife, and always most properly, when it can be so done.
In other cases, it can be done by exciting a sup. puratory inflammation on the verge of the living part, whereby its cohesion with the dead may be everywhere broken off, so that the latter may fall off by itself. While this is doing, it is proper to prevent the further putrefaction of the part, and its spreading wider. For this purpose, various antiseptic applications have been proposed : but it appears to me, that while the teguments are entire, these applications can hardly have any effect; and therefore, that the fundamental procedure must be to scarify the part, so as to reach the living substance, and, by the wounds made there, to excite the suppuration required. By the same incisions also, we give access to antiseptics, which may both prevent the progress of the putre. faction in the dead, and excite the inflammation necessary on the verge of the living part.