A treatise on the nature, causes, and treatment of erysipelas / by Thomas Nunneley.

  • Nunneley, Thomas, 1809-1870.
Date:
1844
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the nature, causes, and treatment of erysipelas / by Thomas Nunneley. 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.)

    37/236
    diffuse inflammation of other tissues, as the adipose, and veins or lymphatics, are attended with similar symptoms/ That the disease depends upon the slate of the constitution, rather than upon any unvarying specific local action or any peculiar exciting cause, (ex- cept in one instance, the bite of poisonous serpents,) is evident by the fact, that in every case the topical affection is accompanied, and not unfrequently preceded, by excessive constitutional irrita- tion, and a high degree of typhoid fever, with much prostration ; while the exciting causes are exceedingly various, and often are not evident; at least, those of a local nature. They are mechanical and chemical irritants. A bruise, a sprain, and the application of adhesive plaster, trivial as they are, have often been sufficient to excite the disease in a severe form. Wounds of every degree ; vege- table and animal matter; and the bites of venomous creatures, are amongst the most frequent exciting causes ; but above all, there seems reason to suppose that the inoculation with morbid animal matter, is not only one of the most common and dangerous causes, but also that the matter poured out during the course of diffused inflammatory complaints, is more likely to excite this formidable complaint than any other kind of matter. The two causes, which by far the most frequently are found to produce this form of disease, are injuries to veins, either by ligature or incision, and wounds received in the dissection of dead bodies before putrefaction has taken place. From the fact of such serious consequences so much more frequently following wounds received in the examination of fresh bodies, than of those where putrefaction has already occurred, it might be supposed to depend upon some peculiar poison, generated during the course of the disease which has destroyed the person, did we not sometimes see the same ef- fects follow clean flesh wounds, punctures, fractures, or bruises, and even occurring spontaneously/ While, however this prevents v See Dr. Craigie's most able and excellent work, Elements of the Practice of Physic, vol. ii., 1840, page 254, where he enters into a lengthened argument to show that the diseases which have been described by Dr. Duncan, as cases of diffuse cellular inflammation, and by Mr. C. Hutchinson and others, as of phleg- monous erysipelas, are, in reality, not so, but consist of inflammation of the adi- pose membrane. That this tissue may be, and undoubtedly is often, if not al- ways, involved, and that to a considerable extent, is certainly true. I am, how- ever, by no means disposed to think that the peculiar features of the disorder are dependent upon the organization of the adipose membrane alone. That as a tis- sue which possesses but a low degree of vitality, when inflamed, it is more apt to slough and be destroyed, is perfectly true; but this does not explain why the inflammation should spread so extensively ; it merely shows that the spot which is inflamed is disposed to die, and not that the inflammation should necessarily be propagated far and wide, the cause of which depends, I apprehend, upon the constitutional disposition, which I have endeavoured to point out. Indeed the inflammation and consequent destruction of the adipose tissue appears much more frequently to be an effect than a cause, even of the local mischief. y The following quotation from Dr. CarswelPs Article on Mortification, affords a strong support to what is advanced in the text. It is difficult to say how far wounds received in dissection, or in the inspection of dead bodies, and which are followed by diffuse erysipelatous and gangrenous inflammation, depend on the presence of a septic agent developed during the progress of disease, or after 4*