« AnteriorContinuar »
FIXED HEAT AND PAIN OR SORENESS; INCREASED SECRE
TION; LESION OF A PARTICULAR PART OR ORGAN;
Class III. The diseases comprised under this order are sometimes Order II. called Local Inflammations; as the term General InflamThe species sometimes mation is, by a few writers, and particularly by Dr. called local Fordyce, applied to Cauma or Inflammatory Fever. In tions. the present text the ordinal name made choice of is Phlogotica PHLOGOTICA, from paéyw, " incendo”, “ango”. Linnéus why used as employs phlogistica from the same root; but as the chethe ordinal term. mists have long since laid hold of phlogiston, and the
term, though lately disused, has a chance of being restored, the derivative PHLOGOTICA seems preferable. Dr. Cullen has PHLEGMASIÆ, after Galen and Sauvages; but as phlegmasia, and phlegmatic, from the same source, import, in common medical language, a very different and almost an opposite idea, the author has also purposely passed by this term in order to prevent confusion.
But we may
The nature of the fever accompanying the inflammation Class III. cannot enter into the definition; for this will
Phlogotica. the nature of the inflammation itself, and not unfre- Inflammaquently with the structure of the organ. make this observation, that the symptomatic cauma, or
the fever symptomatic inflammatory fever, seems to have followed depends the fortune of this fever in its idiopathic state; and to be upon that of
the inflamas much less common in the present day, compared with mation. what it was formerly, as we had occasion to observe the Inflammasimple cauma is when treating of that disease. Such is less frequent also the remark of Mr. Hunter. “ I believe”, says he, concomitant
than for" we have much less occasion for evacuations in inflam
merly. mation than there were formerly; the lancet, therefore in inflammation, and also purgatives, are much more laid aside.” *
When an inflammation takes place near the surface of Inflammathe body, there is not only heat and pain, or soreness, tion, how but more or less swelling, hardness, and redness, and when deepwe hence infer the existence of these last symptoms in seated. inflamed parts which lie beyond the reach of vision.
Inflammation in most cases appears to begin at a point; Origin and for, at the commencement, all the local symptoms lie progress of
. within a very small compass. The spreading of the in- tion. flammation is owing to continued sympathy, the surrounding parts participating with the point of irritation ; and in proportion to the health of the surrounding parts and constitution, this sympathy is less.
The act of inflammation seems to consist in an increased action of the vessels; mostly, if not altogether, of the extreme vessels; for wherever inflammation appears, be confined to a point in which none but the smallest vessels can exist. Independently of which, Mostly bewe have already had occasion to observe that the capil- gins in the laries are endowed with the property of contractility, and and why. consequently are more capable of sustaining the phænomena of inflammation than the arterial trunks.
CLASS III. · The first act of the vessels when the stimulus which ORDER II.
excites inflammation is applied, Mr. Hunter supposes Phlogotica. Inflamma- to be precisely similar to a blush ; and to consist in a tions.
simple distention or increased diameter beyond their naCommences as a blush ; tural size; such as we see takes place on the application and is ac- of a gentle friction, or of gently stimulating medicines, companied with a gentle to the skin; and the consequence of which is a warm glow.
glow, when limited to the degree we are now supposing ; but which, if carried farther, would be followed with ex
coriation, suppuration, and ulceration. Coagulating
The inflamed vessels, being thus enlarged and irrilymph is next sepa- tated, begin to separate from the blood they contain
some portion of its coagulating lymph, together with some serum, red globules, or whatever other fluid the vessels may be loaded with ; and to throw these materials out on the internal surface of the part inflamed; probably
through the exhalants, or, perhaps, through pew vessels and pro
which may be now forming around them; whence the duces adhe- sides of the cellular membrane, which receive the effusions, together with sion, become covered with it, unite with the opposite increased
sides with which they are in contact, and thus form the bulk :
first foundation of adhesions. “It appears ”, says Dr. Lucas, “that whenever the vessels act with unusual force, there is a tendency in the coagulating lymph to separate from the other constituent principles of the blood-by the effusion of which, as the most sanguineous part of the blood, it is probable that the circulation of the remaining part is facilitated, independent of the relief obtained by the diminution of volume.”* We may at least hereby readily account for much of that diminution of pain which often takes place while the swelling still continues, or is even augmented. The increased bulk of an inflamed part is produced chiefly by this effusion; and the increased redness, partly by the larger quantity
of blood continued in the distended old vessels, and and new
partly by the production of new vessels formed out of the coagulable lymph thus extravasated; and which, by Class III. innumerable inosculations and adhesions, interpose a
* On the Principles of Inflammation and Fever, 8vo. 1822.
