INFLAMMATORY DISEASE. 



thirr!:. See), there is a fised putn in fome part of the cheft, 

 cough, and difficuUy of Ireaih'ing. (Cullen, Nofol, Meth. 

 Clafs i. Ord. ii. Gen. ii.) Now fiver occwrs from many 

 other caufes, and without thcfe other iVmptoms ; in which 

 cafe no pulmonic inflammation is judged to beprafent. Pain 

 may be fok in the cheft when there is neither cough nor fe- 

 ver, nor difficult i-efpiratioii, as in the cafe of rheumatifm in 

 the intercollal mufcles, the diaphragm, or perhaps the me- 

 diaftinum, or in the cafe of partial or gesieral fpafm in thefe 

 inufcles. It may be alfo felt, with diifiqulty of breathing, 

 but without fever, as in the cafe of fpafm of the diaphragm, 

 in hydrothorax,_ or in angina pectoris-: or it may concur with 

 fever when there may bo nc cough, as fometimes happens 

 when the liver is inflamed on the furface contiguous to the 

 diaphragm. Again, there may be an impeded funftion 

 (;. e. in this cafe difficulty of refp'iration) without fever or 

 pain, as in many cafes of afthma and chronic dyfpnxa, con- 

 nected with a fpafmodic conllridlion of the bronchia) paf- 

 fages, or a conJiderable fecretion of mucus into the cells and 

 bronchial tubes. But where tliere is inflammation in "the 

 lungs, there is neceffarily, in the firft place, a fymptomatic 

 fevsr ; in the next, from the congeilion and over-dillention 

 of the veffels of the inflamed organ, there is a fixed ^^/n, and 

 alfo a difficulty of adaiifllon of air into tlie comprelfed cells, 

 i. e. difficult breathing; and the irritation upon the nerves 

 of the bronchia, by this congeilion, as well as by the mucus 

 fecreted, neceflarily excites cough. 



Thefe concurring phenomena, tlien, of pain and impeded 

 funftion in any organ, with general fever, are the diagnollic 

 fymptoms of all internal inflammat,ory difeafes. But there 

 are ftill other phenomena which indicate the degree of vio- 

 lence of the inflammation which is going on. Thefe are 

 principally the other conditions of the puhe, befides its fre- 

 quency, and the appearance of the blood drawn from the 

 veins. Where an acute inflammation fubfifts, the pulfation 

 of the heart and arteries is generally very vigorous ; fo that 

 the pulfe at the wri'ft ilrikes againll the finger with a confi- 

 derable force, and with a iharpnefs of ftroke which elevates 

 the finger, comprefhng the artery, even when firmly held on 

 it. The terms hard, llrong, and fharp, have been ul'ed to 

 <lenote this vigorous pulfatioii of the artery. The degree 

 of hardnefs, ftrength, or iharpnefs of the pulfc, however, 

 varies greatly, not only according to the violence of the 

 difeafe, but to the vigour of the pationt's natural con- 

 ilitution ; and it> differs alfo according to the peculiar llruc- 

 ture of the organ inflamed ; all of wliich circumftances inuft 

 be taken into the confideration of the phvliciau before he 

 decide uJ)on the practical treatment which he fl.all adopt. 

 Even in the moft fevere inflammation, which a very dehcate 

 liabit is capable of und-rgoing, tiie pulfe may be lefs full 

 and ilrong than in a flight febrile aifeftion in a robull habit ; 

 l>ut there is generally a degree of fharpnefs in the ilroke of 

 the pulfe, even in a feeble habit under the excitement of 

 acute inflammation, which the taci, acquired by a little ex- 

 perience, enables the phyfician to eilimate. Befides, in fuch 

 cafes, the degree of pain and of impeded fundtion, and the 

 ftate of the pulfe, mutually illullrate each other. If the pain 

 has remained fixed and fevere for many hours, and the fundion 

 of the fuffering organis greatly deranged, although the pulfe 

 may betray but a moderate degree of iharpnefs or hardnefs in 

 % habit not originally ilrong, the proper evacuations for the 

 cure of inflammation mull be confidered as indicated. This 

 is particularly necelfary, as we have juft hinted, in refpedl to 

 certain organs. When there is an acute inflammation in the 

 Ungi or liver, and efpecially when tiie enveloping membranes 

 ere affected, the pulfe is perhaps invariably charafterized by 

 lardnefs aid llrength. (See H«?ATiiUi and Pleurisv.) 

