-No. 3.] LONDON, SUNDAY, OCTOBER 19, 1823.

SURGICAL LECTURESDELIVERED BY

SIR ASTLEY COOPER, BART.

Theatre, St. Thomas’s Hospital,MONDAY EVENING,Oct. 13th, 1823.

LECTURE THiRD.

PREVIOUSLY to the arrival of

Sir Astley, there was brought intothe Theatre, and placed upon thetable, some diseased part or parts,and which, from th6,freshuess ofthe blood that stamed the enve-lope, it was evident bad been veryrecently removed. ,

The learned Professor, after re-capitulating the conclusion of thelast Lecture, &erved, that ,

Innammatioa is of two kinds:

CUTE, and. ’

CHRONIC.

The first usually goes throughits various stages with great ra-

pidity-while the latter is exceed-

ingly slow in its progress; and iseither the result of acute infiam-

mation, or owing to a peculiarstate of constitution : that, for in-

stance, which occurs in personswho have lived intemperately, be-comes chronic,, and obstinately so.One of the best examples of

acute inflammation termKtatmg in

chronic, is observable in ophthal..mia (inflammation of the eyes),When called to causes ofthis de-

scription, and. during the first

stages of violent action in the ves-sels of the part, you must take

away blood both locally and con-stitutionally. This may be done

either by opening a vein in the’arm, together with the applica-tion of leeches to the temples; or,by opening the temporal artery orarteries : this method has a direct

influence locally and generally atone and the same time. You shouldlikewise apply such lotions to thevessels themselves as will tend tolessen nervbusa.ndrvascular power,and which lotions should consist

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of sulphate of zinc (vulgarly called Bwhite vitriol) and rose water-or

superacetate of lead (vulgarlycalled sugar of lead) and rose

water. Now when by these meansthe acute inflammation ends, it

frequently happens that the chronicbegins-in the first our object wasto decrease power; in the last it

will be to increase it-this must

be accomplished by the applica-tion of warm fomentations; andas in this affection there is a very

great degree of irritability, not

only of the eye and eye-lids, butalso of constitution, opium con-joined with calomel will be foundthe best medicine that can be ad-

ministered for its removal: and as

the system of depletion that is ne- I Icessarily pursued during the acutestate brings on great debility, theuse of tonics must not be for-

gotten. Sir Astley remarked, thathe could give many other examplesof the acute inflammation termi-nating in the chronic: as in go-norrhoea, during the first stageswe are to the utmost obliged tocheck action ; yet in the gleet thatcommonly succeeds, we are underthe necessity of stimulating byinjections or otherwise, and thus,apparently occasion the return ofthat action which we had before

destroyed; the action or inflam-mation, however, reproduced is

widely different from that whichfirst existed; that which we createby injections, &c. is a healthy in-flammation, whilst the other wasa poisonous one.

Inflammation is of two kinds,either -

CoMMON, orSPECIFIC.The first, with its terminations,

have been already described, andis called healthy inflammation,But the second or specific, is of a

peculiar kind, and is called un-

healthy. In this inflammation the

vessels have an entirely differentaction to what happens in the

healthy, and thus the fluids and

solids that they secrete have a de.cidedly opposite character.There are two descriptions of

specific inflammation ; the first isproduced by a peculiar conditionof the consetution ; and the se.cond from the application of apoison.

Gout is an example of the firstkind. If a man for a length oftime yields to every injurious ex-cess, loading his stomach with foodand wine, so as to weaken the di-

gestive powers, he probably ex-cites in his system, what is calledthe gouty disposition; he expe-riences dreadful pain in one orboth of his great toes, &e. and

severe inflammation ensues, which

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frequently terminates in the se-

cretion of a matter that speedilybecomes solid, usually called

chalk stone ; this name, however,is incorrect, as it has been provedby analysis to consist of uric acidand soda, consequently is now

very properly named urate of

soda. The formation of schirrhusor cancer is another example ofspecific inflammation, arising froma peculiar state of constitution.Let us suppose that two women

receive each, a blow in the breast ;one woman with a constitution

in a healthy vigorous state, andthe other with a system predis-J

posed to the formation of cancer:in the first individual the inflam-

mation will be strictly healthy,going through its different stagesuntil a cure is accomplished; yetin the other person, owing to aconstitutional peculiarity, the sameextent of injury will produce can-cerous disease, a malady overwhich medicine has no influence,and extirpation is the only remedy.Persons afflicted by cancerous orfungous complaints are of exceed-ingly anxious minds (at least ninetimes in ten); this anxiety occa-sions a sort of irritable fever, that

invariably proves detrimental.-The last example of specific in-flammation that Sir Astley wouldmention was Sorofula. Persons

attacked by this disease have ge-nerally light hair, fair complexion,

and delicate fibres ; the inflam-

mation is slow in its progress, and

at last when ulceration takes place,the discharge is any thing buthealthy pus, being sometimes thickand lumpy, like curds ; at others,as thin as water.