Phlogotica. check to suppuration, which would otherwise most pro- Inflamma
tions. bably take place. Inflammation, therefore, consists in an increased im- Hence in
flammation, petus and accumulation of blood in the vessels affected, increased accompanied with a proportionate swelling and sense of impetus, heat. The pathologists have pretty generally concurred mulation of in ascribing this accumulation of blood to an obstruction blood. of some kind or other; but they have differed upon for by an
Accounted its nature and origin; and have not been able to deter- obstruction. mine whether it be dependent upon the crasis of the blood itself, or the resistance of the vessels that contain it. Generally speaking, however, it has, by all the schools Proximate
cause of ob of medicine, been ascribed to whatever has been sup-struction posed to be the proximate cause of fever: and hence the explained
variously. humorał pathologists attributed it to a lentor or visci
Doctrine of dity of the circulating fluid ; and the corpuscular, to an the humoerror loci, concerning both of which we have already
ralists: treated; the cause of obstruction, in the view of either of the cor. hypothesis, being seated in the nature or misdirection of rians: the constituent parts of the blood itself: while Dr. Cullen of Cullen. refers it to the same kind of spasm which he regards as the proximate cause of fever; and heace derives the obstruction from a constrictive resistance in the vessels of the part affected : which, he farther supposes, forms but a mere link in the tensive chain of a phlogistic diathesis, which more or less runs through the entire habit at the time of inflammation, and constitutes the predisposition to its rise and progress.
“ That a spasm ”, says he, “ of the extreme vessels takes place in inflammation, is presumed from what is at the same time the state of the whole arterial system. In all considerable inflammations, though arising in one part only, an affection is communicated to the whole system ; in consequence of which an inflammation is readily produced in other parts besides that first affected. This general affection is well known to physicians under the name of diathesis phlogistica. It most commonly ap
Class III. pears in persons of the most rigid fibres; is often maPhlogotica. nifestly induced by the tonic or astringent power of cold; Inflamma- increased by all tonic and stimulant powers applied to
the body; always attended by hardness of the pulse; and most effectually taken off by the relaxing power of blood-letting. From these circumstances it is probable that the diathesis phlogistica consists in an increased tone or contractibility, and, perhaps, contraction of the
muscular fibres of the whole arterial system."* Objections To the first two of these hypotheses the same objecto the first
tions apply that we have already seen apply to them as two hypotheses. causes of fever. That an error loci occasionally takes
place, or, in other words, an entrance of red or other particles of blood into minute vessels to which they do not naturally belong, is unquestionable; but then this is rather a secondary than a primary link in the chain of inflammation, and consequently an effect rather than a cause, as we shall presently have to notice more at large.
Yet the hypothesis of Dr. Cullen does not seem to be more satisfactory, and is especially open to the two following objections, to say nothing of various minor diffi
culties with which it is attended. Objections
It supposes, in the first place, as a general rule, that to Cullen's inflamimations of every kind, however minute and cirhypothesis.
cumscribed, are dependent upon a particular habit of body at the time, distinguished by the name of a phlogistic diathesis. But we see inflammations occurring in babits of every kind, and varying in many of their features according to the variety of the habit; and we see them also
arise in individuals who have no such phlogistic habit or Its incon- diathesis as is here referred to. And we often, moreover, gruity.
see examples of this very diathesis operating upon individuals for years, without producing any such effect as inflammation in particular parts. And we cannot, therefore, regard such a diathesis as a proximate cause of in
flammation in general, though it may often be so of a Difficulty particular kind of inflammation. Dr. Cullen, indeed, was in his own explanation
• Pract. of Phys. Vol. iv. Sect. CCXLVII.