I N F 



in direfting tlie farther ufe of the lancet, and is only to be 

 dcemcJ a fccondary adjuvant in determining the proper mode 

 of praftice, in conjunction witli a careful iuvelligation of 

 the violence of the fymptonw of the difcafe, its duration, and 

 tendency, and of the age, llrength, and conllitution of the 

 patient. 



In attempting to form an accurate diagnofts, in regard to 

 inflammatory difeafes, two difficulties prefent themielves : 

 the firll of thefe is the difficulty of dilHnguifliing the inflam- 

 mation of one organ from that of another, which is contigu- 

 ous to it, or in its vicinity. For inllance, the leading fymp- 

 toms of inflammation of the lungs, in very many cafes, are 

 prefent in hepatitis, or inflammation of the hver, on the one 

 hand, and in carditis, and pericarditis, or inflammation of the 

 lieart, and of the pericardium, on the other. The dillinc- 

 t'.on, wiiich is commonly fuppofed to exift between the in- 

 flammation of the heart and its membranous bag, and inflam- 

 mation of the lungs, confiftsin the occurrence of palpitation, 

 fyncope, and an irregular pulfe, in the former difeafe, in 

 addition to the fymptoms of the latter : but Dr. Cullen 

 admits that thefe three fymptoms are occafionally abfent in 

 pericard'tth, and accords with the cbfervation of Vogel, 

 that " the fymptoms of cardilh are nearly the fame 

 as thofe of pcripneumony, but more fevere :" i. e. fever, 

 with pain in the left fide of the chell, difficulty of breath- 

 ing, and cough. (See Cullen, Nofol. Meth. Clafs i. Ord. ii. 

 Gen. 1 ^ and 1 1.) In hke manner, thefe four diagnon.ic fymp- 

 toms of peripneumony and pleurify are commonly prefent 

 in inflammation of the liver, efpecially when the convex fide 

 of that vifcus, which hes in contaft with the diaphragm, is 

 the feat of the inflammation : for in addition to fever, and 

 pain in the fide, a difficulty of breathing is occafioned by 

 the fuffering, which any attempt to deprefs the diaphragm 

 in the aft of infpiration, excited by comprefling the inflamed 

 liver ; and a cough, which, however, is commonly dry, or 

 unaccompanied by expectoration, but not always, and which 

 is excited probably by the vicinity of the feat of irritation 

 to the lungs. As tlie hepatitis proceeds, tlie other fymptoms 

 belonging to it, efpeci-al'y the bilious tinge of the Ikin and 

 eyes, point out clearly the feat of the inflammation. 



It is fatisfaftory, however, to know that, in fuch cafes of 

 extreme fimilarity of fymptoms, no practical evil can arife 

 from the inability to decide as to the feat of the difeafe : for, 

 in the firft place, the inflammation actually fpreads, in fome 

 inllances, to tlie contiguous organs, fo that the fymptoms 

 indicative of the diforder in both mud neceflarily co-exilt ; 

 and, in the fecond place, the inflammation requires the fame 

 praAical meafures to be adopted for its removal, in whatever 

 vifcus it may be feated ; namely, evacuations proportioned to 

 its violence, and to the vigour of the patient. 



