Dunglison's American JVtedical Library. 
SELECTIONS 
IN 
PATHOLOGY AND SURGERY; 
OR, 
AN EXPOSITION OF THE NATURE AND TREATMENT OF 
LOCAL DISEASE; 
EXHIBITING 
NEW PATHOLOGICAL VIEWS, 
AND POINTING OUT AN 
IMPORTANT PRACTICAL IMPROVEMENT. 
ILLUSTRATED BY CASES. 
BY JOHN DAVIES, 
SURGEON TO THE GENERAL INFIRMARY AT HERTFORD, AND LATE EDITOR OF 
THE LONDON MEDICAL AND SURGICAL JOURNAL. 
PHILADELPHIA: 
PRINTED AND PUBLISHED BY A. WALDIE, 46 CARPENTER STREET, 
1839. TO THE GOVERNORS 
OF THE 
GENERAL INFIRMARY AT HERTFORD, 
THIS WORK 
IS INSCRIBED, WITH EVERY SENTIMENT 
OF RESPECT, BY THEIR VERY OBEDIENT SERVANT, 
THE AUTHOR. 
Hertford, June 20*7?, 1839. PREFACE. 
The author hopes that he will not be considered as arrogating 
too much in claiming the character of novelty to the pathological 
views promulgated in the present work. If, however, it should be 
pointed out, by those more extensively acquainted than himself 
with medical literature, that similar views have been already made 
known, he will readily relinquish all claim to originality. 
The physiological principles upon which the pathology of 
inflammation here set forth is based, were published eleven years 
ago, in a series of essays in the Medical Repository, and the 
London Medical and Surgical Journal, of which the author was 
then editor. The principles developed in those essays are founded 
upon a long course of experiments, repeated so frequently as to 
leave little doubt as to their correctness. 
The object of the second part of the work is to bring into 
general notice a remedy whose superior curative properties, as an 
external application, appears to be but little known to the profession. 
This remedy is iodine in liquid form. Respecting the employment 
of iodine as an external remedial agent, the author lays no claim 
to originality; but, with the exception of a small volume, published 
some years ago, by Mr. Buchanan, he is not aware that the mode 
here recommended for its application has been pointed out to the 
public. During the last ten years the author has employed the 
remedy in question very extensively, both in infirmary and private 
practice, and the object of the present work is to acquaint the 
profession with the result of his experience respecting its use 
during that period. 
Being very desirous that a knowledge of the curative properties 
of iodine, as an external agent, should be diffused as extensively as 
possible amongst the members of the profession, the author has 
caused the second part of the work to be published in a separate 
volume. SELECTIONS, Ac. 
PART I. 
LOCAL PATHOLOGY. 
INFLAMMATION. 
According lo the pathology of the present day, the term “ inflam- 
mation” is applied to almost every disease to which the human 
body is subject. The consequence of this view of the nature of 
disease is, that inflammation has been divided into numberless 
varieties, and scarcely any two authors agree respecting the manner 
in which the divisions ought to be made. Thus, according to 
some, we have the acute and the sub-acute or chronic: others 
furnish us with the adhesive, the suppurative, and the ulcerative: 
others divide the disease according to its immediate seat, or to the 
tissue which is affected; while others again classify it according to 
its tendency to spread, or to confine itself to a limited space. The 
dispute in every instance is, not whether the disease be inflamma- 
tion or not, but whether it ought to be classified under one head or 
under another. 
With regard to the proximate cause of inflammation, pathologists 
have been equally at variance in opinion. It has been attributed 
to error loci of certain particles of the blood; to the existence of 
irritating or acrid matter in some of the humours; to the viscidity 
of the blood itself, thereby causing lentor in its movement through 
the vessels; while most of the pathologists of the present day dis- 
card all notion of the blood having any thing to do with the causa- 
tion of the disease, and seek for the origin of the malady in the 
solids alone. By some of them it is attributed to an increased 
action of the arteries of the inflamed part; by others to a dimi- 
nished action; by others to an increased action of the capillaries, 
thereby causing them to attract more blood to the seat of disease 
than naturally belongs to it; whereas others again attribute all the 
mischief to irritation in the extremities of the nerves. In fact, the 
theories of inflammation are as various as the aspects which the 
disease presents to the senses of the observer. 
Notwithstanding all the theories that have been advanced respect- 
ing the nature or proximate cause of inflammation, all must agree, 
that the visible and tangible signs of it depend upon the condition 8 
DAVIES ON PATHOLOGY AND SUItGERY. 
of the arteries of the inflamed part, and upon the modification of 
the circulation of the blood within them. Taking these facts as 
the groundwork of the enquiry, we shall proceed to examine what 
this condition really consists in; we may then be able to assign 
some rational or probable cause for the inflammatory appearance 
put on by so many diseases, possessing in all other respects 
such various properties, and leading to consequences so differ- 
ent in their nature. First, however, as our views differ essen- 
tially respecting the natural functions of the vessels principally 
engaged in the representation of the more striking phenomena 
of inflammation, from those of any author with whose works we 
are acquainted, it is necessary to say a few words upon that 
subject. 
A view of the Mechanism and Structure of the Blood-vessels.1 
The apparatus which conduces to carry on the circulation of 
the blood consists of a forcing1 machine, to which is attached an 
elastic tube, which tube divides and sub-divides into innumerable 
ramifications. These ramifications unite into larger branches, 
which branches again unite into larger and larger tubes, until, 
lastly, they form only two trunks which deliver the blood back to 
the machine from which it originally started. 
We are first to notice the peculiar texture of the heart. This 
organ differs in respect to texture from all the other muscles. It 
is remarkably dense; its fibres are firmly bound together by trans- 
verse striae, and, compared with the other muscles of the body, very 
little cellular membrane intervenes between these fibres. This 
modification of structure indicates considerable strength, but with 
a limited scope of motion ; for we find those muscles whose sphere 
of motion is extensive, imbedded in proportionately a large quantity 
of cellular tissue. 
The texture of the arteries is also peculiar, but it is well adapted 
for the functions which they have to perform. Yery erroneous 
notions respecting the muscularity of these vessels have been enter- 
tained by authors and by anatomists generally. In order to be able 
to determine this point, it is necessary to define what are meant by 
muscular fibres. 
It must be admitted that a muscle, like all other bodies, has cer- 
tain distinct characters which determine it to be what it is. It is 
composed of a greater or less number of elastic fibres, placed 
parallel to each other; and these fibres are bound together, at in- 
tervals, by striae or smaller fibres, each being separated from the 
rest by a very small portion of cobweb-like tissue. The primitive 
'This subject has been treated at length, in a series of essays published 
by the author, in the Medical Repository for 1S27 and 1828, of which he 
was then editor. Only a short sketch of.the experiments and deductions 
therein given can be adduced here. LOCAL PATHOLOGY. 
9 
or simple fibres are gathered together into fasciculi or small bundles, 
surrounding each of which there is a larger quantity of cellular 
tissue than is found around every simple fibre. The muscle is 
composed of a number of these fasciculi or compound fibres, and, 
like them, the whole body of it is invested in a coat of cellular 
tissue. This is the character of muscular structure. 
Now, the next question is, do we find any thing in the coats of 
the arteries corresponding with the above definition? We presume 
not; that is, we presume so upon a very strict examination of their 
structure. 
Including the external coat, which is composed of condensed 
cellular membrane, an artery is made up of three layers or coats. 
The innermost layer, which, on one side, presents a polished surface 
for the blood to move on, is formed of a highly elastic tissue, but 
nothing like muscular fibres are discoverable in it. The next layer 
is also considerably elastic, but less so than the innermost coat. 
This being the coat usually considered muscular, we have paid 
much attention to its structure; but upon the minutest examination, 
nothing could be discovered in its texture to correspond with the 
fibres of muscle. The mistake may have occurred from consider- 
ing the fibrous processes, which unite it to the outermost coat, as 
muscular fibres; for, with the exception of these, scarcely any 
tissue in the body presents less the appearance of muscle. The 
outermost layer is likewise elastic, but its elasticity is inferior even 
to that of the middle coat, though its toughness considerably exceeds 
that of the latter. 
An artery, thus composed of its different layers of coats, is elastic 
to a considerable degree; but the elasticity does not depend upon 
muscular fibres. Indeed, such a structure, as will be pointed out 
hereafter, would be inconsistent with the functions which these 
vessels are destined to perform in the animal economy. It may be 
noticed that the elasticity of the arteries is somewhat greater in 
the longitudinal than in the circular or transverse direction. 
With regard to the veins, they have been deemed almost unwor- 
thy of notice by authors. It is true that, in a surgical point of 
view, they are less important than the arteries, but, 'physiologically 
considered, they are scarcely so. 
Although the veins are greatly more elastic than the arteries, yet 
few, if any, anatomists have attributed their elasticity to muscular 
fibres. The range of calibre in this class of vessels is very con- 
siderable ; and it may be remarked that their elasticity is much 
greater in the transverse or circular direction than in the longitu- 
dinal. This quality is different in them, in that respect, from what 
it is in the arteries, whose range of calibre is not, upon the whole, 
very extensive, compared with that of some other elastic tissues. 
As this subject is of considerable importance towards a right un- 
derstanding of the functions of the blood-vessels, we may be allow- 
ed to offer a few more remarks upon it. 10 
DAVIES ON PATHOLOGY AND SURGERY. 
In the human body, as well as in the bodies of all the higher 
classes of animals, we find that a considerable part of the structure 
is endued with the property of elasticity. Thus, the voluntary 
muscles, for the most part, are highly elastic; so are all the organs 
of which the alimentary tube is composed; so are, likewise, the 
urinary and the gall bladders; the uterus is endued with the same 
property in a different modification ; the arteries and the veins ; the 
lacteal tubes and the thoracic duct, as well as the ducts of the secre- 
tory glands, &c. are all possessed of an analogous property; but it 
differs in degree and modification in each organ, according to the 
duty—according to the extent of motion—which the organ has to 
perform. Thus, in the voluntary muscles, it enables them to shorten 
themselves from one third to one half their natural length ; whereas, 
the stomach, the urinary bladder, &c. possess a scope of motion 
ten times as great. In the small intestines the scope is less than in 
the urinary bladder; the veins possess the elastic property still less 
than the small intestines, and the arteries less than the veins. 
Now, we find here a general analogy in a number of organs, 
but each presents a modification peculiar to itself, and which quali- 
fies it for its own particular function. It is characteristic of a mus- 
cle to contract in one direction only, that is, in the direction of its 
fibres, because its ultimate object, with the exception of the sphinc- 
ters, the heart, and a few others, is not so much to undergo motion 
itself as to move other parts to which it is attached. On the other 
hand, the urinary bladder will contract almost equally in all direc- 
tions. In this respect it differs essentially from muscle; for the lat- 
ter will only display its elastic property in one direction. It cannot 
be said that the sphincters, the heart, the pharyngeal muscles, &c. 
are exceptions to the rule, for we find no instance of muscular mo- 
tion otherwise than in the direction of the fibres of the moving mus- 
cle. Again, the motion—accordingly the elastic property—in the 
small intestines is both in the longitudinal and circular directions, 
but much greater in the former than in the latter ; whereas in the 
colon and rectum the reverse is the case. The arteries, being situ- 
ated so near the bones, and consequently being liable to great and 
sudden extension, by the movements of joints, are very yielding 
longitudinally; whereas, although elastic to a considerable degree 
in the circular direction, yet much more power is required to force 
their extension in the latter than in the former direction. The 
veins are equally elastic with the arteries longitudinally, and are 
fully capable of following the motions of joints without the risk of 
being ruptured; but as, in the due performance of their peculiar 
office, they are required to undergo a ready and rapid change of 
calibre, their elastic property in the direction of their circle exceeds 
that of their longitudinal direction. 
Having exhibited this view of the structure of the blood-vessels, 
we shall next proceed to a short examination of the functions which 
their different parts have, each, to perform. LOCAL PATHOLOGY. 
11 
On the Functions of the Blood-vessels. 
Any one who will take the trouble to examine the action of the 
heart in a living animal will be satisfied that, during its contrac- 
tion, the fibres are drawn below the medium of their elasticity. The 
contraction is active; but the dilatation of the cavities is passive, 
depending simply upon the elasticity of the structure of the organ. 
If the heart be taken out and placed on the hand before its action 
has ceased, and then if the hand be gently closed round it, every 
time the ventricles contract, the organ will be felt to exert consi- 
derable force : it will be felt to swell and harden, and to cause a 
good deal of pressure against the hand ; but, during the dilatation 
of its cavities, it will be felt merely to relax its fibres, without any 
active force. 
The idea obtained by means of the sense of touch respecting the 
nature of the heart’s action is fully confirmed by that of vision. 
When viewed in active operation, and regularly supplied. with 
blood, its contraction will be seen to take place in a very quick and 
sudden manner, whereas its dilatation appears quite passive, and it 
takes a much longer time to be accomplished. Again, when view- 
ed in action, not supplied with blood, that is, when the organ has 
been removed from the body, or when the blood has been allowed 
to escape through a puncture of one of the principal vessels, the 
contraction will be seen to consist in an active jerk, and to be over 
in an instant ; whereas the motion which corresponds to the dila- 
tation of the ventricles, when the viscus is regularly supplied with 
blood, will consist comparatively of a slow and gradual elongation 
of the fibres ; which fully satisfies the mind that it depends merely 
upon these fibres recovering the medium of their elasticity, after 
having been compelled by some previous cause to contract them- 
selves below that medium. 
It may, perhaps, be asked, by what power are the muscular fibres 
of the heart enabled to shorten themselves below that medium 
which characterises them as an elastic substance? In explanation 
of this point we must be permitted to offer a few remarks, which 
may not, perhaps, be generally considered to pertain to the practi- 
cal part of the subject, but which are essential towards acquiring 
a rational idea of the pathology of inflammation. 
Every organ, and even every tissue, in the animal body must be 
viewed, physiologically, in two conditions: first, as composed of 
material molecules which contribute to make up the structure, and 
which, according to their proportions in the different organs, are 
endued with all the properties of matter in general, and are subject 
to all the laws which govern the material world : second, as parts 
endowed with something in addition to the common properties of 
tangible matter, which something1 confers upon them the character 
1 This subject is discussed at great length in the essays to which refer- 
ence has been already made. 12 
DAVIES ON PATHOLOGY AND SURGERY. 
of vitality. It is unnecessary, in this place, to enter into an enquiry 
of all the properties which distinguish animate from inanimate 
matter: it is sufficient for our present purpose to state generally, 
that those properties and those functions or effects only are to be 
attributed to life which an organ is capable of manifesting in a liv- 
ing state, and which it is not capable of exhibiting in the state of 
death. Thus, the liver, as a material organ, is as perfect for some 
time after death as before, yet blood may be forced through it in 
vain, so far as the secretion of bile is concerned. The dead stomach 
is equally insensible to the presence of food; nor will the dead kid- 
ney show any disposition to secrete urine, though fresh blood be 
injected into it. It is true that a muscle which has been attached 
to two or more points during life will contract, when liberated, even 
after death ; but it accomplishes this effect by a property connected 
with its material structure, and which is equally manifested by In- 
dian rubber and other inanimate substances endued with the quality 
of elasticity. The phenomenon of contraction in a living muscle 
is very different from that exhibited by the same muscle in an in- 
animate state. Nature, by her laws, has destined all things to be 
as they are. We may examine their properties, we may compare 
the properties of one substance with those of others, and observe 
what each substance is capable of doing, so far as our senses fur- 
nish ns with the means of so doing, but if we attempt to search into 
the why and the wherefore they have the power of doing what they 
do, our curiosity will be very likely to meet with disappoint- 
ment. 
Now, to return from this apparent digression, we may state that 
the medium of elasticity of the heart is at that point where the 
fibres rest quiescent after death. That point corresponds to the 
state of expansion or extension of its cavities during life. The 
contraction of the organ is caused by its vital principle; it is a 
vital operation, acting for a very short period of time before re- 
suming a state of repose. During the cessation of the vital energy, 
the elastic force of the fibres comes into play. As soon as this lat- 
ter has accomplished its part, and has restored the muscular fibres 
to the point where resides their medium of elasticity as material 
substances, the vital force is repeated, and it acts again upon the 
muscle as pressure would upon any elastic body. This active, 
vital contraction, and passive, elastic dilatation or extension of the 
muscular tissue, go on alternately, both in the auricles and ventri- 
cles ; and when the ventricle undergoes the one kind of motion the 
auricle undergoes the other, and vice versa. 
It follows from these facts, of which any one may satisfy himself 
by minute and accurate examination, that the vital contractility of 
the heart is a power opposed to its innate elasticity. The force 
of the former is very considerable, as may be felt by pressing the 
organ in the hand. Its duration is only momentary. It appears 
to be over as suddenly when the organ is on the point of death as 
when it acts in full vigour on being first exposed to view. After LOCAL PATHOLOGY. 
13 
death the organ rests in the state of expansion—that state into which 
it has been brought by its elastic property. 
That the heart propels the blood into the arteries by the contrac- 
tion of its ventricles, is a fact in physiology generally admitted ; 
‘but it has been, and is still, a very disputed question as to whether 
✓the power of the heart be the sole cause of the motion of the fluid 
throughout the circulating system. We shall first enquire what 
share, if any, the arteries perform in the office of circulation. 
Without re-describing experiments already published more than 
ten years ago, we may be allowed to state generally, that the coats 
of the arteries do not undergo any sensible motion during the cir- 
culation of the blood. We have repeated experiments upon ex- 
periments respecting this point, and the result was a conviction 
that, with the exception, in some instances, of a small portion of 
the root of the aorta, the arteries are mere passive tubes in the 
office of circulation. Having made this general declaration, it may 
be necessary to reconcile some known facts with the statement so 
unhesitatingly expressed. 
It will, perhaps, be asked, if the arteries merely supply passive 
channels for the motion of the blood, how can the “ pulse” be ac- 
counted for? Do we not feel the artery beat on placing the finger 
on it? Nay, do we not sometimes see it pulsate through the skin — 
that is, see the skin move over it? Do we not, when sitting cross 
legged, often see the pendent foot move simultaneously with the 
pulse, in consequence of the beating of the popliteal artery? These 
and other similar questions will be asked by those who have taken 
it for granted that the arteries contribute an important share in for- 
warding the motion of the blood. But all these facts are easily ac- 
counted for without supposing the vessels to perform any move- 
ment like that of the pulse. They occur from the following cause: 
the arteries are always full of blood. Every contraction of the 
left ventricle drives the column a step forward. The motion may 
be compared to that of a rod pushed forward from one end; but in- 
stead of being solid like a rod, the column of blood is fluid, and 
contained within an elastic tube. The blood being fluid, and the 
containing tube being soft and elastic, almost any degree of pres- 
sure, however slight, on the artery will cause a depression or in- 
dentation of its coats ; and as the contractions of the heart cause 
the blood to be driven forward with great power, the column ex- 
erts a force, at each contraction, to raise the indentation or de- 
pressed portion of the coats of the vessel. 
In like manner, in cases where the skin is seen to pulsate over 
an artery, the pulsation is caused by the tightness of the skin in 
that part, owing to the position of the limb at the time. If the ves- 
sel which, in such a case, produces the motion or pulsation of the 
skin, were laid bare, which would, of course, cause the removal of 
the pressure on its coats, not the slightest pulsation could be dis- 
covered in it. In a similar way, the pulsation of the pendent foot 14 
DAVIES ON PATHOLOGY AND SURGERY. 
when one is sitting cross-legged, is occasioned by the pressure of 
the knee of the corresponding limb on the popliteal artery. 
If an artery be laid bare, and the finger be placed very lightly 
upon it, no pulsation will be felt; and to the sight the vessel will 
present an unmoving cord. Even a powerful lens will not enable 
us to discover any pulsation in it. Also, in some very thin per- 
sons, the principal arteries of the arm exhibit a thick cord through 
the skin ; and, in these cases, if the finger be laid very lightly on 
the vessel no pulsation will be felt; but the slightest pressure on 
its coats will cause an indentation or depression, and will immedi- 
ately communicate the sensation of pulsation to the finger. 
The importance of this subject entitles it to more consideration 
than can be bestowed upon it according to the confined limits 
marked out for this work ; but we may, in passing, notice, that no 
property usually attributed by physiologists to the coats of the ar- 
teries would enable them to render any assistance to the heart in 
the propulsion of the blood. Now, let us just consider two points, 
respecting which no small degree of error exists. 
In the first place, it is maintained by some authors, that the ar- 
teries are always in a state of “ forced distention,” that, in fact, the 
blood within forces them to expand beyond their medium of elasti- 
city. If such were the case, it is difficult to conceive in what way 
they could render any assistance to the heart; for not only would 
that organ have then to move forward the whole weight of the 
column of blood, but it would also be required to force the expan- 
sion of the arteries. What else than the power of the heart, driv- 
ing the fluid into them, could force them to expand? It may be 
further demanded, what benefit could result from such a state of 
things? Nature does not often, probably never, create an useless 
obstruction merely for the sake of showing her capability of crea- 
ting a force strong enough to overcome it. 
Secondly, it is a common error to suppose, not only that the 
arteries pulsate independently of the heart, but also that their pul- 
sations may be slower or quicker than those of that organ. That 
a subject so easily put to the proof should have been so long allow- 
ed to remain a source of error, does not argue much in favour of 
the industry of physiological writers. It causes some trouble to 
satisfy one’s self upon points requiring a series of experiments on 
animals, but it is less pardonable to propagate error respecting a 
subject which any one may prove without even quitting his easy 
chair. 
The pulse will often vary in the number of beats in a given time. 
One minute it may beat 85, and the next it may beat 87 or 88, or 
perhaps only 82 or 83. But is this any proof that it depends upon 
the action of the arteries? If the pulsation of the heart itself be 
examined, if will be found to vary quite as much as that felt in the 
arteries. The fact is, that the pulse or beat is felt in every part 
of the arterial system at the very same instant of time, and that LOCAL PATHOLOGY. 
15 
instant of time is the same as that in which the ventricles of the 
heart contract. 
The only way in which the arteries could assist in propelling the 
blood forward, so as to aid the heart, would be by a series of con- 
tractions and dilatations following one another along the course of 
the tubes. If the vessels possessed such a power, then we might 
expect the pulse to vary in different parts of the body, nay, in dif- 
ferent parts of the same tube; for while one part was in a state of 
contraction, another, two inches above, would be in a state of dila- 
tation, and so on throughout the whole course of the tube. In the 
alimentary canal, especially the large intestines, such a motion 
may be observed to be continually going forward. In fact, there 
exists no other power for the propulsion of the faeces. In the arte- 
ries, however, the fact is equally certain that no such motion exists, 
but that an exposed artery will present to the eye the appearance 
of an immovable cord. 
Having established these preliminary facts respecting the state of 
the heart and arteries during the natural and unobstructed circula- 
tion, we next come to that part of the subject upon which mainly 
rests our new views respecting the pathology of inflammation. We 
shall, therefore, place the statement before the reader under two 
heads: 
1st. The only motion which the arteries undergo is that of gra- 
dual contraction, and of gradual dilatation, so as to adapt them- 
selves to the quantity of blood within them ; 
2d. The calibre of all the arterial branches, during life, and in a 
healthy state, is below the medium of their elasticity. 
The overlooking or being ignorant of these two facts have led 
pathologists into endless absurdities respecting the pathology of in- 
flammation ; at any rate, respecting the theory of the phenomena 
presented by it. 
Now, during life and health the blood-vessels are always full of 
blood. Whatever artery or vein we examine it will never be found 
empty. It is true that the vessel is sometimes remarkably small in 
proportion to what it is found at other times, or to the correspond- 
ing vessel of another person ; yet, still, when examined it will prove 
to be, according to its size, full of fluid. 
For instance, the superficial veins of the arm are sometimes so 
small as to render it difficult to puncture them with the lancet; 
whereas at other times they show themselves in the form of thick 
blue ropes. But however small they may be they always preserve 
their cylindrical form ; and though sometimes not so large as a 
crow-quill, yet if punctured they will be found full of blood. The 
veins on the back of the hand will occasionally present very pro- 
minent cords when the member is allowed to hang down. While 
in this state, if the hand be raised above the level of the heart, so 
as to allow the fluid to gravitate towards that organ, the veins will 
be found to diminish immediately in size ; but the diminution will 
not be owing to their falling into a flat shape, as we see them after DAVIES ON PATHOLOGY AND SURGERY. 
death, for they will still present the cylindrical form, though the 
cylinders will be very small compared with their former size. 
The venous system is subject to this constant change of calibre 
in its several parts ; its power of adaptation, therefore, to the size of 
the column of blood within is very great. When the calibre of one 
part of it diminishes, that of some other part must necessarily in- 
crease in proportion, so as to make up for the diminution. These 
vessels are, of course, well adapted for the sudden changes which 
take place in them. Their structure is considerably more yielding 
than that of the arteries, yet it is sufficiently dense to enable them, 
when endowed with vitality, to preserve their cylindrical form un- 
der the ordinary pressure of the atmosphere. 
Now, we find this principle considerably modified in the coats of 
the arteries. The object of the veins is simply to return the blood 
to the heart; and whether more or less of it moves through one 
channel than another—whether a larger or a less proportion finds 
its passage through the superficial, or the deep seated veins—is per- 
fectly immaterial, so long as the right side of the heart receives its 
regular supply. In the arteries the case is different. Every branch 
of an artery conveys nourishment to some seat or other. Every 
twig is charged with the conveyance of all the materials requisite 
for the nutrition, secretion, and other functions connected with the 
seat which it goes to supply. This being the case, although the 
stoppage of the blood through a branch of an artery is not fatal to 
the part which it supplies, for nature has provided other means of 
conveying nutriment to it, still a limb would suffer great evil if 
changes in the calibre of its arteries were to take place so frequently 
and so suddenly as they do in its veins. When an artery of some 
size is obstructed, it is well known that some time must elapse be- 
fore the limb which it supplies recovers its natural warmth and 
healthy condition. 
It is therefore reasonable to expect that the arteries would be less 
liable to a sudden and rapid change of calibre than the veins. In 
truth such is the case. The ordinary change which the arteries 
undergo is the following: supposing the body to contain twenty 
pounds of blood : the arteries will be perfectly full—that is, every 
part of their inner coat will be in contact with the column of blood 
within : we abstract one pound of blood ; the arteries will still be 
ns full as before: we abstract two pounds more : yet not a portion 
—not a quarter of an inch—of the arterial tubes will be empty: 
we go on abstracting more and more ; nevertheless, if we examine 
any part of the arterial system, we shall find the vessels perfectly 
full, until the animal be actually dead from loss of blood. The 
vessels adapt themselves to the column of blood within them; and 
as the diameter of that column is reduced by abstraction, the dia- 
meter of the vessel also which contains it diminishes in the same 
proportion. 
On the other hand, as the mass of blood in the system undergoes 
an increase, the arteries will gradually enlarge, so as to allow it LOCAL PATHOLOGY. 
17 
sufficient space. They will not be in a state of forced distention, 
for the pressure of their contents will not be greater than if the 
fluid column were only half the diameter. The relation between 
the coats of the vessels and the blood will be the same whether the 
system contains forty pounds, or twenty. 
This property of the arteries we have proved, beyond the power 
of dispute, by repeated experiments. By a series of bleedings, at 
short intervals, allowing just time enough between them for the 
circulation to recover its equilibrium, the blood-vessels may be re- 
duced to so small a calibre as almost to render their canals imper- 
vious. This fact is so well known to butchers that their practice 
is entirely founded upon it in their mode of killing veal. By re- 
peated bleedings and starvation, for two or three days, almost every 
drop of blood may be abstracted from the animal at the last bleed- 
ing, and the flesh will be left bleached. When an animal is bled 
to death at once, life ceases to exist before the vessels have had 
time to adapt themselves to their contents. The disturbance is so 
sudden and so great that the inherent powers of all the organs are 
destroyed ; and, after a certain quantity of the vital fluid has es- 
caped, death ensues, leaving still a considerable portion of blood in 
the system. On the contrary, when intervals are left between the 
bleeding, so as to enable the vessels to modify their calibre, and suit 
themselves to their new relations, the animal will live with a very 
small portion of blood in its body. 
Then comes the enquiry, upon what does this remarkable pro- 
perty of the blood-vessels depend ? Does it depend upon the innate 
elasticity of their coats? The answer must be in the negative; for 
if the animal were bled to death at once, the circumference of the 
arteries would be found much greater after the cessation of life than 
it was immediately before death, when the blood has been abstracted 
by repeated bleedings. We must therefore seek for the cause of 
the property in something not essential to the vessels as mere ma- 
terial tubes. In a word, this property of contractility is conferred 
upon them by the principle of life, which resides in their coats and 
which regulates their functions as vital agents: 
We have already alluded to that principle in its relation to the 
heart, and have assigned to it the power by means of which the 
contraction of that organ takes place. One of its essential proper- 
ties, in alliance with the elastic tissues, is contractility. The heart 
expands by the force of its elastic structure, but it contracts by the 
force of its vital properties. 
The same properties, in a different modification, are recognised 
in the alimentary canal; in the urinary-bladder; thoracic duct, 
&c. If these several parts be examined in a living animal, the 
mind will become satisfied that the vital action or movement con- 
sists in contraction merely, and that the dilatation of the tube is 
caused by other agents. In the alimentary tube—take the large 
intestine as the best specimen—the dilatation of one portion 
is caused by the contraction of the portion immediately behind 18 
DAVIES ON PATHOLOGY AND SURGERY. 
forcing on the contents. A long series of such contractions and 
dilatations incessantly succeed each other, and, generally speaking, 
the dilated portions are filled principally with gas, which appears 
to be the agent—in addition to the excrernentitious matter—em- 
ployed for the purpose of expanding the tube. 
The cavities of the different reservoirs are expanded by their 
fluid contents, in a measure opposed to both their inherent elasticity 
and vital contractility. For instance, if the bladder of an animal, 
when full of urine, be exposed, and a small puncture be made into 
it, as the urine escapes, the vessel contracts; which proves that not 
its vitality, but its contents, kept it in an expanded state. The 
tendency of its vital property is to cause it to contract; not to ex- 
pand. 
The arterial tunics are provided with other means of dilating 
their cavities. Their structure is of such a nature that, if either 
extended or compressed, as soon as the force which extended or 
compressed it is removed, it will instantly resume its former state. 
In other words, the coats of the vessels are endued with an elastic 
power which constantly tends to preserve their calibre of the same 
size. 
But, as in the heart, that power is opposed by another, capable, 
in some measure, of overcoming its effects. The difference appears 
to be, that in the heart its action is alternate with that dependent 
upon the elastic structure of the organ ; whereas in the arteries the 
contractile force is unceasingly in operation. 
We now come to the most important part of this subject. A ma- 
terial fact, which has been overlooked by physiologists, is, that the 
calibre of the arterial tubes is always below that point which would 
obtain if the vessels were allowed to submit to their innate elastic 
forces. Instead of obeying the laws of dead matter, and of remain- 
ing at that state at which their elastic medium would place them, 
they are forced to submit to the vital force of contractility, and 
thereby reduce their canals to some extent below that medium. 
This subject has been already discussed in another place. The 
present work will riot permit its being fully entered into. It must 
suffice to state generally, that experiments have proved the fact, 
that if an animal be gradually bled to death the arteries will reduce 
their calibres more and more, until their canals become, ultimately, 
almost obliterated; and that, when the animal has become actually 
dead, and has remained so for some time—sometimes longer and 
sometimes shorter—the vessels will again dilate and assume that 
state in which consists the medium of their elasticity as dead mat- 
ter, at which point they will afterwards remain. 
Moreover, the circumference of some of the principal arterial 
branches has been measured in animals from whom no blood had 
been previously abstracted; the animals were then killed, and the 
vessels injected without any force beyond that necessary to throw in 
the wax. In every instance where the experiment was accurately LOCAL PATHOLOGY. 
19 
and satisfactorily made, the vessels measured more after than before 
death. 
This remarkable property of the arteries increases in degree as 
we approach the extremities of the vessels. In the root of the aorta 
it. appears to be quiescent during the ordinary state of the circula- 
tion. On the contrary, as we stated before, that portion of the tube 
is forced somewhat beyond its medium of elasticity at every con- 
traction of the left ventricle. This must tend to soften the jerk 
caused by the sudden contraction of the heart upon the column of 
blood, and to modify the motion of the current. 
As the blood moves onward it enters into a more capacious chan- 
nel, and its velocity becomes less and less at every step, until, in 
the extreme branches, its motion is so slow that the jarring of the 
heart is not at all felt. The fluid glides on slowly and in an even 
stream, as may be seen with the microscope, and as is also proved 
when the skin is pricked. 
Now, independently of direct experiments, there are several ac- 
knowledged facts which prove the blood-vessels to be more capa- 
cious after death than during life. We have already noticed the 
practical knowledge of butchers, that an animal may be drained of 
nearly all its blood by slaughtering it by repeated bleedings, instead 
of by one bleeding. This can only happen by the vessels closing 
themselves, by means of their vital contractility, upon what re- 
mains of the blood after each abstraction. After death has occurred 
they are again expanded by the influence of their elastic property. 
When a ligature is applied to an artery the vessel beyond it will 
contract into a thin cord, and will become in time perfectly imper- 
vious. 
Again, we are well aware that when an artery of a moderate size 
is cut across, and left exposed, the bleeding soon ceases, in conse- 
quence of the circular contraction of the vessel, until, at last, only 
a little lymph is seen to ooze out. If the contraction depended upon 
its elasticity it would take place immediately on the vessel being 
divided. 
Moreover, it is a well known fact, that the vessels generally are 
not half full of blood after death. Why should that be the case ? 
During life they are quite full, as has been already stated. Is it 
that a great part of the blood has escaped, or is it that its vessels 
have become enlarged, that such a difference should be found to 
exist in the two states? It cannot be denied that some of the serum 
of the blood exudes through the coats of the vessels some hours 
after death, but that such a quantity as would be required t > fill up 
the vacancy observed in the arteries should escape in that manner 
is by no means probable. 
It will, perhaps, be asked, how is the fact to be accounted for, 
that the arteries empty themselves at the time of death, if they exert 
no propelling power on the blood? The reply is, that the arteries 
render no assistance to the heart as far as relieving that organ of 20 
DAVIES ON PATHOLOGY AND SURGERY. 
any power which may be necessary to move the column of blood 
all the way round, from the left to the right side, is concerned. 
The organ is endued with sufficient power to do so without any 
aid. But when the action of the heart has ceased, there is then a 
small degree of power exerted by the vessels on their contents, and 
that force results from their vital contractility. 
It must be considered that the blood moves along a channel 
whose area is continually increasing ; and that, therefore, the ob- 
stacles to its motion are much less than if the tubes were of the 
same diameter throughout. Now, as death approaches, the blood 
first begins to meet with an obstruction in the lungs, owing to the 
failing of the respiratory functions. The left side of the heart, not 
receiving its regular supply of blood, acquires a quick but feeble 
action, which proceeds from little to less, until, at last, its move- 
ments entirely cease. During this time the arterial tubes are also 
deficiently supplied, and, according to that law which induces 
them to preserve their mutual relations with their contents, they 
gradually contract more and more as the heart’s action diminishes, 
until their canals become almost obliterated by the time that death 
actually takes place. By this slow and gradual contraction, and 
the channel gradually increasing in area, from the root of the aorta 
to the utmost extent of its branches, the gentle pressure of the coats 
of the vessels on the blood induces it to move forward towards the 
capillaries. But when death has actually ensued the coats expand 
again, by the elasticity of their structure, and present, on examina- 
tion, the appearance of large empty tubes. 
To sum up this part of the subject, we may conclude; 1st. 
That the contraction of the heart depends upon a vital cause ; but 
that its expansion is owing to the natural elasticity of its structure. 
2d. That no motion takes place in the arteries calculated to pro- 
pel the blood forward. That the heart is the sole agent which 
moves the blood through the arteries, and that the latter are mere 
passive tubes as far as the circulation is concerned. 
