CLASS III.

ORDER II. Phlogotica.

tive inflammations and abscesses cannot well be placed in either of the genera we have thus far noticed; and have a claim to be considered by themselves. They are hence Inflammaincluded in the genus APOSTEMA, with which the order will be found to open.

tions.

Often diffu

sive, and

why.

In circumscribed cavities, where from a peculiarity of constitution, or the peculiar nature or degree of excitement, an inflammation is deflected from its common tendency to produce adhesion; we often find it run on with great rapidity from one part of the cavity to another, till the whole becomes affected. We have already had occasion to notice this in inflammation of the peritonæum*; and we shall have further occasion to notice it in psoas abscess† and acute rheumatism. And we may hence account for the alarming progress of the same morbid action when it attacks the surface of arteries or veins, from an accidental wound, as in venesection, from true aneurism, or from any other cause; of which acute rheumatism seems, at least, occasionally to be one. The French writers, who have studied the subject with considerable attention, are disposed to regard these inflammations as in many instances idiopathic, and have distinguished the former by the name of ARTERITIS. But I Arteritis. am not aware of their having hitherto been found to occur otherwise than as concomitants or sequences of other affections.

inflammation of veins.

The inflammation of veins, by some writers called Phlebitis; or PHLEBITIS, has of late occupied more attention than that of arteries. It is occasionally a result of an irri- Accidental tated varix, and especially where such varix has under- causes. gone the operation of removal, as we shall further observe when treating of this complaint§: it has also occasionally followed on venesection where the lancet has been affected with rust or some other irritant: and es

Cl. m. Ord. 1. Gen. iv. Spec. I. p. 262.

+ Cl.. Ord. n. Gen. 1. Spec. II.

See Enecia Cauma, Cl. 111. Ord. 1. Gen. Iv. Spec. 1. p. 216.-as also Arthrosia Acuta, Cl. III. Ord. II. Gen. xi. Spec. 1.—and Cl. 11. Ord. IV. Gen. x, Spec. 11. Exangia Varix.

Cl. I. Ord. IV. Gen. x1. Spec. II.

Phlogotica. Inflamma

tions.

determining these by external signs.

CLASS III. pecially where the constitution, or perhaps the vein alone, ORDER II. has been in a state of morbid irritability. And it has sometimes occurred where no distinct cause could be assigned either during life or on dissection afterwards. Difficulty of It is by no means easy, and for the most part altogether impossible, to trace an inflammation of a vein or artery by external signs; for although, in the former, there is sometimes a red streak or two accompanying the general pain and swelling of the limb, and in the latter a more rapid pulsation or throbbing, and in both a line of hardness like that of a cord; yet in various cases nothing of the sort is to be found, and consequently they cannot be regarded as pathognomic criteria. And on this account the author has allotted no distinctive place or name to these affections in the course of his classification; as feeling that to do so would be to make an empty display, and a verbal subdivision unattended with Exemplified. any real use. In a striking case which proved fatal, described by Dr. Duncan, the disease was so little indicated by either the general or local symptoms that it does not seem to have been suspected, and was only accidentally discovered on a post-obit examination. At the time when the symptoms were most aggravated and less than twenty-four hours before death, when the swelling had extended up the arm, and the pulse was at 120, the limb had an uniform appearance, the intumescence a defined margin, "but still without much redness, heat, or pain, unless in a point at the bend of the arm on considerable pressure, and on the outside of the elbow." A knowledge, however, of the precise fact could have made little or no difference, nor ever can do so, in the mode of treatment; which must uniformly be founded upon the general process for diffuse inflammation, whether more or less complicated in its range.

Inflamma

tion of tendons,

It is on this account that Dr. Duncan has rather chosen to regard such wide-spreading phlogoses, whether

• Case of an Inflamed Vein, Trans. Medico-Chir. Soc. Edin. Vol. 1. p. 443. Svo. 1824.

Phlogotica.

flammation

Perhaps too

of veins, fasciæ, tendons, or lymphatics, as mere modifi- CLASS III. cations of what he has specifically called "Diffuse In- ORDER II. flammation of the Cellular Texure"*, which, in truth, Inflammais in almost every instance, more or less affected, and in tions. lymphatics, many instances, with an ulceration that knows no bounds. fascia. Perhaps this may be to generalize rather too much, and Duncan's especially in the case of that very singular and more de- diffuse infinite description of inflammation which takes place from of cellular contagion absorbed by a sore or wounded part in dis- texture. secting, and which the present author will be found much genetherefore to have separated for a particular investigation ralized: under the name of ERYTHEMA anatomicum+; but he is particularly well aware of the difficulty of making even this distinc- erythema tion; and of the tendency there is for the diffuse kind of anatomicum. inflammation we are now considering to run into every form, exhibit every variety of combination, be conjoined with every type of fever, and productive of every diversity of danger, from the peculiarity of the general or the local constitution, the influence of the patient's habit of life, or some other incidental predisponent or concomitant.

