Assuming this view of our theory to be correct, we must next ascertain whether any poisonous matter is absorbed. The fact of the same affection being produced by clean lancets, clean needles, common skewers, delicate splinters of wood, various kinds of thorns, the spicuke of the bones of the ox or sheep, broken glass, or an abrasion of the finger against a wall, should at once put to rest the idea that absorption has any concern in producing such a disease; for since to the same causes we are en titled to ascribe the same effects, why should we search for the unknown and fanciful, when such simple and natural causes are before us? Before the time of Pare, musket bullets were supposed to be poisonous, and there are modern authors who are so credulous as to believe, that Malaria travels, like the carrying pigeon, from Italy and Holland to London! Some authors assert, that recently dead morbid animal matter is more poisonous than putrid, while others the reverse. and some think that the saline solution employed in injecting dead bodies is a cor rective. If what has been advanced be correct, it follows that putrid dead morbid matter, and saline dead morbid matter, should be more irritative than recently dead morbid matter. We do not mean to deny, that putrid dead morbid matter may be ab sorbed, although it is well known that the syphilitic virus and many other living animal poisons cease to affect the living system the moment death takes place; but we do mean to deny, that absorption oc curs in punctured wounds, producing erysipelas phlegmonodes or diffuse inflammation of the cellu lar tissue. By some a specific virus is supposed to be generated in the dead body, but this appears fal lacious if we are correct in our theory. It is also imagined that this virus is absorbed even when the skin is sound in those constitutions considered to be peculiarly susceptible of the impression of dead animal matter, and that gloves, oil or lard, are ex cellent prophylactics ; but that these arc totally in ert there appears scarcely a shadow of doubt. Some authors contend, that a person engaged in dissection, will resist this disease and the putrid effluvia better if his diet be nutritious ; but the very reverse ought to be the case.
With regard to fever, we have already stated, that idiopathic inflammatory fever is caused by the application of cold to the body while heated. The same appears to be the cause of all other fevers with the exception of hectic, so that we are of opin ion that neither putrid effluvia, marsh miasmata, nor pestilential vapours, ever give rise to fevers. These effluvia appear only to render the constitution ill-conditioned and feeble, and more susceptible of cold, and hence, when attacked with fever, make it more violent.
The treatment of this variety of erysipelas phleg monodes, originating from punctured wounds re ceived in morbid dissections, is as various as its theory, which must ever be the case so long as we are ignorant of the correct pathology of the disease; it equals the farcical medley of a thousand reme dies as applied to ulcers, so humorously described by John Bell. When suppuration is established, all are agreed that vent should be given to the mat ter by free incisions. Nor has the general treat ment been more consistent than the local. The treatment of this should be the same as that recom mended for erysipelas phlegmonodes. Sec also in flamed vein and inflammatory fever. In the last
stages of this fearful affection, as in other fatal dis orders, hiccup, which is an inverted action of the stomach and diaphragm, is no unfrequent concomi tant, and is easily checked by the patient sipping any bland fluid, swallowing it constantly without intermission until the hiccup ceases ; and after wards he must avoid speaking, for it is exceedingly liable to recur, sneezing and coughing reproducing it.
Adhesion is that termination of inflammation which takes place when the inflammatory action is moderate, and coagulable lymph only is secreted; in common phlegmon, this occurs very soon after the increased action has begun, the lymph being ef fused into the contiguous cellular tissue, which limits the extension of the inflammation. It takes place also in all acute abscesses, and in all incised wounds, whether accidentally or intentionally in flicted. Adhesive inflammation or union by the first intention, although a termination of inflamma tory action, begins a new series of operations, and its doctrine being one of the most interesting and important in surgery, has engaged the pen of our most able pathologists. When a clean incised wound is made, such as that in amputation of a limb, and the sides of such a gap are made to ap proximate, the first process in nature to effect a re union, is a moderate degree of inflammation, by which coagulable lymph is effused, which appears to be effected by a modification of the capillary ar teries, influenced by the nerves, to secrete this or ganizable fluid. That coagulable lymph is a se cretion, appears evident from the consideration that in slight degrees of inflammation of serous membranes, it is unquestionably secreted, and in abscesses and ulcers it is poured out in profusion; that in fractured bone it is a pure secretion; that in incised wounds, the blood acts as a foreign body, and that every fluid, either healthy or diseased, is secreted, or undergoes modification in vessels; it is also one of the simplest of diseased secretions. The bleeding of a wound must have entirely ceased before coagulating lymph can be effused, hence it appears that some modification of the bleeding or capillary arteries, influenced by the nerves, takes place. This coagulating lymph differs from that obtained when recent blood is allowed to coagulate, by being of a lighter colour, nearly transparent, like animal jelly or made starch, and being more tenacious, also more organizable.
The common doctrine of this lymph either issuing from the half-closed mouths of the vessels, or from the surface of the opened cells of the cellular sub stance, seems incorrect. After this coagulating lymph is effused, the capillary arteries and veins of each side of the wound shoot into it, soon rendering it a firm bond of union; and an inosculation has been proved to take place in the short space of twenty-four hours. In inflammation of the serous membranes, the pleura, pericardium, peritoneum, internal tunics of arteries, &c. the degree of the inflammatory action is often exceedingly mild, and the duration very short which accomplishes ad hesion, apparently almost as soon as inflammation is established, the serous secretion is checked and that of coagulable lymph substituted. On the prin ciple of this adhesive inflammation, are the various incised wounds healed, also as the renovation of a nose, or under lip, or a deficiency of the urethra.