ORDER II. Phlogotica. Inflamma CLASS III. sedatives, and find stimulants to be as injurious as the others are beneficial. For these considerations I am 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 action with distention of the vessels."* tions. Suggestions for explain ing away the difficulties attend ant on increased action. Additional tion must follow upon the common hypothesis In the prosecution of this inquiry Dr. Bostock observes that the distention must be produced by an obstruction of some kind or other, and he suggests that the cause of such obstruction may be derived either from the contained fluid, or the containing vessels. The first he 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 of action by no means necessarily imports increase of strength, and that the motific or contractile power communicated to the muscular fibres never flows, even in a 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 SPASM†; where of increased action. Elementary System of Physiology, p. 426. Cl. iv. Ord. 1. Gen. 11. . CLASS III. ORDER II. tions. The con muscular fibres not ternate Such pauses tions more prolonged and obvious in debilita the more condition of common parts. we shall show that in weakly habits, in which a morbid increase of nervous action must frequently take place, the more violent the jet and consequently the contractile ef- Inflammafect that ensues, the more prolonged and complete the alternating pause, and consequently the relaxation in the traction of same fibre; excepting in cases of rigid or entastic spasm, which will be explained in its proper place. And hence continuous the very fact of increased contraction paves the way for but with ala subsequent and alternating dilatation, and this too in proportion to the violence that the contraction exhibits; since the stream of nervous power, thus communicated or relaxaby jets from the sensorial fountain, is expended instantaneously and before the next supply arrives. This must be 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 inflammation far more generally takes place in the former than in the latter; and, as we have shown also, inflamed that the capillary vessels in which inflammation seems to commence, are endowed with a far higher proportion of contractile power than the larger arteries, it must follow that the morbid irregularity of action which exists of necessity in the vessels of an inflamed part, by such 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 resistance of a healthy state. And when to these facts we 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. Capillary vessels peculiarly subject to such increased alternations, and why. Hence the difficulty Concerning the proximate cause of inflammation, how- Remote causes. ORDER II. 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 Phlogotica. Inflamma- informed. The remote causes may be contemplated under the three following divisions : tions. Accidental violence. Local irritation. Particular disposition to inflamtion. tion the First, some accidental violence applied to a part, so as 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. Secondly, some irritation which does not destroy the texture of the part, but merely its natural action; as pressure, heat, cold, blisters, pungent applications, and often fevers of every kind. Thirdly, a particular disposition to inflammation, 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 character 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 inflammation is the same in all; for we can only contemprinciple; plate it as a remedial process, an instinctive effort, or exertion of the vis medicatrix naturæ, to bring about a reinstatement of the parts nearly to their natural functions. Yet, though inflammation is uniformly the same in its in its mode principle, it often differs widely in its mode 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. same in yet differs of action. Healthy inflammation. 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 inflammation consists of many species, for numberless are the diseases that affect the health of the constitution; and inflamma tion. CLASS III. tions. consequently that may influence the character of the inflammation, by superadding peculiarities or specific ac- Phlogotica tions of its own: though it is often affected also by the Inflammaparticular 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. 110 Three dif effects of healthy in ferent flammation; adhesive, Simple or healthy inflammation is capable of producing three different effects, which, where the whole take place healthily, follow in regular order, and constitute so many stages. These are adhesion of the parts inflamed, suppuration, and ulceration; to which three different ef- suppurafects Mr. Hunter has given the names of the adhesive, ulcerative. the suppurative, and the ulcerative inflammation. There is good reason for this division into different heads; for although, where the whole take place healthily, they follow in the order now enumerated, yet the whole do not always take place either healthily or un healthily; nor is the order thus enumerated in every instance attended to. For pus, as we shall have occasion 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 tive, and Good reatemplating it under effects as so many son for con these three states or stages. ORDER II. Phlogotica. CLASS III. cular course the inflammation is likely to run, and regulate our treatment accordingly. And it is of still farInflamma- 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. tions. Hunter's observations on the subject of high value. Adhesive inflamma chiefly seated. The whole of the observations of Mr. Hunter upon this interesting point are entitled to the most patient 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, suppurative, and ulcerative. Adhesive inflammation belongs tion, where chiefly to the former of the above two parts of the body, 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 kinds. The ulcerative inflammation belongs chiefly to the second order of parts, as the mucous and serous mem→ branes 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 Ulcerative, where chiefly seated. |