tions. aware of this difficulty, and even admits it. "Such a CLASS III. state of the system", says he, "seems often to arise and ORDER II. Phlogotica. subsist for some time without the apparent inflammation Inflammaof any particular part; but such a state of the system renders it likely that a spasm may, at the same time, Cullen. readily arise in any of the extreme vessels, and a particular inflammation be there produced. It does, however, appear, also, that the general diathesis frequently arises from inflammation begun in a particular part."* Now this is not only to admit the difficulty but to fall prostrate before it. It is to admit what at once settles the entire question. The cause and the effect are made to change places: and the phlogistic diathesis is as broadly stated to originate from inflammation in a particular part, as inflammation in a particular part is stated to originate in the phlogistic diathesis. admitted by with the of inflam But, secondly, this hypothesis seems not only to be At variance chargeable with incongruity, but to be directly at va- common riance with the ordinary train of phænomena by which phænomena inflammation is accompanied. That the habit here al- mation: luded to under the name of diathesis phlogistica exists, and that very frequently, is not to be questioned; and Dr. Cullen has very lucidly described what is ordinarily meant by it." It seems probable", says he, "that the diathesis phlogistica consists in an increased tone or contractility, and perhaps in an increased contraction of the muscular fibres of the whole arterial system" ;—" it appears most commonly in persons of the most rigid fibres". But I believe it will be found by every one who investigates the subject, that so far from this being the habit of body in which inflammation is most frequently to be met with, it is that in which it occurs more rarely than in many others. That it occurs in it at times is unquestionable, for inflammation under some form or other occurs in habits of every kind: but if we look for specimens of larger or smaller inflammation, of deepseated or superficial, nay, even of suppurative or ulcera • Loc. citat. Phlogotica. tions. which occur more frequently in atonic than entonic habits. CLASS III. tive, we shall meet with them, if I mistake not, far more ORDER II. generally in constitutions marked by mobile and irritable than by firm and rigid fibres; in habits characterised by atonic rather than by entonic action. It is not till the constitution has been broken down, and the liver rendered feeble and torpid by the influence of a tropical sun, that hepatitis makes its appearance in its ordinary course of attack; phthisis occurs in relaxed and delicate, and not in hardy and robust frames: psoas abscess, peritoneal inflammation, struma, and those vast formations of pus which are sometimes found in parabysmic tumours or physconies, for the most part follow the same track; while the best, if not the only remedy for the innumerable host of erythematic inflammations, whether erysipelatous, gangrenous, or vesicular, pernio or intertrigo, is to raise the part or the constitution to that scale of vigour the reduction of which is well known to form a common predisposition to all of them. That there may exist such a condition of body as an inflammatory diathesis, or a predisposition to inflammatory action of some kind or other, according to the idiosyncrasy or established habit, or some controlling accident, is unquestionable; but such a diathesis cannot be made synonymous with the phlogistic diathesis as described by Dr. Cullen, unless there be but one kind of inflammation, and that such an inflammation as has a natural and necessary relation to the entony and rigidity of fibre which is here presupposed. Summary of what is known upon The little that we know upon the subject may, perhaps, be comprised in a few words: the standard of firm the subject: health is the best guard against inflammations of every kind, or the state in which a man is least susceptive of them; and a deviation in either direction, whether towards a habit of entony or of atony, capacifies him for breeding them. But it does not capacify him equally : for in the latter case they are produced far more easily in an entonic and generally than in the former. In fibrous entony, obstruction appears to take place, and inflammation to follow, from an increased tendency to contraction and rigi state of fibres: CLASS III. ORDER II. Phlogotica. tions. state. dity in the muscular tunic of the arteries generally, and an actual contraction in those of the part affected; in consequence of which the diameter of the tube is dimi- Inflammanished, and the blood, though urged by a stronger impetus from behind, works onward with less freedom than usual. In fibrous atony, obstruction takes place from in an atonic the relaxed and yielding state of the vessels which admit grosser corpuscles of the blood than what naturally belong to them, and thus become accessary to the error loci of the Boerhaavian school. But a mere error loci is not sufficient for inflammation; since the erratic corpuscles are readily forced back, or pass diagonally into larger vessels from the numerous anastomoses that prevail in the arterial system. Of this we have a pertinent Illustrated. example in the red suffusion which frequently takes place in the tunica albuginea of the eye; which is often an effect of weakness alone, is unaccompanied with heat or pain, and consequently with inflammation, and perhaps