'-   ;-V.   -  .■''.'*
 
NATIONAL LIBRARY OF MEDICINE




          Bethesda, Maryland 
 
 
A VIEW
OF THE PREVAILING
Theories of  Inflammation;
SUBMITTED TO THE CONSIDERATION OF THE
Honourable Robert Smith, Provost,
AND THE REGENTS
OF THE
UNIVERSITY OF MARYLJLND.
         BY PHILIP R. EDELEN,

      OF ST. MART'S COUNTY, MARYLAND.
HONORARY MEMBER OF THE BALTIMORE MEDICAL SOCIETr.
        BALTIMORE^:
PRINTED BY BENJAMIN EDES,
    Corner of South and Market Streets.

          1815. 
/ 
      TO NATHANIEL POTTER, M. D.
  PROFESSOR OF THE PRACTICE OF MEDICINE
                   IN THE
         UNIVERSITY OF MARYLAND,
  The following essay is most respectfully  in-
scribed  as a tribute of sincere respect  for the
many and valuable favours received by the auth-
or while prosecuting his professional pursuits un-
der his able guidance. 
 
INTRODUCTION.
  MEDICAL opinion had found a common level,
and the spirit  of enquiry, destitute of an object,
had  been dozing for years, when the Harveian
tide  burst upon the world.   The curious fabrics
of medical philosopy reared with care,  and con-
secrated by  time, ingeniously contrived, and fan-
cifully adorned, possessed no principle of intrin-
sic gravity which could resist the impetuous flood.
They were  shaken from their centre, overturned,
and  engulphed.  In this wreck perished the Hu-
moral doctrines of medicine.  The monuments
and  records of past ages were  swept away, and
a new surface presented, for the more  correct
inscription of the laws and purposes of the human
body.   Happily for  science and humanity, the
opportunity was not lost.  The work of improve-
ment, though slow, has been progressive.
   From this important era may be dated the for-
tunate commutation  of the  ground of  physical
enquiry  in  medicine.*  A more just relation of
attributes has been deduced from a more correct
acquaintance with the harmony of structure. And
the  purposes and conditions of the living body in
health and  disease, traced to agencies and modes
more  elevated and respectable, than  mechanic
principles, and hydraulic laws.

  * The Humoral doctrines of physic were not immediately aban-
doned.  They  survived for a time, the improvement of general
science, bottomed on the inferences of anatomical discovery.  But
from the period to which we refer, their footing became insecure. 
iv
  Though the mists of obscurity are becoming
every day more dense around the errors of past
time; and we look in vain for more than casual
truth, through a mass of opinion which has been
rapidly increasing since man possessed the instru-
ments for its record, it is pleasant and not use-
less, to review the various modes which ingenui-
ty has devised for the accomplishment of this
great aim.   For that truth was the object of our
predecessors in this walk,  we cannot doubt; and
when we assert, that but a casual ray lighted their
footsteps, we do  not mean to plunder  them of
the merit to which they  have a claim.   On the
score of industry in research, a more enlightened
age must yield them the palm.   It is rather with
the interest  of the advocate than the austerity of
the judge, we revert to their pretensions. While
they were ignorant of principles, they wrre  not
inobservant  of facts, and noted  correctly, what
they  erred  in explaining.   Had they not failed
here, they would  have effected what is rarely ac-
complished.  They would have outstripped the
science of the period in which they lived.   We
must look to the subsequent discovery of the cir-
culation, and the astonishing progress of chemis-
try,  for the  improvement of our  science.  As it
is to  them  we are indebted  for our only true
knowledge  of the relation between the agency of
natural laws, and the  phenomena of animal life.
The  sole source  of correct  opinion in physic.
From the first we derive  our acquaintance with
natural powers;  from the latter our chief know-
ledge of natural agents.
   It is not then from feelings of unmanly hostili-
ty to opinions which  we consider fairly contro-
verted,  and holding no longer a ground of de- 
V
fence, that we engage in a retrospect  of what
those opinions were.   Nor is it from motives of
curiosity alone that we prosecute such a review.
From the closeness and industry of research, for
which some of the ancients  are  remarkable, we
meet in their writings  with  much  fidelity  of ob-
servation, and considerable  ingenuity in the de-
ductions  they have  attempted to establish.   A
gUmmering of light occasionally broke in upon
their labours,  and in their efforts to trace its
source,  they made indirectly one step towards its
discovery, by affording to their successors a warn-
ing,  how, and where, they had failed.  They also
detailed effects with a minuteness and accuracy,
which obviated every difficulty in this respect to
those who came  after them;  and by the  extent
and  variety of their conjectures  as to cause, fur-
nished hints which modern commentators have
appropriated to their use, and by a dextrous man-
agement of them have built up theories for which
they arrogate reputation,  while they are disinge-
nuously silent about the debts they have  contract-
ed.  Although it is  no more than  a  dextrous
management of specious errors, adopted from the
suggestions of others, it is one purpose of this re-
view, occasionally to restore to the right  owner,
what has been borrowed without acknowledge
ment. 
i 
THEORIES OF INFLAMMATION.
Harvey's discovery was particularly adverse  to the
dominant  opinions on  the subject  we are about to
discuss; the existing  Theories of Inflammation.   Pre-
vious to that event all inflammations were supposed to
consist  in  Fluxions  and  Congestion.     From both
causes the  same effect ensued, viz:  obstruction.  And
the two terms, which have in fact a common meaning,
were adopted as significant in the understanding of their
authors, of the mode by which the consequence was pro-
duced.  Inflammation, from Fluxion,  consisted  in  the
flow of humors into a part they did not naturally occupy,
and the inflammation was either simple, or received a
specific  appellation, as those humors were supposed to
be natural, or charged with some foreign and noxious
matter.   Congestion was the imaginary stagnation of
the natural humors of a part.
   Such were the  general principles, the primary divi-
sions of their theories of  inflammation.    A few  trifling
subdivisions were  marked out;  but to those two  genera
were referred all their reasoning upon  the  subject: all
their discussions about the cause and cure of inflamma-
tion.  The natural or contingent qualities attributed to
the humors, the immediate consequences of their deten-
tion in a part, and  the consecutive changes resulting from
their seclusion and confinement, were the data by which
were illustrated the condition of the part, and the  phe-
nomena of the disease.
   Those sentiments were  grounded on the prevailing
theories of physic.  The blood and humors were supposed
to have  a diurr al revolution; their source and receptacle
being in the liver.  From this rendezvous they went
abroad  into the body in the day, and to it they returned
at night.   Let us  not censure the authors of such opin- 
10
ions hastily.  Before the true mode of circulation was
discovered, nothing could be known on this subject.
  As obstruction constituted the prominent feature in all
the conditions  of inflammation, and as mischief in a
greater  or less  degree, consistent  with the nature  and
properties of the  contained  fluid,  must result from its
remora  in  the  part,  we have  a constant regard paid to
the necessity for its removal, and  some ingenuity in the
means devised  for its  accomplishment.  There was at
least a  harmony between  the ideas entertained of the
nature of the disease, with the manner of its production,
and the modes by which  its removal was attempted.
The fluids  being  subjected by the  distributive powers
to but slow and feeble motion, except when those powers
were excited by extraordinary agency or stimulus, it was
supposed  that  their  current might be easily changed.