 •V.6t. XIX. 



But when \.he Jlomach is inflamed, the pulfe is often without 

 any confiderable hardnefs, and generally fmail, but very 

 fretiuent. In this cafe, therefore, the exillence of acute in- 

 flammation might be overlooked, if we judged principally 

 from the pulfe ; and it is necelfary to compare the ilate of 

 the pulfe with the degree of fixed burning pain in tin; fto- 

 mach, and the fudden increafe of that pain, as well as the 

 vomiting wliich is excited by any thing whatever that is 

 taken into the ilomach, in order to afcertain the nature of 

 the difcafe. See G.vstiutis. 



The other circumilance, which has been mentioned as aid- 

 ing us in dift-inguilhing the degree of violence of any inter- 

 nal inflammation, is the appearance of the blood- drawn from 

 the veins. When the lancet is ufed in inflammatory difeafes, 

 the blood, which is drawn, after (landing fome time in any 

 veffel until coagulation has taken pl.ice, exhibits, on the fur- 

 face of the coagulum, a thick gelatinous fubllance, with- 

 out any admixture' of red blood : this has been varioufly 

 termed the bujy coat, or fimply the biiff, the inflammatory 

 crufl, &c. ; and has been confidered as a proof of the exilt- 

 ence of inflammation, and as a teil, in a great meafure, of 

 the feverity of the difeafe. It is certain, that this buffy 

 cruft is commonly found in pleurify, peripneumony, hepati- 

 tis, acute rheumatifm, &c., ar.d is not leen where bl«od flows 

 from a perfon in ordinary health. It feems to arife from a 

 difference in the mode of coagulation, fo that the red particles 

 fubfide and leave the upper portion of the coagulating lymph 

 unlinged ; and not to confifl of a morbid humour in the 

 blood, as the humoral pathologifls believed. But experience 

 has taught us, that the buffy fl.ate of the blood is not a 

 criterion, by which the necefSty or propriety of blood-letting 

 can be determined in difeafes. For, not to mention the'ab- 

 furdity of relying upon a teft, which requires the praftice 

 to be adopted, to iome extent or other, before its propriety 

 can be afcertained, (a dodlrine which has often led to the 

 folly of taking away a little blood, "to fee how it looked,'') 

 obfervation has proved, that the blood is actually often in 

 the condition to (hew the buffy coat, where no inflammatory 

 adtion is going on, and where, akliough a certain degree of 

 inflammatory adtion may be prefent, yet it will not be removed 

 by blood-letting; but if the blood-letting be repeated, the pa- 

 tient may be dellroyed before the buffy coat on the blood 

 will difappear. Thus the buffy coat is almoll invariably 

 feen on blood drawn from women in a flate of pregnancy ; 

 it is likewife feen on that, which is taken from perfons la- 

 bouring under heftic fever, from pulmonary confumption ; 

 nay, it has been obferved on the blood drawn from patients 

 affected with the typhus fever, and with fcurvy (fee Four- ._ 

 croy, Connoiff. Chimiques ; alfo Blood, morbid alteration*',' . 

 of,); in all which cafes we fhould occafion infinite mifciiief/ : t^ 

 were we to conceive tliat this appearance indicated the neccfj^. 1L 

 fity of repeating the ufe of the lancet. But, farther, it is 

 a fadl, which has not hitherto been fatisfadtorily explained, 

 that in a violent attack of unequivocal infl.immation, as of 

 pleurify, if, during one bleeding, the blood be received in 

 two or three different veffels, the coagulum in one or two of 

 tlie veffels fliall prefent the buffy coat, while none^vill appear 

 on that in the otliers ; and in like manner, if blood-letting 

 be repeated two or three times, the blood of the firft draw, 

 iiig (hall exhibit no buffy cruft, while that of the fubfequent 

 drawing (hall fliew it in large quantity. This variety has 

 been principally attributed to the velocity with which the 

 blood flows from tiie vein ; thus it would appear, that the 

 blood which trickle.^ (lowly down the arm, fcldom (hews fo 

 much buff, as that which flows in a full and copious llream. 

 In a word, then, the appearances of the blood drawn in the 

 cure of difeafes, is to be confidered as a very imperfed guide 

 - O ia 