as including

tion, how

racter by

irritants in

Inflammation, therefore, is influenced by the nature of Inflammathe part in which it takes place. It is also, as we have far affected already observed, equally influenced by the nature of in its cha the constitution itself; and, thirdly, it is influenced by incidents. the nature of the remote cause. And we may add, that, Not changed where the inflammation is regulated by the constitution, by specific and the constitution itself is healthy, specific irritants will sound hanot change the nature of the inflammation, but only de- bits; termine its situation, extent, duration, or some other but greatly peculiar property. But where the constitution is un- unhealthy healthy, or predisposed to any particular morbid action, specific as that of erysipelas, putrid fever, or plague (for some irritants individuals receive even the plague much more readily themselves. than others), as soon as the specific virus is communicated, the disease will degenerate into a mixture of both,

* Case of an Inflamed Vein, Trans. Medico-Chir. Soc. Edin. Vol. 1, p. 455. 8vo. 1824.

changed in

as are the

CLASS III.

ORDER II. Phlogotica. Inflammations.

Illustrated.

Farther explained

from vaccination.

Application of these re. marks to

gularities

and appa

and discover its double source; it will give proof that a specific inflammation has been set down upon a constitution of a peculiar kind, and will partake of the nature of both. In consequence of which, the specific properties will by no means be so distinct or well formed as if they were to appear in a sound and untainted constitution.

Thus, if the constitution have a susceptibility to become putrid, and the small-pox attack it, the inflammation will be that of the small-pox combined with the constitutional tendency to putrescency; which will so far affect the action of the small-pox as to interfere with the specific difference of its inflammation. In consequence of which, the pustules will spread, but not suppurate, and assume a livid hue, and perhaps prove fatal; while if another person possessing an uncorrupt and, so to speak, unbiassed constitution, be inoculated even with this mixed virus, the variolous principle will separate itself from the principle with which it is combined, improve with the improvement of the new soil, and yield a crop of genuine and unadulterated pustules.

In like manner vaccination is, generally speaking, a specific preservative against the small-pox. But it sometimes happens that it is not so; and that the small-pox is caught and makes its appearance many years after vaccination has been resorted to, and performed with all possible circumspection. And it generally happens in such cases, though not always, that a mixed or hybrid disease, a sort of degenerate small-pox of a milder character than the true, is hereby produced.

The remarks just laid down will furnish us with a clear and sufficient clue to these singular and interesting various sin- facts. Some persons have a peculiar predisposition to small-pox, which is by no means easily eradicated, and rent anoma- far less so than in others. Vaccination, which permanently counteracts the predisposition among mankind in general, does not permanently counteract it here. It introduces a new but less rooted diathesis, and the former is rather suppressed than extirpated. In process of time the predisposition revives, re-acquires its anterior

lies.

CLASS III. ORDER II. Phlogotica.

influence, and the moment it comes in contact with variolous contagion, subjects the system to small-pox. But while the variolous diathesis is thus again become predo- Inflammaminant, the vaccine diathesis has not altogether lost its tions. hold; and the disease, as in the preceding cases, is a mixed product of both causes in co-operation, or rather in antagonism. It is small-pox raised upon a constitution not yet totally liberated from the influence of vaccination; I say, "not yet totally liberated", because we occasionally meet with instances in which the constitution, little open to the impression of the vaccine disease, even when first communicated, becomes in time liberated from its influence altogether, and receives the small-pox, after vaccination, as freely as if it had never been vaccinated, and with a violence that proves fatal in a few days.

Inflammashows a tendency to

tion always

the surface,

deep-seated

It is a wise and beneficent law of providence, and affords an incontrovertible proof of the existence of an instinctive remedial power, that inflammation, wherever seated, is always more violent on the side of the inflamed point nearest the surface, and shows a constant tendency to work its way externally rather than internally. This even in law applies equally to the thorax, to the abdomen, and parts. to parts which lie close to the different outlets of the body. Thus, if an inflammation attack the peritonæum covering an intestine, and adhesions are hereby produced between the two, the inflammatory action works upwards through the thick walls of the abdominal muscles, while the proper coats of the intestines in most instances remain sound. This, indeed, is not always the case; for the inflammation may be so violent as to pass in both directions with great rapidity, or some accidental circumstance may force it inwardly; but it is so common as to form a general rule. We see the same thing in the obstruction of the natural passage of the tears producing a fistula lachrymalis; for here the ulceration points externally to the inner angle of the eye, while the inside of the nose defends itself by becoming thicker; so much so, in many cases, as to block up the cavity of the nostril, and produce inosculations with the septum; which has