This opinion applied to the doctrine of Fluxions, estab-
lished  a maxim,  that  when inflammation  was the con-
sequence of an increased flow or  determination of  hu-
mors to  a part,  Revulsion, or a change in their distribu-
tion was necessary, and might be  effected by inviting a
flux to some other part.  Bloodletting at a distance from
the seat of disease, was the plan adopted for this  pur-
pose: as they hoped in  that way  to produce a counter
current  or drain which would  avert injury from the  part
threatened.   In Congestions they  had  recourse to repel-
lents and discutients. Articles externally applied possess-
ing a supposititious power of disloding the confined  hu-
mours,  or bringing them into a condition  favourable to
their escape by transpiration.  When the inflammation
resisted all those means,  the plan  was chan^sd; and
they then talked about promoting concoction, suppura-
tion, mundification,  incarnation  and cicatrization.    To
each of those  objects  they adapted specific  materials,
formulas and management.   Producing an inflamed con-
dition  in some less dangerous part than the original seat
of  disease,  was  another mode of treatment, in which
much confidence was reposed.  Great faith being cher-
ished in the attractive power of local disease.
   Time has not completely obliterated a  partiality for
some of the inventions to which those doctrines gave rise.
A farrago of applications,  a medley of poultices, baths, 
11
fomentations, &c.  still encumber this department of the
practice of phyt ic and surgery.  Fooleries for the most
part by which science is clogged and  degraded; and
from which it  cannot escape until man will consent to
believe  that there is a wisdom  in  the  structure of the
body, and the appointment of its laws, superior to his
cunning and art in supplying its  wants.
  Having contemplated for the present but a general and
brief summary of  old opinions on inflammation, and in-
tending to make their authors speak for themselves, as
fairly and  fully as our investigation and understanding
of them will  permit,  we will now proceed in our pur-
pose, with more attention to method.
  It is a complaint urged  now more frequently than at
a period more remote, that the characters of inflamma-
tion are not sufficiently determinate.  By  this remark is
intended to be  conveyed an idea of the difficulty oppos-
ed to the establishment of certain uniform essential signs
which  may serve  the  purposes of correct definition.  I
think the objection groundless; and that upon this occa-
sion as on  many other subjects of our science; an affecta-
tion of refinement,  has superseded a regard to facts.  That
plain and natural expressions  have been  removed to
make way for, or obscured, by being blended  with,
arbitrary  and  capricious conceptions;  and the laws of
disease,  not deduced  from nature,  but made for her;
or rather, to suit the prejudices of  writers.   No  one, I
presume, who  is  informed with a moderate degree of
accuracy^ on the  general laws of the animal  economy,
can be for  a moment  at  a loss to detect the presence of
inflammation,  when  that condition  of parts does  exist,
provided those parts  were  accessible  to  examination.
He could be involved in no difficulty as to the existence
of inflammation, if its laws were then  in operation, or
even in ascertaining  their previous  operation, where its
consequences  still remained.   I have before ventured
to compliment  the old writers  upon inflammation, on
their fidelity and accuracy of observation.   And I think
we shall find  by a  recurrence to  the records of that
period,  dark and  unscientific as it was, that the  tribute
was not unmerited.    In these records  we shall finjd the
phenomena of inflammation laid down as they then were, 
IS
as they now are, and as they ever will be.   And I dare
to hazard the assertion, that we cannot improve the de-
scription, by adding to, or taking from the number and
character of the signs they have presented us.
   Together with their accuracy of observation,  we find
in those writers a remarkable concordance of opinion as
to the symptoms of inflammation. No diversity of sen-
timent,  regarding  the  mode of its  production,  has in
the smallest degree affected  its diagnostic  or definition.
They all agree in assigning as the distinguishing  fea-
tures of such a deviation from health, four uniform and
essential marks or  expressions, viz:  increased  heat,
redness, tumor and pain.   These make up that result
of observation, which  I have said for fidelity and  accu-
racy,  will not suffer by a comparison  with  the opinions
or discoveries of the  present enlightened  age upon the
same subject.  I will go one step farther, (and  rest the
proof of the assertion upon what will appear in the course
of these remarks) in advancing a declaration that some
Pathologists of our day, of more than modest pretensions,
have fallen into gross error, when those early adventurers
in science have adhered strictly to the evidence of  truth
and nature.
   In the writings of Hippocrates, little is said respect-
ing inflammation; nothing distinctly.   In his work how-
ever,  "He Capitis Vulneribus," he says,  that the parts
in the  neighbourhood of the wound become inflamed
and tumid, on account of the influx of blood into them.
He of course means the influx of more than ordinary
or natural quantity of  blood.   He  says nothing of the
mode by which the parts were fitted to receive a more
than ordinary quantity of blood,  or how such quantity
effected its passage there.  He enters into no discus-
sion of  the subject.  Yet as far as  his remark  extends,
it  is undoubtedly the result of correct observation.   A
result similar to that which we deduce from our attention
to the  subject at the  present time;  and simple as the
notice is, we shall find nothing better calculated to open
the right road to farther enquiry, in  the  more  labour-
ed accounts of his successors, for  many years.   His
Disciples, not satisfied with his plain doctrine upon the
subject, (for it certainly was reasoning about inflamma- 
13
tion, though but partially, to say that it was occasioned
by  too  great a flow  of blood  into a part) attempted to
extend and improve  it.   He is however  under no obli-
gation to them for the attempt.   They would have done
him a greater favour by calling it when thus altered,
their own doctrine.   Rejecting the influx of common
blood as insufficient, they held the inflammation to con-
sist in the influx of  a fluid  (it might be  blood,  or any
other fluid of the body) possessing acrimony and vis-
cidity,  with a capacity for attracting similar fluids.
   It will not be stepping far out of our path to see how
those doctrines,  absurd  and  awkard  in their  present
dress, would look if translated  into language more con-
sonant to our taste  and comprehension.   From  motives
of  curiosity we will examine briefly what amendments
could be thus made.  They  saw effects which they at-
tributed to  acrimony, viscidity, and attraction.   They
witnessed an increased quantity of fluid in a part, saw
it detained and gradually augmenting.    Suppose then
we say their acrimony was a cause preternatural stimu-
lating the vessels of a  part and exhausting their tone,
permitting an unusual flux  of blood into the part affect-
ed by  diminishing  the  capacity  of its  vessels for re-
sistance to the current from behind.  That their viscidi-
ty was  an  impeded current of fluid through the part,
 from defect of power in the vessels to send it on.   And
 that their attraction of more  fluid was a continued aug-
 mentation of quantity in the  part from  increasing disa-
 bility in those vessels, to  oppose its entrance into them,
 or part with after they  had received it.   But it  is not
 our intention to anticipate discussions which belong more
 properly to  another place.  We  turned aside to notice
 that we have thus early an argumesit in favor of our posi-
 tion that the phenomena of inflammation, are not vague
 and indeterminate.  That we  held them established  on
 the ground of experience,  before reason as the  instru-
 ment of  demonstration could serve the  purposes  of our
 knowledge  as  to the cause and mode of their existence.
