INFLAMMATION, 



1. Strong injunctions are, therefore, given not to re- 



? :!n inflammation of this kind, left the method fhould 



loduftive of fome worfe and even fatal di order. We 



.i\v,iys confidort d this mode of rcafoning unfatisiaftory, 



. livjuld have little apprehcnfion of any real evils, which 



V, arife from the attempt to diminiPa an inllammalion, 



: ijpears as a confequence of a fever. 



'iv' following obfervations refpeCling the proximate caiife 



ilamm:ition,are taken from Mr. S. Cooper's Dittionary 



t '.idical Sur^i-cry. 



: nerou.5 opinions have been entertained upon this fub- 

 ■ , but almoll every theory has been built upon the fup- 

 poUtion of there being fome kind of obftrucliun in the 

 inflamed part. 



While the circulation of the blood was imknown, and the 

 hypothetical notions of the power of the liver, in preparin"- 

 and fending forth this fluid continued to prevail, it is not 

 adonifning, that the theories of phyfic rfiruld be exceed- 

 ingly imperfect. So fully perfuaded were phyficiar.s of the 

 exiltenceand influence cf different humours and fpirits, and 

 fo litrle did they know of the regular and conl'.ant motion 

 of the blood, that tli y beheved in the poflibility of depo- 

 fitior.s and congellions of the blood, the bile, or lymph ; 

 and acknowledged thefe as the caufe of inflammation. 

 Their anatomiils taught them, and their profeflors of phyfic 

 fupported the opinion, that the liver was the centre of the 

 i-afcular fyftem, from which the blood went forth by day 



of the ancients in the treatment of inflammation ; but (haU 

 refer the reader to what Mr. Burns has written on the fub- 

 jed. Our prefent objca is only to trace the leading doc- 

 trines which have at diftVrent times prevailed, refpcainjr the 

 proximate caufe of infiammation. 



From the theories o{ Juxlon and congejion, w hidi were 

 quite incompatible witii the laws of the circulation of the 

 blood, we I urn our attention to the doctrine of olijlnillion. 



Boerhaave inculcated, (Aph 37J et feq.) that iiidam. 

 mation was caufed by an obllruaion to the free circulation 

 of the bood in the minute vefl. Is, and this obftruftion, he 

 fuppofed, might be caufed by heat, diarrhoea, too copious 

 flow of urine and fweat, or whatever could diflipate the 

 thinner parts of the blood and produce a thiekncfs or \'\{: 

 cidity of that fluid. When the lentor did not exill before 

 theproduclion of inflammation, he imxi^nned, that the Inrn-er 

 globules of the blood got into the fmall veflbh, a-d thi-s 

 plugged them up. When, for inllance, the perfpiration 

 wa.^ Itopped, the fluid, beinir retained, dibted the vcflels and 

 allowed lome ot thefe mifchi. vous globules to enter, and 

 produce a more permanent obltruCfiun. This circumilance 

 was termed an error led, and was one of the chief caufes 

 affign-d for inflammation. The obltruction, whether caufed 

 by vlfcidily or an err r loci, was imagined to occaiion a re- 

 to the circu ation in the part affeded ; hence in- 



fill 



afed it in the othe 



efll-ls 



heart, and augmenting the force or attraction of the b 



proving an irritation to the 

 ood 



the extremities, and returned again by night. If then any j" '.''^' P^""' °' the veliel which was behind the obftrudtion 

 the blood was fent out Z!*"^ caufed heat and pain, while the accumulation of the 



peccant matter irritated the li 



more forcibly ; and if, at the fame time, any part of the 

 body were weakened, or otherwife difpofcd to receive a 

 greater quantity of fluid than the reft, then a fwelling was 

 produced by the flow of humours to this place. Fluxions, 

 or flows of humour to a place, might happen either from 

 weaknefs of the part which allowed the humour? to enter 

 more abundantly, or from the place attradting the hu- 

 mours, in confequence of the application of heat or other 

 agents. 



