INFLAMMATION. 



other parts, which conftitute a portion of the original fabric 

 of the body : hence, when inflamed, they are exceedingly 

 apt to be deftroyed by ulceration, or mortification. 



When an inflammation is of trivial extent, and not fe- 

 rioufly painful, the efFeAs of the complaint are dltogether 

 local. In the contrary cafe, the whole circulatiuu partakes 

 in the excitement, and the inflammatory fever occ jrs. 



The blood, taken from a patient labouring under inflam- 

 mation, is well known by all medical praclitionei-s to exhibit 

 peculiar appearaaceB. The biood, when it has cfcaped out 

 of the living veffels, fpontanooufly feparates into two diftinA 

 parts, the ferum and the crafTamentum. The laft is a com- 

 pound fubilance, confiding chiefly of coagulating lymph and 

 red globules, the moll heavy ingredients in the blood. Now, 

 it is to be obferved, that blood, taken away from perions 

 affcfted with inflamm.ilion, is longer in coagulating, and 

 coagulates more firmly, than when drawn from people in 

 other circumllances. Hence the red globules, which are 

 very heavy, not being fo fcon entangled in the Ijmph, 

 defcend by their gravity more deeply from its furface, 

 which, being in this manner more or lefs divefted of tlie red 

 colouring matter, is, from its appearance, termed the huffy 

 coal, or inflammatory crujl. The firmer and more compact 

 coagulation of the lymph compreifes out an unufual quan- 

 tity of ferum from it, and the furface of 'Cae fi^y blood, as 

 it is frequtiitly called, is often formed into a hollow, tlie 

 edges being drawn inwards. Thefe changes in the blood 

 are, in fome cafes, a more infallible proof of the exiftence 

 of inflammation than the piilfe iifelf. At th« fame time, 

 it is probably only a criterion of fome unufual operation 

 going on in the fyi1;em ; for the blood, taken away from 

 pregnant women, is always found to exhibit the above ap- 

 pearances, a circumfiance which fliould always be recol- 

 leded. In peritoneal inflammation, the patient fometimes 

 feems to be in the mod feeble Hate, and the pu'.fe, abfl;radl- 

 edly confidered, would rather induce the pradiitioner to 

 employ tonics and itimulants, than evacuations ; but fhould 

 the continuance, or exafperation of the diforder, or any 

 other reafon, lead the furgecn to ufe the lancet, then the 

 bujfy coat, the concave furface of ilif blood, and the large 

 quantity of ferum, clear away all doubt concerning the ex- 

 igence of mflammation. But every praftitioncr ought to 

 bear in his mind, that, befidcs pregnant women, there are 

 a few anomalous conllitutions met with, where the blood, 

 taken away by the lancet, always exhibits the foregoing 

 peculiarities, though inflammation may not prevail. 



We fee three very remarkable eflefts follow the preva- 

 lence of inflammation j to's. adhefions of parts of the body 

 to each other ; the formation of pus, or fuppuration ; and 

 ulceration, a procefs in which the lymphatics are more 

 concerned than the blood-vefleis. Hence Mr. Kunter 

 termed the differen: ftages of inflammation the adhcfive, the 

 fuppuraliv!, and the ulcerative, 



All parts of the body are not equally liable to each of 

 the preceding confequences. It was remarked by Mr. 

 Hunter, that in the cellular membrane, and in the cir- 

 cumfcribed cavities, the adhefive liage takes place more 

 readily than the others ; fuppuration may be faid to follow 

 next in order of frequency ; and, laiUy, ulceration. When- 

 ever mucous membranes arc affefted, the fuppiirative in- 

 fiammation comes on more readily, than either the adhefive 

 or the ulcerative. Here adhefions, which originate from 

 the ni;;hte(l degree of inflammation in other fitua'.ions and 

 ftiuAures, can only be produced by the moll violent kind. 