    Erasistratus, another  writer of some celebrity and great
 antiquity, for he lived  some hundred years before the
 christian era, has given us  an opinion on the subject of
 inflammation.  He appears to consider inflammation, not 
14
 as some have  asserted for him, as occasioning certain
 motions in  the blood,  by which it was impelled into
 places or parts it did not naturally occupy, for this is in-
 volving him in  absurdity, by making  him speak of in-
 flammation as  present, before it could be known to exist,
 but as the consequence of certain motions excited by some
 cause in the blood, by which  it was forced into the small
 vessels, at that time thought to be air tubes, and into the
 spaces supposed to exist every where  between separate
 parts.
  Here  then we have the first direct notice of the Boer-
 havian doctrine of Error Loci.  A doctrine less  mis-
 conceived as to fact, than mistaken as to principles.  For
 that there is too much  blood in  an inflamed part, every
 body will now  admit.  Even  those writers, on whom
 modern opinion has  concurred, to confer the proud pre-
 rogative of universal decision, can in no other way ex-
 plain,  one of  the invariable  characters of inflammation;
 yiz. Redness.
  Though we take up the Boerhavian doctrine rather out
 of order as to time, yet having fallen in our way incident-
 ally, we will notice it here.   This doctrine holds a pre-
 eminence as the doctrine of obstruction.  It is true this
 distinction is  somewhat  partial.   For obstruction  in
 some form or other, was the fundamental principle of in-
 flammation,  with nearly  all Boerhave's predecessors.
 But  it claims this regard from  having  been the first to
 examine closely, the capacities of the part receiving, and
 the condition of the fluid received.  Save this it has little
 merit.   And even for this its title to credit is equivocal.
 Before his time, Harvey's discovery  had  put to flight
 fche'doctrine of fluxions.  Congestion was not so easily
 routed.  For  between it  and the  subsequent  favourite
 obstruction, there is much intimacy.  In  the latter, the
 blood,  &c.  is forced  into  places from  whence it cannot
 escape.  In the former it wanders there casually, and is
locked up, or not permitted to get out.   But congestion
being disgraced by having kept company with fluxions,
its name was seldom mentioned.
  It Mas Boerhave's  opinion,  that inflammation was
caused  by an  impeded circulation in the small vessels.
This obstruction was owing to a lentor, from uncommon 
15
density of the blood, which arresting its free passage, it
remained stationary in those vessels, until by the resist-
ance thus  opposed to the  current from behind, the heart
was excited to more  powerful efforts, and if it  was not
forced through the vessels by the repercussion thus pro-
duced, part of it was impacted or wedged fast, and part
of it driven  into the smaller series of vessels, in conse-
quence of their mechanical dilatation.  This last effect
was called "Error LociP  As the vessels which were
supposed  to convey only serous fluid before, now contain-
ed red globules.  The irritiation of the heart caused by
the impediment to circulation, was supposed to  occasion
a  more powerful impulse, a dashing or friction of the
blood against the walls of the obstructed vessels, in the
parts still pervious.  Hence followed heat and pain.
The  tumour and redness were the consequence of unu-
sual  quantity of blood in the obstructed and  enlarged
vessels.   If the repeated and forcible propulsion of the
current a  Tergo, did not effect a passage by driving out
the mass  of blood,  which plugged up the vessels, thus
accomplishing what was called a resolution, then changes
took place  in the part  said  to be consequential to an
acrimony, either originally  possessed by the blood, or
acquired  by its stagnation.  On this acrimony depended
all the mischievous terminations of inflammation.
   Galen  and his followers entered more deeply into this
 subject.  They are the first  who have given us a distinct
 and  clear enumeration of the principle features of the
 disease, in connection with those accompanying charac-
 ters, which though secondary and consecutive, come on
 so early,  and are so strongly marked, as to claim a con-
 sideration in the account of genuine inflammation.  In
 laying down their definition, they give us the following
 train of symptoms:  Increased heat, redness, tumor, pain
 with tension, and a sensation of throbbing in and about
 the part.   That they have failed  in applying a philoso-
 phy, which wiH satisfactorily evolve the laws by which
 those phenomena  were  produced, we must admit; yet
 the strictly correct notation of those phenomena, is placed
 beyond the ground of  controversy.  We shall  look in
 vain into the records of modern pathology, for any thing
 upon the subject more accurate and intelligible.  When 
                             16

   they come to the application of their philosophy, such as
*  it is, we find them holding their principal law upon cour-
   tesy.   They beg the  ground from which they set out.
   Inflammation with  them consists in too great a flow of
   uncommonly warm blood into a part, which gives it the
   first increase of heat, and the redness.  The vessels be-
   coming too full, the finer parts of the fluid  exude into
   the empty spaces about them, giving the increase of bulk,
   and producing tension, pain and throbbing, by putting
   the parts on the stretch.  To account for  the  progres-
   sively increasing temperature of the part, they  called in
   the aid of putrefaction of its contained fluids.  They do
   not tell us how the blood became unusually warm in the
   first instance, yet we can forgive them  their neglect on
   this head, for  if our opinions on the subject of animal
   temperature, are correct, they could know nothing about
   it.  The state of their  chemistry, is  an ample  apology
   both for the omission and their ignorance.
     Old Celsus  used to say, "Ases  nostra  conjecturalis
   est," and we are almost persuaded to  believe him, when
   we  observe with what curious  consistency opinions are
   linked together: each  preserving some trait by which
   their relationship to their predecessor may be known.
   The opinion of Galen about the effusion of fine fluids in
   inflammation, was in some measure new in his day,  and
   though it is old now, it has not been forgotten.  A cele-
   brated philosopher of the present age, finds it convenient
   to call in the aid of this same effusion, in the elucidation
   of the same  subject.   It is true he has made an addition
   to the doctrine of effusion, which Galen never dreamed of,
   viz. The manufacture of blood vessels in it.   In order
   to spoil as much farther as possible the likeness of Galen,
   he determined also to cut  something off"; and instead of
   removing the  putrefaction  as a cause of  heat, he took
   away the heat itself.  A feature in our opinion as well
   entitled to a place in the picture, as any  which has been
   suffered to remain.
     The Galenists advanced  a step  farther in this road,
   than their predecessors, and effected a division of inflam-
   mation into  two species, to which  our terms acute and
   chronic, bear a very close analogy.   These w ere in their
   language, the first a consequence of sudden and rapid 
17
influx of blood into a part.   The  second they called
simple obstruction.    The  complete  doctrine of fluxions
and congestion.   A subdivision  was  then established
into varieties, receiving specific names from the supposed
causes affecting their diversity of sensible  signs.  Sup-
posing the two first to consist in a change effected by the
pure  blood  alone, the latter they considered  the conse-
quence  of foreign admixture  with  the blood,  such as
bile,  phlegm, &c.  And upon these principles they at-
tempted the illustration of  many modifications of inflam-
mation.   To a  differently vitiated  state  of  the blood
were  ascribed (Edema, Erisipelas,  Schirrus, &c.   It
will not be  necessary  to follow them in  those  minute
and capricious details,  which establish any thing rather
than fact or probability.
  The  principal proselytes to this doctrine of inflamma-
tion,  were Etius,  Paulus JEgineta, Oribasius, Fernelius
and Sennertus.