3d. That the pulse depends solely upon the contraction of the 
left ventricle ; that it is simultaneous in every part of the body, 
corresponding to the action of the heart, and that the arteries them- 
selves possess no power of pulsating. 
4th. That the only mechanical motion connected with the arte- 
ries is a gradual contraction, dependent upon their vital contrac- 
tility, and a gradual dilatation, dependent upon their elasticity, so 
as to enable them to adapt themselves to the quantity of blood which 
they contain at the time. 
5th. That the diameter of all the arterial branches is smaller 
during life than after death : that, during the former state, their 
contractile property retains their calibre below their medium of 
elasticity, but that, when the vital principle has actually forsaken 
their coats, they acquire that medium, by the elastic force of their 
structure. LOCAL PATHOLOGY. 
21 
On the Pathology of Inflammation. 
The elements of inflammation, from Celsus down to the present 
time, have been considered to be pain, heat, redness, and swelling. 
That the disease is generally attended by these marks cannot be 
denied, but, according to the pathology of the present day, ap- 
pearances called inflammation are often seen in parts after death 
where two. at any rate, of the elements have been unobserved du- 
ring life. 
We shall first consider the two last of the four essentials above 
mentioned, namely, the redness and swelling which are presented 
to the eye and feel of the observer by a seat undergoing the process 
of inflammation. 
That the redness of the part is owing to the quantity of blood 
contained in it, cannot be doubted, and, we believe, has not been 
disputed ; but the question is, by what pathological process does 
the part acquire the increased quantity? Some will answer, “ by an 
increased action of its arteries;” while others again will maintain 
that the disturbance is caused by “ increased action of the heait 
while some will attribute all the mischief to the “irritability of the 
nerves.” 
That the arteries do not act in the way generally supposed, has 
been already shown. They do not do so even in their principal 
branches ; much less do they at their extremities. In the smaller 
vessels the blood glides on in a smooth and even stream, and pre- 
sents no appearance of being pushed about by the action of the 
arteries; nor does it seem to suffer any of the shock by which it 
was first put in motion. 
But supposing the arteries did act as represented: how could 
they, by that means, increase the quantity of blood in the inflamed 
part? In the first place, the arteries could dispose of no more blood 
than was supplied to them by the heart; and, in the second place, 
an increased action of the arteries of a part, far from tending to 
augment the quantity of blood in it, would necessarily tend to 
diminish that quantity. The quicker they acted the faster the 
fluid would be driven on to the veins, and, instead of presenting 
an appearance of redness, the part ought to put on a paler aspect 
than natural. 
How an increased action of the heart can determine more blood, 
in proportion, to one part than to another, it is difficult to under- 
stand. The left ventricle of the heart contracts and throws out its 
contents into the aorta ; this quantum is pushed on by another dis- 
charge from behind, and the same thing goes on in uninterrupted 
succession. This is all the mechanical influence which the organ 
exerts on the blood. Now, we frequently find one leg of a person 
inflamed while the other is healthy; but how can the heart direct 
more blood to one leg than to the other ? When the organ has dis- 
charged the blood into the aorta, it has done with it. It cannot, 
therefore, be the agent which distributes or apportions the fluid to 22 
DAVIES OX PATHOLOGY AND SURGERY. 
the different parts of the body. If we could suppose the whole 
body to be in a state of inflammation, we might then, by a stretch 
of the imagination, suppose the increased action of the heart to be 
the cause of it; but the notion that the heart can produce a greater 
determination of blood than natural to a particular part is inconsis- 
tent with possibility. 
All obscure phenomena are generally attributed to causes equally 
obscure—upon the principle, probably, that inasmuch as two nega- 
tives will make a positive, so ought two obscurities to make one 
transparency. The functions of the capillaries are but little under- 
stood : their properties, and the mode by which they perform those 
functions, are still less so ; consequently, various effects, which 
could not be otherwise accounted for, have been attributed to them. 
They have been supposed to be the agents which relieve the arte- 
ries of their contents at the time of death, and in order to be able 
to perform that office they have had various imaginary properties 
conferred on them. By some they have been supposed to act their 
part by suction : others have thought attraction to be the means 
employed for the accomplishment of the object; but whether they 
act by means of the one or the other of these properties, or by any 
other property, it is certain that physiologists have relied greatly 
upon the aid of these diminutive giants for the accomplishment of 
phenomena for which they could not otherwise account. 
As a yrima facie proof that the arteries are not exhausted of 
their contents by any power of suction, or of attraction, in the ca- 
pillaries, the greater part of the blood after death is found to have 
passed quite through them, into the veins. The capillaries of the 
skin contain scarcely any blood after death in ordinary cases, and 
those of other seats much less than they do during life, in propor- 
tion to the quantity in the system. If the capillaries exerted an 
attractive power on the blood the consequence would be, that the 
fluid would move towards them from both sides, that is, both from 
the arterial and venous sides, and the capillaries themselves would 
be found to form the centre of the mass. Even if their relations 
were with the arterial blood only, the greater part of the fluid must 
be found in their immediate neighbourhood if any attractive influ- 
ence existed between the two. The same would be the case if they 
could by possibility be supposed to exert a power of suction on it. 
But we find the blood principally in the veins, as before stated, and 
in the pulmonary artery, having passed quite through the supposed 
seat of attraction. 
A power of suction must presume a vacuum in the capillary 
vessels, and a degree of atmospheric pressure on the arterial tubes 
sufficient to compress their parietes, so as to push on the fluid 
within. What is there in the mechanism and structure of the ca- 
pillaries calculated to enable them to cause a vacuum? While the 
blood is circulating, the capillary tubes are full of fluid, and, while 
in this state, it is evident that they can exert no power of suction on 
the rest of the mass. Even if we suppose them empty—which LOCAL PATHOLOGY. 
23 
would be supposing a thing which can hardly happen—still they 
must possess some innate power of expansion, so as to create a 
vacuum within, before any effect could be produced upon the blood 
in their neighbourhood. We know of no such power connected 
with the capillary tubes. Indeed, we know of no inherent power 
of expansion in any of the tissues, except that dependent upon the 
elasticity of their structure. 
A power of suction in the capillaries must also, as stated, pre- 
sume a degree of atmospheric pressure on the arterial system suffi- 
cient to compress the coats of the vessels and to diminish the dia- 
meter of their tubes. 
Now, that the pressure of the atmosphere on the arteries, as well 
as on all other parts of the body, except the interior of the skull and 
of the cylindrical bones, is very considerable, no one can dispute. 
It is, in fact, equal to about, fifteen pounds to every square inch of 
surface. It is also true that by relieving a part from some of that 
pressure—for instance, by the application of an exhausted cupping- 
glass—the arteries will expand very considerably, and the part im- 
mediately acquires a greater influx of blood. But it must be borne 
in mind that this is not the natural state of the part. The circum- 
stances under which it is placed by the application of the exhausted 
glass are different from those under which nature intended it should 
exist. Under the ordinary pressure of the atmosphere the arteries 
will maintain a certain calibre. If the pressure be increased by 
any extraordinary weight—by standing up to the neck in water for 
instance—their diameter will necessarily diminish. If, on the 
other hand, the weight be reduced—as by the application of an 
exhausted glass—their diameter will increase. 
As the arteries, therefore, are destined to bear the ordinary pres- 
sure of the atmosphere on the surface of the globe without under- 
going a change of calibre; and as this pressure is equal on all the 
surface of the body, and on the internal parts, through the medium 
of the soft structure—on the capillary tubes as well as on the 
arterial branches—it is evident that it can contribute no share 
whatever towards forwarding the blood from the trunks towards 
the extremities of the arterial system. 
With regard to capillary attraction being the cause of preter- 
natural determination of blood to a part, it may be said that this 
cause, if it existed, ought to act at all times the same. It ought to 
act in one part as well as in another. What can make the capil- 
laries of an inflamed leg more attractive than those of the other 
leg? 
We shall not enquire at present what share the nerves may exer- 
cise in producing the phenomena of inflammation; but it must be 
clear to every one that they can exert no mechanical influence on 
the blood. They may, or may not, conduce to modify the vitality 
of the vessels, so as to induce them to put on those appearances 
which they exhibit in an inflamed part, but the nerves cannot, as 
direct agents, attract the blood from one part to another. 24 
DAVIES ON PATHOLOGY AND SURGERY. 
All those causes failing to account for the mechanical phenomena 
—that is, the redness and swelling—of inflammation, it becomes 
necessary to seek for some other causes which, so far as we are 
acquainted, have not yet been pointed out by authors. 
Physiology is a science applicable to living bodies alone; no 
theory, therefore, which does not take into its estimate the proper- 
ties of life can be founded on facts. A living body is endued with 
all the qualities of dead matter. It possesses form, solidity, weight, 
colour, extension, and all other properties which are capable of 
being recognised by the organs of sense. Its elements are also 
subject to chemical laws, like those of the rest of the material 
world; and by the new combinations into which they may enter, 
and the new relations which they may form with one another in 
the order of causation, either parts or the whole of the ma- 
terial fabric may undergo extensive changes in constitution. But 
living bodies possess some properties in addition to those common 
to matter in general, and these are the properties which stamp 
their character, and which distinguish them from dead matter. 
It will be asked, perhaps, what do these properties consist in? In 
reply it can only be said that they are to be recognised from their 
phenomena or effects in union with tangible matter—or, in a phy- 
siological sense, in relation with the materials of which the body is 
composed—but so far as the essence or principle upon which they 
immediately depend is concerned, it would be extraneous to the 
object of this work to institute any enquiry. Those who feel 
curiosity respecting such speculations are referred to the essays 
already alluded to. 
The properties of life manifest themselves in their alliance with 
particular seats or organs only. In a word, all the phenomena 
which an organ is proved to produce during life, and which it is 
incapable of producing after death, are fairly attributable to the 
vital properties connected with it. During life the liver will pro- 
duce bile: after death it will not do so. Now, as we know, at any 
rate assume, bile to be manufactured from the blood, and as we call 
that species of change “secretion,” we have a right to infer that 
the vital properties of the liver confer the power of secretion on 
that organ. In the stomach it is the same: in the kidney, the pan- 
creas, the salivary glands, &c., it is again the same: yet, still, it 
must not be forgotten that the “secretion” is special—that it is 
differently modified—in every secreting organ. 
Again, life manifests itself in the nerves by the phenomenon of 
sensation. A dead nerve will not feel, though perfect so far as 
structure is concerned. In connection with nervous matter, then, 
the vital principle is the agent of sensibility, and the phenomenon 
resulting from the alliance of the two is sensation. 
Moreover, if we examine—as we have already partly done—the 
properties of life in their relations with the elastic tissues, we shall 
find invariably that the phenomenon presented by the union of the 
two is contraction. This being the case, we are justified in in- 25 
LOCAL PATHOLOGY. 
ferring that nature destined the vital properties of these tissues to 
be those of contractility. In this class of tissues may be placed 
the heart, the arteries, the veins, the absorbents, the alimentary 
canal, the urinary and gall bladders, the ducts of the secretory 
glands, the uterus, &c., in all of which contraction is the vital 
function, and the opposing notion, namely, dilatation, as before 
observed, depends either upon the innate elasticity of the structure, 
or upon the internal pressure of the contents of the vessel. 
In the arteries, as well as in every distinct seat, the vital properties 
are modified of such a nature as to suit them for the peculiar office 
which the vessels have to perform. In the heart they manifest 
themselves by a quick and sudden contraction ; in the arterial tubes, 
on the contrary, the contraction is slow and gradual, and, during 
perfectly healthy state, uniform in proportion throughout the whole 
arterial system. The tubes are always full: if a pound of blood 
be abstracted, the vessels adapt themselves closely to the remainder: 
when the mass of blood increases, by the sudden absorption of 
liquids from the alimentary canal, or by the gradual augmentation 
of the circulating fluid, the calibre of the tubes, on the contrary, 
enlarges, so as still to suit them to the increased diameter of the 
column. This dilatation is caused by the contractile or vital pro- 
perties giving way to the innate elastic force of the tunics, in a 
manner analogous to that of the dilatation of the heart after the 
contraction of its ventricles has ceased. We may infer that the 
arteries are never filled up to the point constituting their medium 
of elasticity; and that such a state of plenitude could not exist, 
not only compatibly with health, but even with life. 
The power of adaptation to the quantity of their contents in- 
creases in a progressive ratio as we trace the tubes from the root of 
the aorta towards the capillaries. In the extreme branches of the 
arterial system the range of change in the area in the channels is 
very considerable. We sometimes witness a transient blush over- 
spread the pallid face. In such a case it is probable that the 
diameter of the vessels doubles itself at least. But their dilatation 
is often only momentary: their contractile properties soon resume 
their power: their calibre decreases; and the redness” entirely dis- 
appears in a few minutes. In an inflamed part the mechanism is 
precisely the same; but the cause is different, and the eflrect, being 
according to the nature of the cause, is more permanent. 
In a work intended to lead to practical results it would be in- 
consistent to enter intoany the oretical speculations respecting the 
immediate or proximate cause of these phenomena. With regard 
to the phenomena themselves, and the properties of the different 
tissues upon which our remarks have been made, any one may 
satisfy himself who will take the trouble to examiue the facts, and 
to bestow a moment’s reflection upon them. It is sufficient, in this 
place, to state, that there exists a certain vital relation between the 
blood-vessels and their contents, which enables them to adapt them- 
selves to each other, and to maintain a regular proportion between 26 
DAVIES ON PATHOLOGY AND SURGERY. 
the one and the other. Whether the vital properties be immediately 
and solely connected with the nervous fibrils, or with some other 
particular tissue, or whether they pervade all the coats of the 
vessels, does not come within the province of enquiry at present; 
for it is enough to know the fact that certain phenomena are mani- 
fested by certain tissues and certain organs in a vital state, which 
those tissues and organs are incapable of exhibiting in a state of 
death. 
Now, in the case of blushing, it is often that the face alone 
assumes increased redness. It may be asked, how do the aiterial 
branches of one part only of the body manage to acquire more 
blood than their due proportion? The heart pumps out the fluid 
equally for the benefit of all the branches. The power, therefore, 
of causing the disproportion must reside in the arteries themselves. 
Then conies the question—the most important question—by what 
process, or by what means, do the arteries of one seat succeed in 
obtaining more than their proportionate share of blood? 
The answer is short and clear—simply and solely by e7ilarging 
their diameters or calibres in that seat. 
We have already proved that the arteries are mere passive tubes 
so far as the movement of the blood is concerned: that they are 
never in a state of forced distension, although it is quite possible 
that they may sometimes contain more blood than is compatible 
with health: that they do not pulsate: that their calibres are always 
below the point constituting the medium of their elasticity as 
material bodies: that their only mechanical movement consists in a 
gradual diminution and a gradual dilatation of their canals, so as 
to fit them to the diminution and increase of the mass of blood: 
that the range of this movement extends downward from that 
point which forms the medium of their elasticity, to an almost 
obliteration of their canals: that the movement is regulated by two 
distinct and different causes, namely, the diminution of calibre by 
vital contractility—a property connected with the life of the vessels, 
and the augmentation of calibre by elasticity—a property depend- 
ent on the peculiar structure of the arterial coats. 
When these properties of the arteries are considered, it is easy to 
conceive that the contractile force may vary in degree in different 
seats. We may again refer to the case of blushing, where a sudden 
mental emotion causes a temporary reduction of the contractile 
power, so as to allow the vessels to expand by the force of their 
elastic property, and admit into their canals more than their pro- 
portionate share of blood. Soon, however, the contractile force 
returns; the vessels resume their natural calibre; the circulation 
is equalised throughout the system, and the local seat loses its 
“redness” and recovers its natural hue. 
Now, if the cause were different—if it were of such a nature as 
to weaken permanently the contractile power of the vessels—more 
especially if it totally destroyed that power—then the vessels would 
be incapable of resuming their natural diameters; an undue pro- LOCAL PATHOLOGY. 
27 
portion of blood would constantly exist in them; the seat of the 
disturbance would present the appearance of redness, and some 
degree of swelling, and furnish all the characters of incipient In- 
flammation. 
In a word, the visible and tangible characters of inflammation 
depend entirely and solely upon an undue enlargement of the 
capillary extremities of the arteries. The enlargement may, and 
often does, extend some distance towards the larger branches, but 
its origin is invariably in the capillary tubes, and its extension 
takes place by continuity along the vessels. This enlargement 
enables them, as a matter of course, to hold more blood than the 
quantity naturally or proportionally belonging to them; which 
circumstance is the cause of the “redness” of the inflamed part. 
Owing to the increased calibre of myriads of minute vessels, 
and, consequently, to their containing more blood than usual, the 
seat of disease presents, as a matter of necessity, the character of 
“swelling;” which is very properly laid down as another element 
of inflammation. But, after a time, the swelling takes on a differ- 
ent character, and is dependent upon a very different cause. The 
capillary tubes, having lost their contractile property, and their 
substance having, consequently, become relaxed and their parietes 
become thinner, allow some of the more serous portion of the blood 
to ooze through, the albumen of which coagulates in the interstitial 
spaces of the inflamed part, and gives rise to a more durable 
“swelling” than that by which the disease was distinguished in its 
more incipient stage. 
We shall not, in this place, enquire into the cause of animal heat, 
for it would be foreign to the intention of this work. It may be 
stated as a general fact, but not without exceptions, that the heat of 
a part bears some proportion to the quantity of blood it contains. It 
is possible that the heat of an inflamed part may be sometimes greater 
than that of the blood in the great arterial trunks ; but the facts 
we possess are not sufficient to decide that point. It is undeniable 
that the temperature of the blood is, in general, higher in the trunks 
than in the extremities of the vessels. Now, as there is an undue 
accumulation of blood in an inflamed part, it is natural, according 
to the above fact, that there should also be an increased accumula- 
tion of “heat.” Another fact may likewise be noticed, which we 
shall point out more particularly by-and-by, namely, that the mo- 
tion of the blood is very slow in a seat undergoing the process of 
inflammation, so that more time is allowed for the fluid to disen- 
gage its caloric than in the ordinary course of the circulation in the 
same seat. There are, therefore, two physical causes to account 
for the augmented temperature in the seat of inflammation ; which 
are, first, a superabundance of the fluid vehicle, charged with the 
distribution of heat; and, second, the diminished velocity of that 
fluid in the inflamed part, thereby allowing more time for the ex- 
trication of its caloric. 
With regard to the influence of the nerves in the production of 28 
DAVIES ON PATHOLOGY AND SURGERY. 
increased heat, we deny not the fact; nor do we, on the contrary, 
fully acknowledge it. If it be a fact, it can only be stated as such ; 
for by what means the nerves are capable of raising the tempera- 
ture of a part has not yet been explained. It may be casually re- 
marked, that the mere sensation of heat in a part is not always a 
proof of increased temperature when tested by the thermometer. 
We now come to the consideration of the remaining element of 
inflammation, namely, “ pain.” What is pain? What are its re- 
lations? Has it any tangible properties? Is it a physical entity, 
forming a link in the chain of causation ? Or is it a mental, im- 
material essence, which cannot be analysed. 
Nature appears to have endowed every being with a disposition 
to preserve its identity. Why she should have done so, it would 
not be a very profitable employment of time to enquire, for the 
enquiry could lead to no satisfactory result. It is sufficient to 
know, that from a drop of dew on the cabbage leaf, lip to the “ lord 
of the creation” himself, there reside in the being an innate disposi- 
tion to self-existence, and an inherent and unceasing effort to self- 
preservation. The drop of dew, or a drop of quicksilver, or a 
piece of chalk, or a crystal of Glauber’s salts, or a rose tree, or an 
insect, or man himself, will, one and all, resist a change of form 
and a dissolution of identity of the being until subjected to some 
cause stronger than that by means of which the identity is pre- 
served. 
Now it would be a mere useless speculation to argue the point, 
as to whether inanimate bodies, or even vegetables, suffer any 
thing analogous to pain in the transition from one state to another; 
but pain appears to be an almost—we may say, in a strict philo- 
sophical sense, absolutely—essential attendant on the change of 
form—that is, on the process of death—in animal bodies. It pre- 
cedes the actual dissolution or the change of identity of the being, 
and is probably intended to warn him of the existence, or the 
approach, of causes inimical to him. This property, like every 
other recognised in the animal body, is in alliance with a certain 
organisation or special tissue. The pain is a nullity in the seat of 
the inflammation, and can only be developed in its full character 
by its communication with the brain. 
It may be said that pain is an effect, composed of elements : that 
it is no pain without the combination of all its elements: that these 
are derived partly from the brain, and partly from the seat of dis- 
ease: that the three other elements of inflammation may exist in 
combination without “pain,” unless a direct nervous communica- 
tion subsists between the seat of disease and the brain ; and that, 
on the contrary, pain can have no existence in the absence of all 
derangement of some part of the body. Pain, then, is a vital effect 
—an effect peculiar to living bodies—resulting from the combina- 
tion of causes derived partly from the seat of derangement and 
partly from the brain. It is an index implanted by nature to warn 
the individual that there is something wrong in the economy— LOCAL PATHOLOGY. 
29 
that causes are in operation, which, if not neutralised by other 
causes, may lead to a change of identity. 
We must now return, in order to account for some physical phe- 
nomena, which have only been yet casually noticed, connected 
with inflammation. 
The exciting causes of inflammation are many and various, and 
are very different in their nature; but the proximate cause, or, 
more properly speaking, the mechanical condition of the extreme 
vessels of the inflamed part, is the same in every case. The excit- 
ing cause may be mechanical, such as the prick of a pin ; the 
laceration of the soft parts ; a blow from a heavy body ; an inci- 
sion by a sharp instrument, &c.: or, it may be chemical, such as 
the effect of corrosive acids, or other caustic substances ; the effect 
of intense caloric ; of irritating substances, either animal or vege- 
table, which have the property of removing the cuticle, &c.: or it 
may be of that nature which, for want of a more determinate term, 
may be called vital—that is, the cause may consist in the relation 
or operation of agents conveyed to the part through the medium of 
the blood, or some other vehicle, which agents are not cognisable 
by our senses : in other words, our means of examination are not 
sufficiently perfect to enable us to obtain a precise knowledge of 
their nature. 
But, notwithstanding the great variety of causes which may con- 
duce to give existence to those phenomena which, according to the 
pathology of the present day, when combined in the same seat, are 
called “inflammation,” the invariable effect of all of them on the 
capillary vessels is to diminish the contractile poioer of those ves- 
sels, so as to enable them to give way to the elastic force of their 
structure, and to the increased pressure of the blood within them, 
which increase, as we shall presently show, is a necessary conse- 
quence of their altered condition. 
As this subject is of the first importance, and as we are anxious 
that our views should be well understood, in order, if correct, that 
they may be generally adopted, or in order, if erroneous, that they 
may be refuted, we must be permitted to enlarge a little on it here. 
As the arteries are mere passive tubes in the function of circula- 
tion, the motion of the blood through them must necessarily obey 
the same laws as the motion of fluid in inanimate tubes similarly 
constructed. Lt is influenced by gravitation ; by atmospheric pres- 
sure, to the extent already stated ; by the increasing and decreasing 
area of the different parts of the channels along which the fluid 
moves; by the number and degrees of the angles which it meets in 
its course; by the friction caused by its contact with its conducting 
tubes, and by other causes which influence the motion of fluids in 
confined canals. 
As the heart forces the blood forward, by vis a tergo, into the 
canal of the arteries, it must follow that it will find its way in equal 
proportions into all the arterial branches in their ordinary or natu- 
ral state. The proportion must, of course, be calculated from the 30 
DAVIES ON PATHOLOGY AND SURGERY. 
diameter of the arterial trunk and all its branches. The velocity 
of the fluid in all the system, as well as the quantity of it moving 
through every branch, will maintain its due proportion as long as 
the tubes are in their natural and healthy state. The quantity 
passing through each arterial branch will be according to the size 
of that branch, allowing for the difference in the angles of the dif- 
ferent vessels. 
It is necessary to distinguish between velocity and quantity of 
motion. Velocity of motion may be the same in one drop of fluid 
as in a gallon, and so may the quantity; but before the two can be 
equal the drop must move 61440 times faster than the gallon. If 
we suppose the drop and the gallon to pass through equal space in 
equal time, their velocity will be equal; but as the gallon contains 
6L440 times the quantity of fluid which the drop does, the quan- 
tity of motion in the gallon will be that number of times greater 
than in the single drop. Quantity, in a word, is made up of the 
velocity and weight of the moving body ; whereas velocity regards 
the time only which a body occupies in moving through a given 
space, and has no relation to the weight of that body. 
Now, if fluid be forced, or be allowed to flow, through a tube 
varying in diameter in different parts, the velocity of its motion 
will also vary in exact proportion to the variation of the diameter 
of the canal in which it moves ; still the quantity of fluid which 
will pass through every inch of the length of the canal in a given 
time will be precisely the same. Where the tube is narrower the 
velocity will be greater, and where the tube is larger the velocity 
will be less; but the diminished velocity will be made up in the 
increased diameter of the column of fluid in the wider parts. If we 
suppose such a tube to vary even fifty times in its diameter in the 
course of its length, any quantity of fluid moving through it, sup- 
posing it to be full, will pass in equal time through every inch of 
its length. In the narrower parts, the velocity will be great, but 
the diameter of the column will be small : in the wider parts, the 
velocity will be slow, but the diameter of the column will be great; 
so that the result will be, that precisely the same quantity will be 
discharged at one end as will have entered at the other. 
If we suppose the diameter of the aorta to be equal to two, and 
that of its branches collectively to be equal to four, it will follow 
that, as all the blood injected into the former must pass through 
the latter, so its velocity in the former will be double that in the 
latter. But, as a strike off against the rapidity of movement in 
the aorta, the column of blood in the branches collectively will be 
double that in the trunk. Thus, if we add the diameter of the 
column in the trunk to its velocity, the product will be the quan- 
tity of motion: if again we add the diameter of the column in the 
extreme branches to the velocity with which the blood moves in 
them, the product will be the same in both—we shall have the 
same quantity. In a word, the velocity will bear an inverse pro- 
portion to the diameter; whereas the quantity that will move LOCAL PATHOLOGY. 
31 
through any given space in a given time will be the same in every 
part, notwithstanding the variation in the diameter of the different 
parts of the tube. 
A necessary consequence that must follow from the above facts is, 
that the quantity of fluid existing at any time in a wider portion 
of the tube must be greater than that existing in a narrower portion 
of the same length. If we suppose an aneurism of the trunk of the 
aorta, for instance, it is evident that more blood is contained in the 
aneurismal sac than in any other portion of the vessel of equal 
length ; but it is equally evident that not a larger quantity of blood 
can pass through the sac in a given time, than through a space of 
the same length in another part of the tube; because the amount 
discharged at the distal side must be just equal to that which en- 
tered at the proxymal side of the aneurism. 
In the same manner, as the diameter of the capillary branches 
collectively is very considerably greater than that of the root of the 
aorta, so the quantity of blood actually existing in every inch of 
their length, collectively, must be, even in their natural and healthy 
state, incalculably greater than that contained in an inch of the 
aorta. But in proportion as the area of the channel increases, so 
does the velocity of the motion decrease, until, towards the extreme 
ends of the tubes, the fluid glides on at a comparatively very slow 
rate. Owing to the elasticity of the fluid column, and to the slight 
yielding of the walls of the canal, the effect of the jarring action of 
the heart is entirely lost in the extreme branches of the system. 
The motion is even, and extremely slow, so as to allow time for 
the new relations into which the blood enters before its return by 
the veins. 
From the foregoing facts it must follow, that, if the calibre of 
any one or more of the capillary branches should become enlarged 
from any cause, whether that enlargement be temporary or perma- 
nent, during the time of its continuance that branch or branches 
will contain more blood than their due proportion, according to the 
natural and healthy state. Another necessary consequence of the 
enlargement will be a diminution of velocity in the motion of the 
fluid through the enlarged branch or branches. This is the exact 
condition of the capillaries in a seat undergoing the process of 
inflammation. The contractile power of one or more of the ex- 
treme vessels is reduced, or sometimes destroyed, by some cause— 
the causes, as stated before, may be very various and dissimilar in 
their physical nature ;—the vessel then obeys the elastic force of its 
coats, and expands: the column of blood within, immediately, as a 
matter of course, augments its diameter; its velocity diminishes in 
the inverse ratio of its increased diameter, and the part presents all 
the physical phenomena of inflammation. 
It is clear that the exciting or morbific cause may act upon a 
narrower or upon a wider scale. For any thing we know to the 
contrary, it may sometimes consist in a mere obstruction in the 
extremity of one of the capillary tubes, thereby giving rise to the 32 
DAVIES ON PATHOLOGY AND SURGERY. 
commencement of the derangement; which derangement may 
extend to the tubes in the immediate neighbourhood of the ob- 
structed vessel, and augment in degree as the extension increases. 
If such a cause ever exists its action must be mechanical, in the 
first instance, in its nature, like that of an external wound. It is 
probable that inflammation thus occasioned, in an otherwise healthy 
constitution, would be of a phlegmonous character ; and it might 
extend by continuity of vessels over an extensive seat, as the dis- 
ease often does when proceeding from an external wound. Or the 
cause may be of such a nature as to act upon a considerable num- 
ber of tubes at once, and reduce, or totally destroy, according to its 
degree, their contractile powers. Such a cause would have its 
relations with the vital department of the vessels, and would 
modify, or entirely neutralise, the vital properties upon which their 
contractility depends. It may be supposed to be conveyed through 
the medium of the blood; and as it must be admitted that the vital 
properties of all the seats or tissues are differently modified, so we 
may easily conceive the morbific cause or principle to be capable 
of passing through various seats or tissues without forming any 
alliance with them, and yet to form a relation with another tissue 
to which it bears an affinity, and with which it may be brought into 
contact in the course of circulation. If such a cause be admitted, 
it may be inferred that the inflammation resulting from its opera- 
tion would be of an erysipelatous character. But these specula- 
tive views may be either rejected or adopted, according to the 
reader’s own fancy. 
Whatever the nature of the cause may be, the mechanical condi- 
tion of the capillaries is the same in kind in every species of inflam- 
mation. When the disease is slight, the enlargement of the vessels 
is not considerable, any more than the proportional quantity of 
blood contained in them. The velocity of its movement, also, is 
not much diminished. But, when the vessels have been entirely 
deprived of their contractile force, the enlargement proceeds to the 
utmost limit to which the vessels are capable of extending. The 
motion of the blood ceases; the fluid coagulates, and the inflamed 
part dies. An approach to this state of things, depending upon the 
same physical cause, takes place in almost every large aneurismal 
sac; the velocity of the blood through the enlarged space is so 
greatly diminished, compared with the rest of the vessel, that a part 
of the fluid coagulates in its cavity. 
When the vessels have exceeded their natural calibre they be- 
come subject to another mechanical cause, whose constant tendency 
is to enlarge them more and more. 
It is well known that, according to the laws of hydrostatics, fluid 
contained in vessels presses equally in all directions. The absolute 
pressure on the containing vessel will be in proportion to the ex- 
tent of surface exposed to the fluid. The same rule holds good 
with regard to the arteries. The heart propels the blood into the 
aorta with a certain force: that force exerts a pressure on the LOCAL PATHOLOGY. 
33 
internal surface of the arteries according to the extent of that sur- 
face—that is, the pressure is so much to every square inch, or the 
square of any other measurement, according to the degree of force. 
In the healthy state of the arteries, the thickness and strength of 
their coats are proportionate to the diameter of the vessels; the 
pressure is therefore in equal ratio throughout their whole course. 
For instance, an inch in length of the aorta presents a much larger 
surface to the blood than an inch in length of the radial artery: so 
does an inch in length of the radial expose to the fluid a surface 
considerably larger than an inch of a capillary tube; so that, as 
the sum of pressure is in proportion to the extent of surface exposed 
to the fluid, it must follow that the force exerted on an inch in 
length of the aorta is very considerably greater than that exerted 
on the same length of tube towards the arterial extremities. But, 
in order to secure the safety of the vessels, the coats of the trunk 
and larger branches are made much thicker and stronger than those 
of the extreme ramifications. 
It will appear clear, from the above facts, that, when the capacity 
of the capillaries in any seat becomes preternaturally or dispropor- 
tionally enlarged, the pressure of the fluid within them will in- 
crease in the same proportion as the enlargement. The pressure 
is according to the square of the surface, and if, instead of present- 
ing a surface equal to 1, the vessels in their state of preternatural 
enlargement or inflammation present a surface equal to 3, the force 
exerted on their parietes will, of course, be three times that which 
is natural to them. The tendency, as well as the general conse- 
quence, of this increased pressure must be, it is evident, to increase 
their calibre still more; and the greater the preternatural expan- 
sion, the greater will be the force tending to augment it. 
We may refer again to an aneurismal sac in illustration of this 
principle. A small or incipient aneurism, is, comparatively, slow 
in its growth, because, at its commencement, its diameter is not 
much larger than that of the tube in which it is situated; conse- 
quently, the pressure upon its parietes does not materially exceed 
that on an equal length of the rest of the tube. As, however, the 
sac enlarges, the pressure equally increases, and the proportion 
which originally existed between this part of the tube and the other 
parts becomes less and less. Having acquired a certain size, the 
aneurism grows rapidly, because the force within it increases with 
its growth. When the sac is of a certain size, let us suppose there 
to be a given pressure on its internal surface; when that surface 
has doubled in extent, the pressure will also double in amount; so 
that, at this point, the sac will have twice the tendency to enlarge 
that it had when only half the size. The enlargement and the 
tendency to enlarge increase in a regular proportion. 
The contractile force of the arteries must be considered as differ- 
ing in degree in different individuals, in different parts of the same 
individual, and in the same individual at different times. In this 
respect it is analogous to every vital property of which we possess 34 
DAVIES ON PATHOLOGY AND SURGERY. 
any knowledge. For instance, the liver secretes more regularly in 
one individual than in another; and the bile is more healthy in 
the same individual at one period than at another. Moreover, the 
secretion of the liver may be normal, and that of the kidney ab- 
normal, in the same individual at the same time. In like manner, 
absorption may be deficient in the peritoneal cavity, and efficient 
in the cavity of the pleura, of the same person. In fact, the ana- 
logy is derived from every vital function in the body. 
The above fact, applied to the capillary vessels, will account for 
the degree or intensity of the inflammation of any seat. The 
cause which acts in producing the disturbance of the equilibrium 
may be of such a nature as merely to weaken the contractile force 
of the tubes in the smallest degree; or it may be such as totally to 
destroy that force. Between these two points there are various 
degrees; and, as a consequence, the inflammation may present 
various degrees of intensity. 
Although the least degree of expansion increases the tendency to 
a greater expansion, by reason of the augmented pressure within 
the tubes, yet there exists a provision, on the other hand, in the 
constitution of the vessels themselves, which acts in opposing the 
effects of that increased pressure. It must be borne in mind that 
the contractile power of the tubes serves to maintain their calibre at 
all times below that which would obtain if the elastic force were 
allowed its full play. It is evident that the more the calibre is 
reduced below the point of the medium of elasticity, the greater 
will be the resistance offered by the elastic power of the structure. 
The tendency to expand in the coats of the vessels—leaving out of 
consideration the pressure of the blood—diminishes as the expan- 
sion advances towards the medium of elasticity; so that the resist- 
ance to the contractile force becomes less and less as the calibre 
enlarges. The result must be, that, if the cause of the derangement 
be of such a nature as only to weaken the contractile power in a 
small degree, though the remaining power may not be able to 
retain the calibre in its normal state, yet, as its opposing force— 
namely, the elasticity—progressively decreases as the tubes expand, 
the power of contractility which remains may be sufficiently strong 
to prevent the expansion from extending very far. 
It will, perhaps, be argued against all the foregoing views, that 
the capillary vessels of an inflamed part are felt to pulsate very 
strongly, therefore there must be an increased action of the vessels 
themselves ; that the large branches running towards the inflamed 
seat beat much stronger than natural; and that the heart itself 
often partakes of the disturbance. 
