Lectures on the principles and practice of physic : delivered at King's College, London / by Thomas Watson.

  • Watson, Thomas, Sir, 1792-1882.
Date:
1845
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Licence: Public Domain Mark

Credit: Lectures on the principles and practice of physic : delivered at King's College, London / by Thomas Watson. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    membrane of the alimentary canal. To denote this mode of cure, by stimulating distant parts, the terms counter-irritation, derivation, and revulsion, are employed. Most commonly, even under moderate inflammation, some amount of extrava- sation takes place into ihe texture or from the surface of the part. ' The first effect or event of that kind which we notice, is the pouring out or effusion of serous liquid. The liquid is so like the serum of the blood, that it is called serosity or serous liquid ; and there can be no doubt, I conceive, that it consists of the serum of the blood, slightly modified perhaps. You will recollect my stating that the swelling which accompanies phlegmonous inflammalion is not equally firm throughout the whole extent of the inflamed part; that it is hard in the centre, softer towards the circumference; and that in the latter situation it sometimes retains for a few seconds the impression of one's finger;—pits. Now this results from the effusion of serous fluid into the areolar tissue immediately surrounding the part inflamed: it is neither more nor less than oedema,—oedema (which may exist also quite independently of inflammation) being a filling or infil- tration of the areolar tissue with serous fluid. Anasarca is an example of the same state, on a larger scale. Now anasarca is very constantly produced by some impediment to the passage of the blood along the veins ; the serous portion of the stagnating blood transudes through the coals of the vessels: and I apprehend that the same explanation may be given of the less extensive cerlema which takes place around a phlegmon ; the blood being stagnant in the neighbouring capillaries. But whatever may be the intimate cause of serous effusion, it is one of the earliest events of inflammation ; and in some cases it is its most important event; producing, mechanically, new symptoms, and giving rise to conditions of the most perilous kind. The quantity of serous fluid poured out in a short time is often immense. One of the pleura may be thus filled in a few hours, and the whole of one lung strongly compressed, and the respiratory apparatus reduced to one half of its customary efficiency. And if inflammation and effusion should take place on both sides of the chest at once—if double pleurisy should occur, as it sometimes does—the patient must presently perish by apncea, unless his con- dition is recognized, and free vent is given to the fluid. More than once or twice have I seen persons snatched from the brink of suffocation by what is called tap- ping the chest. Fatal coma is no uncommon result of the effusion of serosity, as an event of inflammation, into the ventricles of the brain. Even in the areolar tissue, where it is properly enough called cedema, a very trifling amount of this serous effusion may be sufficient to destroy life: when, for instance, it takes place into the submucous areolar tissue of the glottis, closing up by its pressure that little chink, the rima glottidis, and suffocating the patient after another fashion. Here also art may come to the rescue : an artificial chink or hole is made for the entrance and exit of air, below that part of the larynx in which the disease is situated, and the patient is delivered from imminent death. I have had two cases under my own care, and have seen several others, in which life was so preserved. I allude to such cases now, merely to convince you of the importance of attending to this event of inflammation, and of studying the indica- tions of its existence. Sometimes some of the small vessels give way, and hemorrhage into the part becomes an event of inflammation. Some slight degree of this ocnirs probably in most cases; and we frequently find that the colouring matter of the blood is mixed with the other effusions, giving to the serous liquid a deep tinge of red. I hinted before, that we must not infer inflammation from the presence of serous effusion alone. -Serum will exude, I believe, from loaded veins, even after death ; but this never can be much in amount. It is certain that dropsical effusions may be, and very often are, the result of congestion of a purely mechanical kind. A third event of inflammation is the effusion of what is called coagulable lymph, which, as I explained to you before, appears to be nothing else than the fibrin separated from the other constituents of the blood, and concreted. It is poured forth, at first, in a state of solution, or in a soft semi-fluid condition, and mixed