John Burns

“ Resolution is the quickest termination of inflammation, and, therefore, ought, perhaps in every instance, to be attempted, unless in cases where the injury is such that suppuration is unavoidable; as, for instance, extensive bruises, &c. It is our great object, even in those inflammations which we raise intentionally; as, for instance, in the operation for hydrocele. At one time, however, this was not admitted without limitation; and suppuration was, in many instances, anxiously sought for, being considered by some as the only way of obtaining a cure. ”

“ The condition and qualities of an ulcer, do not, in every instance, depend upon causes which are entirely local, but frequently are connected with some general state, or mode of action, of the system. General weakness must, for example, influence the performance of any action in a particular part; and, therefore, an ulcer in those who are infirm, and exhausted, cannot readily perform the necessary healthy action, or proceed quickly toward a cure ”

“ When the skin is not directly affected, but only the parts immediately below it, as, for instance, the muscles in chronic rheumatism, or the articulating surfaces of joints, we may sometimes, by applying cloths dipped in laudanum, or strong diffusion of opium, propagate, from the surface to a certain distance, the narcotic action, and alleviate the disease; but, most frequently, we are obliged to trust entirely to the effect of the sympathy of equilibrium, diminishing the action of the internal parts, without any considerable change of nature, by increasing that of the surface. ”

“ The remedies which we employ, with the intention of abating and removing the inflammatory action, are either general or topical.
General remedies are perhaps only useful, or have only a superiority over topical ones, when a general disease, or fever, accompanies the local inflammation. Topical ones are only to be trusted to alone, when the disease is entirely local. ”

“ When an abscess has been formed slowly, and runs its course rather tediously, we may suppose, that the action shall continue for a considerable time without being converted into the ulcerative one; and, therefore, the abscess shall remain long without healing. In this case, a free incision, or the irritation of a foreign body, may excite the ulcerative action, and thus accelerate the cure ”

“ On the other hand, we must not allow the constitution to suffer too much, but must interfere, whenever we perceive that our labours are fruitless, and that the hectic is regularly and progressively increasing, and the strength sinking. When this is observed, the only chance for life is an operation; and every day this is delayed adds to the risk attending it; for there is a degree of injury, more than which the constitution cannot sustain, and which will prove fatal, even although the exciting cause be removed. ”

“ Here I shall only observe, that were the reverse true, then the contagious matter must pass through every gland, and every portion of the human form, in as much as the blood circulates in every point; and, therefore, every spot should become diseased, and every part, in the same circumstances, should become diseased at the same moment126. Disease is not spread in the living system mechanically, by the absorption of matter, which is conveyed over the whole body, but by the sympathetic connection of parts, which has been already explained, and which will afterwards be farther illustrated. ”

“ When inflammation has taken place, either in wounds, or in other cases, our great object is, to remove or lessen it as quickly as possible, which we effect, first, by removing the exciting causes of inflammation, or such causes as tend to increase the action; and, secondly, by applying such remedies as tend directly to abate the inflammatory action. ”

“ The good effects of pressure, applied in a degree proportioned to the effect which we wish to produce, and to the state of the sore, are so universal, that it is unnecessary to give any examples of its success and utility. But, at the same time, it must be observed, that in old ulcers, and even in many of a more recent date, which have been much neglected, no application whatever will produce an uninterrupted cure; for, after some time, it ceases to produce the same effect upon the action. The part seems, by continuance, to be less acted on by the agent ”

“ The general remedies, are naturally such as tend to abate action in general, or to diminish the natural action; and, therefore, will consist of bleeding, cold, purging, sweating, nauseating medicines, and some of the agentes dissimiles.
Bleeding is justly considered as the most powerful, and the most useful of all those remedies; and, in many cases, is the only one which can accomplish a cure. The quantity of blood which it is necessary to detract, will be regulated by the effect of the inflammation upon the system, and by the previous condition of the person, with regard to strength ”

“ In general, an adult ought, if possible, to take half a drachm, or two scruples, every forty minutes, in the most palatable vehicle; for much depends upon the taste, owing to the sympathy betwixt the mouth and the stomach; and, for this reason, the same vehicle ought seldom to be used more than twice in immediate succession; because, by changing the vehicle, we not only change the taste, which has a tendency to prevent loathing, but also modify the immediate action on the stomach, changing, to a certain degree, the former impression, which was perhaps beginning to produce sickness. ”

“ The remedies which tend to diminish the inflammatory action, by producing a peculiar, or specific change, are, the agentes dissimiles, of which, for this purpose, lead is the best, and the one which is most frequently employed. Lead, in the state of an oxyde, was long ago used; but it does not appear, in this condition, to have much activity; and, therefore, the saline preparations are now introduced into use. The acetite of lead, on account of the supposed power of vegetable acids in abating inflammation, has been considered as possessing a great superiority over other forms ”