That the pulsation felt in the inflamed part is sometimes strong, 
cannot be denied. For instance, in a case of whitlow of the fore- 
finger, or of inflammation of the hand, the inflamed seat is felt to 
throb strongly, and the pulse in the radial artery is found much 
stronger than natural. But these facts are easily accounted for 
without attributing any pulsating action to the vessels themselves. 35 
LOCAL PATHOLOGY. 
If the radial artery, or any one of its larger branches, were to be 
exposed, in such a case no motion whatever would be seen in its 
coats. 
Now, the strength of the pulse in an artery, as a general rule, is 
in proportion to the size or diameter of the vessel. The brachial 
beats much stronger than the radial; the femoral stronger than 
the anterior tibial, where it passes over the instep ; the common 
carotid stronger than the temporal, &c. In fact, whatever artery 
be felt, there will be found a regular proportion between the size of 
the vessel and the strength of the pulse; and it may be stated that 
all other peculiarities in the pulse depend upon the action of the 
heart. We have then observed that the diameters of the vessels in 
an inflamed part are considerably increased in some cases, and that 
there is an augmentation of their calibre in every instance. In 
some instances, as in inflammation of the cornea of the eye, vessels 
which usually do not admit the red globules of the blood become 
equal to small needles in diameter, and present a red, arborescent 
appearance. This occasionally takes place even when the inflam- 
mation is not what is termed “ very high” in degree; and the phe- 
nomena attending the disease in this peculiar tissue will furnish us 
with some idea of the increased diameter assumed by the capilla- 
ries in seats whose texture will more readily yield to the expansion 
of their coats. The phenomenon of pulsation in an inflamed seat 
depends upon the enlargement of myriads of vessels which are too 
small, in the healthy state, to impart to the finger the effect of the 
stroke of the heart, but which, in their state of enlargement, com- 
municate the effect of the jar, as all other arteries of a similar 
diameter do. In consequence of this preternatural state, or preter- 
natural enlargement, of the capillaries, if we place the hand on the 
seat of inflammation, we, of course, feel a regular and sometimes 
strong pulsation, upon precisely the same principle as we do in a 
larger vessel, namely, in consequence of the impression we produce 
in the arterial coats by the very means we use in feeling them— 
that is, the pressure of the fingers. 
This subject may be illustrated by facts connected with certain 
tumours; with what are called “erectile tissues;” with nsevi ; 
with the gravid uterus, &c. In some sarcomatous tumours the 
arteries are found remarkably large, and they will communicate 
the feel of a very strong pulsation to a finger placed on them ; yet 
the arterial connection of the tumour with the part on which it 
grows is sometimes so slight that the new growth may be removed 
without the slightest risk of hemorrhage. The fact is, that the 
arteries of the healthy part in the neighbourhood of the tumour 
have only slightly enlarged, and the pulse, if felt in them, would 
be of a strength similar to that of any other artery of the same size. 
But these are in connection with the arteries of the tumour: the 
column of blood is continuous through them into the latter vessels: 
the vessels of the new growth are very considerably larger than 
those immediately connecting it with the part in which it is situ- 36 
ated: they bear a similar relation to the latter as an aneurism does 
to the artery to which it is attached: in consequence of their great 
size, of the column of blood being continuous between them and 
the heart, and of the .pressure of the fluid within them being in 
proportion to the surface exposed to it—the resistance, in other 
words, the “pulse,”—is felt, as a matter of course, very strong if 
the finger be placed on them. 
In a similar manner, the vessels of a naevus, whether arteries or 
veins, are very considerably larger than those which connect them 
to the general vascular system. So are likewise those of the gravid 
uterus. The strength of the pulse in each, and all, of them will be 
proportionate to the diameter of the artery at the point where it is 
felt, whether the vessel be connected by a small or a large branch 
to the general arterial system. 
The derangement which gives rise to the inflammation may be 
very limited in extent, as may be noticed from the prick of a 
needle; or very extensive, as often occurs from lacerated or punc- 
tured wounds, or in what is commonly called “spontaneous in- 
flammation.” When the cause is slight, the extent of the derange- 
ment is generally limited, and all the phenomena are slight. It is 
seldom, or never, that the inflamed part can be circumscribed by a 
distinct line of demarcation. Generally, the enlargement of the 
capillaries ends imperceptibly in the normal diameter of the branches 
with which they are continuous. At other times, the augmented 
calibre extends to some of the principal arterial branches leading to 
the inflamed part. When this occurs, the pulse felt in these 
branches will be, of necessity, stronger than natural, because the 
column of blood presses on a larger surface. For instance, in a 
severe inflammation of the hand or fingers, the radial artery will 
partake of the disturbance: it will lose a part of its contractile 
power : its calibre will sensibly enlarge : the diameter of the column 
of blood within it will consequently increase; and, instead of im- 
parting the sensation of a radial pulse, the amount of pressure on 
the finger will be such as to produce a pulse equal to that of the 
brachial artery in its ordinary state. 
It may be noticed that the sensation of throbbing which the 
person himself, who is the subject of the inflammation, feels in the 
inflamed part, is owing to the tightness of the integuments, and to 
the density of the tissues surrounding the enlarged vessels. This 
tightness or density causes a compression of the parietes of the 
vessels, upon the same principle as the finger does in feeling the 
pulse; and the coats react and impart the impulse to the nerves of 
sensation distributed in the integuments. In internal inflammations, 
such as pleuritis, peritonitis, &c., there is a total absence of the 
sensation of throbbing; because, however the enlarged vessels may 
be compressed by the surrounding tissues, yet, as the nerves of the 
inflamed seat are not those destined for the office of sensation, and 
as the pulsation is not powerful enough to be communicated to the 
surface, through the medium of the parietes of the chest or abdomen, 
DAVIES ON PATHOLOGY AND SURGERY. LOCAL PATHOLOGY. 
37 
like that of an aneurism, for instance, no sense of throbbing is per- 
ceptible to the sufferer. The only feeling is that of pain, which, as 
already observed, is a property attendant on almost all vital de- 
rangements in the animal system. 
That the action of the heart is often disturbed in cases of local 
inflammation, affords no reason to conclude that the inflammation 
depends upon the disturbance of the heart. That would be mis- 
taking the effect for the cause. The action of the heart is disturbed 
in hysteria, in hydrophobia, in epilepsy, in chorea, and in a variety 
of other maladies wherein none of the phenomena of inflammation 
are observable, but no one ever thought of attributing those affec- 
tions to any derangement of the heart. The fact appears to be, 
that, in inflammation, there exists a certain vital derangement—a 
reduction of the vital powers—a modification of some of the vital 
properties—and the necessary consequence is pain: pain is a pro- 
perty related with the nervous system: the centre of this system, in 
the higher animals, is in the brain: from the brain some of the 
effects of the pain are transmitted to the heart, probably through 
the medium of the same system, and the consequence is a derange- 
ment of its natural function. In fewer and more common terms, 
the derangement of the action of the heart is caused by the inflam- 
mation ; not the inflammation by the derangement of the action of 
the heart. 
If the views we have taken respecting the properties of the arte- 
ries are founded on facts, it might be considered sufficient to state 
them simply, without any further explanation ; but as, possibly, 
some may be disposed to dispute them, without taking the trouble 
of examining the facts upon which they rest, we may be permitted 
to say a few words upon the advantages derived from the nature 
of those properties, and to show that they are the best adapted for 
the functions which the arteries are destined to perform in the 
animal economy. 
That the coats of the arteries are endued with an elastic pro- 
perty, no one will dispute. We are told, very justly, in all proba- 
bility, as a general principle, “that nature does nothing in vain.” 
What, then, is the object of the elastic quality in the coats of the 
arteries? It will, perhaps, be answered, “to press the blood forward 
along the tubes.” But, before it can do so, it is clear that the ves- 
sels must be first forced out beyond the medium of their elasticity, 
and that they can only react on the blood by their resilient force, 
or their effort to resume that medium. Now, let us ask, by what 
power can they be forced out? There is no power with which we 
are acquainted that can act upon them, calculated to force their 
expansion, except that of the heart. But, as it is a law of nature 
that the resistance should be equal to the force applied, the power 
of the heart would be totally wasted, or spent to no purpose, if it 
went to force the vessels beyond the medium of their elasticity, in 
order that, by their resilience or reaction, these vessels might, in 
their turn, press the blood forward; because the same quantity of 38 
DAVIES ON PATHOLOGY AND SURGERY. 
power which would be expended by the heart in dilating the arte- 
ries would suffice to move the column of blood a distance equal to 
that to which the re-action of the vessels would move it. In such 
a state of things, there would be one force set up to oppose another, 
without any object or advantage to be gained. 
On the other hand, the reason why the ordinary and natural 
calibre of the arteries should range below the medium of their elas- 
ticity is quite clear, when once pointed out. 
It will not, we presume, be disputed that the mass of blood in the 
body varies very considerably in quantity at different times. Some 
persons swallow two or three quarts of liquid within a short period, 
most of which remains for a time in the vessels, before the kidneys 
can act in throwing it off. In cases of cholera, we have inject- 
ed above two gallons of water, containing carbonate of soda in 
solution, into the veins of persons at one time, yet nothing like 
over distension seemed to take place.1 Some practitioners are in 
the habit of abstracting two or three pounds of blood at once in 
cases of inflammation, or of inflammatory fever, and a much larger 
quantity is frequently taken away by repeated bleedings within a 
short period of time. Now, if the contraction of the arteries de- 
pended upon their elastic quality, and their dilatation upon the 
force of the heart forcing the blood against their parietes. it is diffi- 
cult to conceive how they could adapt themselves to the great 
1 In the first patient in whose case this practice was adopted, we were, 
together with Dr. Furnivall of this town, who assisted us, rather surprised 
at the large capacity of the vascular system. He was a bargeman, naturally 
strong and healthy, but, before the operation, reduced, in a very few hours, 
to the very last stage of cholera. A vein in the arm was opened, and 
syringeful after syringeful injected, until nearly two gallons of fluid were 
thrown in before the skin appeared to change its aspect. Gradually, how- 
ever, the interstices began to fill; the shriveled appearance of the skin began 
to relax; the blue colour gave way to a more natural hue, the man, who 
had been some time quite insensible, and in a state almost doubtful whether 
he was alive or not, opened his eyes, and became gradually able to answer 
questions put to him; the pulse became perceptible at the wrist, and the 
change was altogether most extraordinary. Considerably more than two 
gallons of fluid were injected, yet the surface of the body was hardly re- 
stored to its natural fulness. In this case there came on, shortly, attacks of 
an epileptic nature, which were repeated at intervals of some minutes until 
he died; which occurrence took place some hours afterwards. In five other 
cases, in which the injection was practised, the temporary good effects were 
equally striking; but not one of the patients permanently recovered. The 
practice was only adopted in the very last stage of the worst cases. They 
were all roused for a time, and none but the first suffered any cerebral affec- 
tion from the injection, although equally large quantities of fluid were 
thrown in. The effects in all these cases were the following: as soon as,or 
immediately after, a sufficient quantity of fluid to rouse the patient was in- 
jected, either a vomiting came on, or the bowels acted, so that, in a few 
minutes, a quantity about equal to that injected was discharged from the 
body. A repetition of the experiment was invariably followed by the same 
train of effects; namely, first, a temporary rousing ; then an enormous dis- 
charge from the bowels, leaving the patient each time in a state similar to 
that in which he was before the injection. LOCAL PATHOLOGY. 
39 
variation in the quantity of the fluid contained in them. If the 
quantity were great the force required on the part of the heart to 
dilate the vessels must be enormous, for it is in the nature of an 
elastic body to increase its resistance the more it is stretched beyond 
the medium of its elasticity. On the other hand, if the fluid were 
reduced in quantity, so as not to be sufficient to fill the vessels up 
to the medium of their elasticity, there would necessarily be a 
vacuum in some part or parts of their canals. If such were to 
happen, it is evident that a fatal disturbance must take place in the 
circulation. The column of blood would be broken, and the heart 
would not receive a regular supply of fluid to act upon. 
But, regulated in their calibre by a vital property, which always 
retains their diameter below the medium of their elasticity, but 
which, owing to the vital relation subsisting between them and the 
blood, yields gradually to an increase in the quantity of their con- 
tents, the arteries are fully capable of adapting themselves to any 
variation which may take place in the circulating mass, so as, 
under all ordinary circumstances, to embrace the column of fluid 
in such a way as to leave no vacant space within the vessels. It 
may be said that the maximum of blood in the system, compatible 
with health, or perhaps with life, would fill up the vessels to that 
point which constitutes the medium of their elasticity. What the 
minimum may be is uncertain, but that the tubes are capable of 
diminishing their calibre to a very small comparative size, we have 
had abundance of proof. 
As a guard against any inordinate pressure on the interior of the 
arteries, from over distention, the veins are so capacious, and so 
capable of accommodating themselves readily to the amount of their 
contents, that the mass of blood might temporarily receive great 
increase without causing very material inconvenience. The quan- 
tity of blood in the veins must depend upon that transmitted to 
them by the arteries. In a word, the arteries possess a complete 
command over the veins, and the calibre of the latter will be de- 
termined, as a general rule, by the supply which they receive from 
the former. 
But it is, on the other hand, quite evident that a disturbance of 
the equilibrium between the two systems of vessels could not last 
long without causing serious injury. If we suppose the veins to 
contain more than their due proportion at any time, as one end of 
the column continually discharges itself into the right side of the 
heart, and thence into the lungs, these organs would soon become 
over-loaded if the left side were not equally ready and capable of 
passing it off into the arteries. In the natural state of the circula- 
tion the equilibrium is soon restored by the mutual correspondence 
of the action of the two sides, after having been disturbed by sud- 
den exertion of the body, or any other cause. The circle must be 
at all times a continuous column : in other words, every artery and 
vein is full of fluid throughout the circle ; but their diameters will 
depend entirely upon the quantity of blood in the system. 40 
DAVIES ON PATHOLOGY AND SURGERY. 
From the facts which have been stated in this section, we are 
justified in concluding: 
1. That the calibre of all the arterial branches, in the normal 
state, bears a uniform proportion throughout the system. 
2. That the proportion is governed by a vital property residing 
in the coats of the vessels, and bearing a relation to the blood within 
them. 
3. That any reduction in the amount of the vital power of the 
vessels will allow their calibre to be enlarged by the force of their 
elasticity. 
4. That the immediate consequence of a preternatural enlarge- 
ment of the vessels is an increased influx of blood into them. 
5. That the visible phenomena of inflammation result from a 
number of the capillary branches of the arteries having lost a part, 
or the whole, of their contractile power, thereby having become 
enlarged in their calibre, so as to admit, and retain, an undue pro- 
portion of blood. 
6. That, while the capillaries are in the state last mentioned, the 
velocity of blood within them undergoes a decrease, although the 
quantity of fluid existing in them has acquired an increase; which 
increase imparts to the seat of disease the character of redness. 
7. That the strength of the pulsation of an artery—in other 
words, of the “ pulse”—bears some ratio to the size of the vessel at 
the point where it is felt. Thus, if a branch whose diameter in one 
part is equal to 2, expands a short distance further on into a dia- 
meter equal to 4, the “ pulse” felt at the latter part of the branch 
will be much stronger than that felt at the former, where the tube 
is smaller, although the latter is nearer the heart, which is the 
source of the pulsation. 
8. That the throbbing felt in an inflamed part depends upon an 
increase of size which the capillaries have acquired in consequence 
of a reduction, or loss, of their contractile power; thereby pre- 
senting a larger internal surface to the force of the heart through 
the medium of the column of blood ; and, 
9. That the preternatural expansion may extend to a principal 
arterial branch leading to the seat of the inflammation, and, by con- 
sequence, may give rise to an increase of strength in the pulse in 
that branch compared with its normal state. 
Cause of Difference in the Character of Inflammation. 
What are the physical causes which serve to give inflammation 
the great varieties of character observed in different cases? In 
some cases it presents the appearance of hardly any thing more 
than a mere blush, attended with a slight pain, and a trifling in- 
crease of heat in the part, and its duration is almost the only thing 
which distinguishes it from a blush. In others, the characters of 
the disease are more striking; the redness shows a deeper body; 
the pain is more intense; there is a degree of fulness or swelling LOCAL PATHOLOGY. 
41 
of the part, and its temperature is augmented ; yet, in a few hours, 
or a few days, it may resume its natural state by means of the vis 
medicatrix of nature alone. Sometimes the disease spreads over a 
great extent of skin, without causing much disturbance among the 
deeper seated tissues; whereas, at other times, the subcutaneous 
cellular membrane of nearly a whole limb may be destroyed by it, 
where the integuments themselves suffer comparatively little. In 
some instances, the vessels of the inflamed part assume a new func- 
tion, and give rise to the formation of pus in one place, and in 
another throw out a mixture of lymph and fibrine, whilst in a third 
the fluid product is mere serum. In one case the disease eats up 
the part by piecemeal, or by small ulcerations, whereas, in other 
cases, it destroys the vitality of a whole limb at once. In fact, the 
varieties of character presented by “ inflammation,” according to 
the general application of the term, are very numerous. 
The two principal divisions of inflammation made by authors 
has been into phlegmon and erysipelas. The former has been de- 
fined as being less disposed to spread than the latter; more ple- 
thoric in its character; less dangerous in its tendency,though more 
active in its nature; the inflamed part opposing greater resistance 
to the pressure of the finger, and presenting more fulness and 
swelling, with a deeper intensity of redness. Erysipelas, on the 
other hand, has been considered more insidious in its character, 
sometimes spreading to a great extent without affording any clear 
proof of the magnitude of the mischief going forward ; to show, 
according to the common expression, less “ action” in the inflamed 
seat, yet to have a greater tendency to destroy its vitality; to op- 
pose less resistance to pressure, and to be altogether more diffuse in 
its character than phlegmonous inflammation. 
Now, that inflammation presents these extreme differences in 
different instances is well known to every practitioner; but it is 
also equally certain that there are cases, even more numerous, 
occurring, which belong to the one class as much as to the other. 
In order to reconcile these, which, in truth, form the great majority, 
authors have termed the doubtful cases “phlegmonous erysipelas,” 
thus thinking, we suppose, that they must be right if they applied 
a term embracing both divisions of the disease. 
The principal divisions have been again subdivided in various 
ways. We have the “acute” and “chronic,” which are the oldest 
terms we possess respecting the subdivision of the disease ; but the 
term “ chronic” has been of late years changed for the term “sub- 
acute.” So far as we can perceive, one is as applicable as the 
other ; but neither will convey any precise or distinct idea of either 
the nature or degree of the malady. How long must the inflam- 
mation last before the term “chronic” will apply to it? Again, 
where is the line to be drawn between the “ acute” and “ sub-acute?” 
How are the degrees to be measured? What is the scale to consist 
of? Intensity of symptoms ? Who is to judge of the comparative 
intensity? If we were to estimate the degree or intensity of the 42 
DAVIES ON PATHOLOGY AND SURGERY. 
disease by the heat, redness, and swelling observed in the part— 
which are the only outward signs of inflammation—vve should often 
find all these much less in a limb on the point of running into a 
state of gangrene than in many cases where the tendency is con- 
siderably less serious. In some instances we find considerable 
redness, and some degree of swelling, without any perceptible in- 
crease of temperature, and unattended with any sensible pain. This 
state of the vessels is called congestion by some authors, and 
chronic inflammation by others. 
From the great difference of opinion among pathologists, re- 
specting the mode of classifying the varieties which inflammation 
presents in different cases, there is reason to suppose that various 
diseases are arbitrarily included in that term, which bear but slight, 
if any, resemblance to each other in their nature. That the same 
disease may differ in degree in different cases, is reasonable to sup- 
pose ; but that the same disease should present itself sometimes in 
the form of a small pimple, as in the measles, and other exanthe- 
matous affections; at other times in a circumscribed tumour of a 
determinate extent, as in a common boil; in other instances in a 
diffused form, of unlimited extent, &c., and should lead to such a 
variety of terminations, is not probable; and we doubt the benefit 
that can arise, in a practical point of view, from viewing it in that 
light. 
There are three things to be considered as determining the na- 
ture of a disease, and it is probable that these will embrace all the 
varieties which diseases can present under any circumstances. 
These are— 
1st. The nature or properties of the cause which conduces to 
create the vital derangement; 
2d. The tissue or immediate seat upon which the cause exerts 
its influence; and 
3d. The general constitution of the patient, or the constitution of 
the tissue upon which the cause primarily acts. 
In a work like the present, it is unnecessary to discuss these 
points at length, for the treatment of a disease is determined upon, 
in general, from the more prominent signs which characterise it. 
In order to point out, and to render clear, our notions respecting 
the immediate operation of various causes in the production of dis- 
ease, more space would be occupied than can here be applied to 
the subject. 
But it may be noticed shortly, that it should not be forgotten 
that disease is a state or condition of a part possessing vital proper- 
ties ; and that, in analysing its character, these properties should 
never be left out of the estimate. The properties of life might be 
discussed 'physiologically in the abstract, as distinct entities from 
those of the material fabric; but, in a practical point of view, it is 
convenient to consider them as parts of the constitution of the tis- 
sues with which they are connected. In looking upon them in this 
light, our enquiry should be directed to two points; first, what is LOCAL PATHOLOGY. 
43 
the amount of all that a tissue can do: in other words, what is the 
sum total of its functions? Second, in what way can that tissue 
suffer—what character does it put on under the influence of a 
morbific cause? In proceeding in an enquiry like this, the legiti- 
mate mode consists in not attributing any effects to vital properties 
which can be proved to depend upon mechanical causes; and, on 
the other hand, to assign to the vital department of the tissues those 
effects which, from their nature, cannot owe their existence to 
causes of a mechanical kind. For instance, the motion of the blood 
in the vessels has, among other causes, been attributed to an innate 
mobile power existing in the fluid itself. It is true that the globules 
of the blood, examined through a powerful microscope, are seen to 
move among themselves, even out of the vessels, for a short period, 
while the blood remains fluid ; but this fact affords no proof that 
they are capable of progressive motion along the tubes of the ves- 
sels. Facts equally convincing, and even more so, prove that the 
blood is not capable of moving along the vessels by its own inhe- 
rent impulse, for when the power of the heart is removed from it, 
its progressive motion immediately ceases. 
On the other hand, it is evident, according to the extent of our 
present knowledge, that the secretion of bile, of gastric juice, &c., 
cannot be the effect of a mechanical cause, for we know of no ana- 
logous products emanating from any combination of mechanical 
powers. And although chemistry enables us to discover the mate- 
rial elements of which these secretions are composed when out of 
the body, yet no power of chemistry is capable of compounding 
fluids suited for the offices which these have to discharge in the 
animal economy. 
Now, it is one property of every tissue endowed with life to pre- 
serve its own identity. In the course of the operations going on in 
the body every tissue maintains its own distinct character, notwith- 
standing the constant removal and renewal of the material mole- 
cules of which its structure is composed. The mucous mem- 
branes do not assume either the character or the functions of the 
serous membranes; nor do either of these transfer themselves into 
cellular tissue; nor into muscular fibres; nor into gland, &c. 
Each preserves itself, feeds itself, renovates itself; thus maintaining 
a marked character, which distinguishes it from all other tissues. 
As we know of no mechanical or chemical process in nature ana- 
logous to this, we are justified in attributing it to vital causes. 
Hence, each tissue, during life, is endowed with an innate power 
of preserving its own identity, by the agency of its vital properties. 
The next thing which each tissue is capable of doing, is to per- 
form the function for which it is destined. It will, perhaps, be 
said, that we know nothing of the nature of the powers by means 
of which it is capable of accomplishing such an object. It may be 
replied, that we are equally ignorant of the power which brings a 
stone to the earth ; which binds together the particles of which the 
stone is composed; which determines one crystal to be different 44 
DAVIES ON PATHOLOGY AND SURGERY. 
from another, &c. We only know that certain properties are con- 
nected with the elementary constitution of bodies, which prompt or 
compel those bodies to do what they do; and that, when the same 
properties are in combination, the same effects will always follow. 
In this respect, our knowledge will apply with equal correctness to 
the functions of living parts. What we find these parts do, we 
know them capable of doing. In the normal state, each organ per- 
forms a distinct function, and observation has proved what that 
function is. Observation also proves that certain causes conduce, 
while operating, in modifying that function. As, therefore, facts 
prove these points respecting the nature and properties of the 
organs, it follows that, as every tissue which enters into the compo- 
sition of each organ forms an essential part of its constitution, each 
tissue of which the structure of the organ is made up must possess 
properties peculiar to itself—properties differing in modification 
from those of all other tissues. 
As mere conduits for the blood, the properties of the capillary 
vessels in all the organs, and all the tissues, are similar. The ves- 
sels are equally capable of adapting themselves to their contents in 
one seat as in another. Their elastic quality will expand them, 
and their contractile power will reduce their capacity, in the liver 
as well as in the stomach ; in a serous, as well as in a mucous, 
membrane; in a gland as well as in a muscle: but it must be con- 
sidered that contractility is only one vital property connected with 
them. 
By examining this subject according to the principles already 
laid down, namely, that if the effect be different the cause must 
also be different, we are led to conclude that the modification of the 
vital properties of the capillaries is different in every seat—in every 
tissue of which an organ is composed. This conclusion is founded 
upon the facts, first, that the physical characters of all the tissues 
are different; and, second, that the nature of their functions is dif- 
ferent. We may instance the liver and the kidneys in illustration 
of this point. Although secretion is the function of each, yet the 
product of the function is different, notwithstanding it is derived 
from the same mass of blood in both. 
As all the structure, in the first step of vitality, and all the secre- 
tions resulting from the structure in a vital state, in the second step, 
are derived from the same common mass of blood, and as both are 
dependent upon some property connected with the extremities of 
the arteries, it must follow that if this property were the same in 
all the extremities, the structure must be the same in every part, 
and, as a consequence, there could be only one function. This 
proposition is as self-evident as that two and three will make five. 
The necessary inference, therefore, is, that the secerning, and in 
the secretory organs the secreting, extremities of the arteries— 
whatever their form or nature may otherwise be—differ in their 
vital properties in every tissue, so as to be suited for the particular 
office which they have to perform in each seat. In this respect LOCAL PATHOLOGY. 
45 
they are analogous to all the works of nature; and it would be as 
fruitless to enquire why they should be so, as to enquire why a 
heavy body should gravitate towards the earth. It must suffice to 
know that if the effect be different, the cause of that effect must be 
also different. 
According to the foregoing view, the extreme vascular branches 
are different in their modification in every tissue, so as to suit them 
for their particular functions; although, in all parts, they possess 
the property of contractility, which enables them to adapt their 
calibre to their contents. As this is the case, it will follow, as a 
consequence, that even the same cause acting upon them in dif- 
ferent tissues, may—nay, must, in some respects—give rise to 
different modifications of phenomena. One common consequence 
may follow in all, namely, dilatation of their canals, and, conse- 
quently, the admission of an undue share of blood, attended by the 
other characteristics of inflammation ; but that inflammation must 
differ in its modification in every tissue, according to the peculiar 
properties of the vessels in each. As the various shades of differ- 
ence in these properties cannot be defined, because the effects re- 
sulting from them are so minute, in some instances, as to escape 
our observation, we must found our illustrations upon tissues some- 
what in the gross. 
Now, as a general principle, we find the tendency of inflamma- 
tion of the serous membranes to be the secretion of a sero-fibrinous 
fluid, and the formation of adhesions between their opposite sur- 
faces. This is the case in the common or diffused variety of the 
disease. It is true, that, in some peculiar inflammations of those 
membranes, granular ulcerations and the secretion of pus are found 
to have taken place; but any one may satisfy himself that, in such 
cases, it is not the general serous tissue that has suffered as a prin- 
cipal, but certain points either enveloped within its texture, or 
situated immediately behind it. These points evidently differ in 
their physical characters from the membranous tissue itself; but 
as, like all other tissues, however small in size, they must owe their 
existence to vessels and to the blood, their arteries must be specially 
modified in their properties, and must, therefore, bear special rela- 
tions or affinities to any causes which may act upon them. By 
continuity, or by immediate contiguity, the disturbance may, and 
always does more or less, extend to the vessels of the general tissue, 
which, consequently, is made to partake of the disease, and to give 
exit to its own peculiar morbid fluid, which becomes mixed with 
the more purulent matter emanating from the original seat of the 
disease. In almost all cases of this description, the leading cha- 
racters of the inflammation are stamped by the properties oi the 
tissue originally affected. 
As an analogous principle, we find that the tendency of the mu- 
cous membranes, in a state of inflammation, is to secrete ] a.nc* 
that this modification of tissue is not endued with that adhesive 
property which forms a distinguishing part of the character ol the 46 
DAVIES ON PATHOLOGY AND SURGERY. 
serous membranes. Inflammation of the mucous tissues, also, has 
a much stronger tendency to cause softening and ulceration than 
that of any other tissues. Like the serous membranes, the mucous 
are liable to suffer in an extensive degree; in other words, their 
inflammation has a tendency to spread over a great part of their 
surface. Like the serous membranes, also, when traces of inflam- 
mation are found in circumscribed spots, it will be discovered, on 
close examination, that the origin of the disease was not in the 
membrane itself, but in certain points or glands either enveloped in 
its substance, or situated immediately in contact with it. 
In the cellular membrane, again, we find the inflammation sui 
generis. When limited in extent, its tendency is to form a circum- 
scribed abscess, if it does not terminate in what is commonly called 
“resolution.” On the contrary, when the cause acts upon a wider 
scale, death ensues in the tissue, and extensive sloughings take 
place, if the vital powers of the general system be sufficiently strong 
to bear the effects of the constitutional disturbance. The tendency 
of the disease is similar in all the parenchymatous structures. The 
consequence, in its first degree, is a resumption of their normal 
state by the vessels—a restoration, by virtue of the vis medicatrix— 
of the innate principle of self-preservation implanted in the consti- 
tution of all bodies—of their contractile power. In its second de- 
gree, its tendency is to limit itself, by forming a circumscribed 
abscess. By this means the vessels are enabled to ease themselves 
of a part of their undue burthen. In the last degree, the conse- 
quence is the death of the tissue affected. Owing to the entire 
destruction of the contractile power of the capillary vessels, the 
blood, whose motion has decreased in velocity in proportion to the 
expansion of the tubes containing it, comes to a complete stagna- 
tion, and the secerning function—the function by means of which 
the structure is perpetuated—ceases. The result, of course, is the 
death of the part. 
These peculiarities of inflammation in the different tissues are 
general in the animal body. Where they differ, the difference is 
only in modification, for the general character of the malady is the 
same. The same analogy is discoverable in all the tissues. When 
the skin is the seat of the inflammation, the disease puts on a very 
diffusive character, which has its peculiarity, like that of other seats. 
Here, it is commonly called erysipelas. As the vessels of the skin 
must be modified differently from those of all the other tissues, ac- 
cording to the principle already stated, it is natural that they should 
exhibit their sufferings, under the influence of a morbific cause, in 
a manner different from all others. 
From the foregoing observations, then, it must, we should con- 
ceive, be admitted that the nature of the tissue affected has a consi- 
derable share in determining the character of the inflammation. Irr 
fact, we may say that the tissue constitutes the basis which is to 
form the distinguishing points in its character, because inflamma- tion of the same tissue always presents phenomena very similar in 
their nature, though differing in degree and modification. 
In the next place, it may be enquired how far the character of 
the inflammation is determined by the nature of the cause which 
produces it? 
The fact cannot be refuted, that the same tissue presents, in 
general, similar characters while in a state of inflammation—that, 
as already observed, the serous membranes furnish a fluid 'peculiar 
to themselves, and show a great disposition to unite their surfaces— 
that the mucous membranes secrete pus, and are not disposed to 
form .adhesions—that the cellular membranes, and the parenchy- 
matous tissues, readily run on to sloughing, if the disease be so 
extensive as to preclude the formation of a limited pfbscess—that, in 
the true skin, the disease is diffuse in its character; peculiar in its 
sensations, owing to its immediate connection, with the nerves of 
touch; dangerous in its tendency, owing, probably, to the same 
cause producing disturbance of the cerebral functions: that its 
secretions are serous or lymphatic, which appear in the form of 
blisters, similar to those secreted by the same tissue under the ac- 
tion of vesicatories. The same analogy applies to the glandular 
tissues. It is true that the liver, the kidneys, the mammse, the 
testes, the pancreas, <fcc., each present diseases, in different cases, 
very unlike in their characters; but. it must be remembered that 
every secreting, as well as other organ, is made up of various tis- 
sues, and that it may often happen that the real or original seat of 
the disease is not that tissue which gives its peculiar distinction to 
the organ, but a subsidiary tissue, such as the cellular, which per- 
vades all the other tissues. That this inference is not altogther 
hypothetical, is proved by the fact that each of these organs, as 
well, indeed, as every organ in the body, does present disease of a 
character peculiar to itself. That peculiar carcinoma which takes 
place in the mammae never exhibits itself in any other tissue as an 
original disease. The kidney is subject to a peculiar granular 
affection, the like to which is not found in any other part of the 
body. The liver exhibits morbid appearances different from what 
is ever discovered in any other seat. It is the same with the pan- 
creas, testes, lymphatic glands, the thyroid gland, &c. How far 
additional ar,d. more minute examinations may hereafter enable us 
to find out the special seat of the various eruptive diseases, it is im- 
possible to tell, but as they, in every instance, present distinct and 
peculiar characters, it is legitimately to be inferred that they are 
allied with some special points or tissue distinct from the rest of 
the general structure. 
But, although each tissue sets forth its diseases in a way peculiar 
to itself, and although the diseases of each agree at all times in the 
most prominent points of their character, yet the same tissue pre- 
sents great modifications in the character of its affections in different 
cases. The facts already stated are sufficient to prove the basis 
upon which the character of various inflammations is founded, hut 
LOCAL PATHOLOGY. 48 
DAVIES ON PATHOLOGY AND SURGERY. 
there must be some other powers which determine the modifications 
of the disease. The question, then, is, what are those powers? 
Now, an effect is sometimes made up of many causes: it must 
always consist of more than one cause. It has been already shown 
that one reason of the varieties put on by inflammation is the na- 
ture of the tissue affected. This cause is inherent in the constitu- 
tion of each tissue, and plays its part in mankind generally, as well 
as in every individual case of inflammation. This cause forms the 
groundwork of the character. The next is the exciting cause. 
We mean by “exciting cause” not those mediate causes, such as 
cold and moisture, but that cause, whether mechanical, chemical, 
or vital, which acts immediately upon the living tissues. The 
enquiry, therefore, is, what facts are we in possession of to deter- 
mine the manner in which such a cause acts? 
It is a fact, in the first place, that any violence inflicted upon the 
vessels of a part, is a sufficient cause of inflammation of that part. 
Whether the violence be a blow, a laceration, a puncture, a cut, or 
whatever its nature may be, a vital disturbance is the result. 
Why living parts should be subject to any disturbance from vio- 
lence, it would be just as profitable to enquire as why sulphuric 
acid should consume a piece of marble. By the next step we arrive 
at a point where we can trace causation better:—vital disturbance 
of a part is very soon followed by a dilatation of its capillary ves- 
sels, thereby inducing them to admit larger columns of blood : this 
is the first visible character of the inflammation. Now, the link in 
the chain of causation which binds the vital disturbance with the 
enlargement of the capillary tubes, appears to be this : any disturb- 
ance or derangement of the vital powers must tend to weaken those 
powers : the natural tendency and object of the vital powers, in the 
capillary vessels, is to regulate their contractility, and determine 
their calibres according to the nature and function of the tissue 
which they supply ; the necessary consequence, therefore, of 
such disturbance or derangement must be dilatation of the tubes 
of the capillaries. Let us see in what respect this view could be 
disputed. 
