INFLAMMATION. 



Dr. CuUcn attributed the proximate catifc of inflamma- 

 tion to a " ipafm of the extreme arteries fupporting an iii- 

 creafed aftion in the coiirfe of them." This theory only 

 differs from that of Boerha.ive in the cavife which is alfigned 

 for the obftniftion. Some caiifcs of ineqiiahty in the diftri- 

 bution of the blood, may tlirow an unufual quantity of it 

 upon particular veflTcls, to which it mult neceflarily prove a 

 ftimulus. But, farther, it is probable that, to relieve the 

 congeftion, the vis medicatrix uaturos increafes ftill more the 

 aftion of the vefTels ; and which, as in all other febrile dif- 

 eafes, it atfecls, by the formation of a fpafm on their extre- 

 mities. " A fpafm of the extreme arteries, fupporting 

 an increafed aftion in the courfe of them, may, therefore, 

 be confidcred as the proximate caufe of inflammation ; at 

 leaft, in all cafes not ariling from direft ftimuli apphed ; 

 and even in this cafe, the ftimuli may be fuppofed to pro- 

 duce a fpafm of the extreme veflels." 



The inconfiflencies in CuUen's theory are very glaring. 

 The congeftion or accumulation of blood, which is only an 

 effeft or confequencc of inflammation, is fet down as the 

 caufe of the fpafm of the veflels, to which fpafmodic con- 

 flriflious CuUcn, ftrangcly enough, affigns the name of 

 proximate caufe. Tlie fpafmodic contraftion of the ex- 

 tremities of the veflels, inftead of pi-opelling the accumu- 

 lated quantity of blood, would render the paflTage of the 

 Hood from the arterial into the venous fyftem lliU more 

 difficult. Spafmodic conttriftion of the i'mall veflels is 

 fo far from being a fatisfaftory explanation of the proxi- 

 mate caufe of inflammation, that even tying a large vefTel 

 does not of itfelf bring on the uffeclion. Phlegmon is alfo 

 attended with an effufion into the cellular fubftance from the 

 extremities of the arteries ; a circumftance not ea(ily ex- 

 plained upon the principle of obftrufted circulation. See 

 Burns on Inflammation. 



We fliall nov/ notice tise celebrated, and very original 

 opinions promulgated on this fubjeft by the famous John 

 Hunter. According to him inflammation is to beconfidered 

 only as a difturbed ftatc of parts, which requires a new, but 

 falutary mode of a>?tion, to reftore them to that ftate, 

 ^vherein a natural mode of aftion alone is neceflary. From 

 fuch a view of the fubjeft, therefore, inflammation, in itfelf, 

 is not to be confidered as a difeafe, but as a falutary ope- 

 ration, confequent either to fome violence, or fome difeafe. 

 Elfewhere, the author remarks, the aft of inflammation is 

 to be confidered as an increafed aftion of the veflels, which, 

 at firft, coniifts limply in an increafe or diftention beyond 

 their natur.il fize. This increafe fecms to depend upon a 

 diminution of the mufcular pov.er of the veflels, at the fame 

 time that the elaftic power of the artery muft be dilated in 

 the fame proportion. This is, therefore, fomethin^ more 

 than fimply a common relaxation ; we muft fuppofe it an 

 aftion in the parts to produce an increafe of fize, to anfwer 

 prticular purpofes, and this Mr. Hunter would call an aft 

 cf dilatation. The whole is to be confidered as a neceflTary 

 operation of nature. Owing to this dilatation, there is a 

 greater quantity of blood circulating in the part, which is 

 according to the common rules of tlie animal economy ; for, 

 whenever a part has more to do than fimply to fupport iti'elf, 

 the blood is there coilcftcd in larger quantity. The fwtll- 

 ing is produced by an cxtravafation of coaguLiblc lymph, 

 with fome ferum ; but this lymph differs from the ccmmon 

 lymph, in confequence of pafling through inflamed \\([\-h. 

 It is this lymph which becomes the unituig medium of in- 

 flamed parts ; veflels flioot into it, and it has even the power 

 «f becoming vafcular itfelf. The pain proceeds from fpafm. 

