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272. When the gangrene proceeds from a loss of tone; and when this, communicated to the neighbouring parts, prevents that inflammation which, as I have said, is necessary to the separation of the dead part from the living; it will be proper to obviate this loss of tone by tonic medicines given internally; and, for this purpose, the Peruvian bark has been found to be especially effectual. That this medicine operates by a tonic power, I have endeavoured to prove above (214); and, from what is said in 215, the limitations to be observed in employing it may also be learned. When the gangrene arises from the violence of inflammation, the bark may not only fail of proving a remedy, but may do harm: and its power as a tonic is especially suited to those cases of gangrene which proceed from an original loss of tone, as in the case of palsy and oedema; or to those cases of inflammation where a loss of tone takes place, while the original inflammatory symptoms are removed.
273. The other terminations of inflammation either do not admit of any treatment, except that of preventing them by the means of resolution; or they belong to a treatise of surgery, rather "than to this place. N
Having thus, therefore, delivered the general doctrine, I proceed now to consider the particular genera and species of inflammation.
It has been hinted above, (263), that the difference of inflammation arises chiefly from the difference of the part affected: I have therefore arranged them, as they are Cutaneous, Visceral, or Articular; and in.this order they are now to be considered.
OF INFLAMMATION, MORE STRICTLY CUTANEOUS.
Vjutaneous inflammations are of two kinds, commonly distinguished by the names of PhlegMon and ERYSIPELAS.
Of the latter there are two cases, which ought to be distinguished by different appellations. When the disease is an affection of the skin alone, and very little of the whole system, or when the affection of the system is only symptomatical of the external inflammation, I shall give the disease the name of Erythema; but when the external inflammation is an exanthema, and symptomatical of an affection of the whole system, I shall then name the disease Erysipelas.
275. It is the erythema only that I am to consider here.
For the distinction between Erythema and Phlegmon, I have formerly referred to the characters given of them in our Nosology. See Synops. JNosolog. Meth. Vol. ii, p. 5, gen. vii, spec. 1, and '2. But I think it proper now to deliver the characters of them more fully and exactly here, as follows:
A Phlegmon is an inflammatory affection of the skin, with a swelling, rising generally to a more considerable eminence in the middle of it; of a bright red colour; both the swelling and colour being pretty exactly circumscribed; the whole being attended with a pain of distention, often of a stounding or throbbing kind, and frequently ending in suppuration.
An Erythema, Rose, or S'. Anthony's Fire, is an inflammatory affection of the skin, with hardly any evident swelling; of a mixed, and not very bright red colour, readily disappearing upon pressure, but quickly returning again; the redness of no regular circumscription, but spreading unequally, and continuing almost constantly to spread upon the neighbouring part; with a pain like to that from burning; producing blisters, sometimes of a small, sometimes of a larger size ; and always ending in a desquamation of the scarf-skin, sometimes in gangrene. ,
This subject I am not to prosecute here, as properly belonging to surgery, the business of which I am seldom to enter upon in this work ; and shall therefore observe only as necessary here, that the difference of these appearances seems to depend on the different seat of the inflammation. In the phlegmon, the inflammation seems to affect especially the vessels on the internal surface of the skin communicating with the lax subjacent cellular texture; whence a more copious effusion, and that of serum convertible into pus, takes place. In the erythema, the inflammation seems to have its seat in the vessels on the external surface of the skin, communicating with the rete mucosum, which does not admit of any effusion, but what separates the cuticle, and gives occasion to the formation of a blister, while the smaller size of the vessels admits only of the effusion of a thin fluid, very seldom convertible into pus,
Besides these differences in the circumstances of these two kinds of inflammation, it is probable that they also differ with respect to their causes. Erythema is the effect of all kinds of acrids externally applied to the skin; and, when arising from an internal cause, it is from an acrimony poured out on the surface of the skin under the cuticle. In the phlegmon, an acrimony is not commonly evident,
276. These differences in the seat and causes of the phlegmon and erythema being admitted, it will be evident that, when an erythema affects any internal part, it can take place in those only whose supfaces are covered with an epithelion, or membrane analogous to the cuticle.
277. The same distinction between the seat and causes of the two diseases will, as I judge, readily explain what has been delivered by practical writers, with respect to the cure of these different cutaneous inflammations. But I shall not, however, prosecute this here, for the reason given above (275); and, for the same reason, shall not say any thing of the variety of external inflammation, that might otherwise be considered here.
OF OPHTHALMIA, OR INFLAMMATION OF THE EYE.
278. JL He inflammation of the eye may be considered as of two kinds; according as tit has its seat in the membranes of the ball of the eye, when I would name it Ophthalmia Membranarum"; or, as it has its seat in the sebaceous glands placed in the tarsus, or edges of the eye-lids, in which case it may be termed Ophthalmia Tarsi.
These two kinds are very frequently combined together, as the one may readily excite the other;