It will, perhaps, be maintained, that any disturbance of the vital 
powers must tend to increase, rather than diminish, their amount, 
and that, therefore, if their object be the contractility of the vessels, 
as represented, the calibre of the tubes ought to become less by the 
effect of violence applied to them—in other words, that derange- 
ment in any living part must add to the vital powers of that part, 
instead of taking away from those powers. 
In reply, it may be said that such a view of the vital powers 
would be contrary to every analogy. It would be assuming, con- 
trary to known fact, that the effect of disease is to render the body 
stronger than it was in a state of health ; or, in an analogous 
manner, that the more drops of sulphuric acid you let fall into a 
solution of carbonate of soda, the more carbonate of soda you will 
find in the solution. LOCAL PATHOLOGY. 
49 
If, as is reasonable to suppose, the object of the vital powers be 
the preservation of life ; and as the first step towards the destruc- 
tion of life is the disturbance or derangement of health, or of the 
natural condition of the living parts, it would be an inconsistency 
to infer that such a derangement can add to the strength or power 
of those parts. It may be said that health, in its most perfect state, 
consists in the highest power of vitality which the body can attain, 
and that any deviation from that state must be the effect of a dimi- 
nution, and not of an increase, of the powers upon which the phe- 
nomena of life depend. Health, then, being the natural condition 
of a living part, must consist in, or be the result of, its most perfect 
vitality; and disease, on the contrary, being also a state or con- 
dition of living tissue alone, must depend upon some abstraction, 
or neutralisation, of the vital properties of the part. In whatever 
point of view we examine the subject, we cannot infer a disturb- 
ance, or derangement, of the vital properties of the vessels of a part 
to impart any addition to the powers of life in them. In consonance 
with these views, let us analyse the effects of mechanical violence 
on the vital properties of the capillary vessels. 
There is no known reason why a blow, a puncture, or a cut 
should not act in a similar manner on the capillaries of all the 
tissues. Certain derangement takes place as a consequence; L it 
as the cause is of a general, and not of a specific nature, it must je 
supposed to produce the same kind of derangement in all the ves- 
sels within the sphere of its influence, in proportion to the degree 
of force acting upon them : at any rate, we are acquainted with no 
reason why the effect should be otherwise. 
But if such be the case, how are we to account for a degree of 
violence, in one instance, producing death, whereas, in another, no 
such effect follows, although the degree of violence, according to 
every proof, has been much greater? In one case, the effect may 
be erysipelas; in another, the formation of an abscess ; in a third, 
extensive sloughing of the cellular tissue ; in a fourth, gangrene of 
all the tissues of the part on which the violence has been exerted. 
In other cases, again, we find a mixture of these effects—we find 
erysipelas, abscesses, sloughing, and partial gangrene, all combined 
in the same limb. Now, the cause of this must be sought for in the 
constitution of the tissues themselves. As the mechanical violence 
is the same in all, we must look for the difference in the effect in 
the conditions of the parts which have suffered the injury; for it 
would be inconsistent with our knowledge of the operations of na- 
ture to suppose that the effect does not owe itself to some physical 
cause. This cause will be found in the difference of modification 
in the vitality of the part. For instance, the capillaries of one 
tissue may be in a state nearly, if not quite, healthy, while those 01 
another, in its immediate neighbourhood, may swerve one or more- 
degrees from that state. It is reasonable to suppose that the same 
degree of violence inflicted upon the two, in such different con- 
ditions, would produce different degrees of derangement of then 50 
DAVIES ON PATHOLOGY AND SURGERY. 
functions; and it, in fact, requires only this difference to stamp the 
character of the inflammation. The disease will put on characters 
according to whether one or more of the tissues suffer, and ac- 
cording to the degrees in which they respectively bear a part. The 
inflammation is, in general, a compound effect, proceeding from 
derangement of various tissues, and exhibiting, therefore, a mixed 
character; but it will also be considerably modified according to 
the grades of suffering of the different tissues. 
It was the opinion of John Hunter, that the character of inflam- 
mation could not be determined by the tissue affected, otherwise we 
ought to expect various kinds of inflammation to take place in an 
amputated limb, because the knife cuts through all the tissues alike. 
The same reason has been often repeated since, by authors in 
support of the same opinion. Let us examine its force. 
First, has it been proved that the same stump does not present 
different kinds of inflammation ? On the contrary is it not a fact 
that different varieties of the disease are observed in the same stump? 
In a great number of amputations, the degree of vital disturbance is 
so small that not sufficient inflammation follows the operation to 
impart a decided character to the disease ; but in those cases where, 
either from the violence of the injury which gave occasion for the 
operation, or from the peculiar modification of the constitution of 
the patient, inflammation is fully established, it cannot be denied 
that the disease frequently, nay, generally, does exhibit the mixed 
character resulting from the peculiarity of the affections of each 
tissue. So far as the skin is concerned, its vital derangement 
presents those distinguishing marks which characterise erysipelas. 
Its colour is of a bright crimson hue, like that of erysipelas ; its 
redness disappears on pressure, as in erysipelas; and it has a ten- 
dency to vesicate, as it has in genuine erysipelas. In this respect, 
therefore, the inflammation, as it affects the skin, is of the erysipe- 
latous kind from its commencement in a mere crimson blush, even 
to its highest degree, marked by vesication and death of the part. 
The subcutaneous or cellular tissue, also, puts on the character 
peculiar to itself while labouring under disease. If the inflam- 
mation be moderate, yet a degree above that which favours 
the exudation of the glutinous lymph, through the medium of 
which nature carries on the process of union, the cellular tissue 
gives exit to purulent matter, similar to that contained in the 
cavities of abscesses. In a higher degree of inflammation, the tissue 
shows its usual disposition to slough. As this tissue surrounds all 
the muscular fibres, inflammation of the muscles themselves will 
necessarily be modified by that of the cellular membrane which 
pervades, as well as envelopes, them. Indeed, we know but little 
more of inflammation of the muscular tissue than that the vessels 
of the muscles become fuller than in the healthy state, and that, in 
the highest degree of the disease, the blood stagnates in these vessels, 
and the tissue dies. 
It follows, therefore, so far as our observations extend, that the LOCAL PATHOLOGY. 
51 
facts connected with inflammation proceeding from the amputation 
of a limb, are in favour of the view that the character of inflam- 
mation is determined by the tissue affected ; for we find the disease 
differently modified in every tissue; and the modification observed 
in each tissue is similar to that resulting from the vital derangement 
of the same tissue under all ordinary circumstances. 
In the second place, even if the characters of the inflammation, 
in alliance with the different seats, were not so uniform as they 
really are, other causes might tend to modify them, and render them 
unlike in different cases. As we stated before, one tissue may be 
in a healthier or more natural condition than another, and the 
several tissues may vary materially in their condition with respect 
to the natural and healthy standard. This variation may owe 
itself to some original defect of constitution, as scrofula, or other 
hereditary causes ; or it may have been brought about by causes 
acting during life, by their relations or affinities with particular 
seats. In cases of this nature, it is reasonable to infer that a 
tissue whose condition is furthest from the healthy state, would 
suffer most under the influence of the same cause. In other terms, 
the same cause, acting upon several tissues, varying in the amouut 
of their natural vital powers, would affect those most whose powers 
are least—whose powers are lowest or most distant from the natural 
or healthy standard. 
From the foregoing observations, it would appear that inflam- 
mation arising from external violence will be first, in a degree pro- 
portionate to the amount of that violence ; second, that it will be 
characterised according to the tissue or tissues upon which the vio- 
lence has been inflicted ; and, third, according to the conditions, 
with regard to the amount of vital powers, of those tissues at the 
period of receiving the violence. Thus, a slight blow may cause 
inflammation so intense as to end in gangrene in a short time. We 
only know these conditions, or modifications of vital powers, from 
their effects ; but that they are dependent upon some peculiarity of 
the living tissues, is reasonable to infer, because the same mechanical 
cause—the violence—does not produce the same effect in all cases. 
In the next plaxe, we enter upon a consideration of causes whose 
nature is more hidden from our observation than that of causes 
connected with mechanical violence, namely, internal causes, or 
those whose relations with the vital tissues are of a more obscure 
character than the simple operation of external violence. The 
object of enquiry is the extent of our knowledge, or experience, 
respecting the influence of such causes in determining the character 
of inflammation. 
Now, there exist certain facts connected with inflammation, 
which show that the varieties it presents are not accidental, but 
that they are determined by some physical causes which act simi- 
larly on all constitutions. Nothing can prove this point more 
satisfactorily than the circumstances attending specific inflammation, 
although differing in degree and modification in almost every case, 52 
DAVIES ON PATHOLOGY AND SURGERY. 
yet the'general aspect of each species is so much alike in all, that 
the mind cannot reject the conviction that there exists a similarity 
of causes for the same disease in each individual. Whether we 
view the venereal inflammation, the scrofulous, the gouty, the 
variolus, or whatever other species of the specific kind, the pro- 
minent characters of each, in different persons, are so nearly alike, 
that the rational inference to be drawn from the phenomena is, that 
a similar cause, though differently modified in some respects, acts 
upon the same tissue in every case, though the tissue also may 
be modified differently in each. The condition of the tissues, 
as before observed, may either depend upon their original formation 
—upon an innate defect of vital energy in them—or upon a change 
having taken place during life, by the gradual operation of physical 
causes. 
In illustration of the same properties in the animal body, we 
may notice the effects of different medicines. Medicine like the 
morbific poisons acts as a physical cause upon the vital structure. 
It is well known—indeed, this knowledge forms the very foundation 
of our practice—that almost every medicine acts specially upon 
some seat. That many substances exert, besides, some general 
action on the various parts is very probable; but we have sufficient 
proof that each bears a special relation to some seat more particu- 
larly than to any of the others. For instance, mercury exerts its 
influence more especially on the salivary glands; ipecacuanha on 
the nerves of the stomach ; sulphate of magnesia on the mucous 
surface of the small intestines: opium on the brain, &c. In fact, 
there exists scarcely a medicine of any activity which is not well 
known to exert some special influence upon some particular organ 
or tissue : so that, in nineteen instances out of twenty, its effect in 
that respect may be depended upon. The same effect is produced 
whether the medicine be introduced into the body by the stomach, 
by injection into a vein, or by absorption from the surface: which 
proves that it is not the result of mechanical action or of local irri- 
tation simply, but that there exists a necessary relation or affinity 
between the properties of the medicine and those of the seat or tissue 
whose functions it modifies. 
As medicines exert their influence upon some particular seats or 
tissues in preference to others, and as this effect is found to take 
place almost uniformly, even when they are administered to indi- 
viduals differing in general habits and constitutions, it cannot but 
be inferred that the same tissues, in all individuals, possess a great 
similarity of properties, and that they are liable to be affected by the 
same causes. 
Our knowledge respecting the manner in which medicines act 
on the different tissues, is not of that positive kind which will justify 
us in laying down practical rules; but we may be justified in in- 
ferring that other substances introduced into the system, though not 
coming under the denomination of medicines, will also act upon 
some seats or tissues rather than upon others. With the exception. LOCAL PATHOLOGY. 
53 
perhaps, of those substances which exert their influence directly on 
the nervous system, we know of no way in which medicines can 
act on the various parts but by being first conveyed to those parts 
in the common course of circulation. It will, probably, be said, that 
cathartics are also exceptions to this rule—that their action depends 
upon the irritation they are supposed to cause on the nervous mem- 
brane of the intestines. In support of such a supposition there is 
no proof. Indeed the proof exists on the other side, namely, that 
the ingredients first enter the circulating tubes, and are conveyed 
through the medium of the blood to the parts upon which they exert 
their influence, because, when injected into the veins, or are made 
to be absorbed from the surface of the body, they still act upon the 
same special seats as when applied directly to those seats. 
It cannot be denied that the body is liable to imbibe various 
materials, from the external world, that bear injurious relations to 
it. Besides the stomach, into which matter in almost all possible 
modifications is received, at various times, the lungs, and the whole 
surface of the body, present a sufficiently extensive area for the 
admission into the system of morbific causes. The history of 
malarious diseases in all countries, and the facts which present 
themselves daily to our observation respecting the small-pox, and 
other exanthematous disorders, furnish abundant proof of the apti- 
tude of the animal body to admit substances whose physical opera- 
tions are injurious to its well-being. 
Now, in every specific disease we find the same seat affected in 
almost all individuals labouring under it. Syphilis affects the 
tonsils first; then the skin ; then the periosteum of the tibiae. It 
might be asked, why does it attack these bones more than others? 
The only answer we can give is, that these bones, or their perios- 
teum, are differently modified from all the others, and that, conse- 
quently, their relations are different. If the periosteum of the tibiae 
is modified according to its own kind, the vessels by which it is 
manufactured, nourished, and preserved must be also modified 
differently from those of the periosteum of the other bones, and must 
therefore, have their peculiar relations or affinities modified. Facts 
of this kind are not to be rejected because we cannot tell why they 
should be as they are, for we are equally ignorant of the “ why” an 
acid should have the power of changing the properties of an 
alkali. 
Again, variola, and other cutaneous diseases, intermittent and 
remittent fevers, <fcc., present the same leading characters in all 
cases. It is true that they differ materially in degree; but they 
affect the same parts and exhibit similar symptoms, in every case. 
In truth, were it not for this uniformity of character, we should 
have no means of knowing them to be what they are. It is the 
resemblance of the most prominent signs of a disease in all consti- 
tutions that enables us to distinguish one disease fiom another, and 
that forms the foundation of all classifications. Iruly, in most of 
our nosological classifications, diseases are classed together which 54 
DAVIES ON PATHOLOGY AND SURGERY. 
have very few properties in common ; but that is not the fault of 
nature but of art: nature is uniform in her operations, however 
changeable art may be. 
In well known and long observed specific diseases, whether 
general or local, their identity is exhibited in all constitutions. 
However various the modifications may be, still their prominent 
characters cannot well be mistaken. But affections of a more irre- 
gular occurrence, and the causes of which are not so general in 
operation throughout nature, do not present themselves to our notice 
in the same definite and striking manner as those termed specific, 
or even as those arising from epidemic or endemic causes. In one 
instance we find “spontaneous” inflammation take place in the foot; 
another time in the leg ; another time in the knee ; in another case 
a whitlow occurs ; in another a diffused inflammation of the 
integuments of the face and head ; in another an abscess of the 
liver; a carcinomatous tumour of the breast; the development 
of pulmonary tubercles, &c. These, and numerous other affec- 
tions not owing their production usually to causes acting upon 
a general scale have been considered more obscure in their origin; 
and they have not been traced up to their sources, like those 
dependent upon specific, or epidemic, causes. 
But the question is, do these, or do they not, owe their existence to 
physical causes, as regular in their operations, when applied to the 
body, as those which give origin to syphilis, variola, intermittent 
fever, or any well known malady? Are they the effects of real 
physical laws, or do they break out “ spontaneously” in the strict, 
sense of the term? 
We can form no idea of a change taking place in any part of the 
body without its being brought about by something possessing a 
substantive existence. If a part is originally perfect, it must con- 
tinue perfect, unless changed by the intervention of something which 
bears an unhealthy or abnormal relation to it. Let us suppose all 
the tissues entering into the composition of the kindney to be in a 
real state of perfection—that is, to be in a state of absolute health, 
or possessing the highest degree of vitality of which they are 
capable : we can form no idea of the organ changing from this con- 
dition so long as the satne causes which kept it therein continue to 
operate. It could no more start spontaneously from a healhy to a 
morbid state, than a piece of chalk could transfer itself spontaneously 
into plaster of Paris. In both cases there must be the interposition 
of some new ingredient, which, by playing its part as a cause, serves 
to modify the properties before connected with the body. In the 
case of the piece of chalk, there must be the interposition of sulphuric 
acid, which destroys, or considerably modifies, all the properties 
which the chalk possessed, and gives existence to others possessing 
new characters. In the kidney, the change must be analogous from 
the really healthy to a morbid state. Some physical cause must 
interpose its properties, and thereby modify those of the organic LOCAL PATHOLOGY. 
55 
tissues, so as to reduce the quantum of their vitality below the 
degree which marked it before. 
The same principle will apply to every tissue in the body. 
When its condition is changed, the change must owe its existence 
to the intervention of a new cause. 
As the blood is the common pabulum for the supply of all the 
tissues, it is very probable that it is also the vehicle which conveys 
substances deleterious to those tissues; and that the relations of 
substances, so conveyed, are formed in the different seats, in the 
manner found to take place in specific diseases. They may pass 
through the capillaries of various seats without disturbing their 
functions, or producing any derangement of their vital properties ; 
but when arrived at a seat with the properties of which they bear 
such a modification of affinity as to excite a disturbance of their 
vital arrangement, the vessels of that seat—being the labourers by 
means of which the material fabric is kept in repair—loose a portion 
of their vitality: in other words the vital properties are changed ; 
their contractility is diminished ; their calibre is increased, by virtue 
of their innate elastic power; the velocity of the blood through them 
becomes less, although the quantity existing in them is greater, 
than natural ; all the phenomena of inflammation take place differ- 
ing in degree according to the scale of vital derangement, and in 
modification according to the tissue affected, and its condition in 
relation to the healthy standard at the time of the action of the 
cause. 
From the view we have taken of the morbific cause of inflam- 
mation, there exists no necessity for assigning any mechanical ob- 
struction to the capillary tubes. M. Magendie in the last of his very 
interesting lectures,1 appears to attribute the origin of common 
inflammation to obstruction, as many pathologists did before. It 
cannot be doubted that the microscopical appearances of a part 
commencing to inflame, are such as might be expected to show 
themselves from obstruction in the capillary tubes. The motion of 
the blood, at a certain point, diminishes so much as to give the 
appearance of its being obstructed in its passage. The vessels, at 
the same time, increase in fulness and redness; and these appear- 
ances extend rapidly to the neighbouring tubes, as if the fluid were 
driven in torrents to the collateral channels in consequence of 
obstruction to its natural course. 
But a moment’s consideration must satisfy us, that a mere 
mechanical obstruction in a capillary tube cannot occasion the 
phenomena just described. We do not find such an effect follow 
the tying of a larger branch, where complete obstruction is produced. 
The blood directs its course, or its course is directed, to the 
collateral branches, without occasioning any disturbance in these 
branches resembling inflammation. The collateral tubes very soon 
adapt their calibre to the additional quantity of blood sent into them, 
1 Published in the Lancet. 56 
DAVIES ON PATHOLOGY AND SURGERY. 
and no functional disorder takes piace. Now, if an obstruction of a 
considerable arterial branch may be produced with so little disturb- 
ance to the circulation, and if the subsidiary branches so readily 
adapt themselves to the additional duty imposed upon them, of 
giving transit to an increased quantity of blood, it would be almost 
an absurdity to suppose that the mere obstruction of a single 
capillary tube could give rise to phenomena like those of inflam- 
mation, where myriads of collateral tubes surround it on all sides. 
It is probable that fifty anastomosing ramuscules would join within 
the fiftieth part of an inch of any part in a capillary tube where the 
molecular obstruction might be supposed to occur; and amongst so 
many channels of conveyance in the immediate neighbourhood, any 
obstruction of a single tube, or of fifty tubes,'would create little dis- 
turbance to the circulation. 
The only manner in which an obstruction can be supposed to 
cause inflammation is, not by acting mechanically in blocking up 
the passage of a capillary tube, but by the deleterious relation sub- 
sisting between the obstructing object and the coats of the vessel, 
thereby giving rise to a disturbance, or in more common terms, 
producing irritation, of those coats ; the necessary consequence of 
which irritation or vital disturbance is the abnormal dilatation of 
the obstructed vessel, followed by the other phenomena of inflam- 
mation. Whether inflammation ever originates from such a cause, 
can be a mere matter of surmise. If the affirmative opinion be 
adopted, we must also adopt the doctrine of error loci; for it is 
evident that the moving molecule could not become impacted unless 
it entered a tube too small to permit it to pass through. However, 
the being obliged to admit such an opinion is no reason for rejecting 
a fact, provided the fact itself has been proved. 
The microscopic phenomena observable in a point commencing 
to undergo the process of inflammation, are so like those which 
might be expected to arise from obstruction, that it is not to be 
wondered at that they should have been mistaken for those of 
obstruction, by pathologists who entertain the common notions of 
inflammation. The first sudden application of a stimulus, whether 
to the web of a frog’s foot, or to the capillaries of any part of the 
human body, causes, perhaps in all instances, for a moment, an 
unnatural contraction of the vessels; but this momentary contrac- 
tion is succeeded by a preternatural dilatation, and by a diminished 
velocity of the blood within the tubes. Whether the momentary 
increase of the contractile force be an effort to resist the influence 
of the deleterious cause, by inducing the vessels to draw their parts 
together into the smallest compass, and to condense their properties 
into the most compact state, may be a matter of dispute, but it is 
indisputable that the vital powers are soon subdued, and that the 
preternatural contractile efforts are immediately obliged to succumb 
to the influence of the morbific cause. 
As soon as the vessels begin to relax, after the application of a 
stimulus, whether that stimulus be the prick of a needle, or some- 57 
LOCAL PATHOLOGY. 
thing else applied to the vital part, the motion of the blood imme- 
diately diminishes, and the fluid appears to the sight as if something 
obstructed it in the tubes. As the vessels continue to enlarge, the 
velocity becomes less ; and as the enlargement extends by continuity 
to the neighbouring capillaries, the part puts on an appearance as 
if the blood rushed into the collateral branches owing to an 
impediment to its course in one of the canals. It is evident that all 
this appearance cannot take place from the stoppage of one tube 
among a million—that such an accumulation of blood, and such 
intense redness, cannot owe their existence to such an insignificant 
impediment in the middle of so wide a channel. On the other hand, 
an appearance like that described must be the natural consequence 
of an inordinate expansion of the capillaries extending from a single 
point. 
Admitting the facts adduced in the present section we may be 
permitted to conclude, 
1. That the most prominent characters of inflammation are 
dependent upon the tissue affected. 
2. That every variety of inflammation—in other words, that in- 
flammation of each tissue—is modified considerably according to 
the nature of the cause producing it. 
3. That every variety of the disease is also modified according to 
the condition of the tissue affected. 
4. That every variety is likewise modified according to the 
general condition of the system; which, of course, embraces the 
condition of each tissue. 
5. That the same cause may produce more than one variety of 
the disease, by acting upon more than one tissue. 
6. That the nature and properties of each tissue are determined 
by its nutrient vessels. 
7. That the vital properties of the nutrient vessels are differently 
modified in each tissue, so as to suit them for the special purposes 
of the tissue. 
8. That, therefore, the vessels of all the tissues are liable to be 
affected somewhat differently, and in a different degree, by the same 
cause. 
Condition of the Blood in Inflammation. 
In the lectures to which an allusion has been made, M. Magendie 
seems to attribute inflammation in general to the condition of the 
blood alone. His views are founded upon experiments of whose 
correctness we entertain no doubt; but the conclusions which he 
draws from them are remarkably worthy of doubt in a practical 
point of view. . 
The facts are, that defibrinised blood or blood whose nbiine 
is deficient* in proportion to its other ingredients, is liable to, an 
generally does exude through the coats of its vessels m dineien sea s, 
and gives to these seats, when examined after death, the appearances 58 
DAVIES ON PATHOLOGY AND SURGERY. 
of being in a state of inflammation. Also, that some of the tissues 
of an animal whose blood has been defibrinised are subject to 
redness and ulceration. 
Now, with regard to the redness observable, on post mortem 
examination, in animals whose blood has been defibrinised, it cannot, 
if dependent on transudation of the blood, as we believe it is, bear 
any analogy to inflammation. The redness is, probably, the only 
element of inflammation existing. As the morbid appearance depends 
upon a cause similar to that which gives rise to the eccbymosed 
spots of scurvy, of petechise or the livid spots which often take place 
in those who have been long confined in jails, there is reason to 
infer that the exudation is unattended both by heat and by pain. 
With regard to the swelling•, it can amount to no more than what 
depends on the quantity of fluid extravasated, for the blood is defi- 
cient in that very ingredient to which the permanent swelling of 
inflammation is owing, namely, fibrine. 
But it will be said that ulceration takes place, and that ulcera- 
tion cannot occur without inflammation. If it be insisted on that 
the ulcerative process can in no instance go on without being pre- 
ceded and accompanied by inflammation, then it must be admitted 
that the morbid appearances observable in animals whose blood has 
been deprived of the greater part of its fibrine, are those consequent 
on inflammation. But it would be almost as reasonable to insist 
upon every function in the body to depend upon an inflammatory 
operation, as to insist upon ulceration being so in every instance. 
In instances of emaciation from want of food, there is a removal of 
structure upon a large scale, but no one will attribute it to an in- 
flammatory process. There is an instance recorded where the sto- 
mach consumed a portion of itself after death. It is presumed that 
it will not be insisted on, that the process here adopted by the self- 
consuming organ was that of inflammation. The ulceration which 
characterises a chancre is often unattended by the least appearance 
of inflammation. If these facts be admitted, it is possible to account 
for the ulceration of some of the tissues in animals whose blood has 
been defibrinised. 
When the blood has been defibrinised, it must, of course, be in 
an abnormal state. This alone would render it unfit for the nu- 
merous transformations which it is intended to undergo in the 
various structures. But, deprived of its fibrine, it has lost that 
very quality by means of which, principally, the structure of the 
body is renovated after the removal of the old materials. Absorp- 
tion goes on, but the renovating elements are wanting, so that the 
secerning function is at a stand still. The absorbing process, no 
doubt, exceeds the secerning in all parts of the body, so that there 
is a universal course of emaciation going on in the system: but 
the privation does not show itself in the form of ulceration, except 
in parts void of epidermis. From the softness and sponginess of the 
mucous membranes, they are the most likely to be the first to put LOCAL PATHOLOGY. 
59 
on the appearance of ulceration in consequence of the excess of 
absorption over the renovating process. 
We have observed frequently before, that nature has implanted 
an innate disposition to self-preservation in all bodies. As the 
blood is the common pabulum from which all the structure derives 
its renovating elements, and, consequently, upon which the main- 
tenance of the whole fabric depends, it is probable that, in cases of 
accident, or where artificial means have been used to deprive it of 
an essential property, the vital efforts of the whole system would 
be directed towards restoring to it that property. Why does nature 
shoot out roots from a willow branch stuck in the ground? Why 
does she restore the head of a snail? the arm of a newt? why heal 
a wound? restore a piece of nerve? unite a fractured bone? The 
why of these things we are not able, and never shall be able, to 
find out, although we may discover the processes employed for 
bringing about the effects. The blood being one of the most 
essential agents for the preservation of the animal, the absorbent 
functions, in cases of defibrination of the fluid, may assume an 
action sufficient to take up a part of the fibrine already laid down 
in the form of structure, in order to restore its lost quantity to the 
common pabulum. 
But that the condition of the blood exerts an influence on in- 
flammation, is highly probable. Indeed, we are not acquainted 
with any mode in which the morbific cause of the disease can find 
its way to the different seats except through the medium of that 
fluid. Whether the original application of the poison be to the 
stomach, to the lungs, or to the surface of the body, the vehicle by 
which it is conducted to the various seats must be the blood. As 
this is the case, it must follow that this fluid is liable to deterioration 
of properties, like the solid structure; for every thing which is cal- 
culated to reduce it to an abnormal state must be injurious to it as 
a vital agent. 
It is a question well worthy of consideration—but one which 
can only be satisfactorily decided by experiments founded upon a 
more correct knowledge of the chemical and vital properties of the 
blood than at present possessed—how long the morbific cause of 
disease may exist in the mass of blood before exerting its affinities 
and exhibiting its effects on the solid parts? As a second part of 
the enquiry, it would be desirable to determine how long, if any 
time, after having acted in a way to produce morbid symptoms, the 
morbific cause continues to exert its influence on the seat of disease? 
That the morbific cause continues, in some instances, to circulate 
for a considerable period in the mass of blood, before imparting its 
deleterious influence to the solid structure, is probable, from some 
facts connected with the origin of certain diseases. Foi instance, 
in intermittent and remittent fevers, the noxious vapours aie fre- 
quently in connection with the body for a considerable peiiod before 
the disease developes itself. Some constitutions suffer sooner, and 
some later, proving that those who suffer last were exposed to the DAVIES ON PATHOLOGY AND SURGERY. 
morbific cause from the first, equally with those in whom it pro- 
duced a sooner development of the malady. From this circum- 
stance, it is not improbable that a certain quantity, or a certain 
density, of the cause is necessary before the vital properties of the 
structure can be made to submit to its influence. As those proper- 
ties differ in their degree of vigour in different constitutions, as 
numberless facts go to prove, one person may so far resist the ope- 
ration of the cause, as not to present actual symptoms of disease, 
twice or three times as long as another, though, doubtless, some 
portion of the power of the system has been abstracted by its 
influence before the actual breaking out of the malady, or before 
disease manifests itself by symptoms. 
If the blood can become loaded with morbific poison, and remain 
so for some time previous to the development of disease, it is rea- 
sonable to suppose that it may continue to retain the same noxious 
cause after its effects have shown themselves in connection with 
the solid structure. During the continuance of the exposure to 
the same deleterious influence, the body must go on receiving new 
portions of the same poison, and, of course, the blood cannot purify 
itself of it while the external circumstances continue unchanged. 
It will perhaps be asked, if such be the case, how is it that the 
system ever rids itself of the noxious influence while remaining in 
the same locality? As it is a fact that it does so—that intermit- 
tents and remittents get well of their own accord, in localities and 
at periods where and when others are falling under the influence 
of the malaria—it must follow that the system is endued with some 
inherent power of relieving itself from the effects of the poison. 
It is evident that the restoration of the vital power is not dependent 
upon the removal of the cause which first produced the disease, 
because the same cause still continues in operation, as-proved by its 
action upon others ; but it is equally evident that the morbid rela- 
tions of that cause with the vital parts have changed, otherwise 
the effect must still continue the same as at first. It follows, there- 
fore, that the change which has rendered the operation of the poison 
innoxious, must have occurred in the system itself. 
The only mode in which the living parts can be supposed to 
have acquired a new power of resistance, is by modifying their 
properties in such a way as to render themselves proof against the 
affinites of the morbific agent. A power analogous to this seems 
to be inherent equally in animals and vegetables, by means of which 
they are able to neutralise themselves under external circumstances 
foreign to their original habits and conditions. 
But that the cause, which originally gave rise to the disease, fre- 
quently continues to exercise its influence upon the body long after 
the development of the malady, is proved by the recurrence of the 
paroxysms of intermittent and remittent fevers. The former of 
these will often keep on long after the removal of the subject of it 
from a repetition of the influence of the original cause—that is, the 
action of the poison. LOCAL PATHOLOGY. 
Now, the principle which applies to the operation of a general 
morbific cause, will apply equally to that whose sphere of action is 
more limited. It probably seldom happens, in cases of local dis- 
ease, except where mechanical or chemical violence has been ap- 
plied to a part, that inflammation is set up by one application of 
the cause—a single dose of poison—to the tissues whose vital pro- 
perties are disturbed. 
We have already endeavoured to prove that such a thing as 
“spontaneous disease” can have no existence, and that diseases 
whose causes are not capable of being visibly shown are still the 
effects of causes not less physical in their nature. We have also 
shown it probable that the blood is the common vehicle of morbid 
poisons, as well as of nutrition. These points being admitted, it 
may also be readily supposed, considering the circumstances 
attending the operation of endemic causes, that the blood may 
long continue to hold in suspension, or in union, a quantity of the 
same morbific elements which gave rise to a local disturbance, after 
the first development of the inflammation. If this be the case, we 
may account for the obstinancy in some cases, and the rapid pro- 
gress in others, of the inflammatory process: because the seat of 
disease receives an incessant supply of the same elements which 
first produced the vital disturbance. We may illustrate this point 
by the circumstances attending hospital erysipelas, and, indeed, 
erysipelas in general, as well as peritoneal inflammation, especially 
of the puerperal kind. It is probable that most of the eruptive in- 
flammations are supported in an analogous manner, until their term 
of existence has become extinct, from exhaustion of the poison 
which gave rise to them, or from its emission from the system. 
In inflammation of any extent, the blood, when taken by vene- 
section, puts on a well known appearance, called the “buff-coat.” 
This appearance is considerably modified by the manner in which 
the blood is abstracted; by the shape of the vessel into which it is 
received ; by the quantity drawn into it, and by various other 
causes. Although the firmness of the coagulum, and the thickness 
of the buff-coat, differ in degree according to the above causes; 
and although the blood sometimes does not show any of these 
appearances in inflammations of some magnitude, yet they are so 
generally attendant on it, that it is not easy to dissociate the idea of 
a necessary connection between them. 
The buff-coat is nothing more than a layer of fibrine, but why, 
or owing to what physical properties, it separates itself from the 
other ingredients of the blood in cases of inflammation, in cases of 
pregnancy, &c., it is not so easy to determine. Merely to state the 
fact, that the coagulation forms more slowly in these cases than 
during the normal state, so as to allow more time for the red 
globules to subside before they are entangled in the meshes of the 
fibrine, will not account for the physical cause of the difference in 
the quality of the fluid; for it may be demanded, wliy does the 
blood coagulate less quickly in inflammation than when taken from 62 
DAVIES ON PATHOLOGY AND SURGERY. 
a healthy body? But, in truth, it may be much doubted, until 
further observations on the properties of the blood be made, whether, 
as a general rule, the process of coagulation be slower in cases of 
inflammation, than those where that disease does not exist. That 
it sometimes proceeds very rapidly, is a fact well established by 
observation. 
To discuss this subject so fully as it merits, as a general question, 
would occupy more space than can be here allotted to it; but it 
may be suggested as probable, that the firmness of the coagulum 
in these cases bears some ratio to the reduction of the vital proper- 
ties of the blood, either by the influence of the morbific cause of 
the disease, or by the abstraction of the red globules by venesection. 
Where the disposition to form the buff-coat exists, if any number 
of portions of the same blood be drawn at the same time into dif- 
ferent vessels of the same shape and size, the consistence of the 
cake will, in general, be found to vary in them all. The quantity 
of serum expressed, and the density of the coagulum, will be least 
in the portion drawn first, and both will increase in the order in 
which the different portions were abstracted. But this will only 
hold good as a general rule, for the visible qualities of the blood some- 
times change so suddenly as to render it difficult to assign any 
physical cause for the alterations. Blood abstracted during the cold 
stage of an attack of inflammatory fever will often not present the 
slightest appearance of bufiiness, whereas another portion drawn 
an hour afterwards will be as buffy as any inflammatory blood. On 
the contrary, inflammatory blood will sometimes cease to be buffy 
after the first or second bleeding, though by far more commonly this 
quality increases in proportion to the quantity abstracted. 
It may be also noticed, as a general rule, that the thinner and 
more emaciated the patient is, the denser, and generally the quicker, 
the coagulation will be. In such constitutions, the blood presents 
the appearance of buff in the most trifling cases of inflammation; 
whereas in strong, robust, especially fat, individuals, the fluid often 
exhibits hardly any buffiness, even in severe cases. The buff, as 
by far the more general rule, bears an inverse ratio to the vital 
powers of the system. 
It may be asked, why should the blood exhibit the buffy quality 
in cases of pregnancy? There is here no inflammation—no 
abnormal condition of the system—for pregnancy is as much a 
natural process as the digestion of the food or the contraction of 
the heart. But, during pregnancy, there is a new and additional 
draft upon the constitution set up. The vital powers of the mother 
are obliged to be divided between herself and her child. There is 
an abstraction of the natural quantum of blood from her, by the 
amount which goes to nourish her progeny. The effect of this 
cause upon the condition of the blood appears to be similar to the 
abstraction of a part of it by venesection—that is, the removal of a 
portion of the red globules from her system, so as to cause a dis- 
proportion between them and the more fluid part of the mass. LOCAL PATHOLOGY. 