 The rednefs is produced either by the arteries being more 

 dilated than the vtins, or becaufe the blood is not changed 



in the veins. When, after an injury, a part cannot be reftore 1 

 to health by iiiflimmation alone, or by adhcfion, then fup- 

 puration, as a preparatory ftep to the formation of gi-aiii;- 

 latious, and the confequent rcftoration of the part, ukc, 

 place. The vclTels are nearly in the fame ftate as in inflani- 

 mation ; but they are more quiefcent, and have acquired .'. 

 new mode of aftion. See Hunter on the Blood, Inflam- 

 mation, &c. 



An increafed aftion of the veflels is now almoft univcr- 

 fally regarded as the proximate caufe of inflammation. 

 I'his opinion derives ftrong fupport from a review of the 

 feveral exciting caufes of the afteftion, which, being in 

 general of an irritating nature, muft, when applied to living 

 or fenlible parts, occafion a preternat\iral exertion of their 

 veffeli. The method of cure tends alfo to confirm the com- 

 mon fentimcnt concerning the proximate caufe of inflam- 

 mation. See Diftionary of Praftical Surgery. 



Trcalmeni of Iitfiammaiton. — According to the preceding 

 views of the fubjcft, the firft and principal objeft to be 

 aimed at in the treatment of inflammation, is to diminifli 

 that immoderate aftion of the arteries, which exifts in fo con- 

 fpicuous a degree. There are feveral means conducive to 

 this end ; but that which demands primary attention, 

 and, indeed, which feems to be indicated by common fenfe, 

 is to remove, if poffible, whatever conftitutes the ren.ote 

 or exciting caufe of the inflammation. Thus, fuppofing 

 the eye were to inflame in confequence of a fmall infeft 

 lodging under the eyehds, how obvious would be the pro- 

 priety of immediately taking away the fource of irritation ? 

 If the irritation of a thorn or fplinter fliould excite inflam- 

 mation, who would not of his own accord endeavour to 

 extraft the extraneous fubftance ? When the afleftion is 

 excited by extravafated urine, by preffure, friftion, ftimu- 

 lating applications, &:c. tlie furgeon often has it in his 

 power to render moft: effential fervice, by removing at once 

 what excites and keeps up the complaint. Frequently, the 

 exciting caufe is tranfient in its operation, and yet, the 

 inflammation cannot be prevented from running a certain 

 Gourfe. Thus, many kinds of external violence are in- 

 flifted in a moment ; but inflammation muft follow, and go 

 tlu-ough its operations, though the duration of the circum- 

 ftance which gave rife to the procefs has ceafeJ. The 

 living folids demonftrate, in thefe inllances, a kind of re- 

 adion. Since, therefore, the removal of the fti.Tiulus which 

 excites inflammation will not always put an immediate ftop 

 to the complaint, however it may tend to alleviate it, we 

 are generally called upon to moderate, by other nicung, tiie 

 increafed vafcular aftion. 



There are few perfons fo entirely ignorant of the fubjcft 

 before us, as not to know that bleeding is one of the moft 

 powerful means of counterafting inflammation. This well 

 known faft, which has obtained the aflent of the moft cele- 

 brated phyficians and furgeons in every age and country, can 

 hardly fail to be quite congenial with fuch ideas and expec- 

 tations as arc*naturally impreffcd upon the mind by a dcfcrip- 

 tion of the diforder. Indeed, one principal effeft of the 

 increafed aftion of the vefllls, is the tranfmilfion of a larger 

 quantity of blood through the inflamed part. The pro- 

 priety of endeavouring, therefore, in moft cafes, to diminilh 

 this determination of blood to the feat of the inflammation, 

 cannot be doubted. The chief mode of accomplifliing this 

 objeft is by general and topical bleeding. This evacuation is 

 called general, when the blood is taken from a large veffel, at 

 a diftance from the inflamed part ; local or topical, when the 

 blood is evacuated by leeches, fcarifications, or cupping, 

 from the veflels which are near, or belong to the inflamed 

 part. General bleeding is not fo invariably proper as lopi- 

 6 ' * ca!. 



