Pressure, applied to a part, increases in particular the functions of
absorption and deposition. If moderate, these functions are moderately
increased, and the structure of the part continues either the same, or
it augments in size, as we observe, in the effects of walking, on the
skin of the feet; but, if the pressure be greater, then these functions
are morbidly increased, the particles are deposited imperfectly
formed, and are as quickly taken up. The structure is therefore
destroyed, and a vacuity formed. These effects are produced more easily
upon diseased than healthy structures; because their powers of acting,
and sustaining action, are less. Friction is in this respect similar to
pressure.
From these remarks, we may understand the mechanical utility of
pressure in the cure of ulcers; for, when in a proper degree, it causes
the absorption and destruction of the callous edges, or diseased
substance, and likewise makes, if moderate, the diseased granulations
be taken up, and more healthy ones be formed. We may likewise
perceive, that, if the degree be too great, the action will become of
an inflammatory nature, and injury will be done. We are therefore
frequently under the necessity of counteracting this hurtful effect;
for, the degree of pressure which is requisite for answering the
first intention in old sores, or inducing action, in consequence of
bringing the granulations or particles into the natural state of being
in contact with some body, or covered by it[54], is often attended
with such mechanical irritation, that the one effect would destroy
the other, unless we kept the action within due bounds, by applying
cold to the part. In healthy ulcers, the pressure necessary to produce
its first set of effects, or to accelerate healing, by producing
contact, is so trifling, that no counteracting effect takes place
by the production of the second set of effects; and, therefore, no
cold requires to be applied: But, in old ulcers, the pressure must be
greater; and, therefore, cold water must be constantly applied to the
bandage over the sore, by means of a sponge. We thus indeed lessen the
effects of pressure on the absorbing system, and, therefore, the callus
will be longer of being destroyed; but we, on the other hand, prevent
the action of the granulations from being rendered morbid.
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