63 
These statements contain nothing more than the general facts; 
the physical causes upon which the effects depend ought to be traced, 
both by experiments and by inferences founded upon those experi- 
ments, much more minutely than they have hitherto been. As 
there are many grades between the effects observable in the blood, 
and first causes (into which it would be useless to enquire,) there 
is here a field, sufficiently wide, open for research. 
In the mean time, it may be suggested as probable, that the 
coagulation of the blood is a vital process: that it is the last effort 
of the fluid to retain its identity, by drawing together into the 
smallest compass of which its forces are capable, those ingredients 
in it—the red globules and fibrine—in which reside the properties 
most essential to its character as living matter. If deprived of this 
last resource for some time after being drawn from its natural habi- 
tation—the channels in which nature destined it should live—it 
entirely loses the coagulating property, and no power with which 
we are acquainted can restore that property to it. 
Influence of the Nerves in Inflammation. 
It appears to be the opinion of many, perhaps the greater number 
of physiologists, that the nerves are the sole agents of vitality. If 
that be the case, they must also be the sole subjects of disease; be- 
cause nothing but a living tissue can be liable to disease. The 
nerves and electricity are the two most convenient agents in nature, 
for the former will enable us to account for all the otherwise unac- 
countable phenomena in the animal body, and the latter will readily 
supply the defect of our knowledge respecting the rest of the mate- 
rial world. So useful and accommodating, indeed, are these two 
agents, that, in the absence of the one, the other, under the direc- 
tion of some expert savans, has been made to supply its place. As 
a muscle will not move, and a gland will not secrete, when their 
nerves have been divided, the whole of each function has been 
attributed to these agents. But it happens, also, that neither mus- 
cular contraction no secretion will be performed if the arteries of 
the muscle or of the gland be entirely obstructed. As a crowning 
proof, not only that the nerves and electricity are almost almighty 
agents, but that they are also identical, a muscle has been made to 
move, and secreting surfaces have been made to throw out fluid, by 
the application of electricity alone, after the presiding nerves have 
been divided. But it happens that the prick of a needle will pro- 
duce the same effects. Will electricity cause the secretion of gastric 
juice, or any other juice, ten hours after death? or will the two 
agents combined move the fibres of a muscle at the end of that 
period after the heart has ceased to act? 
But, although the nerves do not constitute the whole animal eco- 
nomy, still it will not be denied that they act an important part in 
it. When the combined acts of many agents are necessary to the 
performance of the functions of each, it becomes difficult to deter- 
mine how much is due to one, and how much to another. DAVIES ON PATHOLOGY AND SURGERY. 
Now, it is impossible to separate all the nervous fibrils from the 
rest of the structure; it is therefore impossible to prove that a vital 
part would retain its life for any time in the absence of all nervous 
influence. We do not knouj that the nerves impart no properties 
to, and exert no influence on, the rest of the structure, after their 
communication with the brain has been cut off by division ; but we 
know the fact, that a part will live, and that the blood will circulate 
through it, after the nervous communication between it and the 
brain has been destroyed. We know, also, that the visible phe- 
nomena of inflammation may be produced in a part so circumstanced 
—that, upon the application of stimuli, its vessels will expand, and 
admit more blood than they contained before. 
But, as might be expected when we consider that the vital phe- 
nomena are dependent upon the combined operations of all the 
functions, the power of maintaining its vitality by a part deprived 
of its nervous communication with the brain has its bounds. 
If the ischiatic nerve of a rabbit be simply divided, although its 
ends retract about the eighth of an inch, yet a union is very soon 
formed by the production of new matter. It is several weeks 
before the animal recovers its feeling, and gets rid of its lameness, 
but the nervous influence is sufficient to secure the vitality of the 
part. But if a considerable portion of the nerve be cut out, or if 
divided and its ends be placed in such positions as to prevent their 
union, the limb will generally slough in a week or ten days. The 
circulation in it will go on, apparently, tolerably well for a few days, 
but when it once begins to slough, the sloughing proceeds most 
rapidly, so that, in the course of two or three days, nothing but the 
bones and tendons remain. 
These facts prove two things: first, that vitality continues in a 
part, and that its vessels will perform their functions, although its 
nervous communication with the brain be cut off; and, second, 
that the organic life of the arteries is not dependent upon the rami- 
fications of ganglionic nerves following the course of the vessels 
from their origin in the chest and abdomen, as supposed by some 
physiologists; because, if so, there is no reason why the limb sup- 
plied by vessels so vitalised should die. If it be maintained that 
the (supposed) organic nerves are contained in the same sheath 
with the ischiatic nerve, then it is evident that they are not the 
agents which confer vitality upon the arteries and the mixed struc- 
ture, for both the arteries and the other structures continue to live 
for several days after the sheath has been divided. 
But that the nerves bear an essential part in the process of in- 
flammation, is evident from the pain which usually attends the 
disease. As they are the sole agents of sensation, so must they 
be the media which acquaint the seat of sensation of the vital dis- 
turbance going on in a distant part. Moreover, the nerves, like all 
the other tissues, are preserved and renovated by the agency of the 
arterial extremities, and the elements upon which their very exist- 
ence depends are regularly supplied to them from the common SURGERY. 
65 
pabulum. This furnishes the materials upon which the vessels 
exert their vital powers. Being thus dependent upon the due per- 
formance of their functions by the capillary vessels, it must follow 
that they suffer, like the other tissues, when these functions are 
disturbed. 
PART II. 
SURGERY. 
GENERAL REMARKS ON LOCAL THERAPEUTICS. 
The principle of the division of labour is carried to a consider- 
able extent at the present day in all departments, and we are not 
aware that harm can arise from it in the medical profession, provided 
the members of that profession be originally well grounded in a 
knowledge of its general principles. In the surgical department, 
certain dexterity will be acquired by constant practice, which will 
give the possessor of it an advantage, in intricate operations, over 
those who are less often called upon to exercise their manual skill. 
This manual tact, however, is less required in modern times than 
formerly, for, happily, the application of a more correct knowledge 
of the principles of disease, and of the properties of therapeutic 
agents, to the removal of local affections, have rendered the em- 
ployment of the knife seldom necessary now, compared with the 
frequency of its use some half a century ago. It must be consi- 
dered, also, that the division of labour in the medical profession, 
however unobjectionable in itself, can only be applied to a small 
portion of the community—those inhabiting large towns—for the 
greater part must always rest satisfied with deriving the benefit of 
both medical skill and manual dexterity from the same individual. 
But the grand principle, which should never be lost sight of, is, 
that disease is the same in its nature whether situated externally 
or internally. The first question to be determined is the seat of 
the malady; and the second is, in what manner is that seat affected? 
With regard to outward affections, we have the advantage of the 
direct evidence of our senses, which, combined with our previous 
experience, will give us at once a tolerably correct knowledge of 
of their visible characters. We are capable of examining the con- 
dition of the part affected by the medium of the strongest evidence 
we can possess, and, therefore, except in instances of extreme 
ignorance, the two first difficulties, compared with internal diseases, 
are got over with satisfaction. 
But, however simple this part of the business may appear, still, 
in order to turn our examination to practical use. it is necessary to 
know something more than that the leg is the limb affected, and 66 
DAVIES ON PATHOLOGY AND SURGERY. 
not the arm; that the part is red, not pale; that it is hard, not soft, 
&c. These, truly, are facts with which it is necessary to be ac- 
quainted, but they may be acquired as well by the most ignorant 
as by the most renowned surgical practitioner. He who is unac- 
quainted with the properties, both natural and pathological, of the 
blood-vessels, and with the characters of diseases as they affect the 
different tissues on and near the surface of the body, may exercise 
his senses as long and as intensely as he please, without being 
able to form any rational idea of the nature and tendency of the 
malady. 
If the disease be the same in its nature, whether occurring in the 
interior of the body, or on, or near, its surface, it will appear clear 
that those remedies which are calculated for subduing internal af- 
fections may be usefully employed in external diseases. In out- 
ward diseases we possess the further advantage of being able to 
direct our remedies to the immediate seat of the malady. 
Now, it may be asked, in what manner do external remedies act 
in subduing disease? Before the question can be answered, it is 
necessary to say a few words respecting the nature of different 
diseases. 
In every tissue of which the body is composed, there are certain 
processes unceasingly going on towards the preservation of its 
vitality and the maintenance of its structure. The first of these 
is the essential one by means of which the molecules of matter are 
deposited, and which is usually called the secerning process. The 
absorbent process may be considered in some degree as the oppo- 
nent of the former, although in the healthy state, they rather suc- 
ceed than oppose each other. Into the nature of that influence 
which the nerves exercise in these operations it is not our intention 
to enquire here, but that the three functions are essential to each 
other, is well known and generally acknowledged. Whether there 
be distinct vessels from the arteries themselves whose office it is to 
secrete, and distinct vessels from the veins whose office it is to 
absorb, is a subject foreign to our present enquiry; for the action of 
therapeutic agents may be equally accounted for according to either 
opinion. In health the two functions bear a certain ratio to each 
other. Those particles which are deposited by one set of vessels, 
are removed in their turn by another set, and an equilibrium is 
kept up. But during the progress of disease, this equilibrium is 
destroyed, and it is worthy of special consideration that the pre- 
ponderance is almost always on the side of secretion. It is seldom 
that the diseased part is removed by absorption, for when destroyed 
by ulceration the process is generally that of gangrene or sloughing, 
which is a destruction alike of all its vital properties. 
WThether the secerning vessels be a class distinct from the arte- 
ries, or whether the secerning and secreting functions be carried on 
by the capillary extremities of the arteries themselves, it is highly 
probable, as they are the agents which lay down the materials of 
all the structure, that they are implicated in every derangement SURGERY. 
67 
which takes place in any of the tissues. As, also, the elements of 
all the tissues are derived from the blood, which must pass through 
the capillary extremities of the arteries, the secreting vessels, if not 
these capillaries themselves, must be continuous with them, for the 
particles which constitute the structure must have traveled through 
both. 
We have stated that when a part is undergoing disease, the se- 
creting function generally overcomes the absorbent, which causes a 
preternatural deposite of matter. This is usually the first step 
towards the disorganisation of the structure. The question to be 
now considered is, how does this condition of the part happen? 
It may, and probably generally does, owe itself to causes: first, in 
consequence of the vital derangement of the capillary or secreting 
vessels, the calibres of these vessels enlarge, so as to enable more 
than the due proportion of fluid to pass through them; and, in the 
second place, as the absorbent function is the reverse of that of 
secretion, and must be performed by a different class of vessels, a 
similar derangement and relaxation must diminish their force, and 
thereby render their function less active than natural. For instance, 
if the vital derangement of the capillary extremity will cause this 
extremity, in consequence of its preternatural enlargement, to 
deposite two atoms in the time it could only deposite one in its 
natural state, it does not follow that a similar enlargement of an 
absorbent vessel, to whatever class it may belong, can take up, and 
transmit, twice the number of atoms in the same time. On the 
contrary, any loss of contractile power in the absorbents, (or the 
extremities of the veins, or imbibing pores, or whatever the nature 
of the absorbing apparatus may be) must render their function less 
active than it is in their natural state. 
If the preceding view be correct, it follows that the same morbific 
cause which is calculated to accelerate the secreting function, has 
also a tendency to reduce the activity of the function of absorption. 
As in all cases of local inflammation the dimension of the capillaries 
is considerably increased, they have a morbid necessity of deposit- 
ing more than the natural and healthy quantity of materials in the 
seat of disease; and as, on the other hand, the force of the absorb- 
ent vessels is diminished by the same cause, the inevitable conse- 
quence is, first, a simple swelling, and, ultimately, an organic change 
of structure. 
As this is a subject of considerable importance in its bearing upon 
the principles here insisted on, we may be permitted to dilate a 
little on it, even at the expense of repetition. 
Whatever the nature of the morbific cause of a local disease may 
be, one necessary consequence of it is a derangement of the vital 
functions of the part upon which that cause acts. If the cause be 
external violence, the texture of the structure may suffer at the 
same time that its functions are disturbed. In the next link of the 
chain of causation, a development of morbid phenomena occurs. 
The part becomes red, hot, swelled, and painful. In a word, it 
becomes inflamed. In some—indeed, in many—instances, when 68 
DAVIES ON PATHOLOGY AND SURGERY. 
the cause is conveyed through the medium of the blood, or when 
the disease arises spontaneously, (as the term is,) the derangement 
is so slight, or the nature of the tissue affected is such, that the 
symptoms of the malady are not of that degree as to bring them 
within the common acceptation of the term inflammation: still the 
operation of the cause is the same in kind, that is, the immediate 
effect is a derangement of the functions of the part affected. 
The first train of morbid phenomena having become developed, 
these phenomena may go on increasing; or they may remain 
nearly in the same degree, although, from their existence alone, the 
sensible change of structure must continue to increase; or, lastly, 
they may disappear, so that the part affected returns to its normal 
state. If the last condition should take place, it is a proof that the 
morbific cause has ceased to act, either from its having been re- 
moved, or from the tissue affected having become so changed in its 
modification as to be no longer sensible to its impression. If the 
morbid phenomena continue in the same state or degree, the original 
cause of derangement may be still acting on the seat of disease, or 
if removed, the derangement caused by its original relations may 
be of that kind and extent as to render it difficult for the part to 
return to its normal state by the mere effort of nature. Moreover, 
while in this condition of preponderance of one function over an- 
other, although the morbid phenomena may be moderate, still, as a 
preponderance does exist, great organic changes may take place in 
he tissues involved in the disease. Should the morbid phenomena 
continue to increase, there must either be an accumulation of the 
original cause in action, or the first derangement in the vital func- 
tions of the part affected must have been of a nature to act as a 
cause for further vital derangement, and thus proceed towards dis- 
organisation, by every step or degree of derangement acting as cause 
for derangement further on in the scale. It is probable that this is 
the mode in which disorganisation takes place in most cases of 
gangrene, especially in those following inflammation resulting from 
external injury; for in such cases there can be no specific cause in 
operation. 
It may be said that the morbid phenomena in all local diseases 
are analogous to those which characterise inflammation. That 
term is applied to them in different degrees or modifications, but 
these degrees or modifications are entirely dependent upon the 
tissue affected, upon the condition of that tissue at the time in rela- 
tion to its natural state, and upon the nature of the cause which 
acts upon it and gives existence to the disturbance. As the pro- 
perties of the arterial extremities vary almost without end in the 
different tissues, which tissues, also, are almost innumerable in 
variety, it is no wonder that their derangement should lead to organic 
changes so different in their character. According to the modifi- 
cations of these properties in the different tissues, we have simple 
inflammation, which, according to its degree, may end in resolution, 
or in the destruction of the part; we have a purulent abscess; a 
cellular deposite of coagulable serum or lymph; a mellicerous SURGERY. 
69 
deposite; a steatomatous tumour; a sarcomatous tumour; a carci- 
nomatous induration, and numberless other preternatural forma- 
tions, but it is evident that in all these cases the deposition of 
materials predominates over the absorbent function, and the preter- 
natural deposite is determined according to the peculiar modifica- 
tions or properties of the vessels in the tissue specially affected. 
Such being the condition of a part undergoing the process of 
disease, it is clear that the grand principle of therapeutics must 
consist in the means of restoring its natural functions—in restoring 
the equilibrium between the functions of secretion and absorption. 
Whilst the morbific cause continues in operation, this cannot be 
done; it is therefore a matter of necessity to remove that obstacle 
before a cure can be accomplished. But what do we know of 
morbific causes? We know but little, it is true; but, experience, 
and a collection of facts, assure us that certain articles possess the 
power of subduing diseases, and that the same articles will gene- 
rally subdue diseases presenting similar phenomena in different 
individuals. It is true that we know but litttle of the cause ab- 
stractedly, but we distinguish its effects in relation with the visible 
structure, and from these effects, or morbid phenomena, we form 
our judgment of remedies which experience has proved to be capable 
of their removal. We are also able to draw some inferences re- 
specting the manner in which these remedies accomplish the 
removal of the morbid symptoms. 
Abundant facts, within our experience, prove that living parts 
are endued with an innate tendency to relieve themselves from the 
operation of disease, provided the exciting or morbific cause be 
removed. If this were not the case, it is difficult to account for the 
restoration to its normal state of an internal part which has under- 
gone the process of inflammation; for internal remedies can do no 
more than neutralise the morbific cause, and the vessels must re- 
cover their vital contractility by some inherent properties connected 
with their own coats. Whether we consider bleeding, which, in 
addition to relieving the general vascular system, may be the means 
of abstracting a portion of the morbific poison; or purging, which 
may expel it by secretion and excretion; or sweating, which may 
act in a similar way; or specific remedies, which act by neutralis- 
ing the poison in the system—whether we consider one or all of 
these, we can only suppose them capable of removing that cause 
which first gave being to the vital derangement, and the vessels are 
left to the vis medicatrix—to the vital properties of their coats—to 
recover their lost contractility. 
Now, in external diseases, we have all the remedial means within 
our power which apply to the subduction of internal maladies, with 
the addition of remedies calculated to restore, by direct application, 
the vessels to their normal state and to re-establish the equilibrium 
naturally subsisting between the two opponent functions of secretion 
and absorption. There is no doubt that chronic diseases depend, 
in the great majority of instances, simply upon the non-recovery of 
their contractile properties by vessels whose vital derangement was 70 
DAVIES ON PATHOLOGY AND SURGERY. 
first occasioned by an exciting cause. Frequently, the innate vital 
properties of the vessels are sufficiently powerful to restore them to 
the state of health when the excitement is over; but such is not 
always the case ; and the disproportion between the secreting and 
the absorbent functions continues, thereby giving rise to new for- 
mations, differing in their characters according to the causes already 
explained, namely, the nature and condition of the tissue imme- 
diately affected, and the morbific agent which first produced the 
vital disturbance. 
Disease manifests itself by a combination of phenomena which 
vary considerably in their relative degrees in different cases. In 
acute inflammation, they exist in certain proportions, which, for the 
purpose of illustration, may be considered as a standard. We have 
here, pain, heat, redness, and swelling, in given proportions, and 
these morbid phenomena in combination according to such propor- 
tions constitute the sum total of the inflammation. But, as 
before stated, these proportions vary in different cases. The red- 
ness, for instance, may be intense, still the temperature of the part 
may be even below the natural standard ; or the pain maybe almost 
absent in a part which presents both redness and swelling; or the 
pain may be severe without increased heat, redness, or swelling 
sufficient to enable us to distinguish any difference between the seat 
of disease in that state and its natural appearances. A11 these 
differences exist even in the incipient stages of the affection, but they 
generally become more striking as the disease advances. 
As the predominance of morbid action is on the part of the 
secreting function, the effect of the derangement usually is the 
deposition of new substances, which become organised in their turn, 
and which permanently alter the character of the original seat of 
the malady. These formations, as already observed, will have their 
characters stamped by the immediate tissue in which the disease 
originated ; or, more properly speaking, by the peculiar modification 
of the arteries supplying that tissue. In one seat the deposit will 
be steatomatous; in another carcinomatous, or mellicerous, or mere 
induration from simple lymphatic deposition. 
It is evident that, in all cases of this nature, the equilibrium 
naturally subsisting between secretion on the one hand, and 
absorption on the other, is destroyed, and that, generally, the disease 
must go on continually adding to the original quantity of morbid 
secretion.. The vessels of the preternatural growth—which growth 
was commenced by vessels whose natural vital functions had been 
disturbed by a morbific agent—are, like those of every tissue, 
modified in a peculiar way according to the structure which they 
are destined to supply; and by this modification the identity of the 
new growth is preserved and nourished, in a manner perfectly 
analogous to the preservation and nourishment of all the natural 
tissues of which the animal body is composed. In this stage, the 
disease has assumed a character perfectly different from that which 
constituted it at its origin, and which consisted simply in derange- 
ment of the vital functions of the capillary extremities : in fact, the SURGERY. 
71 
effect of the vital derangement—that.is, the morbid deposite—has 
become the actual disease, and this disease has permanently esta- 
blished itself as a part of the living structure. 
Supposing, then, in the incipient or early stage of local inflam- 
mation, the original morbific agent to have ceased to act, or sup- 
posing the inflammation or vital derangement, to have been the 
result of some external injury, the object is to restore the disturbed 
and weakened vessels to their original state. But, how is this object 
to be accomplished ? What have we to fight with 1 The answer 
is, we have superabundant heat, pain, preternatural redness, and 
some degree of swelling. 
Now, our knowledge of means capable of removing these morbid 
phenomena depends entirely upon observation and experience. 
But our knowledge in this respect is precisely the same in kind as 
that which informs us that an acid will change the properties of an 
alkali; for, in both cases, the result is anticipated from a similar 
result having been observed to follow the application of the same 
causes in a number of instances. If an evaporating lotion has been 
observed to subdue inflammation in a considerable number of cases, 
the mind becomes satisfied that such an application is endued with 
the power of changingthe morbid properties constituting the disease 
in the same way as it satisfies itself that the properties of an alkali 
will be changed by the addition of an acid. This knowledge, then, 
satisfies us that the same remedies which are capable of removing 
one of those phenomena by which inflammation is characterised, 
may, also, remove more than one. 
In acute inflammation, as before observed, the four elements of 
disease are co-existent. By the removal of one of these it is evident 
that the character of the malady is altered. For instance, if we 
reduce the temperature of the part, though the redness continue, 
still the disease has had its force considerably broken, and it affects 
the patient in a much less degree than it did at first. The pain 
diminishes as the preternatural heat continues to be abstracted, and 
what remains is only a part of the original affection—namely sub- 
acute or chronic inflammation, as it is termed. If, again, we empty 
the vessels of their contents by numerous scarifications, thereby 
relieving them of the preternatural quantity of blood within them, 
all the four elements constituting inflammation are reduced: the 
disease, as a whole, becomes much less severe—the redness is less, 
the swelling is less, the heat is less, and the pain is less. 
In inflammation of an acute character ; indeed, in inflammation 
of all degrees, the principal indication, after the removal of the 
morbific agent, is to restore the calibre of the vessels of the inflamed 
part to its natural standard. This indication is usually fulfilled by 
one or more of the following means : 1st, local bleeding ; 2d, eva- 
porating lotions; 3d, poultices ; 4th, fomentations ; 5th, liniments; 
(5th, escharotics ; 7th, pressure. Specific applications to cutaneous 
affections are not here included. 
Local bleeding. It is evident that local abstraction of blood, 72 
DAVIES ON PATHOLOGY AND SURGERY. 
whether by leeches, by scarifications, or by incisions, can only afford 
relief in a mechanical way, by enabling the weakened vessels to 
unload themselves. Although each capillary tube is not divided, 
yet, by the abundant anastomosis which exists between these vessels, 
every tube in the inflamed part may be relieved by free scarification. 
Of all local remedies, bleeding is, doubtless, the most efficacious; 
but it must be considered that by the removal of one disease it 
creates another injury, which experience proves to be occasionally 
troublesome, if not dangerous. 
In the most severe cases of inflammation, that is, in cases where 
the vital contractility of the vessels has been materially reduced by 
the amount of morbid derangement, the motion of the blood becomes 
so diminished as almost to cease altogether. Indeed, it occasionally 
does cease, and the consequence is gangrene of the part affected. 
In cases of this description, it is next to impossible for the vessels to 
resume their contractile powers without being first relieved of the 
weight pressing upon their internal surfaces, and local abstraction 
of blood is, perhaps the most efficient mode hitherto employed of 
affording them that relief. Having been eased of the internal 
pressure, an opportunity is afforded them to recover their tone, by 
virtue of their innate powers as vital parts, at the same time that 
the mischief arising from the preponderance of deposition over ab- 
sorption is in some degree suspended. 
Evaporating lotions. We have already remarked, that agents 
which are capable of removing one of the phenomena of inflam- 
mation may also reduce or remove one or more of the others. 
Increased heat, or augmentation of temperature, not only forms one 
of the striking phenomena of the disease in its acute character, but 
it must also act as a cause in keeping up the derangement. It is 
unnecessary here to repeat any remarks which may have been 
already made respecting the physical cause of the increased tem- 
perature, but as it is an essential ingredient in the constitution of 
the malady, its reduction would be an object of much importance 
did it merely exist as a part of the disease ; but as the natural action 
of caloric upon bodies is to expand them, or to induce their particles 
to separate to a greater distance from one another, and as the con- 
dition of the capillaries in inflammation is already that of preter- 
natural expansion, it must follow that any quantity of heat added 
to them, beyond their natural measure, will tend to increase their 
dilatation still more. This being the case, it is doubly desirable to 
reduce the preternatural temperature of the inflamed part, so as to 
bring it as low, at least, as the natural standard, and experience 
has taught us that the only way of lessening the temperature of a 
body is to apply another body to it colder than itself, or a body 
which, by changing its capacity for heat, creates a degree of cold 
around that whose temperature we wish to reduce. 
Heat and cold are merely relative terms. Whether there exist 
two agents capable of neutralising each other by any physical pro- 
perties, or whether cold be merely the absence of heat, is a question 73 
SURGERY. 
not worth discussing in this place, because it is sufficient to know 
the effects on the living body of the different degrees of temperature 
measured according to the common method. Appreciated in this 
sense the two terms are merely relative; but observation proves 
that the effects of the caloric agent are very different on living parts 
according to its degree. If the temperature of a part be below the 
natural standard of the heat of the blood, that part can hardly be 
said to be in a state of inflammation, according to the definition of 
the term, for preternatural heat is as essential an ingredient of the 
disease as pain or redness. 
As the vital functions of a part become deranged if its temperature 
be raised preternaturally high, so will they also be impeded if the 
temperature be reduced below a certain degree. We find morbid 
affections amounting even to sloughing and gangrene, not only 
without any elevation of temperature, but even as a consequence of 
too great a reduction of heat. The toes often become “ chilled,” 
and, as a consequence, they slough, from exposure to low tempera- 
ture. In these instances, we find some of the elements of inflam- 
mation without the others ; we find redness and swelling, but the 
increased heat is wanting; and the pain in many cases is so slight 
as not to be complained of, even when the part is on the verge of 
gangrene. In cases of this description, the contractility or the 
capillaries is so reduced, and their calibres, consequently, are so 
enlarged, that the motion of the blood within them ceases : the fluid 
coagulates, and gangrene or sloughing is the only remedy which 
nature can apply for the preservation of the rest of the limb. 
Although the general principle upon which lotions are employed 
for the cure of inflammation, is that of reducing the preternatural 
temperature of the inflamed seat, still if medicated they may also 
act specifically on the vessels and nerves of the part, by actual con- 
tact, or by imbibition or absorption. The animal body is subject to 
physical laws, like all other bodies, and its structure is liable to be 
affected by the external agents which surround it. Heat, light, 
moisture, and all other physical agents, continually influence its 
condition by being admitted by imbibition through the porosity of 
its structure; and, according to the same laws, substances arti- 
ficially applied to its surface will exert their properties upon it, 
whether these properties have a curative or a deleterious relation 
with it. 
Poultices. Being subject to physical laws, like matter in general, 
the animal body may be affected in different degrees by the same 
agent under different circumstances. If a piece of iron, whose tem- 
perature is a few degrees above that of the blood, be applied to the 
skin, the effect is very unpleasant, and the functions of the tissues 
would be deranged if the temperature were still a little higher; 
whereas water, or especially atmospheric air, whose temperature is 
considerably greater will be borne with perfect impunity, and even 
without much inconvenience. Again, if the air be dry, the body will 74 
bear a great degree of cold without inconvenience, whereas in a moist 
atmosphere a degree of cold not near so great becomes very unplea- 
sant. It is upon this principle, we conceive, that poultices are more 
advantageous in some cases than evaporating lotions, and less so in 
others. When the preternatural heat is very great, its reduction is 
more readily accomplished by lotions, which, by rising into vapour, 
abstract the caloric more readily and quickly; whereas if the tem- 
perature be only a little above the natural standard, the rapid 
abstraction caused by the lotion reduces it so low as to occasion 
pain, or at least an unpleasant sensation, in the part affected. A 
moist poultice, although presenting an evaporating surface, transmits 
the heat but slowly from the inflamed part, and continually retains 
a part of it in its substance, thereby contributing to render its tem- 
perature more equable. In this respect it is much superior to an 
evaporating lotion, and considerably more efficacious in many cases 
of inflammation. 
A medicated poultice, like a medicated lotion, may exert a direct 
influence on the diseased vessels by imbibition or absorption. 
Fomentations. Unless medicated, fomentations cannot be sup- 
posed to act otherwise than by softening the cuticle and promoting 
a degree of perspiration from the part to which they are applied. 
Experience proves that the effect of dry heat upon the skin is very 
different from that produced by a combination of heat and moisture. 
The sensation occasioned by the application of a hot fomentation, 
even to a part already of a higher temperature than natural, is 
generally agreeable to the patient. 
Heat combined with moisture tends to promote perspiration from 
the surface to which it is applied, thereby in some measure to relieve 
the over distended vessels of a part of their fluid contents. The 
cuticle over the inflamed part is generally dry, and its pores are 
filled up, probably, by a portion of the lymph thrown out by the 
vessels underneath, and which has become coagulated. Whether 
this be the cause or not, it is certain that the perspiratory exsudation 
does not go on so fast as in the healthy state of the part, and that 
warm fomentations possess the property of relieving the density of 
the cuticle, so as to enable it to allow the exsudable serum to pass 
more readily through. 
Embrocations and liniments. It is seldom that remedies of a 
‘'stimulating” nature are applied to a surface undergoing acute 
inflammation. Indeed according to the composition of this species 
of application, the remedy, if employed, might be more unendurable 
than the disease itself. But, that spirituous fluids may not only be 
safely, but beneficially employed in local inflammation, even of the 
most acute kind, is proved by the effect of oil of turpentine in cases 
of burn and scald. It is the addition of ammonia, camphor, essential 
oils, and other ingredients, to the spirit, that renders embrocations 
generally unfit applications for inflammation of the acute form. In 
the employment of remedies of this description—in fact, of all 
remedies—it should never be forgotten that the same ingredients 
DAVIES ON PATHOLOGY AND SURGERY. SURGERY. 
75 
may be congenial or uncongenial to the feelings, according to the 
strength or intensity in which they are applied. Pure alcohol, or a 
concentrated solution of ammonia, would, probably, raise the cuticle 
and produce a blister, whereas, diluted, they would only gently 
increase the exsudation from the extremities of the vessels. Em- 
brocations are most commonly used with the view of remov- 
ing the effects of inflammation, namely, the thickening and 
induration dependent upon the consolidation of serous lymph in the 
interstices of the structure; and, for this purpose, both they and 
liniments are medicated according to the discretion or the fancy 
of the practitioner. As a proof that such applications have their 
effects, not only on the local seat of disease, but also on the system 
at large, we find that mercury thus introduced will very readily 
affect the gums, and cause salivation. 
Escharotics. The employment of escharotics, or rather of the 
nitrate of silver, in inflammation has been in vogue for some years, 
and was first introduced by Mr. Higginbotham, of Nottingham. The 
immediate effect of the application of the caustic to the inflamed 
surface is the conversion of the cuticle into a dry, black scale or 
crust, which peels off in a few days, leaving a new, delicate layer 
of cuticle exposed underneath. That the remedy exerts a powerful 
effect on the arterial extremities of the part, is proved by its causing 
an entire separation between the cuticle and the skin whose vessels 
secrete it. Various conjectures respecting the mode of action of 
this application have been offered, but none of them appear very 
satisfactory. Mr. Higginbotham thought that its efficacy might 
depend upon the exclusion of the air from the inflamed surface, 
owing to the conversion of the cuticle into an impenetrable covering. 
But we find that internal parts, such as the peritoneum, &c. to 
which the atmospheric air has no access, are still liable to inflam- 
mation ; and, moreover, it can hardly be supposed that an agent 
which is necessary to the surface of the skin in its healthy state can 
be injurious to it in a state of inflammation. 
As a ready way of getting out of the difficulty, the lunar caustic, 
like a hundred other applications, has been said to act as a “stimu- 
lus” to the part, and to excite the vessels to a “ healthy action.” 
This, in plain terms, is saying nothing more than that it does good 
—that the inflammation gives way where it has been applied. The 
term “stimulus” is employed so vaguely that no correct idea can be 
formed of what is meant by it. We are told that cold stimulates the 
vessels to contract; that heat stimulates the part to inflame, that 
ammonia stimulates the capillaries to enlarge and the skin to 
blister; that lead stimulates them to contract, and the skin to 
corrugate. Again, with respect to “ healthy action we only know 
that the “ action” of the vessels is healthy from the part supplied by 
them being healthy ; which amounts to nothing more than saying 
that the part is in its natural state. 
Simple Pressure—That compression is capable of producing a 
decided effect on the living structure, is proved by the fact that a 76 
DAVIES ON PATHOLOGY AND SURGERY. 
bandage long worn round a limb will cause that limb to become 
materially smaller than natural. It may be asked how does pres- 
sure act ? In reply it must be admitted that it either diminishes 
secretion or increases absorption, or both ; for we know of no other 
way iu which the reduction of size can be accomplished. We have 
already stated it as probable, that the same agent which causes the 
capillary tubes to enlarge so as to exude more concretible matter 
than they do in their normal state, might also produce an enlarge- 
ment of the absorbent vessels, thereby rendering their function less 
active than natural. If such a view be admitted, the reverse may 
also be true, viz. an agent which causes a diminution of the diameter 
of the secreting capillaries, or secerning tubes, and reduces their 
calibre below its normal standard, will also act in a similar manner 
upon the absorbent vessels, and occasion their function to become 
more active than natural. Now, compression will accomplish both 
these purposes. It acts equally on all the vessels, both secreting 
and absorbent, and the effect is, that the double object is obtained, 
namely, a diminution of the function of the one class, and an aug- 
mentation of that of the other. 
In inflammation possessing no speci fic character, after the exciting 
cause has ceased to act, and when only a relaxation of the capil- 
laries, from diminished contractility, remains, a gentle and equable 
pressure on the inflamed part is one of the most efficacious remedies 
in common practice. Its effect, evidently, is mechanical. It can in 
no other way act than by occasioning a diminution of the calibre of 
the vessels, thereby preventing their depositing a preponderance of 
molecules over those taken up by virtue of the function of absorp- 
tion. The consequence is, that by relieving the coats of the blood- 
vessels of a part of the weight pressing upon them internally, those 
vessels are more free to resume their contractile power, and the 
equilibrium between secretion and absorption is re-established. 
An effect similar to that of pressure may be produced by obstruct- 
ing, by ligature or otherwise, a principal artery supplying a part. 
The structure loses a portion of its sensibility and of its tempera- 
ture, and the part becomes pale and wasted. These are conditions 
the very reverse of those by which inflammation is characterised, 
and such being the case, the inference, a priori, would be that a 
remedy calculated to bring the inflamed part into such a state must 
tend to remove the inflammatory process going on in it. 
Upon the therapeutic properties of those remedies which are 
generally termed “ specifics,” it is not necessary to dilate here, as 
they apply more particularly to a few diseases which propagate their 
kind by contact, or by the transfer of a portion of the morbific 
matter from one person to another. The only idea we can form of 
a specific disease is, that the morbific agent, which first gave rise 
to the malady, continues in operation until subdued or neutralised 
by some other agent capable, by affinity, of converting it into 
another form, thereby altering its properties. SURGERY. 
77 
ON THE THERAPEUTIC PROPERTIES OF IODINE. 
lod ine, as a remedial agent, has been in the hands of the profes- 
sion for many years, but the object of the present work is to show 
that its application may be extended with much benefit to diseases 
and local injuries in which it has hitherto been very limitedly, if at 
all, employed. The various local affections in which we have used 
it during the last eleven years, both in hospital and private practice, 
induce us to set it forth as by far the most efficient topical appli- 
cation in our possession. The mode in which we have generally 
employed it, has been that recommended by Mr. Buchanan, namely 
in the form of tincture ; in which form, certainly, it possesses 
remedial properties which it does not exhibit in any other. Why 
this should be the case we do not profess to know, but long expe- 
rience proves such to be the fact. 
