Alexis Thomson

“ If the natural protective effort is successful, the resulting tissue changes subserve the process of repair, but if the bacteria gain the upper hand in the struggle, the inflammatory reaction becomes more intense, certain of the tissue elements succumb, and the process for the time being is a destructive one. During the stage of bacterial inflammation, reparative processes are in abeyance, and it is only after the inflammation has been allayed, either by natural means or by the aid of the surgeon, that repair takes place. ”

“ A third group of chronic inflammations are those that begin as an acute pyogenic inflammation, which, instead of resolving completely, persists in a chronic form. It does so apparently because there is some factor aiding the organisms and handicapping the tissues, such as the presence of a foreign body, a piece of glass or metal, or a piece of dead bone; in these circumstances the inflammation persists in a chronic form, attended with the formation of fibrous tissue, and, in the case of bone, with the formation of new bone in excess. ”

“ The administration of opiates may be necessary for the relief of pain.
The accumulation of an excessive amount of inflammatory exudate may endanger the vitality of the tissues by pressing on the blood vessels to such an extent as to cause stasis, and by concentrating the local action of the toxins. Under such conditions the tension should be relieved and the exudate with its contained toxins removed by making an incision into the inflamed tissues, and applying a suction bell. ”

“ The shade of colour varies with the stage of the inflammation, being lighter and brighter in the early, hyperaemic stages, and darker and duskier when the blood flow is slowed or when stasis has occurred and the oxygenation of the blood is defective. ”

“ If, however, the reaction induced by the infection is insufficient to check the growth and spread of the organisms, or to inhibit their toxin production, local necrosis of tissue may take place, either in the form of suppuration or of gangrene, or the toxins absorbed into the circulation may produce blood-poisoning, which may even prove fatal. ”

“ Dry cold obtained by means of icebags, or by Leiter's lead tubes through which a continuous stream of ice-cold water is kept flowing, is sometimes soothing to the patient, but when the vessels in the inflamed part are greatly congested its use is attended with considerable risk, as it not only contracts the arterioles supplying the part, but also diminishes the outflow of venous blood, and so may determine gangrene of tissues already devitalised. ”

“ Moist dressings favour the removal of bacteria by promoting the escape of the inflammatory exudate, in which they are washed out.
Artificial Hyperaemia.#--When such direct means as the above are impracticable, much can be done to aid the tissues in their struggle by improving the condition of the circulation in the inflamed area, so as to ensure that a plentiful supply of fresh arterial blood reaches it. The beneficial effects of _hot fomentations and poultices_ depend on their causing a dilatation of the vessels, and so inducing a hyperaemia in the affected area. ”

“ To make a fomentation, a piece of flannel or lint is wrung out of very hot water or antiseptic lotion and applied under a sheet of mackintosh. Fomentations should be renewed as often as they cool. An ordinary india-rubber bag filled with hot water and fixed over the fomentation, by retaining the heat, obviates the necessity of frequently changing the application. The addition of a few drops of laudanum sprinkled on the flannel has a soothing effect. Lead and opium lotion is a useful, soothing application employed as a fomentation. ”

“ The introduction of saline solution into the veins or by the rectum is also useful in diluting and hastening the elimination of circulating toxins.
In surgical inflammations, as a rule, nothing is gained by lowering the temperature, unless at the same time the cause is removed. When severe or prolonged pyrexia becomes a source of danger, the use of hot or cold sponging, or even the cold bath, is preferable to the administration of drugs. ”