  I vill in  this place,  recur for a moment, to a subject
noticed in the first stage of enquiry into the  early doc-
trines of inflammation;  to wit, that I believed  we should
find the old  writers in [^session of  some important and
just grounds of conclusion on this head, as to fact, though
they had arrived at them by tortuous and obscure roads,
in regard  to their  philosophy.   Or  the principles  by
which they  attempted to illustrate their mode  of produc-
tion.   As far as we have advanced,  one particular trait
or  feature  appears  to  have  served  as a land-mark to
every traveller who has imprinted his footsteps  upon
this road  of hoped for discovery.  The evident increase
of  contained fluid;  the sensible signs of unusual flux of
blood into an inflamed  part has arrested the attention of
every adventurer, and found a  distinguished place in
every chart of observation.   It  has  been already re-
marked that the moderns assented to  their accuracy in
this particular.  The combatants on  the  theatre of in-
flammation  now  leave uncontested  this  solitary point,
contented with evincing their dexterity in  unfolding its
law of universal production.   That  the old authors were
also  right in another particular, viz.  the  impeded  cur-
rent through the part,  I would infer  from the very ad-
mission here adduced.  For I think we know enough of 
IS
the natural action of vessels  to be satisfied  that if in
any part those actions are so much overcome as to  per-
mit more blood  to  flow into the vessels  than t'hey  can
manage, in other words trausmit, in proportion to  such
loss of power in the general will be the quantity of their
contents.  But more of this in future.
  The doctrines of inflammation were next taken up by
the chemical school.  And we  are not surprised to  find
its  principles  as confused  and  unsatisfactory, as the
sources from whence they were drawn, were obscure and
unintelligible.  We see them in the first stage of enquiry
occupying nearly the same ground, traced out by their
immediate  predecessors,  the Galenists.  The "febrile
effervescent state oftlie bloody of Dele Boe, Willis, and
the other chemists, is the unusually warm and putrescent
state of the blood of Galen and his followers.  In  their
view of local disease simply,  (to which the old doctrines
are very much confined) both those theories presuppose
an indefinite state of parts.  With Galen there is  a  flow
of unusually warm blood into a part producing obstruc-
tion slowly and a disposition to putrefaction; thus caus-
ing local heat  and other phenomena.   Inflammation and
its phenomena here follow as a consequence of certain
changes in the blood which are  left unaccounted for, viz.
its unusual heat and  putrescent tendency.  The chem-
ists on the other hand assert an orgasm, or disposition in
the part for obstruction, which as soon as acted upon by
"the effervescent  state of the blood," begins to evolve im-
mediately the  signs of inflammation.   They  ventured  a
little farther and attempted to account for what they con-
sidered the chief feature of inflammation, viz. heat. They
asserted that from particular causes the more volatile and
subtile parts of the acid and alkaline principles  of the
blood were thrown off,  and lost,  that in consequence of
the nice equilibrium which those subtile parts preserved
betns!; destroyed,  those principles became more^crid, and
exerted a mutual action upon each  other, by which the
fhJogisim resident in the oily part of the blood  was  more
freely  evolved.   Thus  producing its febrile effervescent
condition.  And  this effervescent heat  evolving  state,
they said,  would come  more fully into  action in parts
through which the motion of the blood was retarded, ac- 
19
counting by this inference for increasing local tempera-
ture.   We cannot attempt the defence, and  think it un-
necessary to enter upon a refutation of such doctrines.—
Thev  were  deductions from  a science at that time
grounded on false principles.
  But of all the old writers upon inflammation, none  of
them appear to have  attracted  more attention than did
the celebrated Etmuller, in his day.  He too, was a dis-
tinguished chemist:  yet his theory of inflammation is far
from being simply an  application of the then principles of
chemistry.  He took a wider range, and fell in with some
of the principal views of the  subject which hold  a place
in many modern doctrines of the pathology of inflamma-
tion.   He published at different times, two opinions on
inflammation,  differing considerably in their leading cha-
racters.   In the first, he attempts to explain upon chem-
ical principles, the existence  ©f natural heat in the blood,
which he says is owing to the reciprocal and duly pro-
portionate action of a volatile spirituous acid, and an al-
kali, both naturally resident in the blood, upon each oth-
er.  Beyond this point his chemistry is carried but little
way.   The preternatural heat of inflamed parts, he says
is owing to the predominance of an acid or acrid property
in the blood, occurring from  an altered  proportion be-
tween the component parts above alluded  to, by  which
the influent spirit of a part is unusually excited.  And
from that cause  an uncommon determination of blood to
such part takes place.   At the same the innate spirit  of
the vessels and fibres of the part is roused: and from this
increased action and reaction, increased heat is generated.
Moreover the nerves and muscular fibres  being put upon
the stretch, by the augmented contents of the part, irrita-
tion and pain  occur, spasms  and contraction take place,
and the blood impeded in its progress, or entirely cutoff
from its passage into the veins, tumor, tension and red-
ness unavoidably follow.
  In the same manner he accounts for inflammation from
an external cause.  By  way of illustrating that effect
iTom the latter cause,  he selects from  Van Helmont the
example of the thorn piercing a sensible part of the body,
by which pain, heat, redness and swelling are produced*
In both those kinds of inflammation, the  remote  (proxi- 
£0
m Jte with him) cause, is an acid or acrid stimulant pro-
perty,  exciting the influent spirit (or nervous power)  of
a part, which again affecting the innate spirit (or irrita-
bility)  of the vessels,  and increasing their actions, there
follows from those primary and secondary effects of sti-
mulus, obstruction, heat and all the phenomena of inflam-
mation,
  Here then we have brought into co-operation the hos-
tile agents of Haller and Whytt; the vis insita,  and spi-
ritus nervosus.   Here too, we have a broad view of com-
mon  intelligence upon the pathology of inflammation, in
the present day.  For in some shape or other,  the  ideas
of irritants, sensibility, irritability, and increased action,
are floating through the understanding of most of  those
who every day see and treat that condition of parts. The
relation of cause and effect is here some morbid agent,
producing a change in the chemical affinities of the  bloud
of a part, by which it acquires an  on usual stimulant pro-
perty.   From  whence  follows  increased  action, aug-
mented heat and obstruction.
  Etmuller's subsequent  opinions  on this  subject  are
more exten4ed, and parts of them ingenious.  In his last
publication he makes  the  proximate cause of  inflamma-
tion  to consist in a preternatural collection of blood in a
part, confined there on account of impeded passage from
the arteries into the veins, more being  received by  the
former than flows on into the latter.   And  as the blood
is a red, warm and spirituous matter, in consequence of
its detention, it will render all the heat of the  detained
quantity sensible, and thus  also produce the redness.—
The tumor is accounted for in the usual way, from full-
ness of the vessels, and the pain from distention.