In urging a remedy on the attention of the profession, it is 
necessary at the same time, to caution the members of that profession 
against the indiscriminate and indiscreet, use of it. Many valuable 
medicines have fallen into disrepute, and have been altogether dis- 
carded from the list, owing to their having been mismanaged or 
abused. Iodine, though not a new remedy, has by no means yet 
had its effects on the human system fully tested. Properties have 
been attributed to it of which it is quite devoid, while, on the other 
hand, it is endued with many therapeutic virtues which it has not 
been generally known to possess. 
It is not the intention here to treat of iodine as an internal remedy, 
but we may be permitted, in passing, to observe that we have never 
witnessed it to produce the effects attributed to it on the testes and 
mammae, namely, causing the absorption of these glands. We have 
administered it internally very extensively, and in many cases, for 
several months together, yet not in one instance did it reduce the 
size of the glands already mentioned. We may also be allowed to 
state that we have been much disappointed in it as an internal 
remedy, more especially in scrofulous affections, for which it has 
been cried up almost as a specific. Its curative effects in broncho- 
cele are so well established as to render it unnecessary to do more 
than mention the fact; but, with the exception of that affection, its 
medicinal virtues, according to our experience, are rather limited, 
when internally administered. It is however proper to mention, 
that we have found it one of the most useful remedies in cases of 
long continued dyspepsia, and in some other affections of the 
mucous membrane of the digestive canal. It is probable that it acts 
in these cases by immediate contact, and not through the medium 
of the circulation : be that as it may, its curative effects are very 
striking in chronic affections of the lining membrane of the digestive 
tube. 
But the principal object of this essay is to point out the benefits 
of iodine as an external application ; and, in doing so, nothing shall DAVIES ON PATHOLOGY AND SURGERY. 
be stated which repeated observations have not proved to he correct. 
W e are well aware that when a single remedy is set forward as a 
cure for a great number of diseases, it is apt to be looked upon with 
great distrust by the profession, and that those who happen to recom- 
mend it are liable to be charged with something like empiricism. 
As well might those who prescribed mercury in a variety of diseases, 
or those who prescribe sulphate of magnesia, or carbonate of soda, 
or opium, in a variety of affections, he charged with empiricism. 
In truth, what do our common external applications amount to? 
Chiefly to lotions and poultices ; and practitioners generally do not 
much vary the characters of their lotions and poultices in different 
local affections. There are few external diseases, or local injuries, 
for which both of these are not employed in their turn. If a simple 
evaporating lotion be applicable to cases of phlegmon, of erysipelas, 
enlargement of the joints, scrofulous swellings of the glands, lace- 
rated, contused, and punctured wounds, and a variety of other 
inflammatory affections, both of the skin itself and of the internal 
parts situated near it, why should not another remedy apply equally 
to a number of similar maladies ? The properties of remedial agents 
can only be judged of from the effects they produce. No one could 
tell d priori that sulphate of magnesia would purge, and that 
carbonate of lime would constipate the bowels. In like manner, 
the medicinal virtues of opium, hyoscyamus, prussic acid, mercury, 
and all other remedies, have been discovered by observation of their 
effects respectively on the animal system, for they exhibit no 
external qualities which could lead to a fore-lmowledge of their 
relations with the living body. 
Now, extensive observation, and the experience of several years, 
have proved iodine to be a most efficacious remedy in a great 
variety of local affections—much more efficacious than any of the 
remedies noticed in the last section. It is very easy of application, 
mild in its effects on the nerves of the part with which it comes in 
contact, and capable of being modified in the degree of its strength, 
so as to suit, it to the intensity of the disease and natural quality of 
the skin of the patient. 
Both at the infirmary and in private practice we are in the habit 
of using the iodine in two forms, but by far more frequently in that 
of tincture in alcohol. The tincture is made by dissolving forty 
grains of iodine in an ounce of rectified spirit ; and its strength 
is afterwards reduced, when necessary, by the addition of more 
spirit. The other form is an iodureted solution, which is made by 
dissolving thirty-two grains of iodide of potassium (hydriodate of 
potass (in an ounce of distilled water, and by adding to the solution 
eight grains of iodine. With this iodureted solution a lotion is 
made by the addition of distilled or of common water, varying in 
strength according to circumstances, from one eighth to one fourth 
of the former. 
The strength of the remedy must be determined by the quality of 
the skin, in the first place. When the skin is thin and delicate in SURGERY. 
79 
texture, the tincture should be reduced to half its strength, other- 
wise the cuticle may be raised in blisters, which should always be 
avoided if possible. When, on the other hand, the cuticle is thick, 
and of a coarser texture, the tincture may be applied undiluted. In 
the second place the strength must be regulated by the nature and 
intensity of the disease. If, for instance, we have an acute inflam- 
mation of any part, and if, most particularly, it shows a disposition 
to slough, the remedy must be used in its full strength. In all cases 
of sloughing ulcers ; in all cases of irritable ulcers; in all cases of 
lacerated, contused, or punctured wounds, the strength of the tinc- 
ture should not be reduced—it should be applied undiluted in the 
first instance ; but when the slough lias separated, or the irritability 
has ceased, and when the remaining object is merely to promote tlie 
growth of granulations, then the strength ought to be reduced about 
one half. In induration of the glands, in chronic affections of the 
joints; in inflamed breast; in fact, in all affections whose seat is 
under the substance of the skin, the tincture should be employed in 
its full strength, unless the skin covering the seat of disease be very 
delicate or irritable—we mean naturally irritable, for the remedy 
itself would soon deprive it of any morbid, irritability. 
Suppose we are called to a case of severe inflammation of the leg, 
in a stout, robust person ; the limb is intensely red, hot, swollen, 
and glossy, all the way from the toes to above the knee ; it is double 
the size of the corresponding one ; and so painful as to disturb the 
general health—as to cause quickness of the pulse, white tongue, 
thirst, &c. We immediately paint the whole limb with the tincture 
of its full strength, extending its application from the toes to several 
inches above the upper margin of the inflammation : the remedy is 
applied with a camel’s hair brush. This is all the local application 
requisite for the present. The limb is directed to be kept in an 
horizontal posture, and either to be very lightly covered over with 
a sheet—which must not come in contact with the skin—or else to 
be left exposed, according to the temperature of the apartment. In 
less than twenty-four hours—in less than twelve hours—the swell- 
ing will be found to have diminished. At the end of twenty-four 
hours the skin will be seen much corrugated, showing its contents 
to have become less in bulk, and the circumference of the limb will 
measure some inches less than the day before. The diminution 
will be found to have taken place more particularly towards the 
upper part of the swelling. We now repeat the application of the 
same strength. In another twenty-four hours the reduction of the 
swelling will have gone on rapidly, and only a remnant of the dis- 
ease will be found to exist. The strength of the tincture must be 
now reduced to one half, and its application continued daily, or less 
often, according to circumstances, until the limb is well. After the 
second or third applications of the tincture, we sometimes brush the 
limb over with spirit of wine alone, so as merely to dissolve the 
iodine which remains on the surface of the skin. 
The above is the usual effect of the remedy in cases of pure 80 
DAVIES ON PATHOLOGY AND SURGERY. 
phlegmonous inflammation, but it varies, of course, in different con- 
stitutions. The variations, however will be found in the degree 
only of its curative effects in different cases ; it may be employed in 
every case, with the full confidence that benefit, and not harm, will 
be the result. The only inconvenience we have ever witnessed to 
arise from its use has been that of causing, now and then, a slight 
watery eruption on the surface of the skin, and a degree of itching 
in the part, when employed too strong, or when persevered in too 
long. These eruptions have invariably given way in a few days to 
a simple evaporating lotion of spirit and water. 
The application of the tincture is almost always followed by a 
desquamation of the cuticle, leaving the part covered by a new, 
clean, healthy layer of cuticle. This takes place when it has been 
applied to a healthy part. On the healthy skin it generally causes 
a sensation of heat, and some degree of smarting after a few 
minutes ; but frequently no smarting or pain is felt—nothing but a 
slight and agreeable warmth. When applied to a part undergoing 
the process of inflammation, the pain which forms one of the essen- 
tial characters of the disease, soon becomes deadened, and is suc- 
ceeded by a sensation of warmth, which, in a few hours, ceases also 
and leaves the patient free from any sense of pain or heat in the 
seat of disorder. If applied to the surface of a sloughing ulcer, or 
to a part on the verge of gangrene, or to a foul irritable ulcer, it is 
seldom felt by the patient. On a healthy ulcer it produces, gene- 
rally, a very sharp, smarting pain for a minute or two, but the pain 
almost immediately ceases and leaves the part in a comfortable state. 
The same sensation is produced by it when applied to the surface 
of a recent lacerated wound, or to any healthy raw surface. 
If any itching, or a slight blush of the skin, should follow the re- 
peated applications of the remedy, especially on the lower extre- 
mities, it should be discontinued, otherwise the cuticle will rise into 
small watery pimples, and will tease the patient for a few days ; but 
this effect is produced by it on the healthy skin only—when applied, 
for instance, to the skin covering a diseased joint, or when any in- 
duration or swelling is situated under the skin—for we have never 
found it to blister the cuticle and to cause exsudation of lymph from 
the surface of an inflamed skin. 
Neither the iodureted solution, nor the tincture of iodine, as 
directed to be prepared by the London Pharmacopoeia, is applicable 
to cases of inflamed or of ulcerated skin, for they both contain 
hydriodate of potass. In either of these forms the iodine is far 
preferable for internal use, to being dissolved alone in alcohol; for 
in the latter form it nearly all precipitates when water is added to 
it, whereas the hydriodate in combination with it renders it per- 
fectly soluble in water or watery infusions. As an external appli- 
cation, however, the hydriodate renders it acrid, and gives it a ten- 
dency to inflame the skin and to cause a considerable degree of 
smarting when brought into contact with any ulcer or ulcerated 
surfaces. The iodureted hydriodate lotion is only applicable to SURGERY. 
81 
affections whose seat is under the skin, such as diseases of the 
joints, scrofulous tumours, glandular indurations, &c.; but even in 
most of such cases the tincture is far preferable, when the patient 
is so situated as to enable the practitioner himself to apply it as 
often as necessary. We state this proviso, because we never trust 
the employment of the tincture to the patient. 
The iodureted hydriodate solution, like the tincture, produces a 
desquamation of the cuticle if used strong, but this only becomes 
observable some time after the lotion has been left off, and the skin 
has become dry. As stated before, we seldom use this form of the 
remedy, except in cases where it is not convenient to see the pa- 
tients so often as required for the application of the tincture, be- 
cause the latter, when properly regulated in its employment, proves 
by far the more efficacious of the two in most instances; but if 
indiscreetly used, on the other hand, it is more likely to cause an 
unpleasant sensation in the skin of the part to which it has been 
applied. The solution forms a very ready mode for an iodine 
gargle, in cases of ulcerated sore throat. Diluted with from seven 
to ten parts of water, with the addition of honey, it forms one of the 
best kinds of applications of that description. But even in affections 
of the mouth and throat the tincture is preferable—it is less nau- 
seous to the patient, and quicker and more efficacious in its cura- 
tive effects. 
We have already stated, that a knowledge of the effects of dif- 
ferent substances on the living body can only be acquired by ob- 
servation. There exists nothing in the external qualities of sul- 
phate of magnesia, of jalap, of colocynth, of scammony, of elate- 
rium, of Glauber’s salts—which are all so dissimilar in their 
outward form—to enable us to foretell them capable of quickening 
the peristaltic action of the intestinal tube, and of increasing the 
secretion on the surface of its mucous lining; nor could any one 
judge a priori that ipecacuanha, sulphate of zinc, or tartarised anti- 
mony, would cause the stomach to eject its contents, for these arti- 
cles, also, possess few outward qualities in common. Their medical 
properties become manifested only in relation with the living parts. 
When so tested, their effects prove to be pretty much the same on 
by far the majority of mankind. In 99 cases out of 100 of the 
whole community—we might, perhaps, say in 999 out of every 
1000—the effects of the articles enumerated above would be the 
same. 
If substances administered internally are so constant in their 
effects on certain inward parts, there is no reason why outward 
applications should not be also constant in their effects on the ex- 
ternal parts. It does not follow that either will cure the disease for 
which it is administered, or applied ; but as Epsom salts exert an 
effect generally alike on the mucous membrane of the intestines, we 
can discover no reason why the analogy should not apply to the 
skin, which is also a continuous tissue, like the mucous. That the 
disease is not cured, or modi tied, in all cases, is not owing to any 82 
DAVIES ON PATHOLOGY AND SURGERY. 
uncertainty in the action of the remedy, but owing to that not being 
the remedy which bears a relation to the special tissue constituting 
the immediate seat of the malady. Experience proves the analogy: 
it proves that nitrate of silver will convert the skin into a black co- 
lour, and will destroy its texture if applied sufficiently intense : that 
pure potass will dissolve all the living tissues: that cantharides 
will raise the cuticle: that mercury, and other substances, will 
penetrate the skin and enter the general system, &c. In fact, all 
substances capable of making any impression on the surface of the 
skin, act alike on the great majority of mankind: the difference is 
in degree only. 
Now, iodine, in the form of tincture in rectified spirit of wine, is 
capable of producing—does produce—certain effects on the skin, 
and on the living parts generally, when applied to them. The 
nature of that effect can only be known from observation. Expe- 
rience proves the effect to be of such a nature as to remove inflam- 
mation ; as to enable the living parts readily to throw off any 
sloughs which may be attached to their surface; as to make granu- 
lations spring up rapidly, so as to fill up the loss caused by the 
sloughing; as to promote the absorption, or cause the removal of 
interstitial deposites situated in the cellular membrane under the 
skin ; and as to accomplish various other changes in the condition 
of morbid parts, which wiil be more particularly specified here- 
after. That tincture of iodine is not as certain of doing these 
things as sulphate of magnesia is of relaxing the bowels, is owing 
to the one exerting its effects on a healthy surface, and to the other 
acting on a morbid part. The effect of iodine on the healthy skin 
is as determinate as that of Epsom salts on the mucous lining of 
the intestinal tube ; namely, it will cause a certain degree of 
warmth to the sensation, followed by a slight smarting, and, lastly, 
by a desquamation of the cuticle. When the structure of parts has 
become changed, as a consequence of morbid action, it is doubtful 
whether there be in nature a remedy capable of restoring them to 
their normal state ; but as the first effects of disease often act as a 
cause for further disease—in other words, as vascular deposites, or 
structural changes, have a tendency to keep up irritation in the 
parts where they are situated, thereby tending to promote further 
morbid changes—it is highly desirable to possess the means of 
modifying the properties of the vessels of the altered structure, in 
such a way as to prevent their depositing more morbid matter, and, 
if possible, to induce them to remove some of that already deposit- 
ed. Experience proves that we possess such means in the remedy 
whose recommendation is the object of this essay. 
Admitting the facts above stated, it is, perhaps, sufficient to know 
that such effects follow the application of the remedy in the majo- 
rity of instances, without attempting to account for its modus ope- 
randi. If we offer an opinion respecting the rationale of its opera- 
tion, we, at the same time, respectfully insist that the reader do not 
take the failure to give a satisfactory reason for its mode of acting, SURGERY. 
83 
as a justification for rejecting the practical facts respecting its 
effects. 
Disease may be considered in two stages: first, the part still suf- 
fering under the influence of the morbific cause which first pro- 
duced the local derangement; second, the part merely existing in 
a state of derangement, as a consequence of the previous action of a 
morbific agent. The first condition may be illustrated by the 
morbid process of a chancre; by the local operation of the vario- 
lous, or of the vaccine virus; by the progressive march of lupus, 
<fcc. In these cases, and various others, the cause or morbific agent 
appears to be of a specific nature, and to increase in magnitude and 
energy as the disease advances : in fact, the agent of disease ap- 
pears to live and feed upon the living parts in which it resides. In 
other cases, the first action of the morbific cause produces a vital 
derangement of the part with which it comes in contact; and the 
agent then either becomes absorbed or swallowed up in the effect, 
by entering into new affinities, or else is eliminated from the body 
among the secretions. We will first consider disease in its second 
state. 
When the seat of disease has relieved itself from the operation of 
the original cause of derangement, it still generally suffers from the 
effects of that operation. The capillaries are in a relaxed state; 
they contain more than their due proportion of blood; there is a 
tendency in the part to preponderate in secretion over absorption ; 
and its nervous functions, dependent upon the integrity of the func- 
tions of the capillary extremities, do not resume their normal con- 
dition. Moreover, there may have taken place a deposite of lymph 
in the interstices of the structure, so as to constitute a new cause of 
vital derangement. 
In such a state of things, it appears reasonable that the first step 
towards restoring the part to its natural state, should be to induce 
the capillary vessels to resume their contractile power, so as to 
enable them to free themselves from their disproportionate burthen. 
That the application of the tincture of iodine is endued with the 
virtue of accomplishing that object, is proved by the fact that the 
swelling of an inflamed limb very rapidly subsides as a consequence 
of its application. We say as a “consequence” of its application, 
because when a similar occurrence invariably takes place under 
similar circumstances, we have a right to assume that there exists 
a necessary connection between them. 
As to the manner in which the remedy acts on the morbidly 
dilated vessels, we are just as ignorant—but not more so—as we 
are of the nature of the action of muriatic acid on a piece of marble: 
all we know is, that one agent possesses the innate virtue of modi- 
fying the properties of the other in either case; and experience 
alone can teach us the result, or acquaint us with the nature of 
the product of the change. 
It is a fact, within the knowledge of every practitioner, that arte- 
ries exposed to atmospheric air will contract, and diminish—nay, 84 
f)A VIES ON PATHOLOGY AND SURGERY. 
close—their canals. When the stump of a recently amputated 
thigh is exposed, thousands of vessels bleed at first. At. the expi- 
ration of a minute not one in a hundred of them will allow any 
blood to escape. At the.expiration of three or four minutes more, 
perhaps the whole number will have ceased bleeding, if the prin- 
cipal branches shall have been secured. Nothing more will appear 
than the oozing of colourless lymph from the whole surface. Now, 
this fact must satisfy every one, first, that vessels of considerable 
size are capable of obliterating their canals, by means of some con- 
tractile power inherent in themselves; second, that the action of 
this power may be encouraged or excited by the application of 
physical agents. In the instance specified, the agent which influ- 
ences their contractile power is the atmosphere. If atmospheric 
air is capable of producing such an effect upon the vessels, there is 
no reason why other agents should not be able to produce a similar 
effect. In truth, we find, as already stated, that iodine, in the form 
of tincture, possesses the property of doing so ; and the effect of 
its application to an inflamed and swollen part is a diminution of 
the redness, as well as of the swelling, in consequence of the pre- 
viously over-dilated capillaries having recovered a great portion of 
their contractile power. 
It was hinted at in the last section, as probable, that the same 
means which are calculated to cause diminution of secretion, have 
also a tendency to increase the activity of the absorbent function. 
The grounds of the inference were there stated. The fact is indis- 
putable that certain agents <lo occasion the removal of interstitial 
deposite, at the same time that they subdue the inflammation, 
which is the cause of that deposite. In doing so, they must accom- 
plish something more than restoring the balance between secretion 
and absorption, because a mere restoration of the balance could 
only serve to subdue the inflammatory condition of the part, leaving 
the morbid deposite where the over dilated capillaries threw it out. 
Before the extraneous matter can be removed, after once having 
been deposited, there must be a preponderance of absorption over 
secretion—the excess must be transferred from the capillaries to 
the absorbents, or whatever agents there be which take up the 
matter. 
Among the agents capable of producing the effects above men- 
tioned, iodine is by far the most efficient with which we are ac- 
quainted. It not only subdues the inflammatory state of the’part 
much quicker than any other local application, but it also reduces 
the swelling, and causes the absorption of morbid deposites, much 
faster than any other remedial agent. It should, however, be borne 
in mind that it will not prove successful in every instance, any 
more than other remedies. 
According to the same principle that it subdues inflammation by 
exciting the contractility of the capillaries, iodine causes the living 
vessels to cast off the slough from the surface of foul ulcers. The 
slough is nothing more or less than a portion of the animal struc- SURGERY. 
85 
ture which has suffered death from the intensity of the disease. In 
consequence of the preternatural expansion of the vessels, the 
blood within them entirely stagnates; and when that condition oc- 
curs in all the vessels of a part, however extensive or however 
limited, its death is the necessary effect. Now, although the pre- 
ternatural dilatation often extends a considerable distance from the 
slough, still there must be a point where the dead and the living 
parts meet—a point where the blood is all but at a stand still, yet 
where it continues to move. As the Stagnation of the blood, and, 
consequently, the death of the part, are owing to the total loss of 
contractility in the capillaries, it seems reasonable that a remedy 
capable of producing their contraction should enable them to resist 
the progress of the sphacelus, and to separate themselves from the 
dead matter. The separation takes place at the point of junction 
between the living and dead parts of the vessels. The living parts 
of the tubes having recovered some of their contractile power, they 
gradually diminish their calibre; the velocity of the blood in them 
consequently increases, which tends to add more and more to their 
vitality; they effuse a purulent fluid from their extremities, which 
serves as a medium of division between the dead slough and the 
living structure; and the consequence is a separation of the dead 
from the living part, leaving a healthy granulating surface ex- 
posed. 
But, supposing the morbific agent still to exist in the seat of dis- 
ease, is the remedy capable of neutralising it, and of rendering it 
innocuous to the living tissues? In reply, it may be said that we 
have no means of proving, indisputably, whether or not the original 
cause of the derangement be still in operation. The inflammation 
may be of that kind commonly called “ spontaneous,—that is, it 
may arise from a cause which cannot be discovered: in one in- 
stance, it will cease without any artificial aid ; in another, it will 
run on to the destruction of the life of the part affected. In the 
former case, the cause ceases to operate of its own accord : even in 
the latter we cannot be positive that the morbific agent has con- 
tinued in operation until gangrene has actually ensued ; for its first 
impression may have been of such nature as to produce so great a 
derangement in the functions of the part as ultimately to lead to its 
death, although the original cause no longer continues to act. This 
point may be illustrated by the effects of mechanical violence : the 
seat of violence may not be destroyed at once, but its vital func- 
tions may be so disturbed as necessarily to lead to its death shortly 
afterwards. 
Under these circumstances it is impracticable, in common in- 
flammation, or its consequences, to determine whether the original 
morbific agent still continues to exert its influence on the seat of 
disease, because, although the malady appears to progress in its 
march, yet that circumstance may be owing to the extent of the 
original disturbance, which disturbance acts as a fresh cause in 
perpetuating the inflammation. The only affections, therefore, in 86 
DAVIES ON PATHOLOGY AND SURGERY. 
which we can infer the morbific cause to be still in operation, are 
those termed “specific.” 
Now, the agent, or virus—or whatever the cause may be called— 
of a specific disease, must be different in every species of disease. 
The syphilitic differs from the variolous, the variolous from the 
psora!, &c. As this is the case, it is not probable that any one 
remedy exists in nature capable of neutralising the cause of every 
disease. It can only be determined by experience what affections 
of a specific kind are able to be subdued by the application of a 
remedy. Those in which our own experience has proved the 
tincture of iodine to be beneficial, will be noticed under their pro- 
per heads; but we admit that our experience of its use in specific 
diseases lias not been so extensive as to enable us to speak with 
positiveness with respect to its curative properties. The facts must 
be taken as they are: we have no wish to magnify them. 
ERYSIPELAS. 
In pure erysipelas, the tissue immediately affected appears to be 
the skin ; but in most instances the malady is of a mixed nature, 
involving both the skin and the cellular membrane underneath. 
When it presents itself in its simple form, the skin looks of a bright 
crimson colour. The redness disappears under the pressure of the 
finger, but very soon returns after the pressure has been removed. 
There is a burning sensation in the part affected, but no sense of 
throbbing, as felt in phlegmonous inflammation. The peculiar 
burning or smarting sensation experienced in this disease, is owing, 
doubtless, to its being so specially allied with that tissue in which 
the nerves of touch spread out their extremities; and the absence 
of throbbing may be easily accounted for, because the vessels en- 
gaged in the inflammation are so exceedingly small and minute, 
that, even at the utmost extent of their expansion, they are not 
large enough to impart a throbbing sensation either to the finger 
when applied to the inflamed part, or to the feel of the patient him- 
self. But, owing to the countless number engaged, and to their 
being situated so near the surface, the skin presents a colour of the 
brightest crimson. 
This variety of the disease generally spreads to a consideroble 
extent over the skin, and, when severe, it gives rise to a separation 
of the cuticle, in the form of bullae or blisters, which contain a 
serous fluid, generally of a yellowish colour, but sometimes almost 
transparent. When these blisters give way, and the fluid escapes, 
incrustations are formed on the surface, under which ulcerations 
not unfrequently take place. 
There is generally a considerable degree of constitutional de- 
rangement accompanying cutaneous erysipelas. The tongue is 
coated ; the pulse is small and quick; there are thirst, uneasy sen- 
sation about the prsecordia, and a universal feeling of languor and 
debility. The severity of these symptoms is often disproportionate SURGERY. 
87 
to the apparent extent and severity of the local inflammation ; 
which, probably, is owing to the peculiarity of the tissue affected, 
namely, its being that upon which nerves of sensation are exten- 
sively distributed. 
The head and face are the parts most subject to erysipelas when 
it arises from constitutional causes: indeed, local injuries of these 
situations are much more apt to be followed by the disease than 
those of any other parts of the body. The removal of small tumours 
about the head, or even the application of a few leeches to the tem- 
ples, is not unfrequently followed by fatal erysipelas; whereas the 
same kind of injury inflicted on any other part would not give rise 
to the malady. 
In all the instances in which we have had an opportunity of ex- 
amining the seat of disease after death occasioned by erysipelas 
about the head, the skin was found very much thickened, and its 
texture to have become very soft; and the cellular membrane be- 
tween it and the bone was converted into a substance exactly like 
yellow jelly. The dura mater, also, in every case, partook of the 
disease. 
But erysipelas seldom confines itself altogether to its simple 
form, in any locality. The cellular membrane in contact with the 
skin, and, frequently, that portion of it also which is situated more 
deeply among the muscle, partakes of the disease. When this oc- 
curs, extensive sloughing generally takes place; openings are pro- 
duced in the integuments, by partial sphacelus, through which the 
dead cellular membrane protrudes in masses, and is ultimately dis- 
charged, if the patient survive, leaving hollow spaces to a great ex- 
tent between the integuments and the flesh. This variety of the 
malady is commonly called “ phlegmonous erysipelas.” 
The foregoing description forms a sufficient illustration of the 
symptoms and morbid appearances of erysipelas to answer the pur- 
pose of this work. With respect to its cause, it is a mere matter of 
opinion or of speculation : our notion, with regard to that subject, 
may be gathered from the previous sections. 
With reference, also, to the constitutional treatment of erysipelas, 
and of the other diseases of which we shall speak in this essay, it 
is proper to state at once, that little will be said here; because the 
object of the work is not to present a full treatise on these several 
affections, but to illustrate the local effects of a certain remedy in 
them. It is not pretended that the local remedy will supersede the 
necessity for general treatment, when constitutional symptoms de- 
mand such treatment. But, as the constitutional disturbance fre- 
quently depends upon, at any rate is aggravated by, the local 
disease, it will often be found that by reducing the latter, the former 
will also diminish, and, perhaps, altogether disappear, without the 
aid of any general means. This fact we have witnessed in very 
many instances. But the safer plan is not to neglect general treat- 
ment in affections insidious in their nature, and whose course is 
generally short, either towards restored health, or towards death. 88 
DAVIES ON PATHOLOGY AND SURGERY. 
As a general statement, then, respecting the constitutional treat- 
ment of inflammation, whether of the erysipelatous or of the phleg- 
monous kind, except in very plethoric cases, experience has taught 
us to be cautious in the abstraction of blood from the general 
system. By this expression, it is not meant to intimate that no blood 
should be drawn by venesection in any case : but even where its 
abstraction is fully authorised, it should be accomplished with 
moderation, and not in the reckless manner too often practised. 
Having well cleansed out the alimentary canal, without loss of 
time, with eight or ten grains of calomel, followed by saline purga- 
tives, our practice has been to administer calomel and opium, in 
doses according to circumstances, and repeated at intervals of from 
three to six hours, until the system has been brought fairly, but 
slightly„ under the influence of the mercury ; which is proved by 
a slight redness along rhe edges of the gums, or by the patient’s 
feeling a slight looseness of the teeth. The remedy should be then 
immediately stopped. 
So much for general treatment, which will apply to every variety 
of acute inflammation, differing, ofcourse, in modification, according 
to various circumstances connected with each case. 
But the object of the present essay, as stated before, is mainly to 
bring to the notice of the profession a local remedy whose curative 
properties, compared with those of other topical applications, are 
very little known at present. 
The topical remedies commonly used in erysipelas are local 
bleeding by leeches ; simple evaporationg lotions, or lotions medi- 
cated with lead, zinc, acetate of ammonia, opium, camphor, or any 
other ingredients, according to the views or fancies of the prac- 
titioner ; fomentations, generally of chamomile and poppy heads ; 
poultices, simple or medicated ; incisions through the seat of inflam- 
mation as recommended by Mr. Lawrence; scarifications as recom- 
mended by Dr. Dobson ; the application of lunar caustic, as recom- 
mended by Mr. Higginbotham. • Of the modus operandi of all these 
plans, we have already spoken, and the degree of reliance to be 
placed on each or all of them in erysipelas, is so well known as to 
render it unnecessary to treat of them specially here. But it will 
be found, upon trial, that the tincture of iodine is a topical remedy 
far more efficacious than any of them, or of all of them put 
together. 
An elderly gentleman, who, in former years, had been a very active 
man, began to decline in general health about 1828, or the beginning 
of 1829. His bowels became irregular : his complexion appeared 
“bilious;” his mental faculties, which were naturally very strong, 
began to show a deeline ; and, in a word, the general functions of 
the system became all more or less disord ;red. He was repeatedly 
cupped and leeched on the nape of the neck and temples, and the 
parts generally showed a disposition to inflame, more especially 
when leeches had been applied. In the summer of 1830, after the 
application of several leeches to the forehead and temples, a severe 89 
SURGERY. 
attack of erysipelas came on, which rapidly spread over the head 
and face, accompanied with a good deal of constitutional disturbance, 
such as quick pulse, furred tongue, and general uneasiness. The 
head was bald, having only a thin curtain of hair behind. The 
tincture of iodine, reduced to half its strength, was applied by a 
camel's hair brush all over the head, temples, and face ; which, as 
may be supposed, gave him an odd appearance, from the brown or 
bronze colour it imparted to the skin. Next day the disease had 
all but disappeared. The local inflammation had very nearly ceased, 
and the symptoms of constitutional derangement had much abated. 
The tincture, however was applied once more, but still reduced in 
strength. No further trouble was found with the case. 
The above was the first case of genuine erysipelas of the scalp in 
which the tincture of iodine was employed, and the effect was so 
striking as to encourage a repetition of the trial. From the un- 
healthy state of the patient, and from the rapidity with which the 
inflammation extended over the head, it was impossible not to 
entertain great apprehension as to the result. Under all the cir- 
cumstances, the effect of the remedy proved most gratifying, both to 
the patient’s friends and to the medical attendant. 
In the autumn of the same year, a young man aged about 19 or 
20, of a sickly bilious look, and subject to headach, especially after 
his meals, was seized with “spontaneous” erysipelas of the face. 
The inflammation commenced in one of his ears, and from thence 
spread over the temple, and ultimately over the whole scalp. When 
he applied for assistance, there were a few vesications about the ear 
and check : the head and face were considerably swollen, and very 
tender to the touch : and the whole scalp felt doughy and soft, and 
retained deep pits after being pressed with the finger. The general 
health was suffering much.—The hair was ordered to be cut off’ 
close to the skin, and the tincture of iodine, in its full strength, was 
applied all over the inflamed surface, which embraced the whole 
head, down to the neck. By the next day the swelling was very 
much abated, and the general symptoms were less severe. The 
tincture was again applied in its full strength. After the second 
application, the tincture, was reduced daily in strength, and used 
for two or three days longer. It is very probable that one or two 
applications would have sufficed to subdue the inflammation, but it 
was deemed prudent to repeat them daily for four or five days. The 
remedy was followed by a desquamation of the cuticle of the whole 
head ; but the skin became quite clean and fresh in a few days. In 
this case, as well as in numerous others, the inflammation began to 
give way before the mercury, administered internally, could have 
affected the general system. Indeed, it was found unnecessary to 
press it so far as to affect the mouth, when the disease was fast dis- 
appearing without. 
The remedy has since been frequently employed in cases of the 
above description—that is, erysipelas, of the head and face—both at 
the infirmary and in private practice, with uniform good effect. It 90 
DAVIES ON PATHOLOGY AND SURGERY. 
is unnecessary to recite more cases of this variety. Indeed, the few 
cases introduced in this work are merely intended to illustrate the 
mode of application of the remedy, and not to swell out or multiply 
its pages. If that were the intention, we could recite some scores. 
In consonance with our object, we shall state the two following 
cases; the first of which will come under the term “ phlegmonous 
erysipelas,” and the second will answer any term applicable to an 
anomalous swelling of a limb. 
In February, 1830, a tradesman’s wife, aged about 50 years, 
stout, but of an unhealthy appearance, had one of her legs very 
much inflamed all the way from the toes up to above the knee; it 
was swollen to at least double the size of the opposite limb. The 
inflammation arose from a slight scratch on the shin, and was of 
some days’ standing, during which time cold lotions and fomenta- 
tions had been applied to the part. The limb now presented a 
glossy, shining redness, from above the knee down to the toes ; its 
size was as just stated ; it pitted slightly on being hard pressed with 
the finger; there were several vesicles, containing transparent 
serum, on the back of the foot and lower part of the leg ; the pain 
was excessively burning and acute, and the constitutional disturb- 
ance was very great. The tincture of iodine, of full strength, was 
applied all over the inflamed surface—that is, from the toes up to 
the middle of the thigh ;—and the limb was directed to be kept in a 
horizontal position, and left exposed to the air. Next day the pain 
was nearly gone : the limb was considerably reduced in size; and 
the skin, especially about the knee and upper part of the leg, was 
shriveled into folds in consequence of the subsidence of the 
swelling. The fluid in the smaller vesicles had been absorbed, 
and the others were much smaller than the day before. No 
new vesicles had made their appearance. However, there was 
still considerable swelling of the lower part of the leg and foot, and 
the inflamed part still pitted on pressure, though not so much as on 
the previous day. The tincture was repeated, in its full strength. 
After the second application it was reduced in strength, and on some 
days rectified spirit alone was applied, merely with the view of re- 
dissolving the iodine which coloured the surface of the skin. The 
disease began to give way immediately after the first application of 
the remedy, and the limb rapidly recovered, leaving only a few 
small ulcers where the larger vesicles had been situated. These 
were treated in the usual way. 
We have since met with several cases like the above, and have 
treated them in a similar manner, with equal success. Such cases 
are some of the worst that can present themselves, for, unless soon 
checked in their career, most extensive sloughing of the cellular 
membrane takes place ; large and numerous openings form in the 
integuments, and the patients are almost sure to sink, either from 
the violence of the inflammation and of the constitutional disturb- 
ance caused by it, or else from the great discharge which follows so 
extensive a destruction of parts. SURGERY. 
91 
In cases of this description, it is generally beneficial to apply a 
bandage round the limb as soon as the inflammatory action has en- 
tirely subsided ; for this will serve to support the weakened vessels 
until their contractile properties shall have been recovered, and to 
promote the absorption of the morbid deposite. 
