THE TREATMENT OF INFLAMMATION. Inflammations of External Parts.—It is not difficult to lay down the broad principles on which treatment of inflammation, wherever occurring, shonld proceed. But it is not always easy to apply these principles in detail ill any given case. For instance, one may truly say that the treatment of an inflamed little linger and of an inflamed kidney is ill principle the same, but the detail of the treat ment, as applied to the little finger, can be easily understood, and as easily pmt into opera tion, but the most intelligent person, who had no medical training, would find it difficult to deduce from the treatment of all inflamed little finger what he should do in a case of inflam mation of the kidneys.
For the sake, therefore, of clearness, we shall, for the moment, put aside internal inflamma tion, and consider the proper lines of treatment to follow where the inflamed region is sonic easily-reached part on the surface of the body, a limb for preference, say inflammation of the hand.
Clearly the first thing to ask in such a case is— What is the cause of the inflammation? and following the answer to that question there are others, namely— Is the cause still present? Is it still in operation? Is it removable? For instance, the cause of the inflammation may have been a wound, a bruise, a tear, a scratch, a burn, corrosion by a strong acid or alkali. If the wound has been caused by a knife—let us say, for the moment, a clean knife,—obviously the cause is over and done with, and the treatment is simple. But if the wound has been caused by a bullet, then the question arises, is it still in the wound? or if the wound has been caused by broken glass, is a fragment of the glass possibly embedded in the wound? If a needle, pin, or such foreign body has caused the injury, may a fragment not have broken off and be still present? The same question would require to be settled if a burn had been due to red-hot metal. In the ease of acid or alkali, the material may not have been completely removed from the sur face and may still be acting.
The Removal of the Cause is in all cases, therefore, the first thing to assure one's self of.
Now this seems easy enough in the cases that have been mentioned. But it has already been noted that the commonest causes of inflamma tions are septic substances, microbic poisons.
It is not easy to say when they are present and when they are not. That is why emphasis, in the case of an injury by a knife, has been laid on the cleanness of the instrument, and the same applies to needle, pin, and all instruments that break the surface. For in such a case the inflammation may not be the mere reaction of the tissue to the injury, whose purpose is . limited to the repair of the breach, but irrita tion also due to substances introduced into the wound. Tile prick of a pin may set up a most violent and dangerous inflammation, not because of the tiny wound, but because the pin was not clean ; and the septic material upon the pin point may be so minute as to be in visible, while its virulence may be unbounded.
To answer the question, then, whether the cause of the inflammation is still present, is not so easy as it sometimes looks. For, in the case of a wound by a knife, it may be quite easy to say that neither the knife nor a fragment of it remains in the wound, but the question is not yet answered whether the knife has not intro duced septic material which is the real cause of the inflammation persisting.
The removal of the cause, therefore, is not limited to the assurance that no tangible foreign body is present to cause a continuance of the inflammation, but ought, if possible, to guaran tee that septic material is not present. Now we have already said it is impossible usually to tell whether septic material has gained entrance to a wound or not. The only safe procedure, therefore, is to assume the extreme likelihood of this having occurred, and to act accord ingly.
The direction, therefore, to discover and re move the cause of inflammation includes such steps as shall, if possible, guarantee the clean ness of any wound or bruise that may attend the inflammation or be in its neighbourhood.
The first direction, therefore, in the treat ment of inflammation becomes something like the following:— Wherever inflammation is associated with a wound, make sure that no tangible foreign body is present, then tho roughly cleanse the wound and all the neighbouring surface with an anti septic lotion of some kind.
The details of such lotions are given under