236 PATHOLOGY. 
of inflammation which fimulate the aCtions in which fuf- 
penfion of the functions of a part takes place with fome 
uneafy fenfations, but without actual difeafe. The more 
obvious marks of inflammation are derived from its ap¬ 
proach, which is generally flow, except indeed in violent 
cafes ; but in thefe no danger or miftake can arife ; the 
other phenomena of inflammation being moll ftrongly 
marked : by its progrejjion , which is generally conftant 
and unremitting, except indeed that the difeafe is great¬ 
er towards evening: by the increafed fenjibility in the 
aft'eCted part, preflure being invariably found to aggra¬ 
vate inflammation, and common ftimuli, which in health 
were unfelt, producing the fame effect: by the derange¬ 
ment of the functions of the inflamed organ, particularly 
of its fecreting function : by its effeCt on the nervousJ'yf- 
tem of the brain, which is to induce in the firft ftage ex¬ 
altation, in the fecond diminution or irregularity in the 
manifeftations of the intellect by its eft'eCts on the ner¬ 
vous fyltem, as Ihown in the voice, the patient exprefling 
his diltrefs by low or gentle moanings (except the brain 
be much aft'eCted), and not by thofe hafty, clamorous, 
and impatient, expreflions, fo common in thofe' who fuf- 
fer from difeafes of irritation : by the fympathetic aCtion 
it excites in the capillary fyftem, inducing an increafe of 
the general temperature : by its aCtion on the heart and 
arteries, which is characterized by an increafe in the ful- 
nefs and frequency of the pulfe, but more efpecially by 
its hardnefs, a condition which mull be particularly at¬ 
tended to ; (fee our directions for afcertaining thefe par¬ 
ticulars at p. 93, 4.) for, in all infidious inflammations, 
though the pulfe be not fuller nor more frequent than 
common, it will invariably be found harder. Each of 
thefe marks of dilturbance, taken feparately, would fail 
in guiding us with accuracy in recognifing inflammation : 
it is by the conjunction of feveral or all of them that we 
mult be directed. 
To prevent the frequent repetition of the fame direc¬ 
tion, we fliall now give a general account of the thera¬ 
peutical indications belonging to Emprefma. Of the 
mode of aCtion by which bleeding reduces inflammation, 
we have already fpoken at p. 209, 10. and here we mull 
repeat our conviction that much error arifes from meafu- 
ring the degree to which it is proper to carry this evacu¬ 
ation by the mere number of ounces. If we have clearly 
afcertained that the difeafe is inflammatory, and that 
the fymptoms before us are kept up by inflammation, we 
mult bleed till relief is obtained : we mull be guided 
folely by the effeds of our practice. 
Next to the agency of bleeding in reducing inflamma¬ 
tion are to be mentioned that clafs of medicines which 
(fomewhat differently from the common acceptation of 
the term) we have named Sedatives. Of thefe the molt 
eftablifhed is the Digitalis. Many drugs are known how¬ 
ever which poflefs the faculty of diminilhing the con¬ 
tractility of the arteries in an eminent degree ; but thefe, 
from their uncertainty or accidental ill eifeCts, we for¬ 
bear to notice, not doubting, however, that a few years 
will fee the remedies in queltion in full ul’e in the medi¬ 
cal world ; among which the Pruflic acid will, under 
fo^ne form or preparation, probably hold a diltinguilhed 
rank. It will be in vain attempted to exercife the ope¬ 
ration of fedatives in intenfe Phlogofes, unlefs evacua¬ 
tions have been premifed. Thus we fee the Italians, as 
before reverted to, giving medicines of this clafs in the 
moll exceflive dofes, without lowering the pulfe, becaufe 
they had negleCted to bleed their patients freely before 
their exhibition : hence in acute difeafes we Ihould al¬ 
ways ufe bleedjng firlt. In the clafs of fedatives we 
Ihould not forget naufeating medicines, though thefe 
aCt through the medium of the nerves. Antimony is 
the molt common drug adapted to this purpofe: it 
Ihould be fo managed as to procure naufea without vo¬ 
miting, efpecially in cephalitis. 
Stimulation is reforted to in inflammation two ways. 