A gentleman, aged about 60 years, rather stout, presented the 
following symptoms ; the right leg and foot were swollen to at least 
double the size of the left ; ihe swelling extended to above the knee ; 
the skin presented a glossy, tuning appearance ; but its colour was 
rather pale ; or, at any rate, was hardly redder than natural: the 
limb pitted very considerably on pressure, and the integuments did 
not recover their level for some time after the removal of the pres- 
sure : there were several bullae or vesicles about the ankle and the 
lower part of the leg—one was large and of a darkish colour: the 
general health did not suffer so much as might have been expected 
from the diseased condition of the limb, still the tongue was rather 
furred, and the pulse slightly quickened. The member was neither 
very hot nor very painful. Evaporating lotions had been employed 
for some days when the case presented itself, but the limb continued 
to swell more and more, and the vesicles went on increasing both 
in size and number. When it presented itself, the case was of four 
or five days’ standing, but had become much aggravated within the 
last forty-eight hours.—The whole limb, from the middle of the 
thigh down to the tip of the toes, was painted with the tincture of 
iodine, in its full strength : it was ordered to be kept in an horizontal 
posture, and to be loosely covered over with a linen rag hose. At 
the end of twenty-four hours the member was decidedly smaller: 
the skin about the knee and upper part of the leg was loose, and 
drawn together in longitudinal folds, proving a diminution of the 
swelling: the smaller vesicles had dried up; the larger ones had 
considerably diminished ; and the dark looking one had discharged 
itself. The application of the tincture was repeated, from the knee 
downwards to the toes. At the expiration of another day, the 
swelling was still more reduced : two or three of the larger bullae 
had discharged themselves, leaving small superficial ulcers of quite 
a healthy appearance. After this time the leg was touched three 
or four times more with the tincture, reduced to about half its 
strength, and the two or three ulcerated spots were dressed with 
Turner’s cerate. At the end of a week, there being some degree 
of oedema of the leg, a bandage was applied, and recommended to 
be worn until the vessels and the skin should recover their natural 
tone. 
PHLEGMON. 
The characters of phlegmonous inflammation are so well known 
to the profession as scarcely to require a description of them here. 
The disease generally commences with pain and a sensation of 
throbbing in the part, before any redness is apparent. The reason 92 
DAVIES ON PATHOLOGY AND SURGERY. 
of this is. that the seat of disease is entirely under the integuments, 
in the cellular membrane ; and the malady makes considerable 
progress before the inflammatory appearance presents itself on the 
surface of the skin The order of attack in phlegmon is the re- 
verse of that in erysipelas; for, in the latter, the skin forms the 
original seat of disease, and the parts underneath become affected 
by contiguity, or rather by continuity of vessels. 
There is another fact worthy of notice which distinguishes the 
two maladies, namely, that the extent of the destruction of the cel- 
lular membrane in erysipelas depends upon the extent of the in- 
flammation of the skin ; whereas, in pure phlegmon, the extent of 
cutaneous redness is determined by that of the inflammation of the 
cellular tissue underneath. When the skin constitutes the seat of 
disease the inflammation spreads rapidly and widely, by continuity 
of tissue ; and as it dips down into the cellular membrane by con- 
tinuity of vessels, thereby giving rise to the variety called “ phleg- 
monous erysipelas.” the latter membrane necessarily becomes very 
extensively affected. In phlegmon, on the contrary, the agency of 
the morbific cause is exerted on the cellular tissue—a tissue not 
prone to stretch out its maladies far—and the skin, being only 
secondarily affected, presents only a limited extent of inflammation, 
corresponding to the extent of disease underneath. 
In pure phlegmon the cellular tissue shows the same disposition 
to die, or to resolve itself into purulent matter, as in phlegmonous 
erysipelas ; only that in the former variety of inflammation the cel- 
lular membrane determines the extent of its own affection, by cir- 
cumscribing it within the limits of an abscess. The destruction of 
the tissue is generally limited, and a boundary is soon formed be- 
tween the healthy and diseased parts. With regard to phlegmon, 
indeed, we may say that its invariable tendency is to end in an ab- 
scess, unless the vessels recover their normal tone by the efforts of 
nature, so as to induce the inflammation to terminate in resolution; 
or unless it be checked by the interposition of art; for we doubt 
whether this variety of the disease ever ends in absolute gangrene, 
properly so called. It is true that it may, and does, cause the 
death of the part immediately affected, so as to occasion sloughing 
of the cellular membrane ; but such sloughing is always of limited 
extent, and is not attended by the dark discoloration of the living 
parts, especially of the skin, and by cutaneous vesication, which 
characterise gangrene. 
The redness in phlegmon is not so florid as that which the skin 
presents in erysipelas, and does not so entirely disappear on pres- 
sure. This is accounted for by the fact, that in simple erysipelas 
the vessels which are enlarged are those of the skin only, so that 
the pressure of the finger puts a stop to the circulation through 
them for a moment, and leaves the point pressed upon free from 
blood ; whereas in phlegmon the vessels chiefly enlarged are more 
deep-seated, so that, although pressure on the surface may obstruct 
the circulation through the capillaries of the skin, still the redness 93 
will show itself from the vessels situated beneath the integu- 
ments. 
It has been already stated that a throbbing pain usually precedes 
the redness and swelling in phlegmon, because the tissue originally 
affected is beyond the reach of sight. Increased heat, gene- 
rally precedes the visible phenomena of the disease. Sometimes, 
indeed, when the part affected is situated very deeply—that is, 
when the inflammation is in a part of the cellular membrane situ- 
ated low between the muscles—a portion of the tissue is destroyed, 
and an abcess is formed, before any external signs of inflammation 
show themselves. The integuments do not begin to inflame until 
the matter has worked its way some distance towards the surface, 
so as to discharge itself through the skin. 
The topical remedies usually employed in phlegmonous inflam- 
mation, are leeches, and evaporating lotions: and, occasionally, 
poultices and fomentations. These are medicated with anodynes 
when the pain is very severe. Scarification of the inflamed part is 
sometimes resorted to ; also the formation of an eschar over the 
part with nitrate of silver. These means are all good in their way, 
and are the most efficient—indeed the only ones—which have been 
used hitherto. But the inflammation will be subdued by the tinc- 
ture of iodine much more quickly, and with greater certainty, than 
with any or all of these means. 
In what manner the influence of the tincture reaches the vessels, 
in deep-seated inflammation of the cellular membranes, we do not 
profess to be able to explain, but that the remedy does exert an in- 
fluence upon them is perfectly certain. In cases where pain and 
throbbing only exist, and where the inflammation has not yet made 
its appearance on the skin, it will generally be found that a single 
application of the tincture, in its full strength, and thickly painted 
over the seat where the pain is felt, will at once check or cut short 
the disease. A sensation of warmth, and probably some degree of 
smarting, will be felt in a few minutes in the part to which the 
remedy has been applied : this may continue for an hour or two ; 
and when it ceases, the original pain also will generally be found 
to have ceased. However, it is safer to repeat the application, 
though no more pain or throbbing be felt; for no harm can arise 
from so doing. We feel satisfied that in many instances where 
suppuration had commenced, repeated applications of the tincture 
has not only checked the progress of the inflammation, but has also 
caused the matter already formed to be absorbed. 
Nevertheless, when the seat of disease is very deep among the 
muscles, especially in the thigh, or about the loins, it is doubtful 
whether any impression would be made upon the inflammation by 
the local application of the remedy : we say it is doubtful, because 
we possess no facts either affirmative or negative of the proposition. 
Affections of that description are often very obscure in the first part 
of their course, and they frequently form abscesses before their real 
character is discovered. However, from our experience of the pro- 
SURGERY. 94 
DAVIES ON PATHOLOGY AND SURGERY. 
perties of the tincture of iodine in promoting absorption of morbid 
deposite, we would trust to its employment in cases of this nature 
in preference to any other topical application. 
When the inflammation takes place nearer the surface—that is, 
in the cellular membrane which intervenes between the integu- 
ments and the muscles—the redness very soon appears externally, 
and the disease presents from the beginning those characters which 
are distinctive of genuine phlegmon. Such cases are to be treated 
in the same manner as phlegmonous erysipelas. The tincture is to 
be applied the first time in its full strength. After the first appli- 
cation, the inflammation will be generally found, at the expiration 
of twenty-four hours, nearly subdued. The skin, which was be- 
fore tense, will appear loose and wrinkled, and the cuticle begin- 
ning to peel off. If there should be no matter formed underneath, 
the remedy may be diluted to half its strength for the second appli- 
cation ; but if pus exists under the integuments, it is desirable to 
let the tincture remain of its full strength, and its application be re- 
peated daily, until the matter shall have been all absorbed, or else 
until it shall have worked its way to the surface, and discharged 
itself, or been let out, through the skin. 
A robust, healthy looking young woman, about 20 years old, 
applied in March, 1834, with phlegmonous inflammation of the 
ri<?ht leg. The disease commenced about the middle of the lea:, on 
the outside, over the fibula. The skin was now inflamed over a 
great part of the leg : it was of a deep red colour, very tense, and 
very hot to the feel. The limb was a good deal swollen, but no 
matter appeared to be formed. The pain was very severe, accom- 
panied by a throbbing sensation. The pulse was quick ; the tongue 
whitish; thirst, and other febrile symptoms. The inflammation 
was “spontaneous,” and of four days’ standing. It had been treated 
with Goulard lotions, which rapidly dried when applied to the 
part, but which neither alleviated the pain nor appeared to reduce 
the temperature beyond a minute or two after each fresh applica- 
tion. The tincture in full strength, was applied all over the leg, 
from the knee down to the instep, and the limb was ordered to be 
kept in a horizontal posture. No general treatment was had re- 
course to. A few hours after the application, the sensation of pain 
and throbbing almost altogether ceased. Next day the swelling had 
considerably abated; and scarcely any more signs of the disease 
remained than a feeling of stiffness in the leg, and a slight soreness 
on pressure. The tincture, diluted to about half its strength, was 
again applied, and the limb was allowed to rest for two or three 
days ; which completed the treatment of the case. 
We could recite at least a score of cases analogous to the above ; 
but one is as good as a hundred in illustration of a principle. It is 
possible that the remedy may fail in some instances, but, if pro- 
perly and prudently applied, cases of failure will be very rare ; by 
failure, we mean where the inflammation runs on and forms an ab- 
scess in spite of the remedy. We have not yet met with such a SURGERY. 
95 
case—that is, a case of superficial phlegmon where the tincture 
was applied before matter had begun to form: such a case of failure 
has not occurred to us. 
In May, 1838, a strong, healthy man, about 35 years old. had a 
thorn run into the outside of his thigh, about midway between the 
hip and knee, in passing through a thick hedge. He took no par- 
ticular notice of the accident atlhe time. The part, however, con- 
tinued painful; and three days after, it began to swell a little, and 
to inflame. He kept poulticing it for three or four days longer, but 
the inflammation went on, rapidly increasing in violence, and ex- 
tending over a great part of the outside of the thigh. The limb 
was now very red, hot, and painful; much swelled; hard to the 
feel, and leaving no pit, but a momentary paleness, upon pressure 
with the finger. The heat and pain were excessive : the latter was 
of a throbbing nature, corresponding with the contractions of the 
ventricles of the heart. There was a considerable degree of gene- 
ral fever. It was doubtful in this case whether suppuration had 
not commenced, for something like an obscure fluctuation could be 
distinguished at the point where the thorn had entered.—The 
whole thigh was painted over with the strong tincture, all the way 
from the hip and groin down to the knee. After getting dry— 
which it did in two or three minutes—the application was repeated 
three or four times to the outside of the limb, especially over the 
part which had suffered the accident. Ten grains of calomel, fol- 
lowed by a saline cathartic, were ordered to be taken immediately. 
About a quarter of an hour after the application, the limb began to 
feel very warm—a warmth congenial to the feeling compared with 
the heat and pain experienced before. This warmth was soon 
succeeded by rather a severe smarting, which continued for three 
or four hours. When the smarting ceased, the original pain, also, 
for the most part, was gone. The next day after the application of 
the tincture, the outskirts of the inflammation had all disappeared, 
leaving the skin wrinkled, and the cuticle beginning to desqua- 
mate. There still remained a hardness, and soreness on pressure, 
with a certain degree of swelling, extending a few inches round the 
point where the injury had been received ; but the throbbing pain 
had entirely left. The undiluted tincture was again applied to the 
hard part, and carried some distance beyond the hardness. The 
application was repeated daily for four days, which served to com- 
plete the cure. 
In cases similar to the last, but where suppuration has gone on 
to some extent, the iodine may not succeed in producing an ab- 
sorption of all the purulent matter deposited; but it will exert an 
extraordinary power of confining the suppuration within narrow 
bounds. It almost immediately stops the inflammatory process, so 
that no more destruction of the cellular membrane takes place, and 
the line of boundary between the dead and living parts of the tissue 
affected is soon determined. In such cases, when an abscess does 
form, instead of having a cavity containing several ounces of pus 96 
DAVIES ON PATHOLOGY AND SURGERY. 
—as we generally find to be the case where the treatment has been 
by poultices, &c.—perhaps not an ounce will escape when the ab- 
scess breaks, or is opened. 
EXTENSIVE SLOUGHING OF THE CELLULAR MEMBRANE. 
Severe cases of phlegmonous erysipelas, especially of the lower 
extremities, are frequently followed by very extensive sloughing of 
the cellular membrane, which protrudes through ulcerated open- 
ings in the skin, leaving large vacancies between the integuments 
and the muscles. While this mischief is going on in one part, the 
inflammation often continues to spread progressively, so as, now 
and then, to involve a whole limb. If the patient does not die un- 
der the violence of the disease, in these cases, he generally soon 
sinks under the enormous purulent discharge which takes place 
as its consequence. 
In cases of this description, almost the only topical remedies in 
use are large poultices and fomentations. It is a question whether 
these be not more injurious than beneficial, for by increasing the 
discharge, without being capable of checking the inflammatory pro- 
cess, they must tend to diminish the little strength which remains 
with the patient. 
Under these circumstances, the tincture of iodine is a most valua- 
ble acquisition as a remedy in these grievous affections. It not 
only has the advantage of being easily applied, without disturbing 
the posture of the patient, but it also has the property of at once 
arresting the progress of the inflammation, so as to give the living 
parts a chance of casting off the dead slough. 
In the summer of 1837. a man. aged 75 years, received a kick on 
the shin. The part became inflamed, and the inflammation pro- 
ceeded from bad to worse, in spite of surgical treatment under the 
management of a skilful practitioner, until the whole leg and thigh 
became involved in one mass of disease. When we saw him in 
consultation, the limb, all the way from the toes to the groin and 
hip, was enormously enlarged. The skin was intensely red and 
glossy, with the exception of several dark coloured vesicles about 
the lower part of the leg. In different parts of the limb there were 
several ulcerated openings in the integuments, through which 
strings of dead cellular membrane protruded. The discharge 
through these openings was very great. Indeed, it appeared as if 
the integuments of the whole member had separated from the mus- 
cles, leaving an empty space between. The constitutional dis- 
turbance was as great as it could well be consistent with life. In a 
word, the patient, considering his great age, and the extensive de- 
struction of parts, appeared quite in a hopeless state. The tincture 
of iodine, of full strength, was thickly painted over the whole limb 
—thigh, leg, and foot; and the application was repeated daily. At 
the expiration of twenty-four hours there was some slight amend- 
ment : on the third day the amendment was very decided. The SURGERY. 
97 
inarch of the inflammation had been checked: no more bullas had 
formed, and most of those which existed before, had discharged 
themselves, leaving small, healthy looking ulcers on their site. 
The only doubt now was as to the strength of the patient to bear 
the enormous discharge that must take place from the excavations 
which ran in all directions between the integuments and the mus- 
cles of the lesr and thigh. After the first four or five days, the 
tincture was applied every second or third day, until all the dead 
membrane was thrown off; and as soon as that object had been 
accomplished, it was still applied occasionally to any spot which 
showed a disposition to inflame. As soon as the sloughing had 
ceased, the openings in the integuments were dressed with simple 
dressing, and gentle pressure was applied to the limb, with the 
view of promoting adhesion between the parietes of the excavations. 
By proceeding upon this plan, the recovery of the patient was ulti- 
mately secured. 
July 15th, 1833, a thin, but healthy man, aged about 58 years, 
was felling a tree. The tree bounded over, and the stem fell upon 
his foot, lacerated the soft parts over the ankle and all along the 
back of the foot, exposing- very extensively the extensor tendons of 
the digits. Independently of the extensive laceration, the foot and 
ankle suffered very severe contusion from the weight of the tree. 
There was also a fracture of both bones of the leg, about three 
inches above the ankle. The fractured bones having been set, and 
the lacerated parts having been brought together as well as could 
be done under the circumstances, and retained so with adhesive 
plaster, an evaporating lotion was ordered to be kept constantly 
applied to the foot and ankle. The lotion was continued for three 
days. The limb did not swell much, nor did there appear to be 
any considerable increase of its temperature, although the weather 
was hot; but on removing the dressing, on the 18th, the integu- 
ments and wound presented a dark, livid, sloughing appearance, 
and the whole foot looked as if gangrene must necessarily take 
place. There was also present that peculiar constitutional dis- 
turbance which usually attends gangrenous affection of any part. 
The tincture of iodine was immediately applied over the foot and 
ankle—the parts were coated over three or tour times with it. The 
internal treatment consisted simply of common saline solution, with 
a small quantity of sulphate of magnesia. By the next day the 
foot presented a much more favourable appearance. It was quite 
evident that the gangrenous tendency had ceased. The greater 
portion of the integuments, whose life was supposed to have been 
entirely gone, showed indications of vitality. Those parts which 
had actually lost their vitality began already to exhibit a disposition 
to separate from the living part. The tincture was repeated daily 
for three or four days, until the vital part cleared itself of all the 
slough ; which it did most rapidly: the remedy, a good deal diluted, 
was then applied every two or three days to the surface and round 
the edges of the ulcer, in order to quicken the growth of granula- 98 
tions. Suffice it to say that the ulcer healed very rapidly, and that 
the patient was restored to his occupation, free from lameness, 
quite as soon as if there had been only a simple fracture of the leg. 
We must be pardoned for again repeating the observation, that 
these are not casual, solitary instances of this description of disease 
where the tincture of iodine has proved beneficial : it is almost 
uniformly successful, so far as our experience tends to prove : the 
exceptions are cases where some extraordinary gangrenous dispo- 
sition exists in the system—as we now and then find when ampu- 
tation of a limb is performed before the dead parts have separated, 
and where gangrene immediately commences in the stump; or 
where the sloughing has already extended so far that the system 
does not retain sufficient strength to restore the lost parts. 
DAVIES ON PATHOLOGY AND SURGERY. 
Inflammation of the synovial membrane of the joints—especially 
of the larger joints—requires very prompt treatment, otherwise per- 
manent organic changes take place, so that the free motion cannot 
be restored. The pain is generally severe in acute inflammation 
of this tissue; and the tenderness is often so great that the patient 
cannot bear the part to be touched. The soft parts covering the 
joint become swollen, and the inflammation presents itself exter- 
nally on the skin. The joints by far the most liable to this kind of 
affection are the knee and hip ; and as the tissue originally affected 
is endowed with but a small degree of sensibility, the disease fre- 
quently makes considerable progress before any particular notice is 
taken of it. This is proved by the fact, that a slight uneasiness, 
or a small degree of tenderness, often exists in the joint for several 
days, or perhaps a week or more, before the patient is laid up ; and 
that, when the disease has once arrived at a certain stage in its 
progress, it runs on very rapidly, so as to produce suppuration 
within the capsule of the joint, unless promptly met by remedies. 
The topical remedies usually employed in this affection, are local 
abstraction of blood, either by cupping or leeching, or both ; evapo- 
rating lotions; poultices, warm or cold, according to the views of 
the practitioner; and, occasionally, fomentations. 
Now, the tincture of iodine has been employed very extensively, 
both at the General Infirmary and in private practice, in this dis- 
ease, and has been found a much more efficacious remedy than any 
of those in common use. It is necessary, however, to state, that no 
disease for which the iodine lias been employed requires so much 
discretion on the part of the surgeon as the one under considera- 
tion. If used too strong at first, or applied too frequently, it may 
give rise to inflammation of the integuments, and cause, or add to 
the puffiness of the soft parts external to the joint; but we have 
not known it in any one instance to aggravate the internal inflam- 
mation. We speak now more particularly of the knee joint. The 
texture of the patient’s skin must serve to guide the practitioner, in 
ACUTE INFLAMMATION OF THE JOINTS. SURGERY. 
99 
a great measure, respecting the strength of the tincture and the 
frequency of its application. It should be at first diluted to about 
half its strength, or more, if the skin be of a very delicate texture ; 
and, if required, its strength may be gradually increased according 
to its effects. It is .seldom that the remedy produces any irritation 
of the skin in other parts of the body; and with regard to the knee, 
our remarks are intended more to put the practitioner upon his 
guard against what may happen, than to inform him of what will 
happen. Should any irritation or inflammation of the integuments 
occur, it will be very readily subdued by a simple evaporating 
lotion, composed of one part of spirit of wine to eight or ten of 
water. 
The tincture, diluted, may be applied at once all over the in- 
flamed joint, with perfect confidence that not only no mischief \ but 
that good, will be the result. But when the disease has been pretty 
far advanced, and where the swelling has been considerable, we 
have generally preferred leeching the joint first, and then, a few 
hours after the bleeding has ceased, to apply the tincture. Whe- 
ther by getting into the leech bites the remedy exerts a greater in- 
fluence on the internal vessels of the joint, we do not profess to 
know, but the fact is that the application of leeches, in this species 
of inflammation, previous to the employment of the tincture, tends 
greatly to assist the good effects of the latter. The remedy will 
generally require to be applied every day, for two or three times; 
then every other, or every third day, according to circumstances ; 
the practitioner exercising his discretion according to the condition 
of the part, and the effect of each application. If, in the interme- 
diate time of the applications, the part should acquire an increase 
of temperature—as it sometimes does very suddenly, without any 
evident cause—it will be useful to lay over it a layer of rag soaked 
in spirit of wine, or in a simple spirit and water lotion. This ap- 
plication will not interfere with the repetition of the iodine. But 
no lead or zinc lotion, or one medicated in any way, should be em- 
ployed. 
When the hip is the joint affected, leeches should be applied to 
the groin and behind the great trochanter ; and after the bleeding 
has ceased, the whole of the upper part of the thigh, the hip, and 
the groin should be well painted over with the tincture, of its full 
strength. The application, as in all other cases, should be re- 
peated according to circumstances. 
Having illustrated the principle and mode of application of the 
remedy, it is unnecessary to occupy the time of the reader by a 
detail of cases of this species of inflammation, for the doing so 
would be only a repetition of the same mode and principle already 
just stated. It is also assumed, as a matter of course, that, in this 
disease, as well as in all other local affections, no general treatment 
calculated to assist in the subduction of the local malady has been 
neglected. 100 
DAVIES ON PATHOLOGY AND SURGERY. 
INFLAMMATION OF THE BREAST. 
The inflammation of the breast which so frequently takes place 
soon after delivery is of the pure phlegmonous kind, having its 
origin and seat in the cellular membrane pervading the mammary 
glands. Its commencement and progress are attended with heat 
and throbbing pain, and it terminates, if not in resolution, in a 
purulent abscess, like that proceeding from common phlegmon. 
The collection of matter is generally very great, attended with a 
good deal of constitutional disturbance, and the abscess usually 
opens by a large hole, denoting much sloughing of the integuments 
and of the cellular membrane within. 
In three cases out of four, or even in a larger proportion, acute 
inflammation of the mammae runs on to suppuration under the 
usual plans of treatment, and the abscess is generally upon so large 
a scale that the gland never afterwards recovers its natural func- 
tion. The topical remedies in common use are leeches, lotions, 
and poultices. The popular remedies are of a more stimulating 
kind, and are applied in the form of embrocations, which, it cannot 
be denied, are oftener followed by success than the professional 
ones. 
Although generally very deeply situated among the glands, in- 
flammation of the breast is not beyond the reach of the influence 
of the iodine. If applied before matter has actually commenced to 
form, the tincture will prove successful in the great majority of 
cases. When suppuration has already commenced, the application 
will materially confine the mischief, probably by subduing the in- 
flammation surrounding the abscess; and instead of having an 
enormous discharge of matter, from a cavity occupying nearly the 
whole of the breast, perhaps not more than an ounce or an ounce 
and a half will come away on the breaking of the abscess. 
As soon as it is discovered that inflammation has commenced, 
the tincture, in full strength, should be applied extensively over 
the part affected. When the disease originates very deeply among 
the mammary glands, the remedy should be made to cover the 
whole breast. The application should be repeated next day, equally 
strong, unless the smarting from the first should have been severe: 
if so, then the tincture ought to be diluted. At any rate, the breast 
should be painted over with it daily, until the pain and redness 
shall have ceased, the strength being regulated according to its 
effect on the skin. Even if suppuration is known to be going on, 
it is still expedient to pursue the same course, because the remedy 
will tend greatly to limit the extent of the abscess, and will accele- 
rate its bursting. When the abscess has burst, or has been opened, 
a poultice should be applied to the part, and continued as long as 
any discharge exists ; but an occasional application of the tincture, 
even after the bursting, will be found to aid the cure very materi- 
ally. SURGERY. 
101 
Three cases of this description have been under treatment within 
the last six months ; and, during the last five years, several cases 
Itave occurred, in some of which suppuration took place, but al- 
ways small in quantity. In the great majority the inflammation 
was checked before any purulent matter was formed, or when it 
was so small in quantity as to be again absorbed under the use of 
the remedy. 
GOUT. 
The inflammation of gout is universally considered as dependent 
upon constitutional causes. No doubt, the morbific cause of the 
disease is conveyed to the local seat of affection through the me- 
dium of the system, and the functions of other parts suffer from it 
besides those which present themselves externally. But the most 
unbearable symptom of the disease is the pain in the local seat of 
inflammation ; and the violence of this is generally such as greatly 
to aggravate any constitutional symptoms that may exist. Previous 
to the appearance of the local inflammation, there is generally an 
uneasiness about the pit of the stomach ; nausea ; general languor, 
attended with a disposition to irritability, both of mind and body; 
darting or shooting pains in different parts of the body, &c. When 
the local pain comes on, the foregoing symptoms become drowned 
in a general fever, which continues, more or less, as long as the 
local affection exists. 
The local remedies usually employed for the removal of the pain 
and inflammation of gout, may be divided into two classes : first, 
professional; second, popular. The former are the same as those 
used in other local inflammations, namely, leeches, evaporating 
lotions, fomentations, poultices, &c. The latter consist in the ap- 
plication of hot flannels, and other hot things; stimulating embro- 
cations ; stimulating plasters, <fcc. The object of the first class is 
to prevent inflammation from taking place, by means of antiphlo- 
gistic remedies : the object of the second class is to promote inflam- 
mation and swelling, because experience has proved that as the 
integuments swell and inflame, the pain diminishes. The virtues, 
and want of virtues, of both classes of remedies are so well known 
to the profession, and to those who are subject to the disease, as to 
render any remarks upon them here unnecessary. 
The curative effects of the tincture of iodine in the pain and in- 
flammation of gout can be appreciated by those only who have 
witnessed them, or those who have received the benefit of the 
remedy. We have generally found one or two applications remove 
the pain almost entirely. We usually dilute the tincture to about 
two-thirds its full strength ; and if the part affected be the foot, we 
paint it and the toes well over, all the way from the ankle ; or from 
higher up the leg if the ankle itself suffers from the disease. The 
application is repeated next day if any pain, redness, or swelling 
remains. In fact the disease is treated like common phlegmonous 102 
DAVIES ON PATHOLOGY AND SURGERY. 
inflammation. When the malady has fixed itself in the fingers and 
hand, the treatment is the same: the whole hand, fingers, and wrist 
are brushed over, and the application is repeated as long as any 
trace of the disease remains. 
A gentleman of our acquintance (who has never had a regular 
attack of gout, but has had many threatenings of it,) whenever he 
experiences pain in the ball of his great toe, with tenderness on 
moving the joint, immediately applies the tincture very liberally to 
the seat of threatened mischief. By so doing he has hitherto 
warded off the attacks; and the constitutional derangements ac- 
companying these threats have been rectified by simple saline 
aperients. 
A gentleman, aged about 50, who had, usually, for many years 
been obliged to lay up for several weeks each year with the gout 
under the old established mode of treatment, has had, of late years, 
the paroxysms reduced to a few days only. The local affection 
has been always preceded by a good deal of gastric derangement, 
and the pain in the feet, at the commencement of each attack, has 
been excessive. The pain, however, has been relieved in a few 
hours by the application of the tincture; and even the redness and 
swelling (when the disease has been allowed to proceed so far) 
have been soon reduced ; and, aided by general treatment, every 
paroxysm has been of late years subdued in a few days. 
A man, aged about 45, of stout make, but of rather unhealthy 
constitution, has been much subject to gout of late years. The 
pain in the feet, as the paroxysms come on, is excessive. Before 
we began to attend him, the feet used to inflame, and swell con- 
siderably, so as to confine him for weeks. Within the last few 
years, the application of the tincture to the feet, and a few doses of 
colchicum internally, have set him up in a few days. The pain 
has been usually subdued in a few hours. 
In very many cases of anomalous pains of the joints, supposed 
to be gouty or rheumatic, unattended by inflammation, the effect 
of the tincture of iodine has been very noted. In such cases it 
ought generally to be used in full strength, unless the texture of 
the skin be delicate. It first causes a sensation of warmth, amount- 
ing in most instances to smarting; and it commonly follows that 
when that sensation has ceased, the original pain is no longer felt; 
or, if felt, it is in a much lower degree than before the application 
of the tincture. 
CHRONIC INFLAMMATION AND ENLARGEMENT OF THE JOINTS. 
This affection constitutes generally a large proportion of the 
surgical cases admitted into hospitals. The disease varies in degree 
from that state commonly called “ white swelling,” down to a slight 
thickening of the soft part, and tenderness on moving the joint. Its 
cause may also vary : sometimes it is connected with a scrofulous 
state of the system; at other times it is produced by some slight SURGERY. 
103 
accident to the joint; whereas it often comes on without any ac- 
countable cause. 
When the large joints, such as the hip and knee, have formed 
the seats of affection, the treatment has usually been local bleeding, 
followed by blisters or setons. In fact, all the remedies commonly 
employed in acute inflammation, with the addition of stimulating 
embrocations, plasters, and mercurial inunctions have been at dif- 
ferent times put in practice in this obstinate malady. 
Iodine, also, has been employed in enlargement of the joints, 
especially in cases accompanied by a scrofulous condition of the 
system, from the supposition that the remedy possesses some spe- 
cific influence over that disease. We have never had reason to 
believe that it does possess any such influence, any further than 
that, as a topical remedy, it will subdue scrofulous inflammation in 
the same way as it subdues any other local inflammation. The 
iodine has been generally employed in these cases in the form of 
ointment. It is not only objectionable in that form on account of 
the friction tending to increase the pain and irritation of the joint, 
but also because its effects are nothing like so beneficial as when 
applied in the form of tincture, or of iodureted hydriodate lotion. 
To the large joints, such as the hip and knee, we generally ap- 
ply several leeches before the employment of the iodine. Having 
done so, the tincture, usually diluted, is applied very extensively 
over the affected joint, and repeated every two or three days, ac- 
cording to its effect on the skin. Should any preternatural heat 
occur in the part, a layer of rag, soaked in spirit of wine, or in a 
simple spirit lotion, should be laid on it, the same as directed to be 
done in the acute form of the disease. 
This plan is to be persevered in for a period limited only by the 
duration of the disease. An amendment will generally be found in 
a few days to have taken place ; and it will go on progressively, 
but in many instances slowly, until the motion of the joint is re- 
stored, as far as art can restore it. 
When the enlargement has been in the ankles, or wrists, and of 
long standing, we have generally preferred the iodine lotion, even 
to the tincture. This is the most ready form of the remedy in 
cases like those of out-patients at hospitals, where the practitioner 
has not an opportunity of frequently witnessing the progress of the 
cure. The strength of the lotion must be determined by the dis- 
cretion of the surgeon. A piece of rag should be soaked in it, and 
laid round the affected joint, and the application should be repeated 
two, three, or four times a day, according to its effect on the skin. 
This plan of treatment has received a long and extensive trial, 
and it has succeeded very far beyond the methods usually adopted 
in affections of this nature. 
INFLAMMATION OF THE ABSORBENTS. 
The first, and worst, case of inflamed absorbents in which the 104 
DAVIES ON PATHOLOGY AND SURGERY. 
tincture of iodine was used, was that of a gipsey-man, aged about 
30, in 1829, who had been bitten on one of his fingers by a horse. 
Some purulent matter from an abscess in another horse got into the 
wound. The part soon inflamed, and the inflammation rapidly 
extended along the course of the absorbents up to the axilla. When 
we saw him the disease was of a fortnight’s standing. There was 
an abscess discharging at the bend of the arm ; another about the 
middle of the upper arm, and a third in the axilla; and there was 
a wide path of inflammation traceable all the way from the wound 
to the axilla, along the course of the absorbents. The man was 
reduced to a mere skeleton. 
The tincture of iodine, of full strength, was freely applied along 
the inflammatory path, and over the abscesses ; and the application 
was repeated daily. Common dressing was then applied to the 
abscesses. The inflammation, by this plan, was subdued in two 
or three days, and the patient was well in a fortnight. 
We might detail a dozen or more cases of inflamed absorbents, 
from slight injuries to the toes or fingers; from the pressure of the 
shoes upon corns; from the too close cutting of corns, and from 
other causes, where the tincture has been applied, and uniformly 
with success. Indeed, one or two applications generally suffice to 
subdue the inflammation of the absorbents; but we have usually 
continued.daily to touch the original source of the mischief-—that 
is, the wound, or corn, or bunion, or whatever the cause may have 
been—for some days after the inflammation has disappeared. 
CARBUNCLE. 
In November, 1836, a man whose constitution has been already 
noticed, as being subject to gout, had a regular and well formed 
carbuncle on the back of the neck. He allowed the disease to go 
on—applying poultices, &c. in the mean time—for ten days, before 
he applied for surgical aid. When we saw him there was a large 
carbuncle in the middle of the nape, having a great number of 
small openings on the surface, and being surrounded by a hard, 
dense, red swelling. The skin was quite tough and leathery. The 
general health was suffering very much. 
The usual practice in these cases is to make a crucial incision 
in the carbuncle, and then continue the application of poultices un- 
til the part is restored to its normal state, or until the patient dies: 
doing all necessary things towards improving the general health. 
The tincture of iodine, of full strength, was applied very thickly 
over the inflamed surface, as well as over the carbuncle. On the 
next day the inflammation was found considerably diminished. 
The application was repeated as before. On the third day the in- 
flammation was nearly gone. The skin corrugated, and the cuticle 
was desquamating all round the carbuncle: but the carbuncle 
itself remained much in the same state, having a great number of 
small openings on its surface, through which the matter within 105 
SURGERY. 
could find no free exit. As there evidently was a considerable 
quantity of dead cellular membrane which must be discharged be- 
fore the abscess could get well, a single transverse incision was 
made through the carbuncle. The tincture was then repeated 
daily, and having allowed an hour to elapse after its application, a 
small poultice was put on, for the purpose of keeping the abscess 
moist. The dead cellular membrane was cast off in three or four 
days, and the cavity left by it filled up rapidly by granulations. . 
Last winter, a labourer, aged about 40 years, of a thin, irritable, 
unhealthy look, applied for relief for a boil (as he called it) on his 
back. He represented it as having been coming on for a fortnight, 
during the whole of which time he had poulticed it. He found 
that his health was fast giving way, and that the boil was daily 
getting larger and more painful, he therefore presented himself for 
surgical aid. 
On examining the back, there was found on the left loin a large 
carbuncle, having a number of very small openings on its surface, 
and being surrounded to a considerable extent by an areola of in- 
flammation. The part was swelled, and felt as hard as a board. 
The skin was of a dark red colour, and communicated a tough, 
leathery feel to the fingers. The health had suffered considerably 
within the last week. 
There was also an incipient boil on the left shoulder, just over 
the blade bone, having precisely the same characters as the one on 
the loin at its commencement. Two applications of the tincture 
served entirely to dispel this young carbuncle. 