The fecond difficulty, in didinguifliing inflammatory 

 difeafcs, to which we have alluded, arifes from the occafional 

 feverity and fixed feat of the pain, which is attendant on 

 cramps or fpafmodic difeafes, more efpecially in the ftomach 

 and the bowels. Hence it is often extremely difficult to pro- 

 nounce, whetlier an acute pain in the belly, for inftance, is 

 occafioned by the colic, or by enteritis (inflammation of the 

 bowels), for conilipation accompanies both ; and although 

 a mere fpafmodic pain is very commonly prefent, witliout 

 any acceleration of the pulfi-, or febrile heat; yet when 

 fuch pain is extremely acute, and has continued for fonie 

 length of time, he conllitution begins to fuller from exccf- 

 live irritation, and tlie pnlfations of the heart and arteries 

 are quickened ; and if it (lill continues, aflual inflammation in 

 the part is hable to enfue, fo that what was colic in the com- 

 mencement, becomes finally enteritis. It is important to 

 Uifcriminate accurately in the outfet between tliefe two dates 



I N F 



of pain ; becaufc that, which is fpafmodic, may be vcnsovcj 

 by large dofesof opium, and other antifpafmodics ; whereas 

 the inflammatory pain would be augmented, and the difeafe 

 itfelf rendered more dangerous, by the exhibition of fpch 

 medicines. In making this difcrimination, the praititioner 

 is principally guided by the hardnefs and force, or the foft- 

 ncfs and we'aknefs of the pulfe; — by the rigidity of fibre 

 and robuft habit, or the contrary condition of the patient ; — 

 by the unvarying iiitenfity and feat of the pain, or its occa- 

 fional remiffions and flight change of place ; — and by a know- 

 ledge of the nature of former attacks, of a fimilar kind, where 

 fuch have occurred. 



The experienced and accurate obferver of the phenomena 

 of difeafes, therefore, will feldom be at a lofs in felecting the 

 proper mode of treatment in fuch cafes : and it is fortunate 

 here alfo, that the evacuation of blood-letting, which is ab- 

 folutely neceffary to fubdue a violent inflammatory affedtion 

 of the bowels, often fucceeds in removing a fixed and fevere 

 fpafm in the fame organs. And as a fpafmodic affeftion, of 

 confiderable duration, is liable to terminate in inflammation 

 and its fatal confequences, the depletion of the blood-veffcls 

 is indicated, under fuch circumftances, both as a preventive 

 and as a cure, where the age, ftrength, and conllitution of the 

 patient do not render the fafety of fuch a depletion very 

 equivocal. 



In regard to the treatm.ent of inflammatory difeafes, we 

 have already in part anticipated the difcuffion. The great 

 decifive remedy for fuch difeafes is found, in diminilhing the 

 quantity of the circulating blood. This operation of blood- 

 letting is fuppofed to produce its beneficial effects upon the 

 difeafe, by removing the" ftimulus of dift:ention'' from the 

 blood-vefTels ; for it is an afcertained property ef tlie living 

 folid, to contract more forcibly after a great extenfion of its 

 fibres. It cannot operate by letting out the viorhid mailer 

 or humour from the circulating fluids, as the older pathologills 

 imagined ; for if we fuppofe the whole mafs of fluids to be 

 impregnated with a morbid humour, how can we, by 

 ab'.lracting a part, purify the condition of the remain- 

 der ? The fr.a, however, is fully eft:abhrned, and cannot 

 be invalidated by any error in the hypothefis. which maybe 

 framed for the purpofe of explaining it. The depletion of 

 the vcflels may be effected by opening the fmaller branches of 

 the arteries, where they are fuperficial, and eafily fubjedted 

 to prefl^iire, as in the temples ;— or by opening the external 

 veins by the lancet ; or by a more hmited and topical dif- 

 cliarge by means of leeches, and cupping. The circnmltances,^ 

 under which one or other of tliefe modes of depletion 

 is to be preferred, vary materially according to the feat and 

 degree of inflammation, and will be mentioned under the 

 head of each difeafe. While this mode of reducing inflam- 

 matory aftion is reforted to, it is generally ncceflary, alfo, to 

 employ other concurring means ; fuch as purging, exciting 

 a diaphorefis or gentle perfpiration, procuring a difcharge 

 from thefl<in in the vicinity of the inflamed organ, by blifters,. 

 &c, ; and, at the fame time, to employ all the negative 

 means of diminifliing excitement, wliich conflitiite the anti- 

 phlogiflic regimen ; fuch as avoiding heat, noife, exertion of 

 body or mind, and fliunning all folid animal food, condiments, 

 fpirituous, vinous, or other fermented liquors, which increafe 

 the action of the vafcular fvllem. 



INFLATION, formed from in, and /«//«; oi fo, I 

 How s blijtving vi, the aft of llrelching or filling any flac-^ 

 cid or dillenfible body, with a flatulent or windy fub- 

 flance. 



INFLECTION, called alfo diffniRion, and defeaioti, in 

 Optics, is a property of light, by reafon of which, when it 

 comes within a certain dillance of any body, it will either be 



bent 