   In this part of  the opinion now under consideration,
we have  with but  one alteration, the old and favorite
hypothesis of obstruction.  He does not here assert  or
admit a preteruaturally heated condition of the  blood in
inflamed parts, but accounts for the sensible heat of such
parts from the blood in them giving out a greater  quan-
tity of its natural heat, from its confinement,  than it <•  rts
with in its ordinary current through  them  in health.—
Judging from obvious phenomena alone, he considers the
primary symptoms, together with their consequences, as 
SI
simply the result of interrupted communication between
the arteries and veins.  His explanation of the presence
of preterordinary heat constitutes  the  aberration a .led
to, from the old doctrine of obstruction; and  looks very
much like a regard to the nice distinctions now so much
agitated respecting evolution of heat and temperature,
  lu the 2d division of his  last  opinion  he  goes  on to
reason about the termination of inflammation in suppura-
tion and gangrene.  The former he makes a consequence
of corruption of part of the fluids from stagnation, or t! eir
being thrown out of the  circulation.   The latter,  viz.
gangrene, takes place when the  blood of an inflamed
part, by being entirely cut off from the general mass and
thus deprived of its vital influent  spirit, robs the part of
its innate spirit also, which depends upon the former,
and  in this way the death of the part ensues.
  We have something iu this reasoning,  differing  but
little in terms,  and still less in fact, from those modern
doctrines  which assert the most pointed and pertinacious
claims to  correct science  on the subject.    For we have
here the vitality of the blood, of one school, on which the
life and actions of  a part, as of  the  whole  system  de-
pends.  Or we may call it  the oxygenous state  of  the
blood of another sect of philosophers, productive  of the
same effect.  With one and the other in proportion to
the existence of their appropriate principle, will be the
life and powers of a part.   And  when that condition of
the blood no longer exists, its life and power giving pro-
perties are totally extinct.
   This part of his latest opinion contains also his first
attempt,  and indeed the first attempt among the old wri-
ters, to account distinctly for the circumstances leading
to the ultimate  terminations of inflammation.
   Sydenham, who was celebrated in  his time for fidelity
and  accuracy of remark,  and still retains some of that
celebrity,  has  not passed this subject without notice.—
But  his opinions on inflammation are among the few de-
ductions we are now compelled to make from  his numer-
ous claims to respect on the score of fair and just obser-
vation.   Indeed his sentiments upon  this subject bear no
evidence of rational inference from the known characters
of inflammation,  but  rather appear the  result of vague 
22
 and thoughtless conjecture.  He refers for the primary
 cause of inflammation,  to an undefined something pro-
 ducing a preternaturally heated condition  of the general
 mass of blood, in which State he supposes that certain
 portions of it becoming (still from unknown causes) more
 heated than the rest,  are conveyed accidentally  to those
 parts of the body in which inflammation subsequently ap-
 pears.  Such with him is the origin  of Phrenetis, Pe-
 repneumonia, Erisepelas, &c.  He  says  nothing about
 the manner in which such effects are produced.  Neither
 does he notice any previously altered  condition of part;
 or in any other way attempt to remove the obvious diffi-
 culty,  why increased  temperature should  be  innocuous
 every where  in the body, save at those points where in-
 flammation occurs as its consequence.
   But the  leading feature of this doctrine is too absurd
 to admit a  farther attention to it.  For I think we  know
 that it  h totally impossible for one portion of a mass  of
 blood which is equally subjected to the laws of circula-
 tion, either to acquire, or if it could, to retain,  a more
 considerable elevation of temperature than  any other.
  Next in order of time we are presented  with a view
 of the theory or pathology of inflammation, instituted by
 what has been called  the Mechanical Sect of Physical
 Philosophers.  I think the distinction not just or neces-
 sary; and so far as applied to  the doctrines of inflamma-
 tion, if we except the chemical philosophy on that  head,
 we shall find but faint shades  of  difference between the
 opinions of this sect and those of their predecessors.
  Pitcairn, Belleni, Hoffman  and Boerhave, were the
 most distinguished advocates  of the mechanic  and hy-
 draulic doctrines.  The latter appears to have bestowed
 the greatest care and attention in explaining and applying
 those principles, and occupied in his  day a pre-eminence
 in this particular, which he still holds.  It is called the
 Boerhavian doctrine.
  I have already discharged towards this doctrine, the
 obligations  of courtesy,  in bestowing upon it a passing
 notice,  But having fallen in with it  again,  I shall be
pardoned for offering it a little farther attention.
  The Boerhavian doctrine (for which we  refer to the
early part of this essay) demands the pre-establishment 
as
of two data, on neither of which it can now be permitted
its rest. It presupposes, First, That the arteries are ma-
thematical cones, of a regular  though greatly extended
figure.  Secondly, That  the action of  the heart is the
only power by  which the  blood is propelled through
those tubes.   We know that the arteries are not cones:
That the  compound area of the branches does not corres-
pond to the mathematical  capacity  of  the trunk.   We
have sufficient evidence also that the blood does not obey
in its motion,  the laws of mathematical  projection.   The
recurrent  branches of vascular  structure, would fully re-
fute this  position.   The vessels  possess powers of their
own, subject to similar laws of structure with the heart
itself.  They harmonize it is true with the actions of the
heart in health.   The systole of the heart  is the result of
a universal law of vascular action.  But under particular
circumstances of derangement, the natural relation is in
part  lost.  Parts of the vascular  system are then obedi-
ent to to the operation of specific laws, not  as to time, but
force of action.
   The Mechanicans do not attempt to explain by what
novel law heat occurs to the obstructed  mass from attri-
tion: they tell us of friction of the circulating fluid, from
increased vis  a tergo, and additional impulse against the
quescent portion of blood.   But heat never was acquired
by fluids from simple motion, however impetuous the cur-
rent, or how great soever the resistance.   But were such
a consequence of the cause  assigned possible,  it would
not prove enough for the present purpose: for the condi-
tion of the general  system does not always bear a sym-
pathetic  relation to the  diseased action of a part in in-
flammation.   Yet increased heat of the part, (if measured
with a regard to the inflamed, and natural state of such
part,) does exist when this respondence of the system is
wanting.*
   The mechanical doctrine was  never completely domi.
uant.  While numbers  subscribed to  its orthodoxy, a

   *  It is not surprising that Mr. Bell, in the introduction to his
Treatise on Ulcers, (page 2S) should have told us, "that the heat
of an inflamed pari, results from the friction or attrition of its
blood."  Great men it would seem may say any thing. 
34
few sceptic pens were  brandished against it with deter-
mined hostiln     Gorier, Stahl, and  Sauvage,  were
among the first, and were also the most distinguished of
those who unfurled the banner  of  opposition.  Their
attempts to occupy that ground in public sentiment, from
which they were labouring to eradicate their predeces-
sors, were not without ingenuity, particularly those of De
Sorter and Sauvage, and  though they are disowned at
the present day as authority,  I think we shall perceive
they are not despised.  We  shall  then have  another
proof how easily obligations are forgotten, or denied.
  I am aware that in giving those writers a place among
the anti-mechanicans, I invade the ground of general opi-
nion.   They have  been placed by their  contemporaries
and successors, on the  same list with them.  Yet a care-
ful examination must satisfy the enquirer, that they have
proceeded a great  way in advance of the hydraulic doc-
trine of their day, and have   attempted though without
complete success, to plant the standard of opinion, among
the fixed and natural laws of the animal economy.