The peculiar nature of the fwelling thus occafioned was 

 fuppofed, by the ancients, to depend upon the kind of 

 humour. Blood produced the true phlegmon, bile, eryli- 

 pelas, &c. 



The ancient phyficians alfo entertained an idea, that the 

 blood and humours might flowly ftagnate in a part, from a 

 want cf expi'.lfive power, and this affcftion was termed a 

 cangejllon, while the exprpffion_^i/.i7en or defiUx'wn was ufed 

 to demote any fwelling aiiling from the fudden flow of hu- 

 mours from a diilaiit part. The firft was formed gradually 

 without much pain, or the feelirg of pulfation, and ran its 

 courfe flowly ; the fecond appeared fuddcnly, was very pain- 

 ful, had a pulfatory feel, and was rapid in its progrefs. The 

 ancients, who fuppofed that the blood had very little mo- 

 tion, and that its courfe could be eafiiy direfted or changed, 

 recommended b'cd;ng from fome part which^as remote 

 fro.n a recent inflammation, by whicli they imagined that 

 the current of blood was altered, and a revuljtcn made. A 

 revulfion was alfo made by raifing a tumour in fome other 

 part, by means of ligatures, cupping-gla.Tes, &c. or by giv- 

 ing nature an opportunity of difcharging the humours from 

 dillant parts, by applying leeches or blifters. Hence fina- 

 pifms were applied to the feet in difeafes of the fuperior 

 parts. 



When blood was drawn from the vicinity of the fluxion, 

 or coi.gellion, the mode was called tlerlvalion, which oi'ly 

 differed from re-vuljion in the diftance to wliich the humour 

 was i^irawn being lefs. 



\. •■ r.uU n<Jt enter further into an account of the pradice 



blood produced rednefs ; which three fymptoms are the 

 eiience of the difeafe. Befides ohjlrudion, Boerhaave alfo 

 brought into the account an acrimonious jaU cf the fluids 

 which rendered refolution out of the queftion, and gangrene 

 likely to follow. Aph. 388. 



The vifcidity of the blood cannot be admitted r.s the 

 proximate caule of inflammation ; becaufe we have no proof 

 that this ftate ever exifts ; or, granting that it did, it wou-'d 

 not explain the phenomena. Were a vifcidity to occur, it 

 would exilt m the whole mafs of blood, would affed every 

 part of the body alike, and could not be fuppofed to pro- 

 duce only a lecal dilorder. How alfo could fuch a lentor 

 be produced by caufes which bring on inflammation fud- 

 deuly, without there being time for changes of the fluids to 

 take place ? 



^ With regard to the dodrine of error loci, or of red 

 giobTes going into veffels,-which did not formerly tranfmit 

 them, the fact muft: be admitted, at the fame tune, that the 

 concluiion is denied. When the eye becomes infl.imcd, the 

 tunxa conjundiva is !een with its Wels full of red blood, 

 winch in health is not die cafe ; but this rcduefs never ap- 

 pears until the inilimmation has commenced ; and mull, 

 therefore, be confidered as an efl'ed, not a caufe. Nor can 

 tins error l«ci occafion any obftrudion in thefe veffels ; for 

 if they be divided, the blood flows freely, which flicws,. 

 that they are large enough to allow an eafy circulation. 



Boerhaave's theory of obftrudion was too circnmfch-ibed, 

 and too mechanical ; it reduced all inflamjnations to one fpe- 

 cies. The only duliiidions which could have arifcn, mull 

 have proceeded from the nature of th* obftrudion itlVlf. 

 This dodrine could never account for the adion of 

 fpecilic difeafes and morbid poifons. 



As for the fuppciition of the co-operation of an acrimony 

 of the fluids, the propc^rtion of the faline matter of the blood 

 has never bt-en j roved to be greater in this, than in any other 

 ftate of the body. Even were a general diforder of this 

 kfiid to be admitted, no rational explanation of the proximate 

 caufe of local iiillammation could be deduced from it. 



Dr. 



many 



