Encyclopaedia Britannica, or, a Dictionary of arts, sciences, and miscellaneous literature : enlarged and improved. Illustrated with nearly six hundred engravings > Volume 13, MAT-MIC

fWHce. M E D I
Phlegma- comes not only Unavoidable but delirable, it may be
fise- , fuppofed that molt of the means of procuring a refolu-
r tion, by diminiQiing the force of circulation, &c. ought
to be avoided. But as we obferve on the one hand,
that a certain degree of increafed impetus, or of the ori¬
ginal fymptoms of inflammation, is neceflary to produce
a proper fuppuration ; fo it is then efpecially neceflary
to avoid thofe means of refolution which may diminilh
too much the force of circulation. And on the other
hand, as the impetus of the blood, when violent, is found
to prevent the proper fuppuratipn 5 fo, in fuch cafes,
though a tendency to fuppuration may have begun, it
may be proper to continue thofe means of refolution
which moderate the force of the circulation. With re-
fpeft to the opening of abfeeffes when completely form¬
ed, fee the article Surgery.
When an inflammation has taken a tendency to gan¬
grene, that event is to be prevented by every poflible
means j and thefe muft be different according to the
nature of the feveral caufes : but after a gangrene has
in fome degree taken place, it can be cured only by
the feparation of the dead from the living parts. This
in certain circumftances can be performed, and moft
properly, by the knife. In other cafes it can be done
by exciting a fuppuratory inflammation on the verge
of the living part, whereby its cohefion with the dead
part may be everywhere broken off, fo that the latter
may fall off by itfelf. While this is doing, it is pro¬
per to prevent the further putrefaction of the part, and
its fpreading wider. For this purpofe various antifep-
tic applications have been propofed : but Dr Cullen is
of opinion, that while the teguments are entire, thefe
applications can hardly have any effeCt; and therefore
that the fundamental procedure mufl: be to fcarify the
part fo as to reach the living fubftance, and, by the
wounds made there, to excite the fuppuration required.
By the fame inciflons alfo we give accefs to antifeptics,
which may both prevent the progrefs of the putrefac¬
tion in the de&d, and excite the inflammation neceflary
on the verge of the living parts.
When the gangrene proceeds from lofs of tone, and
when this, communicated to the neighbouring parts,
prevents that inflammation which, as we have faid, is
requifite to the feparation of the dead parts from the
living, it will be neceflary to obviate this lofs of tone
by tonic medicines given internally j and for this pur¬
pofe cinchona has been found to be moft effectual.
But when the gangrene arifes from the violence of in¬
flammation, the bark may not only fail of proving a
remedy, but may do harm : for its power as a tonic is
efpecially fuited to thofe cafes of gangrene which pro¬
ceed from an original lofs of tone, as in the cafe of palfy
and oedema ; or in thofe cafes where a lofs of tone takes
place after the original inflammatory fymptoms are re¬
moved.
On the other hand, Mr Bell is of opinion, that in-
cifions made with a view to admit the operation of an-
tifeptic remedies in gangrenes, as well as the remedies
themfelves, muff be pernicious from the irritation they
occafion, and from the danger of wounding blood-
veffels, nerves, or tendons, and alfo by allowing a free
paffage for the putrefcent fluids into the parts not
yet affefted. And unlefs they be carried fo deep as
to reach the found parts, applications of the antifeptic
kind can never have any effeCl in anfwering the pur-
C I N E. 29:^
pofe for which they were intended. The fame author PMogofis.
alfo remarks, that all the advantages commonly obfer-
ved from the great number of applications recommend¬
ed for gangrene, are obtained with more eafe, and ge¬
nerally too with more certainty, from the ufe of fome
gentle flimulating embrocation j which, by exciting a
flight irritation upon the furface, efpecially when aflift-
ed by a free ufe of cinchona, produces for the moll part
fuch a degree of inflammation as is wifhed for. With '
this view he has frequently known a weak folution of
fal ammoniac, a dram of the fait to two ounces of vine¬
gar and flx of water, form a mixture of very proper
ftrength for every purpofe of this kind. But the degree
of ftimulus can eafily be either increafed or diminilhed
according to circumftances, by ufing a larger or fmaller
proportion of the fait.
Whenever, either by the means recommended, or by
a natural exertion of the fyftem, a flight inflammation
appears between the difeafed and found parts, we may
in general, with tolerable certainty, expedt, that in due
time the parts will be feparated ; and when a full fup¬
puration is once fairly eftablilhed, there can be little
doubt that the mortified parts will be foon and eafily
removed.
A complete feparation being effedted, the fore is to
be treated in the manner defcribed under the article
Surgery 5 with a proper attention, at the fame time,
to the fupport of the general fyftem by the continuance
of nourilhing diet, and cinchona with fuch quantities of
wine as may feem neceffary.
With regard to the bark, however, it is proper t©
take notice of another cafe of mortification in which it
is likewife unfuccefsful, as well as in that attended with
a high degree of inflammation ; and that is, in thofe
mortifications of the toes and feet, common in old
people, or Avhich arife from any caufe increafing the
rigidity of the veffels to fuch a degree as to prevent the
motion of the fluids through them. In this cafe Mr
Pott has difcovered, that all kinds of warm applications
are very unfuccefsful $ but by the free ufe of opium, to¬
gether with fedatives and relaxants externally applied,
he has frequently feen the tumefadtion of the feet and
ankles fubfide, the Ikin recover its natural colour, and
all the mortified parts feparate in a very ftiort time,
leaving a clean fore. But as to fcarifications, or any
other attempt to feparate artificially the mortified from
the found parts, he thinks them very prejudicial, by
giving pain ; which is generally of itfelf violent in this
difeafe, and which feems to have a great lhare in pro¬
ducing the other evils.
The other terminations of inflammation either do
not admit of any treatment except that of preventing
them by refolution, or properly belong to the article
Surgery.
Sp. II. Phlogosis erythema. 173
Erythema, Sauv. gen. 11.
Eryfipelas audtorum, Vog. 343.
Hieropyr. Vog. 344.
Anthrax, Sauv. gen. 19. Lin. 272. Vog. 353.
Carbo et carbunculus audtorum.
Erythema gangraenofum, Sauv. fp. 7.
Erythema a frigore.
Erythema pernio, Sauv. fp. 4.
Pernio, Lin, 259. Vog. 330.
Erythema