  De Goiter was the first who aimed a decisive blow at
the doctrine of primary obstruction, in inflammation.  He
appears to have taken a comprehensive view of extended
vascular action; the actions of small  as well  as larger
vessels.  He is the first who noted distinctly the sensi-
ble signs of increased vascular action in a part, in  the
forming stage of inflammation, and  asserted the inade-
quacy of partial obstruction, for the production of those
phenomena.  He ingeniously  founds  his objection  upon
the anastomosing  structure of the vascular system;  ad-
vancing the opinion, that the obstruction of a few branches
of an  artery, could not produce a perceptibly  increased
action, in the open branches of the same vessel, nor by
consequence, any augmented  velocity in the  motion of
their blood.   Nor, he says, can the heat any more than
the pulsation, and other evidences of increased action be
accounted for, from obstruction  simply:  And  adopting
tiie converse of the proposition, on this  head,  rationally
concludes, that the heat will  be in the inverse  ratio to
obstruction, supposing it complete, in the vessels in which
it existed.   When  I  call this a rational conclusion, I 
25
must  be understood  as  subscribing to the doctrine no
farther than I think it fair to infer, he meant, though the
opinion has not been  guardedly expressed.  For  when
he says that diminished  temperature of the blood suc-
ceeds to its obstruction,  I understand  him to  suppose,
that when any considerable impair of connection between
the blood of a part and the whole through the medium of
circulation, takes place,  the  temperature of the former
falls off, in consequence of its  losing equal access with
the rest to the great  source of heat.   But to return to
the doctrine as given by himself.
  Gorter  assumes as a first  principle, a vital motion in
the heart and arteries, as the cause  of  .natural  heat.
From this ground he advances to the assertion, that all
causes capable of exciting to a certain degree increased
general or local vital motion,  produces a correspondent
inflammatory  disposition.  That  general inflammatory
diathesis, is the consequence of universally increased vital
motion.   Local  inflammation,  when such excitement is
confined to the vessels of a part.   He opposes the infer-
ence,  that heat,  pulsation, and other phenomena  of in-
flammation arise from obstruction.  And refutes the de-
ductions drawn  from analogy  between inflammatory ob-
struction,  and that produced by ligature.  One argument
on which  the advocates of obstruction reposed with much
confidence.  He proposes the objection (as before noticed)
on  the ground of frequent ramification and anastomosis,
of the extreme vessels. A few of which being obstructed,
could not occasion so much difficulty in the circulation,
as to render a sensible increase of action necessary.
  A considerable  degree of  apparent connection  exists
between the  increased vital  motion of De Gorter, and
Stahl's, increased tonic power of the vessels. But Gorter
does not appear to have  entertained as much confidence
in the credulity  of  mankind, as Htahl and some  of his
followers.   He no where introduces that intelligent ani-
mal principle, or second  soul, which those gentlemen
offer homage to, for kindly undertaking to regulate the
laws of disease, to the best advantage.   He might have
wanted confidence in the existence of such a good genius,
or if he believed in its existence,  reasoning from  obser-
                   4 
26
vation he probably thought its duties so badly performed*,
as to leave us under no  obligation.   Or what presents
the  fairest claim to credit, De Gorter perhaps never imag-
ined that inflammatory action was any part of the healthy
economy.
  The  summary of this  opinion then  is, that whatever
causes  excite  unusual arterial motion, (alias  increased
action) may produce inflammation, general or local, in
proportion to the extent of  parts affected.  By general
inflammation, meaning fever, either with or without local
inflammation as a consequence.  By local inflammation
a condition of parts in which their capacity for action is
brought more fully into  operation.  A condition which
may be confined to the part, may be partially extended,
or may produce sensible increase of action over the whole
system.   This vital motion, or action, produces all the
sensible states and changes of inflammation,  by its in-
crease, falling off, and exhaustion; or the cause being re-
moved, or ceasing to act; the parts, &c. return to the na-
tural state, by the gradual decline of this increased vital
motion, or action, to the healthy or near  the healthy stand-
ard.
  De Gorter has the merit of being the first, (so far as I
can discover,) to lay the ground work  of inflammation in
vascular action.   His doctrine of a century past, is one
of whose  errors we have not entirely washed our hands:
And whose truths we have  been slow to improve.  Had
he  been better acquainted with the natural and relative
capacities of vessels, and  the principles of animal tempe-
rature, he would have left us on this subject nothing to
retrench, and  perhaps but little to add.
   The hydraulic doctrines met their most determined
and dextrous  antagonist in Bauvages.   Their most for-
midable one too, for he wielded against them their own
weapons.  He contends from  the known laws of hydrau-
lics, that the velocity of moving fluids must decrease in
proportion, to the obstacles opposed to them. He holds it
an  indisputable theorem,  that if one-third of the branches
of  any  tube be obstructed, it requires a quadruple impel-
lent force, to  give the same quantity of fluid equal velo-
city, as it possessed previous  to the obstruction.  That 
27
motion dependant on impelling force, will observe a simi-
lar ratio progressively to resistance.
   Neither he says will it favour the hydraulic  doctrine,
to admit  that the arteries are elastic  tubes.   For they
could not  recover themselves when distended, so long as
the distending force  continued  to act;  and when it was
taken  away, they would recover only in  proportion to
the dilation they had undergone.   They could thus com-
municate  only the force tley had acquired by distention,
which could effect nothing more than  the natural or or-
dinary  velocity of the  bloods motion.  Yet Sauvages
assents to the existence of increased velocity of the bloods
movement in  inflammation, and having proved it irre-
concileable with all known mechanical and physical laws,
escapes from the difficulty in which he  is thus self involv-
ed, by appealing to the agency of some  president divinity,
by whose interference and aid,  actions adequate to the
effect are  excited.   An  indulgence of the  imagination
which philosophers have always found convenient.
   Thus far we have been engaged  in noticing early opin-
ions, the sentiments of what are called  old  writers, upon
the subject of inflammation.   We have adopted the dis-
tinction long since  instituted, and still  existing;  their
clasification as Humoralists, Chymists and Mechanicians.
I have added to that  distinction, the opponents of the
latter  doctrine,  and  placed on the list  of the  most distin-
guished of them, under the title of anti-mechanicans.  How
far such  an arrangement is just, is not of consequence,
as we are in search of opinions,  not titles.
   The limits proposed to this essay, would not permit a
diffuse examination of individual sentiment, in reviewing
those  opinions.   A few only,  from among the writers
of each of the grand divisions, and those the best known,
or most respectable at the time they lived, have been held
up to notice; as from those may be procured the clearest
perception of the different doctrines.  A wider range em-
bracing the speculations  of advocates  and commentators,
would add nothing  to those doctrines, and must embar-
rass our comprehension.  We have moreover  arrived at
that  stage of enquiry, at which we think a pause may
most properly be made.  For in the doctrines of He Gor- 
28
ter we have an attempt to bottom the pathology of inflam-
mation on vascular action and capacity.  The ground on
which it stands at the present day.  We will now pass
the artificial barrier, and in falling in company with the
moderns, carry with us a hope that fanciful terms, and
arbitrary distinctions are to be exchanged for an introduc-
tion  to rational principles, and correct  science.
