The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).
- Date:
- 1849-59
Licence: Public Domain Mark
Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). 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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![ENTERITIS —EPHE LIS two hours until an evacuation takes place, and aided by the eneniata recommended above, or with the addition of castor oil. The hot bath has been proposed, but it possesses no advantage over hot fomentations, whilst the motion, to which the pa- tient's body is necessarily sutijected, renders it ob- jectionable. In the course of a few days, the bowels may begin to be evacuated, and lumps of undigested matter—the cause of the whole mis- chief— may be perceptible in the discharges. If signs of suppuration occur, poultices may be applied ; and if there be reason to believe that the parietes of the abscess adhere to the walls of the abdomen, which may be determined by trying whether the latter glide over the tumour, the sooner the abscess is opened the better. Com- monly, the tumour gives an emphysematous feel, and if a free incision be made into it, a fetid gas with an offensive fluid will be discharged.— This emphysematous condition must be distin- guished from the sound rendered on percussion, when the pus has formed on the posterior surface of the caecum, and pushed the intestine before it. In such case, the intestine may be wounded, as has happened, we are told by Grisolle, in one case. After the abscess has been opened, the dis- charge of its contents must be favoured by placing the patient on his right side, and the system be supported by wine-whey; arrow-root, or sago and wine; beef tea, and the preparations of bark. Opi- ates will likewise be required to produce sleep. Where the perforation takes place into the ca- vity of the peritoneum, the case must be managed as directed under the head of Perforation of the Intestines. Little, however, can be done except to administer full doses of opiates. Lastly,—where the abscess is so deeply seated, that an opening into it cannot be made with safe- ty, it has been proposed to endeavour to promote the absorption of the pus by means of repeated blisters, or by moxa applied over the abscess. The treatment of inflammation of the appen- dix vermiformis cxci is the same as in perforative inflammation of the caecum. As in all cases of inflammation likely to terminate in extensive sup- puration, in which the recuperative powers have to be greatly exerted, care must be taken not to reduce too much by general blood-letting, too often, or too largely practised in the early stages. Every practitioner is aware of the difficulty of arresting the suppurative process; and, conse- quently, if the inflammation be not got under by antiphlogistics in the first few days of the disease, the farther use of depletives should be had re- course to, under a wise caution ; for it is proper to remark, that the disease occurs at times very insidiously. The treatment of sero-colitis is the same as re- commended in acute and chronic inflammation of the peritoneal coat of the small intestines, and in inflammation of the caecum.] W. Stokes. [ROBLEY DUNGLISON.] [ENTEKORRHCEA. (See DiAHRHtEA.)] EPHELIS (from hi and 17X105, sol,) a genus ■of diseases of the skin, of the order macitlx, (see the article Macul.^,) characterized by discolora- lions, varying from dark brown to greyish-yellow, and presenting a great diversity of form, from small distinct points, sometimes scattered, some- times grouped, to large confluent or continuous patches. Si/n. Macula? fuses (Plenck) ; Ephehdes {Ali- beri). We use the term ephelis in the extensive sense which has been given to it by Gorroeus — non quod a sole tantum vitia ilia in cute contrahuntur, sed quod a reliquis inducta causis, similcm aspe- ritatem et colorem habeant; (Defin. Med. ad voc. l^ri\iv,) although we do not altogether agree with Bateman, (Synopsis, p. 442,) that this acceptation of the term is sanctioned by the authority of Hip- pocrates, (Prcedict. lib. 2. xxxi. 9; de aUmento, iv. 11; de sterilibus,vi. 8 ; de morb. mulier. lib. 2, Ixvii. 6, Ixviii. 1,) for he appears to have distin- guished between lenticula ((paKbi) and ephelis, both included in this definition. Celsus went far- ther; he not only distinguished between lenticula and ephelis, but also between lenticula and the 0a/c/a of the Greeks. (De Medicina, lib. vi. cap. 5.) These distinctions were lost sight of, and the term ephelis was made more comprehensive by Oriba- sius, (De loc. affect, cur. lib. iv. cap. 52 ; Synops. viii. 33,) .^tius, (Tetr. ii. serm. iv. cap. 11,) and Actu^rius. (Meth. Med. iv. cap. 13.) Senner- tus (De cutis vitiis, lib. v. pars 3,) revived the an- cient distinctions, in which course he was followed, more or less, by Sauvages, Lorry, and Plenck; but whilst the first of these raised distinctions on one hand, he removed them on the other, and thus included under ephelis morbid appearances which have no relation to it. This last is also the error of Alibert, who, in his order of Ephelides, includes scorbutic blotches. These affections of the skin seldom demand or deserve, on their own account, the attention of the practical physician ; but as signs of internal disor- ders they sometimes afford very valuable diagnos- tic evidence, as much as erysipelas, urticaria, pru- rigo, and many other eruptions. And we perfectly agree with Alibert, that they afford matter of in- teresting research to the physiologist, showing how the integuments may become discoloured, and re- vealing in some manner, by external appearance, the alterations to which the human body is sub- ject. Besides, it is shown in the study of the natural sciences that the most trifling facts may be useful, because, being connected by an almost imperceptible chain with phenomena much more important, they sometimes indicate, sometimes ex- plain them. The process of the formation of the ephelis is unknown. It is not the result of any particular alteration of the epidermis, but some modification of the pigmentum of the skin which science is not yet able to explain. It would seem sometimes to be a consequence of an inflammatory action ; it is frequently accompanied with signs of a determi- nation of blood to the skin, but neither of them is constantly observed. It is very variable in its progress and duration, sometimes developing itself fully and extensively in the course of a night, sometimes very slowly; sometimes it is perma- nent, continuing indelible for several years, and sometimes it disappears after a single bath or lotion. Not having found any previous arrangement of this genus which sati'sfactorily comprehends all](https://iiif.wellcomecollection.org/image/b21116817_0064.jp2/full/800%2C/0/default.jpg)