The second kind of specific in-flammation, is caused by the appli-cation of poisons. Thus, in go-norrhæa, the matter secreted is

widely different from common

healthy matter, having; in the firstplace, a much larger quantity ofmucus mixed with it; and, se-

condly, when applied to a secret-ing surface, is capable of ex-citing in the part an action bywhich similar matter can be pro-duced. The matter of small-poxoccasions the same results, as

does also the discharge from achancre; and as far as constitu-

tional efects are concerned, it is

not material how large or how

small a quantity of the poison isapplied, the end in each case willbe the same.

There is another kind of inflam-

mation which Sir Astley said hewould call the irritable: in this

disorder the nerves are much more

affected than the blood vessels.You are called probably to attenda person, who tells you that he

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feels in a particular part, as thehand or arm, a most agonizingpain; and if inexperienced in thesematters, you will be inclined todoubt the correctness of your pa-tient’s statement, and the more soas you can discover no alteration

in the appearance of the part. It

may not be amiss to mention here,said the Professor, what happenedyesterday. Some time ago, Sir A.was requested to see a lady havingthis complaint in her foot : he triedby every possible means to re-move it, but in vain. When un-

successful, he invariably recom-mends the sufferer to some one

else. This lady consulted two

other very eminent surgeons, buttheir efforts, in like manner, wereunable to afford relief: and findingthat she got worse in town, shewent into the country for changeof air, where, without any me-dical means being employed, sheentirely got rid of her troublesome

companion. Sir A. saw this ladyyesterday, and she described thepain that she used to feel as horri-ble ; it was constantly at the bot-tom of the foot; and if she walkedbut a very short distance, it occa-sioned a confinement during fouror five days. ,

The eyelids are likewise subjectto this torturing disorder: it ap-

peara to be a species of Tic Dou-loureux.

But no part is more frequentlyattacked by it than the breasts of

young women. It produces such adegree of tenderness, that theycannot bear the slightest pressure,and their stays consequently oc-casion great inconvenience--the

pain extends to the shoulder, downthe arm, and even to the elbow,at the same time generating con-stitutional irritation. To cure these

pains and general derangement,such medicines must be given aswill influence the secretions, butmore particularly that of the

uterus.

The irritable inflammation fre-

quently attacks the testicles, andrenders them exceedingly sensi-tive, the slightest pressure caus-

ing very great pain. There is in

these cases little or no alteration

of size; if any difference, the af-fected one is the smallest. Inthree instances, Sir A. said he

had been obliged to remove testi-cles for this disease. The subjectof one of these cases was a gen-tleman from C-.--n in South Ca-

rolina : he came to England foradvice, and went the whole roundof medical men, without -expe-riencing any alleviation of his suf-ferings. He then desired Sir A.to remove the torturing part; thiswas done, and the gentleman went

back to his native country quitewell. Sir A. heard, that soon

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after Its return he got married-

(a laugh)-and was happy to

add, that his lady had a child-(excessive laugltte1’),The bladder is also very com-

monly disordered by this irritableinflammation, and the symptoms,in many respects, resemble thoseof stone-in both cases there is

pain in making water, and theurine is frequently mixed with

blood. The grand difference in thetwo cases is this: the irritable blad-der feels most pain when the organis full; the bladder that contains a

stone, when it is empty. In irritablerectum the pain is greatest whenthe part is filled. Upon dissec-tion, the inner coat of an irritablebladder has been seen the colour

of red velvet. Irritable persons’are much more disposed to inflamethan others. As are also personsin a state of debility. Thus in

fevers, when the constitution hasbeen much weakened, the partson which the body has been rest-ing soon become inflamed, and

quickly mortify. But in fractures,where the system is healthy andstrong, no such effects will result.Where there is great weakness,inflammation is always dangerous:and the application of a blister tothe chest, for the removal of a ’,

cough, after measles, will fre-

quently destroy life by bringing

on mortification. - Merclury, in likemanner, by rendering the bodyirritable, disposes it to inflamma-tion. Therefore, never operateon a patient too quickly after amercurial course-for when this

medicine is given to excess, it actsas a poison.The exciting causes of Inflam-

mation are, whatever acts as an

unnatural stimulus to a part-asbruises, cuts, pressure, extrane-

ous substances, &c. &c. The

manner in which nature repairsthese injuries has been alreadyexplained.Proximate causes.-With re-