   It will not be necessary in the progress of an enquiry,
holding in view a distinct and almost  insulated object,
to notice the multiplied systems of physic, to which the
present age has given birth.   In many of them, the sub-
ject under consideration, has either been entirely neglect-
ed; or but  incidentally attended to, as a minor part of
those general  researches into the philosophy of disease,
deduced from the prevalent opinions respecting the heal-
thy economy.   The truth appears  to be that in our sci-
ence, as  in most  others, the  proud  spirit of philosophy
has disdained an appeal to the patient and accurate ex-
amination of particular facts.   The characteristic expres-
sions of certain forms and conditions of disease, have not
been called upon to aid in  a general estimate, or the es-
tablishment of general principles.   But have been capri-
ciously subjected to  an unnatural  connection  with pre-
conceived notions adopted without enquiry, and applied
without  discrimination.
   It is in this way that common marks of diseased con-
dition have been  entirely overlooked or inaccurately ac-
counted  for.   Affecting comprehensive  views,  writers
have begun precisely where they should have ended.—
Omitting the  faithful  attention to facts which common
sense would dictate, and observation might furnish, those
self created judges in the court of nature have frequently
passed sentence on  her works, without  examining her
evidences.
   There is no department of physic which has  held so
little importance  in the estimation of professional writ-
ers, as the pathology of inflammation.  It appears to have
been thought  an aberration from professional dignity, to
euquire minutely into the causes and nature of a diseased
condition so frequent in its occurrence, as no longer to
excite professional  curiosity,  and  so intelligible in its 
29
phenomena, as to have fallen for the most part under the
curative direction of nurses and old women.   When this
condition occurred to any  internal part, or important or-
gan, it escaped the opprohinm of vulgarity; and being
thus elevated above  its ordinary  level, received  from
medical men, the notice which had been denied it under
common circumstances.   But it was then decorated with
specific titles.  And instead of inflammation of the brain,
lungs and pleura, &c. it was ennobled by the appellations
of phrenitis, pneumonia and pleuritis.  This inattention
to common inflammation has been so general, that it is
difficult to meet with a writer, who has paid it more than
partial regard.  The projectors  of systems of physic
especially, to whom we should  conclude it proper to re-
fer for information  on this subject, have permitted it to
remain without the scope of their researches.  And when
we meet with aid in the prosecution of such  an enquiry,
it is from writers  who have been casually led  into its
examination, by its connection  with a differeut and fav-
ourite  object of pursuit.   But as  it will  probably be
thought incumbent on me to shew, the relation it has held
to the medical philosophy of the age, I have  consulted
the pages  of a few  distinguished writers for  this pur-
pose.
   Since the  decline of the school of  Montpelier,  Edin-
burgh has been pre-eminent as authority, in the science
of physic.  Regarded as the great theatre for the cultiva-
tion of that science, the  genius and talent of  Europe, so
far as  engaged in  its pursuit,  has been confided to her
direction.  And the knowledge acquired under her aus-
pices,  has wanted no  other testimonies of its respectabili-
ty, than the  official signet of her approbation.  I shall
select from the numerous class of writers, who have at-
tempted to give permanency to doctrines, compiled from
materials afforded them by this venerable school, Cullen,
Brown and Darwin.   The  chief  favourites of the last
half century.  Their pathology  of inflammation chal-
lenges no extraordinary respect, and will not detain us
long.
   Dr. Cullen says,  "A spasm of the extreme arteries,
supporting an  increased action in  the course of them, 
30
may be considered as the proximate cause of inflamma-
tion.   At least in all cases not arising from direct stimuli
applied; and even in  this case the  stimuli may be sup-
posed  to produce  a spasm in the extreme vessels.*
   The Doctor, in his  reasoning  upon  those positions,
supposes, "That some causes of inequality in the  distri-
bution of the blood may throw an  unusual quantity of it
upon  particular vessels,  to which  it must  necessarily
prove a stimulus."  The  blood thus unequally distrib-
uted,  causes obstruction.   But  to effect a removal  of
the congestion, "A  spasm supporting an  increased
action  in the course  of the vessels,  is necessary.   The
increased action effected by means of the spasm,  is  in-
tended to overcome the obstruction.   And the spasm it-
self, results from  "the  stimulus of the blood," and the
"Vis  medicatrix natura."
   Congestion then and spasm, constitute with Dr. Cul-
len the essence of inflammation.   He  makes congestion
the cause,  not a consequence of inflammation, and  the
spasm a part of the inflammatory  process, but intended
for its ultimate relief, by exciting increased action.   The
first is altogether unphilosopical.   The  latter supposes,
either  that  the accumulated quantity of blood is to be
driven through the  vessels by the  increased impellent
force from behind, while their calibre is lessened by con-
striction, both the work of the spasm;  or else that this
spasmodic constriction expels the blood by imparting to
it a retrogade  course.   In the first  instance the spasm
increases the resistance  to circulation, while it augments
the power for effecting it.  In  the second,  it excites an
action  (increased vis atergo) fitted to  defeat its  object.
These are irreconcileable contradictions: and with  the
exception of the spasm, this is  the doctrine of Boerhave
and  Hoffman;  the doctrine refuted  by  De Gorter  and
Stahl.   The congestion  must  have  had  a remote cause.
The spasm must obstruct circulation.   And we are un-
acquainted with any such thing as a reversed order of
contraction in  the vessels.  A condition indispensable
to  a positively retrograde flow of blood.
145th paragraph, "First lines." 
31
  Dr.  Brown's pathology of inflammation, like his doc-
trine of general disease, is at first view imposing, because
apparently simple.   Those doctrines have been stamped
with the approbation, by indulging the indolence of man-
kin d.  The favouritism thus obtained, has perhaps been
enlarged and confirmed by the rancour which his grow-
ing fame, dissolute life, and severity towards the opinions
of others elicited from his competitors.
  Dr.  Brown divided diseases into two genera.   He
has  given inflammation a similar  classification.    His
general  principles possessed  but a narrow footing,  and
the harmony of  parts must be strictly preserved, or the
whole  fabric must tumble.   Inflammation with  him is
sthenic or asthenic.  The vessels in the  first  state act
with uncommon energy, and send on their blood rapidly;
in the  second, the  vessels  are  preternaturally feeble,
and the blood moves tardily.
  It is only  necessary to observe of this doctrine,  that
its  premises are irrational.   Inflammation is  but one
effect,  and here are  two causes diametrically  opposite.
If increased action constitutes inflammation, diminished
action  is its negative,  or the  absence  of inflammation.
If diminished action simply or of itself could cause in-
flammation, (which is inverting the  order of positive and
negative) then increased action ought to cure it;  and the
higher it rose,  the farther distant it should become from
the diseased condition.   The laws of the human  body
are too simple and uniform for us  to think of inventing
a scale by which these unnatural gradations (or degrees)
of action are to be  happily coaptated. I shall notice some
of the  absurdities (as I conceive)  of those doctrines in
another  place.
   I ought perhaps, to ask pardon for having promised to
examine Dr. Darwin's theory of inflammation.   It is so
inextricably implicated in the mazes of metaphysical sub-
tlety, that I really cannot apprehend it.
   In Zoonomia, page 996,  Dr. Darwin remarks,  "that
when any part is excited into such violent motion that a
quantity of  painful or pleasurable sensation is produced,
it frequently happens, but not ahcays, that  new motions
of the affected organ are generated, in consequence of the 
32
pain or pleasure, which (new motions) we call  inflamma-
tion.  These new motions are ot a peculiar kind, tending
to distend the old, and produce new fibres, and thence to
elongate  the straight muscles  which  serve loco-motion,
and to form new  vessels at  the extremeties,  or sides of
the vascular muscles."