“ The fourth species of sinuses, are those where a specific action exists39, and prevents the healthy ulcerative action from forming. Of this kind is the scrophulous sinus, which is generally accompanied with a caries bone, or diseased cartilage, and, therefore, is a complicated sinus40. This is distinguished, where the bone is diseased, by a shining or polished red skin, like a cicatrix, surrounding the fungus papilla at the orifice of the sinus, or the scrophulous-looking sore which exists there. When no caries bone exists, we have no papilla, but only the diseased ulcer at the orifice. ”

“ When the nose becomes cancerous, the disease either begins in the outside, with a small tumor or wart, as in other parts of the face, or within, by a firm and somewhat painful polypous projection, which frets on the surface, and soon assumes the cancerous ulceration.
The diagnosis of this disease is of the utmost importance; because if we mistake cancer for some other disease, we not only neglect the proper practice, but frequently are led to prescribe remedies which do infinite harm. ”

“ We ought, upon this principle, which has been formerly mentioned, to endeavour, in almost every instance, to bring the sides of the wound together, if an wound has been the exciting cause of inflammation, by which we shall much more readily prevent or overcome the inflammatory action ”

“ If the foregoing reasoning be just, it will appear, that, in scrophulous habits, our great attention ought to be directed to the prevention of the scrophulous inflammation, which is to be done by avoiding, as far as lies in our power, the operation of any agent tending to excite inflammation. It has been observed, that, in scrophulous systems, very slight causes were sufficient to produce disease; because the parts on which they act possess a peculiar constitution, and are less capable of performing their natural and healthy functions properly, and therefore are sooner rendered diseased. ”

“ When the cellular substance is inflamed, and we begin the application before the cutis be much affected, the solution will not require to be so strong as to produce sensation; because, were it to be so, the action excited might, from the quantity required to produce the effect, be so great, and so suddenly induced, that the powers of recovery would be lost, or a specific inflammation be occasioned, as we observe, when the solution is very much concentrated, in which case, even sloughs are sometimes produced. ”

“ When, notwithstanding the use of issues, matter is formed in joints, or, when these fail to procure the absorption of what was formed before they were introduced, then one of two things must happen; either the abscess must be punctured, or it must be allowed to burst of its own accord. In general, I believe, it is most advantageous to allow the abscess to burst, without any interference, except the continuance of the issue, or the establishment of such new ones as circumstances, particularly the situation of the pain, may point out. ”

“ First, In the first variety of the first species, or the simple fungous ulcer, the cure is to be attempted by pressure, and gentle stimulants, which render the action more natural, and the granulations, in consequence, more perfect and compact.
Second, In the second variety of this species, we are to employ the same remedies, as palliatives, or as means which may promote the exfoliation of the bone. But, if the disease in the bone be more extensive and tedious, we must cut down through the ulcer, and apply caustic, or mechanical cures, such as perforation, to the caries. ”

“ With regard to the exciting causes of scrophulous inflammation, I may remark, that they are similar in kind to those capable of inducing simple inflammation; but they frequently operate more powerfully; that is to say, causes which would scarcely induce inflammation in a healthy person, may induce a local disease, and inflammation, in a scrophulous habit; because the different parts of the body perform their functions less healthily in a strongly scrophulous person, and are more easily deranged. ”

“ It may, however, be proper to observe, that we ought not to be satisfied with one application, more than with one venesection, for a general disease, but ought to repeat the local bleeding, whenever it may be necessary, although it may be twice or thrice in a day, founding our indications upon the same principle on which we use general bleeding. It is by a too sparing application of leeches, and their not being repeated sufficiently frequently, that we so often fail in removing inflammations, which, by a more active treatment, we might resolve. ”

“ If this sinus have remained long open, its surface, like that of the chronic abscess, becomes changed, and a coat is formed, like the cyst of a tumour. When this is thick and hard, the sinus has been called a fistula, and it has been deemed necessary to dissect out the tube; but it is in general sufficient to use the remedies which increase the vigour of the action, and make it run its natural progress; such as the seton, or a free incision, if the parts be superficial, or no considerable vessel or nerve runs the risk of being wounded. ”

“ If the cold be long applied, to any considerable degree, it will likewise, by the sympathy of association, weaken the whole system too much, and injure the act of restoration. As bleeding is to be used only until it restores a natural state, and abates pain, so also is cold only to be applied in such a degree as may be necessary for diminishing the preternatural heat, and sensation of the surface; which it does, by lessening the morbidly increased action, and reducing it to the natural state. ”