gard to these there has been, andstill is, much difference of opinion.Boerhaave’s opinion of an obstruc-tion in the smaller vessels arisingfrom the thickness of the blood, isfalse-for, instead of being thicker,it is absolutely thinner. Cullen’s,of spasm in the extreme vessels,is eauallv erroneous. This is al-

ways the result of opinion notfounded upon observation. Weshould observe first, and think

afterwards.. The true proximatecauses of inflammation appear to

be an increase of action in the

vessels of the part, and an increasein the size of the vessels them-

selves. These phenomena are

well demonstrated by the follow-ing experiment; viz. Stretch the

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web of a frog’s foot, and place itunder a good microscope, put onit the smallest drop of nitric acid,or prick a spot with a pin: youwill soon perceive in the vicinityof the irritated part considerable

agitation, and presently a red par.ticle of blood will make its appear-ance in a vessel that had pre-viously been the receptacle of

transparent serum only---eachpulsation pushes it, on farther andfarther. This red particle distendsthe vessel, and is succeeded byothers passing freely into the vein.All the vessels of the part thentake on similar actions; and thus

you create under your eye, speak-ing figuratively, meandering rivu-lets of blood., Sir Astley remark-ed, that he did not know a singleexperiment more beautiful thanthis. The dilation of the vesselsin inflammation is not, however,confined to the part itself, but isalso observable in the larger arte-ries leading to the scene of irrita-tion : thus, in persons who havedied having inflammation in a foot,the femoral artery on the aitectedside has been found larger thanthe opposite. We before explainedthe manner in whichNature throws

a quantity of blood to a part for

the purpose of repairing an injury,or for the removal of irritation;we will give another illustration of

this, which/If yoit have not seen,most probably all of you havefelt. It is this: when any offend-

ing matter gets under the eyelids,it produces irritation ; Natureimmediately sends a quantity ofblood to the lachrymal gland--this blood occasions a secretion of

tears, and these are directed instreams over the eye, for the pur-pose of washing off the offendingsubstance.

Sir Astley then stated,’ that hewould show the gentlemen pre-sent a beautiful specimen of fun-gus bsematodes, (vulgarly spongoidinflammation, soft cancer, bleed-ing fungus, &c.) [This was whatwe spoke of as placed upon thetable before the commencementof the lecture.] The tumour

was of very large size, and whencut open exhibited the usual cha-racteristics of this malignant dis-ease ; viz. cysts filled by a trans.parent fluid, extravasated blood inclots, some of its parts whitish,while others were very dark, andthe whole being of a spongy, elas-tic texture.

The learned Professor concluded

the lecture by alluding to the fouroperations which he performed atGuy’s on Tuesday last; but as weshall have occasion to mention

these Cases hereafter, we will nowmerely state what they were the

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first, was for a cancerous tumourof the breast: the second a fattytumour on the shoulder :. the third,cancerous tumour of the breast

(very bad case) : and the fourth,for nævus maternus (vulgarly call-ed mother spot) of the under lip;there are two descriptions of these,one is formed by veins, the otherby arteries -the one operatedupon originated from the former.

St. Thomas’s Hospital.

WEDNESDAY EVENING,Oct. 15, 1823.

LECTURE FOURTH.

AT the anti-room door this

evening, we were, in rather a pe-remptory manner, desired to pro-duce our ticket of admission; of

course, as it was a very proper re-

quest, we most readily compliedwith it. This method, doubtless,has been adopted by Sir Astley,for the purpose of preventing theattendance of intruders-a pro-

ceeding that the hitherto throngedstate of the theatre has rendered

absolutely necessary ; but, not-

withstanding this precautionarymeasnre, the audience was as nu-

merous as on either of the pre

ceding nights. And the present,

unquestionably, is the largest classof surgical students ever collectedin this metropolis.

Sir Astley arrived at the usualhour, and stated that the subjectof the evening’s lecture would beThe TREATMENT OF INFLAM-

MATION.

This is either constitutional,local, or both. When any impor-tant organ is injured, the treat.ment must be invariably consti.tutional, let your local be what-ever it may; for no vital organcan be disturbed in its functionwithout producing general de-s

rangement, and this will be moreor less, in proportion to the valueof the part wounded, and the ex.tent of the wound. - Inflammation,however, in many persons, re-

quires constitutional treatment,whether any important part be

injured or not; as, in irritable ha-

bits, very trivial local damage willspeedily affect the entire system.The most powerful means of

relieving inflammation, is by theabstraction of blood. Many ofthe gentlemen present would pro-bably smile, if asked wlty theywould bleed in inflammation; butthis is a question not generallyunderstood. Its beneficial effects

principally result from producinga diminution of nervous power;and that it does accomplish this, is