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the difficul. ties attend
Class III. sedativés, and find stimulants to be as injurious as the
others are beneficial. For these considerations I am Inflamma induced to recur to the former idea of increased action
being the proximate cause of inflammation, or at least as being essential to it, and to inquire whether there be no correct method of combining a state of increased ac
tion with distention of the vessels.”* Suggestions In the prosecution of this inquiry Dr. Bostock observes for explain- that the distention must be produced by an obstruction of ing away
some kind or other, and he suggests that the cause of
such obstruction may be derived either from the conant on in
tained fluid, or the containing vessels. The first he action.
seems to think may be produced by an actual increase of fibrin or a greater tendency in its usual proportion to coagulate, occasioned by the inflammatory action itself; or by some new arrangement in respect of the sanguineous globules so that they may coalesce or be more strongly attracted together. And the second may spring from a relaxation in the minute arteries augmented in proportion to the vigour of their contraction so as to admit the fibrin and the globules of the blood into vessels which have hitherto been impervious to them, where they must necessarily become impacted from the vis à tergo on the one hand, and the decreasing diameter of the minuter vessels opened into on the other.
Future experiments and inquiries may find no small explanation degree of truth in the one or the other of these sugin proof that disten- gestions. But it should not be forgotten that increase tion must
of action by no means necessarily imports increase of follow upon the common strength, and that the motific or contractile power comhypothesis
municated to the muscular fibres never flows, even in a of increased action. state of health, in a continuous or interrupted tenour,
but with an alternation of jets and pauses. Upon this subject we shall treat at some length when examining the morbid actions of the nervous system, as well in the Proem to that class as under several of its subdivisions, particularly the genus CLONUS or CLONIC SPASMť; where
* Elementary System of Physiology, p. 426.
^ Cl. iv. Ord. 111. Gen. II.
we shall show that in weakly habits, in which a morbid Class III.
ORDER II. increase of nervous action must frequently take place, the Phile more violent the jet and consequently the contractile ef- Inflamma
tions. fect that ensues, the more prolonged and complete the
The conalternating pause, and consequently the relaxation in the traction of same fibre; excepting in cases of rigid or entastic spasm, muscular
fibres not which will be explained in its proper place. And hence
continuous the very fact of increased contraction paves the way for but with al
ternate a subsequent and alternating dilatation, and this too in pauses. proportion to the violence that the contraction exhibits ; Such pauzes since the stream of nervous power, thus communicated
tions more by jets from the sensorial fountain, is expended instan, prolonged taneously and before the next supply arrives. This musta
in debilitabe the result in all cases of inflammation, whether the ted organs: part affected, or the whole constitution, be in a state of atony or of entony. But as we have already shown that the more inflammation far more generally takes place in the condition of former than in the latter; and, as we have shown also, inflamed that the capillary vessels in which inflammation seems
Capillary to commence, are endowed with a far higher proportion vessels peof contractile power than the larger arteries, it must fol- culiarly sub
ject to such low that the morbid irregularity of action which exists increased alof necessity in the vessels of an inflamed part, by such ternations,
and why. sudden and alternate exhaustions of contractile power, and consequently such intervening periods of rest and relaxation, must lay a foundation for distention; the posterior current of blood now rushing forwards almost without resistance into the inflamed part; where, also, it must accumulate, as, in the same vessels, beyond the inflamed limit, there is no such morbid rest and relaxation, and consequently a continuance of the uniform re
Hence the sistance of a healthy state. And when to these facts we di add also the necessary intermission of the globular and solved. larger corpuscles of blood into vessels whose ordinary diameter is too small to receive them, we can be no longer at a moment's loss to account for the phænomena of an enlargement of the inflamed vessels and a distention of the inflamed part.
Concerning the proximate cause of inflammation, how. Remote
Class III. ever, there is yet much to be unravelled. Of its remote
· causes and a few of its laws, we are in some degree better Inflamma- informed. The remote causes may be contemplated tions.
under the three following divisions : Accidental First, some accidental violence applied to a part, so as violence.
to make a wound or bruise from which it cannot recover except by the process of inflammation, or which, at least,
has a natural tendency to excite such a process." Local irri- Secondly, some irritation which does not destroy the tation.
texture of the part, but merely its natural action; as pressure, heat, cold, blisters, pungent applications, and
often fevers of every kind. Particular Thirdly, a particular disposition to inflammation, disposition to inflam.
