The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen ; edited by John H. Brinton.

  • Erichsen, John Eric, 1818-1896.
Date:
1854
Catalogue details

Licence: Public Domain Mark

Credit: The science and art of surgery : being a treatise on surgical injuries, diseases, and operations / by John Erichsen ; edited by John H. Brinton. Source: Wellcome Collection.

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

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    some alteration in the special nervous sensibility of an organ: thus in the eye, by the patient perceiving flashes of light, and in the ear, by noises of various kinds j in the bladder, by a constant desire to expel the urine, and by a desire to urinate in inflammation of the kidney. Pain is one of the most prominent symptoms of inflammation, and its existence serves a useful purpose by preventing the patient using or moving the inflamed part. The intensity of the pain depends more upon the structure affected than on the violence of the inflammation. As a general rule, it may be observed that the intensity of the pain is in the inverse ratio of the swelling of the part affected. Thus, the pain of inflamed bone or fibrous tissue is excessive; that of cellular membrane trifling. In erysipelas of the scalp, most pain is experienced in the ears; the pain of the inflamed sclerotic is far greater than that of the conjunc- tiva. In some forms of inflammation pain can scarcely be said to exist, though the disease may assume the most destructive form. Thus, in certain inflammatory affections of the throat and of the peritoneum there is little or no pain. Inflam- matory pain is always increased on pressure. The character of pain varies ac- cording to the scat of the inflammation. Thus, when mucous membranes suffer, it is often of a gritty, itching, or burning character, as in conjunctivitis and scle- rotitis ; when the serous membranes of the chest or abdomen are attacked, it is of a lancinating or stabbing character; aching in bones; throbbing when pus is about to form ; sickening when the testis is affected. When the pain is princi- pally elicited by pressure, the part is said to be tender. This tenderness is of great service in a diagnostic point of view; it may be elicited by direct pressure upon the part, as by squeezing an inflamed testis, or by pressing two surfaces together, as in an inflamed joint. In inflammatory pain, especially of osseous and fibrous tissues, there is very commonly nocturnal exacerbation. ' It is important to bear in mind that inflammatory pain is often not seated merely in the part affected, but radiates extensively along the course of the nerves, the terminal branches of which are implicated to a limited extent perhaps. Thus, in inflammation of the testis we have pain in the loins and groins. In deep- seated ophthalmia there is hemicrania in the branches of the Fifth Nerve over the whole side of the head or face, in consequence of the ciliary branches of the nasal, which are distributed to the iris and choroid, becoming compressed or stretched. The temperature of an inflamed part usually rises above its normal standard. Hunter has, however, remarked that it does not increase above that of the left ventricle : thus, in a case of hydrocele, he found the tunica vaginalis at 92° Fahr. before inflammation had been excited in it, and at 98f ° after it had been set up. In a case of extravasation of urine, with severe inflammation, I found the temperature in the incision made in the perineum 98° Fahr. It is probable that there is always a local increase of heat in inflammation. This, however, appears to the sensations of the patient to be far greater than it is in reality. Travers truly remarks, that the nerves measure the sensation, and not the de- gree of heat. In many cases the sensation to the patient is that of burning in the part, though the actual rise in temperature may be but trifling. This is owing to the exalted sensibility of the nerves. The cause of the increase of temperature is interesting. In all processes in the economy in which determination of blood takes place, as in blushing or parturition, the temperature rises. This can clearly not be owing to any production of heat durino- respiration, which may account for the general heat of the blood, but not for its local increase. It is more probable that as the ordinary and general sup- ply is derived from the waste of the tissues, so that of inflammation may be due to increased destruction of organic matters in the part inflamed. Modification of Function, Use, or Nutrition, invariably occurs in inflamma-