In the firlt, which is conftituted for the purpofes of pro¬ 
moting the fecretions of the difeafed part, we exhibit 
medicines which poflefs an exclufive aCtion on it; as 
purgatives in bowel-complaints, expectorants in bron¬ 
chitis, See. The ufe however of thefe remedies is fel- 
dom admiflible in the early ftage of inflammation ; and 
they are upon the whole very limited in their application. 
The next and more important mode of ftimulation is 
inllituted on the aflumption that a lofs of balance ex- 
ilts between inflamed parts and the reft of the fyftem ; 
and confifts therefore in irritating found ItruClures for 
the purpofe of relieving the difeafed ones. Many of the 
medicines having this effeCt operate alfo by inducing 
fecretion, and thereby relieving plethora. In this double 
manner do purgatives aCt. 
We alfo may make ufe of our knowledge of fympathy 
to relieve inflammation. We throw cold water on the 
head in Cephalitis, becaufe, on account of the fympathy 
between the external and internal parts of the head, by 
conftringing the vefleis of the Ikin we alfo conltringe the 
vefl’els of the brain, the dilatation of whiqh is the chief 
condition of the inflammation. The great difficulty con¬ 
fifts in properly timing and diferiminating the neceflity 
for each of thefe meafures. For one practitioner throws 
cold water on the head, and his patient recovers of Ce¬ 
phalitis : another blitters the fcalp on one fuffering un¬ 
der the fame malady, and a like happy refult enfues : 
yet thefe remedies are direCtly oppolite, and the time or 
the attendant phenomena will explain why different 
treatment was neceflary in difeafes nominally the fame. 
The genus Emprefma contains feventeen fpecies. 
1. Emprefma cephalitis, phrenfy, or brain-fever : acute 
pain in the head ; intolerance of light and found; face 
flufhed; eyes red ; cauma ; watchfulnefs and delirium. 
For a long period medical practitioners have been 
ltruc’k with the remarkable anomalies which exift in the 
fymptoms of cranial inflammation. It has been attempt¬ 
ed to account for the principal appearances that inflam¬ 
mation exhibits by the fuppofition that fymptoms wrnuld 
vary as the brain itfelf or its invefting membranes were 
attacked. Many practical authors, on the other hand, 
have denied that the diftinction in queftion can be made. 
Among thefe it may be fufficient to mention Cullen and 
Frank, and more recently the iliuftrious Portal; and in¬ 
deed it muft be confeffed, that, till the prefent time, the 
diftinCtions were by no means clear, and even now it is 
well afcertained that in all fevere membranous inflamma¬ 
tion the inverted parts will fuffer the like difeafe. This 
is particularly remarkable in inflammation of the inveft- 
ments of the brain, in which few cafes are feen without 
derangement of the intellect, an occurrence which can 
only be explained on the fuppofition that the brain is 
inflamed. The French fay that it is only in inflammation, 
of the brain that the faculties are deranged ; but that, in 
inflammation of the membranes, they are merely exalted; 
yet will they fay that the mere membrane can have any 
thing to do with the elevation of thought, except as the 
blood flows falter through the brain ? and will they fay 
that the excitement which follows drinking is membra¬ 
nous not cerebral excitement ? certainly not. 
In our introduction we have mentioned the impor¬ 
tant addition Drs. Martinet and Parent-Duchatelet had 
made to the progrefs of pathological fcience by their 
excellent deferiptions of inflammation of the arachnoid 
membrane, (fee p. 47.) This complaint is commonly 
called arachnitis , but more properly arachnoiditis, which 
term we fliall ufe. It may not be amifs toc.obferve, that 
the arachnoid is a delicate tranfparent membrane, clofely 
in contact with the pia mater, and reflected over the in¬ 
ternal furface of the dura mater. It forms a lining for 
all the ventricles of the cerebrum and cerebellum. It is 
conftantly lubricated by a fine rofy exhalation ; and is 
decidedly a ferous membrane, performing the fame func¬ 
tions in the head as the membranes invefting the heart, 
lungs, and abdominal vifeera, perform in their refpec- 
tive fituations. Like them, it is infenfible to touch or 
torture 