founded, perhaps, as we have just observed, in an irritability in the morbid part itself, and which we often behold in constitutions of the best state of health ; affording proof that the general habit is not, in such cases, concerned in the morbid change. Inflammations from any of these causes will, however, partake of the charac. ter of the constitution; and hence proceed kindly or
unkindly, according as the constitution is in a diseased Inflamma or a healthy condition. Yet the general principle of intion the
flammation is the same in all; for we can only contemsame in principle; plate it as a remedial process, an instinctive effort, or ex
ertion of the vis medicatrix naturæ, to bring about a re
instatement of the parts nearly to their natural functions. yet differs Yet, though inflammation is uniformly the same in its
principle, it often differs widely in its mode of action, of action.
and consequently in its result; for as it has a tendency to partake of the character of the constitution, and especially where it is extensive, according as the constitution is healthy or unhealthy, so will be the nature of the
inflammation and the diversity of its progress. Healthy Healthy inflammation consists probably of one kind
alone, and is' no farther divisible than into different
stages of a restorative action, the effect of an instinctive Unhealthy stimulus rather than of morbid irritation. Unhealthy ininflamma
Aammation consists of many species, for numberless are the diseases that affect the health of the constitution; and
in its mode
consequently that may influence the character of the in- Class. III.
ORDER II. flammation, by superadding peculiarities or specific ac
Phlogotica. tions of its own : though it is often affected also by the Inflamma
emma tions. particular condition of the part in which the inflammation takes place. And hence it is no uncommon thing Illustrated. for particular parts to run into particular inflammations with the character of which the constitution has little concern; such as those that are occasionally found on the skin, particularly the erysipelatous, as they are commonly but not quite correctly denominated, and which we shall presently have to describe under the name of erysipelatous erythema.
, Simple or healthy inflammation is capable of produc- Three dif- :
ferent ing three different effects, which, where the whole take a
effects of place healthily, follow in regular order, and constitute healthy in
flammation; so many stages. These are adhesion of the parts inflamed, suppuration, and ulceration; to which three different ef- suppura
tive, and fects Mr. Hunter has given the names of the adhesive, the suppurative, and the ulcerative inflammation. ., There is good reason for this division into different Good rea
son for conheads; for although, where the whole take place health- templating ily, they follow in the order now enumerated, yet the it under
these three whole do not always take place either healthily or un- effects as healthily; nor is the order thus enumerated in every in so many ,
states or stance attended to. For pus, as we shall have occasion Stages. to observe more largely hereafter, is often produced where there is no adhesive inflammation; and ulceration, where there is neither adhesion nor suppuration : while occasionally the suppurative and adhesive inflammations take place simultaneously; the former being hurried on before the other has completed its own bounds, as is often the case in peritoneal inflammation after child-birth. The degree of violence also with which the inflammation commences, produces a considerable influence upon these points; and the nature of the parts themselves still more. · With the nature of the parts that constitute the chief fields of inflammation, it is of high importance that we should make ourselves deeply acquainted from the first, that we may be able to determine concerning the parti
Class III. cular course the inflammation is likely to run, and reguORDER II.
late our treatment accordingly. And it is of still farPhlogotica. Inflamma-, ther importance that this subject should be attended to
on the present occasion, because it is on this distinction of parts, producing a natural tendency to distinct inflammations, that the genera of the order before us are
principally constructed. Hunter's
· The whole of the observations of Mr. Hunter upon observations on the sub- this interesting point are entitled to the most patient ject of high study, and cannot be too closely committed to memory.
In the present place I can only remark, that, in treating of inflammation, he divides the body into two parts : firstly, the circumscribed cavities, organs, and cellular membrane which connects them; and, secondly, the outlets of the body, commonly called mucous membranes, as the ducts of the glands, alimentary canal, and similar organs. He distributes inflammatory affections, as I
have just observed, into three sorts, adhesive, suppuraAdhesive
tive, and ulcerative. Adhesive inflammation belongs inflammation, where chiefly to the former of the above two parts of the body, chiefly
where they are deeply seated ; and appears intended to take place for the purpose of preventing suppuration. It applies, therefore, peculiarly to that genus of the present order which we shall denominate EMPRESMA, and
which will embrace the visceral organs, allowing for one Suppurative, or two exceptions that are occasionally interposed. Supwhere chiefly seated.
purative inflammation belongs chiefly to the same division of parts placed near the surface ; and consequently applies to the two genera here denominated PHLEGMONE and
PHYMA, embracing small cutaneous abscesses of various Ulcerative, kinds. The ulcerative inflammation belongs chiefly to where chiefly
the second order of parts, as the mucous and serous membranes and outlets; and hence applies principally to the genus ERYTHEMA, Or INFLAMMATORY BLUSH; often, but improperly, called erysipelas, which is an exanthem or eruptive fever, accompanied with erythema. It also applies to that peculiar inflammation which characterises the whitloe, and will be found in the present arrangement under the genus PHLYSIS. Deep-seated suppura