 Indeed, ulceration is much more frequently met with upon 

 ir.ucous furfaccs than adhefions. The celhil«>r membrane 



appears to be much mftre ftlfceptible of the adhefive In- 

 flammation than the adipofe, and much more readily pafTes 

 into the fuppurative. Thus, we fee the cellular fubftance, 

 connecling the mufcles together, and the adipofe membrane 

 to the mufcles, inflaming and fuppurating, and the matter 

 feparatiiig the mufcles from their lateral connexions, and 

 even the fat from the mufcles, while the adipofe fubfl:ance 

 and the flvin are only highly inflamed. Yet, it mufl; be al- 

 lowed, that in fituations where fat abounds, we very fre- 

 quently meet with abfceffes. This is fo much the cafe, thafr- 

 Mr. Brom field accounted the fat a more common nidus 

 for colleftions of matter, than the cellular fubftance it- 

 fclf. Thus abfceffes about the anus, mammas, &c. are re- 

 markably frequent. When we fpeak of the fat inflaming 

 and fuppurating, we fliould rather fay, that the membranous 

 cavities containing this fecretion are io affefted ; . for, fat 

 itfelf has no vcflels, principle of hfe, nor atlion of its own, 

 and, confequen'Jy, cannot be luppofed to be capable of un- 

 dergoing inflammation and fuppuration. 



Parts of the body, which lie deeply from the furface, 

 but more particularly fucii as are known by the name ol 

 vital, are readily affefted with the adhefive inflammation. 

 That they are not fo much difpofcd to fuppurate as the 

 fuperficial parts are, is ftnkingly illvftrated in cafes of ex- 

 traneous bodies, which, if deeply lodged, only produce the 

 adhefive inflammation. By this procefs a cyft is formed, in 

 which the foreign body lies, without much inconvenience to 

 the patient, and may even change its fituatisn, without fe- 

 rioufly difturbing the parts through which it pafles. But 

 no fooner does it approach the Ikin, than abfceffes immedi- 

 ately arife. 



Much might be faid concerning the difference of the pulfe 

 in the various cafes of inflammation. Thus, when any part 

 of the furface of the body is aflttted with a certain degree 

 of phlegmonous inflammation, the pulfe is generally full, 

 frequent, and ftrorg. When the peritoneum and bowels are 

 inflamed, it is very quick and fmall, &c. We fhall net, 

 however, enlarge upon this topic, as the ftate of the pulfe, 

 in the fevcral cafes, will be noticed in the many articles of 

 this work appropriated to the confideration of inflammatory 

 difeafes. 



According to Mr. Hunter, the fufceptibility of the body 

 for inflammation is of two kinds ; the one original, confti- 

 tuting a part of the animal economy, and beyond the 

 reach of human inveftigatioii ; the other acquired from the 

 influence of climate, habits of life, and ftate of the n-.ind 

 over the conllitution. The firft kind of fufceptibihty, 

 being innate, cannot be diminiflied by art ; the fecond may 

 be lefTened by the mere avoidance of the particular caufes 

 upon which it depends. Thefe latter might be named 

 predifpofwg. 



With regard to the remote, e.\citing, or oceafwnal caiifes 

 of inflamniation, they are infinite in number ; but very eafy 

 of comprehenfion, becaufe moft of them are lefernble to 

 two general clafles. The firft includes all fuch as operate 

 by their ftimulant or chemical qtiahtics, as, for inftance, 

 heat, cantharides, fulphuric acid, aqua ammonise puroe, &c. 

 The fecond embraces fuch as aft mechanically, as bruifes, 

 wounds, frafturcs, &o. 



The principle on which cold becomes an exciting caufe 

 of inflammation, is yet contefted among furgical writers, 

 and may Rill be confidered as not decidedly known. 



Fevers would fometimes appear to be the exciting caufes 



, of inflammation. The local affcdion, thus originating, is 



often called critical, and is fuppofed by many to be the 



means, by which a ftop is put to the conftitutional indifpo- 



8 fiiioiu 