A crucial incision was made in the carbuncle on the loin, and 
then the tincture, of full strength, was thickly laid on it, as well as 
on the extensive areola of inflammation surrounding it. A small 
poultice was applied to the abscess, with the view of keeping it 
moist. The only general treatment was a tea-spoonful of Epsom 
salts every morning, in half a pint of water. Next day the inflam- 
mation had considerably subsided, and the leathery hardness of the 
skin surrounding the carbuncle was very nearly gone. The man 
felt already much improved in health : he had had a good night’s 
sleep, which he had not before enjoyed since the local disease had 
made its appearance. The tincture was again applied, both to the 
carbuncle and to the surrounding skin. After the second day it 
was not found necessary to paint the skin, for no inflammatory ac- 
tion any longer existed. The carbuncle, however, was touched 
daily for some time, in order to enable it the sooner to cast off the 
dead cellular membrane, and to form granulations. In a few days 
the slough was discharged, leaving a very large, deep cavity, which, 
however, filled up very rapidly under the occasional application of 
the tincture, diluted to about a third of its full strength. The man 
was fit for work in less than a fortnight from his first applying for 
surgical aid. 
It may be stated here, that the remedy is equally applicable to 
common boils. It has also been used in several cases of bubo— 106 
DAVIES ON PATHOLOGY AND SURGERY. 
some dependent upon chancre ; others upon gonnorrhoeal irrita- 
tion—and its good effects have been uniform. If applied to them 
in their incipient state, before suppuration has actually commenced, 
it will generally cut short their march. If applied after the com- 
mencement of suppuration, and previous to their bursting, it will 
subdue the surrounding inflammation, and confine the abscess 
within a very narrow space. If applied after the bursting, it will 
materially accelerate the removal of the hardness and inflammation 
surrounding the cavity of the abscess. These are real facts—facts 
easily tested by trial. 
LUPUS, OR NOLI ME TANGERE. 
This is a disease kept up apparently by some specific cause, which 
induces it to go on progressively, destroying in its march the in- 
teguments and parts situated underneath, it usually commences 
on one of the alae of the nose, or side of the cheek close to the 
nose; or else on the lips, especially the lower one. It generally 
begins in a pimple or small tubercle, which ulcerates, and the ulce- 
ration spreads in a continuous manner, eating up in its course the 
skin, alae of the nose, or other parts beneath, to a considerable 
depth. 
The principal remedy employed for this destructive malady is 
arsenic, both administered internally, and applied externally, so as 
to cause sloughing of the diseased part. Nitrate of silver has been 
also used with the same view. Ointments made with different pre- 
parations of mercury, as well as pitch and sulphur ointment, have 
all been applied in their turn. 
September 10th, 1829, a respectable mechanic, aged about 36, 
had an eating ulcer on the left ala of the nose, extending some dis- 
tance on the side of the cheek. The disease had crept up the nose 
as high as the nasal bone, and had eaten right through the cartilage, 
so as to produce a slit into the nostril. It was creeping on fast along 
the side of the cheek. The part was excessively painful. The dis- 
ease was of some weeks’ standing. Various applications had been 
tried before we saw him, and he had consulted some noted London 
surgeon; but the malady was steadily progressing in its march.— 
The tincture of iodine, of full strength, was applied over the surface 
of the ulcer, and to some distance round; and the ulcer was then 
dressed with ointment containing hydriodate of potass. The disease 
made no further progress. In a few days an amendment was quite 
perceptible. The ulcer was treated in the same manner daily until 
the 30th: after that period the tincture was only applied every two 
or three days. On the 20th of October the patient was discharged, 
cured. 
In the same year, a labourer, aged about 40, had an eating ulcer 
on the side of the left cheek, near the nose. It had consumed the 
integuments to the extent of a crown piece; but in the middle of 
the part destroyed there was a kind of rough skin forming, which 
was situated below the level of the old integuments. Between this SURGERY. 
107 
and the outward edge of the disease there was an ulcerated space 
exceedingly painful. The tincture of iodine was applied daily 
over the ulcer and surrounding skin: no further dressing was 
employed ; the part being left exposed. No internal remedies were 
used. The malady ceased to spread after the first application. In 
three weeks the case was discharged, cured. 
The remedy has proved equally successful in two or three cases 
of the same disease affecting the 1 ips«, in its incipient stage: 
It is proper, however, to state that the remedy failed in one in- 
stance at the infirmary, although assisted by the internal use of the 
arsenical solution. This was the case of a little girl, about twelve 
years old, whose nose, and the side of whose face, were affected by 
the disease. In this case, whenever the iodine was employed, the 
march of destruction soon stopped, and the parts invariably put on 
a more healthy appearance; but whenever any other application 
was used the affection increased. 
MALIGNANT ULCERS OF THE TONGUE AND TONSILS. 
Ulcers of a very troublesome kind often form within the cavity 
of the mouth. These are occasionally tainted with syphilis, espe- 
cially when they attack the tonsils, and velum of the palate. Fre- 
quently, however, even these parts become the seats of destructive 
ulcerations, in the production of which syphilis has had no share. 
We were greatly puzzled respecting the treatment of affections of 
these seats before we began to employ the iodine; but since then 
the treatment has been easy enough, and almost uniform in its success 
—indeed, we may say quite uniform as far as our experience goes. 
September 7th, 1829, a youth, aged 16 years, had the left tonsil 
very nearly all destroyed by ulceration, which was still proceeding. 
There was also ulceration going on in the uvula and back edge of 
the velum. The right tonsil was considerably swollen, and the 
whole of the soft palate was much inflamed. The tonsil began to 
ulcerate three weeks previous, and the disease was going progres- 
sively on, destroying the soft parts in its course. His general health 
was suffering a good deal. He had been under medical treatment 
since the throat first became bad. He denied having given occasion 
for any syphilitic affection. The tincture of iodine was applied 
with the brush all over the palate, tonsils, and uvula; and the 
application was repeated daily. The only internal remedy was 
the iodureted hydriodate solution, in doses of ten drops twice a 
day, in water. We find, by our notes, that the patient was dis- 
missed, cured, on the 20th of the same month. 
A butcher, aged about 35, healthy looking, though not very 
stout, applied, November 30th, 1829, for relief to an affection of 
the tongue. The disease had been coming on for some months, 
and he had been under treatment for it without finding any benefit. 
The tongue was altogether a good deal enlarged, and several parts 
of it were indurated deeply into the substance of the organ. The DAVIES ON PATHOLOGY AND SURGERY. 
surface of the indurated points was ulcerated. The ulcers were, 
each, small in extent; but they were very numerous, and extremely 
painful at times, and very tender when they came in contact with 
the teeth, or the roof of the month.—The tincture of iodine, of full 
strength, was applied all over the tongue, and the organ was directed 
to be allowed to hang out of the mouth for two or three minutes 
after every application. The only internal remedy was the iodu- 
reted hydriodate solution. After the 5th of December, thinking 
that the tongue was well, the patient ceased to attend. Finding, 
however, that the disease threatened to return, he applied again on 
the 21st of January following (1830.) The same treatment was 
resumed and continued for a week only, when he found himself 
well, and left off coming. He has had no return of the disease 
since. 
These cases are selected because they are among the first of the 
kind that were treated with the tincture of iodine. Many similar 
ones, and various other affections of the mouth have been since 
treated in the same way, with equal success. 
SCROFULOUS SWELLING OF THE GLANDS. 
In scrofulous constitutions, the hereditary malady generally shows 
itself externally in the lymphatic glands under the jaw and about 
the neck. Why it should bear a more intimate relation with the 
glands of these parts than with those of other seats, is one of those 
mysteries connected with the living structure which have not yet 
been fathomed. The commencement of the glandular enlargement 
in this affection is usually unattended with pain. The pain and 
soreness seldom come on until the integuments begin to inflame, 
from the internal pressure of the enlarged gland. When the 
abscess bursts, its contents are found to be a mixture of pus and 
cheesy or curdy substance. These affections very commonly run 
on to suppuration under the common plans of treatment, and when 
the matter has discharged itself by the bursting of the abscess, the 
part is usually slow in healing. It frequently happens that no 
sooner one place heals up than another breaks out, and there is 
often a succession of swellings and sores in various stages of sup- 
puration and healing. 
The topical remedies commonly employed in these affections are 
leeches; lotions, generally medicated with acetate of lead or sul- 
phate of zinc; salt and water, or sea water; and poultices after 
suppuration has been discovered to have commenced. 
The tincture of iodine, applied over the enlarged gland, will 
much more frequently cause a dispersion of the swelling than any 
other remedy. If resorted to before suppuration has actually com- 
menced, and used with discretion, it will, in a great majority of 
cases, check the swelling, and will ultimately promote the absorp- 
tion of the morbid deposite. The same remarks will apply to these 
swellings as to common boils: even when suppuration has begun 109 
SURGERY. 
before recourse is had to the tincture, or when it has taken place 
in spite of the tincture, still the application of the iodine is highly 
beneficial, in limiting the extent of the abscess, thereby limiting the 
size of the scar which is to follow. Moreover, when the swelling 
has burst, an occasional touch of the remedy will be found mate- 
rially to accelerate the cicatrisation of the sore. 
We have never had reason to think that the iodine exerts any 
specific influence over these swellings, as it undoubtedly does over 
that of the thyroid gland. It subdues inflammation of the lym- 
phatic glands in the same way as it does inflammation of any 
other part, namely, by imparting a contractile tone to the capillary 
vessels, so as to restore the balance between the two functions of 
secretion and absorption. 
WHITLOW. 
A deep-seated whitlow, though originally occupying a small part 
of a very small member, is yet one of the most serious local affec- 
tions, dependent upon acute inflammations, to which the attention 
of the surgeon is liable to be called. 
This affection consists of inflammation of some part of the last 
phalanx of the fingers and thumb. It is sometimes superficial, 
being situated immediately under the skin. When this is the case, 
it soon forms a vesicle containing a serous fluid, or serum mixed 
with pus. After this has burst, or has been let out, it often leaves a 
little ulcer about the root of the nail, which proves very troublesome 
and difficult to heal. 
When the disease originates in the deep-seated parts, such as the 
sheaths of the tendons, or the periosteum of the last phalanx, the 
pain is excessive, attended with the sensation of strong throbbing, 
together with increased heat; but the swelling in the finger is 
frequently very trifling for some days. The parts which first and 
most swell, are the hand, wrist, and arm; and the pain, which is 
very severe, extends along the member, up to the axilla. After a 
few days, the finger swells more, and some indistinct fluctuation 
may, perhaps, be felt towards the end of it, generally on the palmar 
side. Suppuration has now commenced, and unless the part be 
immediately—or even before this stage—laid freely open, the bone, 
especially the last phalanx, will be almost sure to die. The soft 
parts about the finger, hand, and wrist will swell enormously; 
matter will burrow in all directions under the fascia, and amongst 
the sheaths of the tendons ; the integuments wiii ultimately ulcerate 
in various parts, and the dead fascia and cellular membrane will 
protrude in ropes through the openings. While this process is 
going on in the soft parts, the bones of the fingers are losing their 
vitality and becoming carious. 
The local applications commonly used for this disease, are, a 
leech or two to the end of the inflamed finger, followed by a Gou- 
lard lotion, or a poultice, to the finger and hand: laying the part 110 
DAVIES ON PATHOLOGY AND SURGERY. 
freely open, down to the bone, and then poulticing it. This should 
be done without fail as soon as it is found that the inflammation 
does not end in resolution. 
As soon as the pain and throbbing of whitlow are felt to be com- 
ing on, the whole finger or thumb (whichever it may be,) ought 
immediately to be painted over with the tincture of iodine, of its 
full strength. In about twelve hours, the application should be 
repeated, unless the morbid sensation has ceased, which is often the 
case, even after the first application. In every case, however, it 
will be prudent to repeat the remedy two or three times, at intervals 
of twenty-four hours. Except where it was certain that suppura- 
tion had actually commenced, we do not remember an instance in 
which the tincture has failed to subdue the disease. Whenever it 
is suspected that matter exists, or even when that is doubtful, if the 
inflammation does not give way in a few hours, a free incision 
should be made into the part: the tincture should then be applied 
over the finger, as well as over the hand if at all swelled; and it 
should be made to insinuate itself freely into the incision. After 
an hour or two have been allowed to elapse, a small poultice should 
be applied to the end of the finger—confining it to as small an 
extent beyond the incision as possible, its object being merely to 
keep the wound from healing. The same treatment should be 
repeated daily as long as any vestige of the disease remains. 
Within the last eight months we have had two fair specimens of 
the destructive nature of this disease under treatment at the Infirm- 
ary. The two cases were so similar that one description will do 
for both—indeed, for almost every neglected case of deep seated 
whitlow. 
In both these cases, the part originally affected was the little 
finger. The only difference in the two, when they presented them- 
selves, was, that in one the palmar surface of the finger was dry 
and black; whereas in the other the whole finger was swelled to 
three or four times its natural size, and it looked a complete mass 
of sloughing cellular membrane and pus. The hand was enor- 
mously swollen and inflamed, with ulcerated openings here and 
there, through which sloughs of dead membrane and fascia were 
protruding. The redness and swelling extended to the other 
fingers, and up the wrist, as high as the middle of the arm. The 
pain was so great that the patients had had no sleep for many days. 
The whole hand and fingers presented such a mass of disease that 
it was impossible to determine the amount of mischief done to the 
bones, any further than that the three phalanges of the little finger 
were destroyed. Poultices and fomentations, or soaking in warm 
water, had been diligently used from the commencement of the 
disease, but incision of the part had been neglected in both cases. 
The hand was first washed clean of the poultice, in warm water, 
and left exposed to the air for a short time, in order that its surface 
might dry. The tincture of iodine, of full strength, was then 
applied thickly all over it, including the space from the middle of SURGERY. 
the fore-arm to the tip of the fingers. After that, a thin piece of 
rag was thrown loosely round the part, and the hand put in a sling. 
The patient, in both instances, slept soundly the very first night 
after the application of the remedy. Next day the swelling was 
found much reduced, and there was only a remnant of the pain 
existing. The same treatment was repeated every day for about 
a week or ten days, when the inflammation was all gone, and the 
swelling was so reduced as to enable us readily to determine the 
extent of mischief done to the bones, and to render an operation 
easy. The finger was removed in each case, at the knuckle joint, 
and dressed in the usual way, only that at each dressing the wound 
and the whole hand were brushed over with the tincture. About 
three weeks after the operation each patient was discharged, cured. 
CHILBLAINS. 
The parts most subject to chilblains are the toes, especially the 
little toe. Those next most liable are the finders, especially the 
little finger. The ears, nose, and cheeks, also, not unfrequently 
become chilled. 
In this troublesome affection we find a species of inflammation 
without any heat or pain, for the most part. It is true that the part 
affected requires a temperature somewhat above the standard when 
it has been in a warm room, or kept near the fire, for some time; 
but that is very trifling, and even then the heat does not convey the 
same sensation as that of common inflammation of the same seat. 
It is also true that, under the circumstances just stated, a certain 
degree of pain is felt, but the sensation is more that of itching, and 
is quite different from that attending either phlegmonous or erysipe- 
latous inflammation. Strictly speaking, the only elements of in- 
flammation observable are redness and swelling. These are often 
present in a considerable degree of intensity—so much so, that the 
death of the part is by no means an uncommon result. Sometimes, 
however, an erysipelatous inflammation of the foot and leg proceed 
from the chilled part, and the case then assumes a new character. 
We have already noticed that those parts are most liable to be- 
come chilled in which the velocity of the circulation is least. The 
vital contractility of the capillaries is reduced by the long continued 
application of cold, so that they become enlarged in capacity, and 
retain considerably more than their due proportion of blood. As 
the vessels continue to enlarge, the motion of the fluid becomes 
slower, until, at last, it ceases altogether, and the part ulcerates or 
sloughs. 
Experience has taught people in general, that applications of a 
stimulating nature are the most efficacious in this complaint, some 
of the professional, remedies, however, are still applied upon the 
antiphlogistic principle. But the most common applications are 
embrocations containing camphor, ammonia, oil of turpentine, and 112 
DAVIES ON PATHOLOGY AND SURGERY. 
other stimulating fluids; and, when the skin has ulcerated, ointments 
containing some of the gum resins form the usual dressings. 
The best preventive of chilblains, with which we are acquainted, 
consists in immersing the parts affected every night in warm water, 
into which some common salt has been thrown. When the fingers 
are liable to chill, the hands should never, if possible, be washed in 
coid water during the winter months. 
Scarcely a week passes in the winter that children with chilled 
feet are not brought for assistance—some with deep and extensive 
ulcerations about the heels and outside of the feet; and others with 
some of the toes sloughing off. The disease is usually checked in 
its progress by two or three applications of the tincture of iodine. 
The remedy should be applied, in its full strength, to the distance 
of some inches beyond the boundary of the inflammation, and 
should be repeated daily for some time. The affected parts should 
also be immersed every night in water as hot as the patient can 
bear. When the ulcers have assumed a healthy aspect, and the 
surrounding skin has lost its dark, livid, unhealthy colour, the 
strength of the tincture may be reduced, and its application re- 
peated every two or three days only, until the ulcers have quite 
healed. The ulcers should be painted over with the tincture each 
time of its application, and then dressed with any simple ointment, 
or, in preference, ointment containing some resinous gum. 
We stated that the chilled parts sometimes assume an erysipela- 
tous character; and when this is the case they have a great tendency 
to run into gangrene. 
A woman, aged about 70 years, had one of her feet much chilled 
throughout the winter and spring. She did not apply for surgical 
aid, but kept poultices and other popular remedies applied to the 
part affected. The weather having become suddenly hot, and she 
being obliged to stand a good deal upon her legs during two or 
three days, the foot began to inflame round the ulcer, which was 
situated on the outside of the little toe, and the inflammation ex- 
tended rapidly up the leg. When we saw it a couple of days after, 
the foot and leg, nearly as high as the knee, were very much swol- 
len and inflamed, and the skin about the instep appeared of a dark 
colour, and was beginning to form blisters. The tongue was of a 
brown colour, the pulse very quick and weak, thirst intense : in 
fact, the constitutional disturbance was very great. The tincture, 
of full strength, was immediately applied all over the foot and leg. 
Next day the skin of the leg was shriveled, and the limb, down to 
the ankle, was scarcely larger than natural. The foot, however, 
was still inflamed and swollen, although the pain in it—which had 
been before excessive—was nearly gone. The tincture was re- 
peated, over the foot and toes. After the second application no 
further trouble was had with the case; the outside of the foot and 
sore were touched occasionally, and the latter dressed with common 
cerate, until it healed. The bullae dried up, and the cuticle des- 
quamated, leaving the surface clean and fresh. SURGERY. 
113 
It is remarkable in cases of this kind to find the constitutional 
symptoms so readily to give way as the local disease abates. Al- 
though in this case, as well as in very many analogous ones treated 
iu a similar way, calomel and opium were administered, yet the 
fever and constitutional irritation abated before the mercury could 
have any great effect upon the system, judging from cases where 
the same internal remedies have been applied, and trusted to chiefly 
for subduing inflammation. 
LACERATED, CONTUSED, AND PUNCTURED WOUNDS 
Wounds vary considerably in their nature, as well as in the 
decree of danger attending them. The danger depends generally 
much more on the part to which the violence has been done, than 
upon the extent or size of the wound produced by it. It not un- 
frequently happens that slight wounds about the head, though 
mere incisions, are followed by fatal erysipelas. Such effects occa- 
sionally follow the removal of tumours from the scalp: still more 
frequently does erysipelatous inflammation take place consequent 
on lacerations of that part. 
Again, wounds, whether lacerated or punctured, of tendinous 
parts often lead to great and fatal constitutional disturbance, though 
very slight with regard to both depth and extent. Locked-jaw and 
tetanus frequently follow very trifling punctures, even when the 
wound itself has healed, or is apparently healing favourably. The 
belief has generally been that wounds followed by these effects are 
accompanied by a partial division of a nerve or tendon: this, how- 
ever, is mere surmise, for the constitutional derangement sometimes 
follows where no reason exists for suspecting any such injury. 
But the most common constitutional effect arising from external 
violence, is fever—that is, an acceleration of the action of the 
heart, accompanied with heat of skin, thirst, coated tongue, and 
general restlessness. These symptoms are almost always preceded 
by a good deal of local inflammation in the seat of injury, and the 
general fever is considered as “symptomatic” of the local disease, 
or as “ sympathetic!'' with it, and is called so accordingly. 
We have already noticed the readiness with which the general 
symptoms often abate as the local disease is subdued by topical reme- 
dies, and have intimated that the former are, in most instances, 
entirely dependent upon the local affection. We are well aware 
that, in broaching such an opinion, we lay ourselves open to severe 
criticism, as well as to misconstruction, but one must not shut his 
eyes against facts; nor for fear of being misunderstood or miscon- 
strued, ought he to remain silent respecting those facts, when they 
relate so intimately to the treatment of disease. 
Now, that local disease is frequently associated with, and occa- 
sionally dependent on, general derangement of health, no one will 
dispute. The history of hereditary diseases, such as scrofula, gout, 
&c. proves that fact.’ It often occurs that, previous to the appear- 114 
DAVIES ON PATHOLOGY AND SURGERY. 
ance of erysipelatous inflammation of the head, legs, or other part, 
the patient has for some days suffered restlessness and uneasiness, 
indicating the general health to be wrong; but the appearance of 
the erysipelas does not mitigate the constitutional symptoms: on 
the contrary, the fever generally runs much higher on the breaking 
out of the local disease, and as the latter becomes abated, the for- 
mer also will abate with it. The instances on the other hand, of 
local disturbance giving rise to constitutional disturbance, are much 
more striking. A person, in perfect health, receiving such local 
injury as to cause inflammation of a certain degree and extent, is 
almost sure to suffer general derangement; and if the local affection 
be removed by topical remedies, the general fever will also give 
way without any aid from internal remedies. 
A part of the body becomes “ spontaneously” inflamed in a per- 
son who does not complain of any general disorder—who, in fact, 
has been long feeling in good health : as the inflammation extends, 
the general health becomes deranged, and a high degree of symp- 
tomatic fever is set up. Had there been any previous general 
derangement, there must have been some symptoms to indicate it. 
The fact appears to be, that, in such cases, there exists in the system 
some morbific agent, which has no pernicious relation with the 
vital structure in general, but which will deleteriously associate 
itself with some special seat, in its passage through it in the course 
of circulation. The functions of that seat are then disturbed, in 
consequence of the local derangement, and the system becomes 
secondarily affected, as it does in cases where external violence has 
been inflicted upon any local part. In such instances, which, in our 
opinion, are the most common, the symptomatic fever will give way 
as the inflammation abates under local treatment, though no general 
remedial measures be used. 
The degree of pain in a wound of the lacerated, contused, or 
punctured kind, is often no criterion of the amount of danger at- 
tending it; for sometimes a whole limb is torn from the body, and 
yet the pain, as felt and described by the patient, is not severe. In 
cases of this kind the impression upon the system is so great that 
the sensibility of the nerves appears to be annihilated, and death 
occasionally takes place before they recover their powers: at any 
rate, the death is not owing either to hemorrhage or to inflammation 
consequent on the injury, but to the general shock impressed upon 
the system by the magnitude of the violence. 
The usual method of treating lacerated wounds, is to bring the 
edges gently together, or to approximate them as near as can be 
done without using violence, and then to retain them in that posi- 
tion by means of sticking plaster. Sutures are occasionally used, 
when the laceration is very extensive ; but sutures should be avoided 
as much as possible, because they serve to add to the disturbance 
already caused by the solution of continuity of the living tissues, 
and may produce gangrene of the edges of the wound. Having 
adapted the torn parts, and secured them in their position, most 115 
SURGERY. 
practioners employ an evaporating lotion, especially that of Goulard. 
This remedy applies equally to lacerations and contusions. Others 
prefer poultices to lotions. In fact, the principle has been that of 
preventing inflammation as much as possible, by those remedies 
which come under the general term “antiphlogisties; and the object 
has been commonly aimed at by means of lotions in lacerations and 
contusions, and of poultices in punctures. 
In infirmary practice, wounds of this nature, of various extent 
and severity, are constantly presenting themselves, and since the 
treatment by iodine has been adopted, little trouble, comparatively, 
has been had with them at the institution in this town. When the 
accident is one of simple laceration, as soon as the wound is well 
cleansed of any dirt or blood that may be adhering to it, and the 
bleeding guarded against, every point of its surface is touched with 
the tincture, generally of its full strength, and the application is 
extended some inches beyond its edges. Having allowed it a few 
minutes to dry, the edges are brought together, and there retained 
with sticking plaster; which completes the dressing. On the third 
or fourth day, according to circumstances, the plaster is removed, 
when, generally, the parts that had been brought into contact will 
be found united, and the rest of the wound will be beginning to 
granulate and presenting a healthy appearance. The remaining 
surface of the wound, and the surrounding skin, are again brushed 
over with the tincture, and the former dressed with common wax 
ointment. The same practice is repeated every day, or every other 
day, according to circumstances, until the wound has healed. The 
cure is generally—nay, almost in every instance—most rapid. 
When the accident is contusion simply, the tincture is applied 
over the contused surface every day or two, and the part is then left 
without any further dressing. The extravasated blood will be ab- 
sorbed in a fourth of the time that it will take to disappear under 
the use of a lead lotion ; and we have never witnessed an instance 
where an unfavourable issue resulted. 
When there exists a combination of laceration and contusion, 
the treatment is also a compound, although simple enough. The 
surface of the wound is brushed over with the tincture, and the 
same application is made to the contused skin, however extensive. 
The wound is then brought into approximation, and there retained 
by means of either a roller or sticking plaster. The remedy is 
re-applied according to the necessity of the case. 
With regard to punctured wounds, those which have come of late 
years under our notice have been upon a small scale; but we con- 
ceive that all wounds of this description require the same principle 
of treatment. Whether a piece of iron be in the shape of a bayonet 
or that of a nail, will not matter much ; if driven into the flesh, or 
into any other tissue of the body, either will inflict a punctured 
wound, attended by similar symptoms, and followed by similar 
consequences. 
In several instances of the minor kinds of punctured wounds 116 
DAVIES OX PATHOLOGY AND SURGERY. 
the tincture of iodine has been used with that kind of almost un- 
deviating success which it exerts over local diseases and injuries 
attended by inflammation. If applied liberally, immediately after 
the receipt of the injury, generally no inflammatory symptoms take 
place. If the application be commenced after inflammation has 
been set up by the violence of the injury, the effect will be the 
same as that attending its use in common phlegmon. Unless sup- 
puration has already begun, the malady will end in resolution after 
one or two applications; and if suppuration has actually com- 
menced, or if there be a disposition to sloughing, the mischief will 
be confined, under the influence of the remedy, to a small compass. 
In these cases, our practice has been to let. the tincture insinuate 
itself freely into the wound, and to apply it thickly to the skin sur- 
rounding the wound : then to allow the part to remain exposed. In 
trivial cases, such as the prick of a pin or needle, it is seldom that 
any further notice is taken of the accident after the first application. 
The injuries from nails, or other pointed pieces of iron, from the 
pricks of thorns, &e., sometimes cause very severe inflammation 
and constitutional disturbance; but we have found them invariably 
give way to the treatment just described. 
In cases of extensive burns, life often ceases to exist before the 
immediate effect of the shock on the system is thrown off. The 
injury is inflicted upon a wide-spread and important tissue, upon 
which an equally important class of nerves is distributed; and the 
danger is generally dependent more upon the extent of the violence 
than upon its intensity. 
Three classes of remedies are used as topical applications in 
burns and scalds: first, cold lotions, medicated with acetate of lead 
or other materials; ice; the scrapings of potatoes, and, in fact, 
every thing calculated to cool the injured part: the second consists 
in the application of oil of turpentine, or of spirit of wine, as soon 
as possible after the receipt of the injury; and then to dress the 
part with cerates containing some of the same stimulants: the 
third class comes between the other two in point of medicinal 
quality ; for it consists neither in the abstraction of heat from the 
part nor in stimulating it to a reaction, but in soothing it with 
linseed oil, or some other oily matter. These different remedies 
have been descanted upon so frequently by surgical writers, that it 
would be a waste of time for the reader to be drawn over the same 
ground again. We may state, however, in passing, that the treat- 
ment with oil of turpentine, or spirit of wine, or any other spiritu- 
ous liquor in the absence of these, is, according to the experience 
we have had in such cases, very superior to either of the other two 
plans. 
Fortunately, since the tincture of iodine has been tried in burns 
and scalds, we have not met with a very severe accident of that 
BURNS AND SCALDS. SURGERY. 
117 
description, but in four or five cases where the injury was upon a 
moderate scale, the remedy proved so successful as to leave scarcely 
a comparison between it and those commonly employed. It seems 
to act on burns and scalds as it does on erysipelas. When the in- 
teguments are nor destroyed, although the cuticle may be in blisters, 
one or two applications of the tincture, of moderate strength, will 
subdue the pain and redness, and the case will require no further 
attention than to prevent the injured part from rubbing against the 
clothes or other things; or if on the legs or feet, to use rest until 
the skin has had time to recover its tone and cuticle. The remedy 
has been used in instances where the injury has been occasioned by 
fire, by boiling water, and by boiling lard, with equal success in all 
of them ; but further trial must determine its effects in cases where 
the violence has been very extensively applied. 
ULCERS. 
Ulcers present such a variety of character as almost to defy 
classification ; and if such an attempt were made, it would occupy 
a volume much larger than the present to treat of that subject alone. 
However, it is probable that all the varieties might be brought under 
two principal heads: first, ulcers dependent upon the sloughing 
of parts: second, ulcers dependent upon the absorption of parts. 
These are divisible into specific and non-specific; and each maybe 
again sub-divided according to its external characters, or its effects 
on the living tissues. 
Most of the specific ulcers depend on the absorption of parts: 
thus, we have chancre, lupus, cancer, &c. Among the non-specific, 
some are caused by sloughing, some by absorption, and some partly 
by both processes. Again, specific ulcers are almost uniform, ac- 
cording to their kind, in their external characters; whereas the 
non-specific present an endless variety in that respect. Hence, we 
have the clean granulating or healthy ulcer; the irritable without 
sloughing, with the jagged edges; the sloughing; the hospital or 
phagedenic; the varicose; ulcers connected with exfoliation of the 
bones; those caused by pressure, such as lying long in one posture, 
and many others, differing too minutely in their nature to come 
within the limit of general description. 
The treatment of ulcers has been as various as ulcers themselves. 
Among the usual remedies, we have lotions; poultices, of bread, 
linseed, carrots; poultices containing beer grounds, charcoal, &c.; 
ointments of ever so many descriptions; fomentations: tinctures of 
myrrh, benzoin, &c.; nitrate of silver; sulphate of copper; diluted 
acids; powdered charcoal; opium; hemlock; chalk; plaster of 
Paris; strapping with sticking plaster; bandages; filling the ulcers 
with wax, and a hundred other means. 
With regard to specific ulcers, they generally require (as stated 
in a former part of this work,) specific remedies. We have already 
spoken of lupus as giving way to the application of the tincture of 118 
DAVIES ON PATHOLOGY AND SURGERY. 
iodine. We have also used it in several cases of chancre, and have 
found the ulcer to heal much quicker than under the usual mer- 
curial application, or the nitrate of silver. The tincture has been 
likewise used in ulcers of a carcinomatous character; and although 
we should not be justified in speaking of it in positive terms as 
being capable of curing cancer—certainly not cancer of the mamma 
—yet so many cases distinguished by scirrhous indurations, ac- 
companied by malignant ulcerations, especially of the lips, tongue, 
and tonsils, have given way under its use, that, certainly, no topical 
remedy at present in the possession of surgery seems to equal it in 
efficacy in affections of that description. 
It is quite evident that the first step towards the cure of a non- 
specific ulcer, is to render its surface clean, granulating, and 
healthy. The rest consists in promoting the growth of the healthy 
granulations. Towards accomplishing these two objects, the long 
list of local remedies already specified, and of a great many more, 
has been frequently searched, and its contents applied, in vain. 
Now, when an ulcer is unhealthy; when it has a slough on its 
surface; or when the parts beyond its edges show a tendency to 
die; or when the discharge from its surface is sanious and acrid; 
or when its edges are jagged; or when its surface looks bloody, and 
the granulations, if there be any, are soft and spongy; or when it 
rapidly spreads, from progressive absorption—in all such cases, it 
is pretty clear that the vessels of the part are not in their natural 
and healthy condition. 
The question then is, what agent is there within our knowledge, 
whose medicinal virtues are capable of restoring the vessels to their 
normal state? The question has already been answered more than 
once: the tincture of iodine possesses that virtue in a much higher 
degree than any topical remedy within our means. As we said 
before, we do not know why it should be endued with such a pro- 
perty—why it should be capable of curing so many local affections, 
differing so materially in their outward characters; but the fact is 
that it is capable of doing so, as any one may prove by putting the 
remedy to the trial. But, if we refer to the view taken of the 
nature of local disease, there seems to be nothing very wonderful 
in such a fact: the wonder would be if it were otherwise. 
In all cases of sloughing, or irritable, or spreading ulcers, the 
tincture, of full strength, is applied freely over their surface, and to 
the skin, to the extent of two or three inches round them. Having 
been allowed to remain for some time, the ulcer is covered over 
with simple ointment of lint, or with a poultice, the former being 
generally preferred. The same application is repeated daily until 
the ulcer becomes clean and healthy. The tincture is then weak- 
ened, and the granulations are touched with it every two or three 
days. Under this plan the cavity of the ulcer fills up rapidly with 
healthy granulations. Where the ulcer is in a situation to have 
pressure applied, either a bandage or strapping with sticking plaster SURGERY. 
119 
is had recourse to as soon as the surface has become clean and has 
put on a healthy appearance. 
Among several other local affections in which the tiucture of 
iodine has been used with good effect, but whose treatment it is 
not necessary to follow out in detail, are gouty and rheumatic 
swellings of the small joints, from thickening of their ligaments: 
fistulous openings ; malignant warts or adventitious excrescences ; 
ganglions; the stinging of wasps; disease of the spine; ununited 
fractures; hernia humoralis; inflamed urethra, and chordee; in- 
flammation of the bursae; chronic opthalmia, and opacities of the 
cornea, much diluted; dissection wounds, or scratches exposed to 
the dead body in dissection, &c. The strength of the remedy in 
the several cases must depend upon the judgment of the practi- 
tioner. 
It may not be amiss, in conclusion, to repeat the caution given at 
the commencement of this treatise, against the indiscreet employ- 
ment of the tincture. If applied to a part too frequently, or too 
strong, it may cause the skin to inflame, and the cuticle to blister, 
but that is the only inconvenience which has ever occurred from its 
use. TABLE OF CONTENTS 
PAGE. 
Part I.—Local Pathology * 7 
Inflammation 7 
A View of the Mechanism and Structure of the Blood-vessels 8 
On the Functions of the Blood-vessels II 
On the Pathology of Inflammation 2i 
Cause of Difference in the Character of Inflammation 40 
Condition of the Blood in Inflammation 57 
Influence of the Nerves in Inflammation 63 
Part II.—Surgery - . . 65 
General Remarks on Local Therapeutics 65 
On the Therapeutic Properties of Iodine 77 
Erysipelas 86 
Phlegmon . 91 
Extensive Sloughing of the Cellular Membrane 96 
Acute Inflammation of the Joints 98 
nflammation of the Breast 100 
Gout 101 
Enlargement of the Joints 102 
Inflammation of the Absorbents 103 
Carbuncle 104 
Lupus, or Noli me tangere 106 
Malignant Ulcers of the Tongue and Tonsils 107 
Scrofulous Swelling of the Glands 108 
Whitlow 109 
Chilblains Ill 
Lacerated, Contused, and Punctured Wounds 113 
Burns and Scalds 116 
Ulcers 117