On Certain New Methods in the Treatment of Diseases of the Skin
Authors: G. Thin
Journal: BMJ (1885)

Fekf P;ARJISJ, W A' ,OjJ,, while the conditions of inj'ry were precisely tlhe samfQ as th9pe o 7-, served in the most severe cases of pyrexia, nameIy, large 1ouei~broce and I may now add that, in half the instances of apyreia, swe4ing waf noted either as simply present, or as very considerable.And, 4aain, th-e tendency of somle individuals to develop'a py-etic state is a fairi4y ascertained scientific fact.It is useless to speculate in the absence of exp6riinnt, especially as I shall hlave occasion to refer to this point in 'my fourthI lecture.I shall, therefore, proceed at once to the third type of traumatic fever * namely, that in which there is marked swelling of the part, and the type in which the temperature rises-slowly,'and shows a doube-pointed composite curve, I may again point out that, after the initial rise in four Sours, the pathology of which I have just discussed, the highest point is reached at about the forty-eiglhth to the fiftieth' hour.It would seem to, be a, justifiable, assumption that, if the temperature rises in this steady way for two days, the cause producing it is developlng duiiug that time, aild reaches its height a few hours before the ,temperature-curve attains its acme.Now, it is interesting, to observe, clinically, that this is the actual behaviour of the cedema, or, as I have roughly termed' it, the' swelling, which sometimes follows a simple 1fac- ture, and which was a constant feature' of the cases we are now considering.I, therefore, consider I am justificl in attributing the peculiar character of this typc to that particular complication'.In confirmation of this belief, let me show you this tiacing of the temperature-curve in an experimclnt perforined by 4ngerer upon his colleague, Dr.Fehleisen (the dotted line in Chart iii).Under the skin of the fore- arm of Dr. Fehleisen was injected sufficient defibrinated perfectly fresh ox-blood to cause a tumour of the size of an apple; this gradually disappeared in a few hours, 'aid 'was succeeded by a secondary swelling of the arm, together'with severe constitutional symptomns of fever.It will be seen from the chart that the temperature-qurve in this case is parallel to that of my third type ; and, i't seems to me that the pathological process in botlh is practically the same, namely, the development of acute cedema, thus causing sqvere tension in the part.I am, of courase, quite aware that -this view may have to undergo con- siderable correqtion ias soon 'as I shall have had the leisure to examine' tt experimentally; and, moreover, I desire that it should not be'bought that in thpse cases, where the .amount of cedema-fluid was very considerable, I deny the possibility of the symptoms being due to the absorption of pyrogenous stuff.It was only in,the instance before cited that I considered it to be practically inconoeivable.Having reached this point, we must review the pathology of the, condition of simple fracture coupled with cedema.From the Yact of,the cedema commencing around the seat of,'fracture, and invading the dis- tal parts first, it is probable that two c4,uses are at wvork.In thA first place, the walls of the blood-vessels in ,the neighbourhood of the