passes off by the next day. In addition, therefore, to the relaxed state of fibres and the error loci before us, there must be something of that irritability which is so frequently an attendant upon relaxed and mobile organs, and which produces spasmodic and contractile action in a far higher degree, though, perhaps, in irregular fluxes and refluxes, than any habitual firmness or rigidity of fibre does at any time. susceptibi lity of irri tation. And as in weak parts or habits a peculiar suscepti- In both a bility of irritation seems to be a necessary adjunct in the peculiar production of inflammation, it is possible that it may be equally necessary in the opposite state of excessive firmness and rigidity of fibre; since this also, as just observed, will, at times, continue for years without giving rise to any inflammation whatever, and seems equally to demand an exciting accessary. And hence the real inflammatory or phlogistic diathesis, constituting however a remote, more properly than a proximate cause, is perhaps to be found in increased irritability of the living fibre rather than in an increased rigidity and vigour. The great difficulty in the subject is that of recon Chief diffi culty in reconciling an ciling the increased action which seems to take place in the vessels of an inflamed part, with the general intumescence of such part, and, as is commonly conceived, the augmented diameter of the inflamed vessels themselves; since the ordinary effect of increased arterial action seems to be that of an increased contraction, and consequently a diminished diameter of the affected vessels which would lead to an extenuation, rather than an enlargement of the inflamed part. And hence a directly opposite view of the subject has been taken by many pathologists of deserved authority in our own day, who have regarded the proximate cause of inflammation, as consisting in a decreased instead of an increased arterial action, and consequently as evincing a lower instead of a higher degree of contractility. Upon this hypothesis the inflamed arteries give way too readily to the impetus of the blood from the heart, and the part affected becomes swollen from the excess of blood that flows into it, and acquires additional heat and redness from the same cause. 真 There is something highly plausible in this explanation; and those who wish to trace it further may find a very neat and interesting statement of it in Dr. Bostock's valuable Elementary System of Physiology *. It was first advanced by Vacca, an Italian physiologist, about the middle of the last century, and has since been supported by Mr. Allen in his lectures at Edinburgh, by Dr. Parr, Dr. Wilson Philip, Dr. Thomson, and Dr. Hastings. I have said that there is something highly plausible in this hypothesis at first sight. Beyond this however its plausibility does not proceed; and hence these respectable authorities, while they agree in the main principle of diminished action of the capillary arteries, differ widely concerning the actual state of the vessels, and particularly upon the question whether the velocity of the fluids they contain is diminished or accelerated. Let these effects however be as they may, the hypothesis, as * Vol. 1. p. 420, Syo. 1824. it appears to me, equally fails in accounting for the heat CLASS III. and the soreness or pain which are essential characters of inflammation, and which accompany it from its com- Inflamma mencement. ORDER II. Phlogotica. tions. Does not account for symptoms. As those of latThe augmented heat is accounted for from the accuImulation of a larger proportion of blood. But a mere the chief accumulation of blood can produce no such effect. Its natural temperature is 98° of Fahrenheit, and, however increased vit may be congested, it cannot without some other heat, -change, give forth a heat of 99° or 100°. In the exerocise of walking or running the increased heat produced is the result of increased action; and so far from being I that of increased accumulation of blood, the heat contisnues to augment as the blood, in conjunction with the sother fluids of the body, continues to diminish. The sore- and pain or iness or pain is ascribed to the distention. But distenetion in vessels or organs of any kind that are in a state of relaxation, and possess little contractility, produces no spain or soreness even when carried to an extreme: while in the case before us these symptoms, as just ob-served, show themselves from the first, and are even most severe when the distention is least of all. soreness. ર But independently of these objections, both the existing causes and the treatment of inflammation seem far better to coincide with the idea of redundant than of debfective action; and the case upon this point is put so candidly by Dr. Bostock that the reader will thank me for substituting his words for my own. "All those circum- Other obistances" says he, "which we are usually in the habit jections by 23ofoconsidering as stimulants excite inflammation; and -where the same effect is brought about by sedatives or olby agents of a more powerful operation, still we can geTenerally perceive the existence of what has been termed bre-action, which is the immediate precursor of the change sin the state of the circulation. In the same way the re medies for inflammation appear to me to be more adaptened to remove or relieve an excess than a defect of vital energy, as for this purpose, except under peculiar circumstances, we always apply either direct or indirect Bostock |