  The reader has now the doctrine before him, and must
make the best of  it he can.  I would oidy observe, that
it is difficult to comprehend what is meant by "a violent
motion in a part:" that  sensation when it accompanies
inflammation is a consequence,  not a cause:  that new (or
irregular)  motions, attended by either  painful or pleasani
sensations, frequently occur without being followed by
inflammation: and lastly, that simple motion, new or old,
does not constitute inflammation.  The Doctor  (or  his
friends) must explain what is  meant by a  peculiar kind
of motion, before  we can meet  him on  that ground.
  We will now pass to the opinions  of the celebrated
Mr. Hunter, of London.  The famous John Hunter, as
called by Mr. Cooper.  Mr. Hunter  has  w rested from
his competitors nearly all honor on this head.   He has
given to common  opinion a bias on the subject which
hitherto has promised to be permanent.  For to no other
theory of inflammation has assent been so general, or op-
position so feeble.   His doctrines are  copious  and  dif-
fuse:  and  his efforts to give them a specious and impos-
ing attitude, were arduous and  persevering.  They were
aided  too, by  industrious  resparch,   by capacities of
more  than ordinary enlargement, and  not a little by  an
ardent and excursive imagination.  We shall engage in
an extensive discussion of Mr.  Hunters principles; pos-
sibly with more freedom than ability.   But we  believe
them erroneous.   We think them also  confused and self-
contradictory.  For those reasons we affect an undertak-
ing in which to fail can scarcely be  disgraceful,  and to
succeed, even partially,  must be useful.   Mr, Hunter's
general respectability we willingly subscribe to;  and if
we know what decorum is, it shall not be forgotten in ex-
amining his pretensions.  We claim every thing which
truth will warrant, and nothing more.
  There is great difficulty in comprehending Mr. Hun-
ter's vague and fanciful phraseology.   He has assumed 
33
a license  in  this particular,  unparalleled in  medical
writing.   I make this prefatory remark, not so much as
an apology for any misapprehension  of Mr. Hunter's
sentiments, into which I may  fall, but to notice (as must
be<i! vlous to every reader)  the extreme difficulty of re-
ducing his loose expressions and detached opinions into
order or connexion.  It is a work truly Herculean (if at.
all to be accomplished) to fit  the scattered members of
this theory to each other in such a  manner as to present
a perfect  body, which may be compassed at one view,
and which shall possess due  harmony  and relation of
parts.  I repeat that this is not an  apology for defects,
from which, as a student, I expect not to be free,   and
challenge him who is more confident  of his powers, or
more attached to Mr. Hunter's opinions, to the trial.
  Before  proceeding farther, I will appeal to the candor
of my readers for an exculpation from the charge of rude-
ness in asserting that Mr. Hunter's doctrines were  con-
fused and self-contradictory.   He says,
  "I have given the most simple idea I can form, of an
injury done to a part,  with the natural, immediate  and
consequent means ef restoration.  I have also treated of
cases, where they become a little more  complicated,  (the
means of restoration,)  requiring the aid of art as a sub-
stitute for the simplicity ofthefirst.  The action of the
parts is not necessary in either of  these, except  that of
the blood  forming its vessels and other solid parts,  and
becoming of the nature of the parts in which it is extra-
vasated.   But I took notice that the violence  done  was
often so great, or that restoration did not take place so
readily, as in all  cases to exclude  irritation,  we  had
therefore  an  action in such cases  taking  place  in  the
parts, called inflammation.   That this action assisted in
the restoration by producing an extravasation of coagu-
lating lymph, which became the second bond of union.
I have also stated what may be called the natural ten-
dency to inflammation, to serve as a  kind of leading prin-
ciple.  We shall find that  inflammation may arise from
very different causes, and often without any  apparent
cause, and that its operations are far more extensive than
simply the act of producing union in parts divided  by 
31
violence, for it more commonly produces  union in whole
parts, or in natural separations, such as the common cel-
lular membrane, large circumscribed cavities, &c. because
such surfaces are not naturally disposed to unite, but
on'y in consequence of some uncommon  action being
produced.  And although these adhesions are unnatural,
yet that tendency of the parts to admit of this union, be-
comes a species of cure.   It is in  consequence of the
parts taking on, in some degree, the same mode  of ac-
tion which divided  parts do when brought into contact,
that in such cases suppuration is precluded.  As inflam-
mation often arises from disease, its salutary purposes
are in many instances not so obvious, although they may
finally iake effect.   As it likewise takes place in disease,
or becomes the ultimate in disease, when it did  not begin
it, as in scrofula, &c; on those accounts too, its salutary
purposes are sometimes not obvious.   However, upon
the whole, as inflammation  is an action produced for the
restoration of the  most simple injury in svund parts,
which  goes beyond the power of union by the first in-
tention, we must look upon it in such instances as  one
of the most simple operations in nature, whatever it  may
be when arising from disease  or in diseased parts.  In-
flammation is to be considered only as  a disturbed state
of parts, which requires a new but salutary mode of ac-
tion to restore them to that state wherein a natural mode
of action alone is necessary; from such a view of the  sub-
ject, therefore, inflammation in itself is not to be consider-
ed as a disease, but as a salutary operation, consequent
either to some violence or some disease."   Page 337-8.
  I shall feel indebted to any one who will render all or
any part of the above intelligible, or consistent.  I  con-
fess my incapacity  for the accomplishment of either.
  Mr. Hunter's fundamental maxim is "that the  act of
inflammation is to be considered as an increased action
*f the vessels."  It has always been understood by his
commentators,  that an ahsolule increase of action is the
position contended  for.  This then is  the chief point of
discussion, the one to which all enquiry must be directed.
For when Mr. Hunter strays from it he has no longer a
peculiar claim.  Increased action of the vessels of the 
33
part, is the  primary condition,  (we  reject proximate
causes,) of the first state of inflammation.
  As 1 intend to contest Mr. Hunter's first principle, I
will take up the subject in this place (to avoid confusion)
noting his auxiliary positions, and his terminations of in-
flammation, as I advance.
  " The act of inflammation (says Mr. Hunter) would
appear to be an increased action of the vessels, taking
place in the smaller vessels of a part.   The larger ves-
sels may  be considered as only the conveyors of the ma-
terials for the smaller to act upon and dispose of accord-
ing to  the different intentions; however inflammation in a
part is not only an action in the  smaller vessels in the
part itself, but in the larger vessels  leading to it."
  "Parts inflamed,  when  compared with similar parts
not inflamed, shew a considerable difference in the size
of the  vessels.  And probably from  this cause  bring  an
increased number to view.  This  incipient enlargement
of the  vessels upon the first excitement of inflammation,
is satisfactorily seen in the following manner.   I froze
the ear of a rabbit and thawed it again.   This  excited a
considerable inflammation and increased heat, and a con-
siderable thickening of the part.   This rabbit was killed
when  the ear was in the height of inflammation, and the
head being injected, the  two ears  were  removed  and
dried.  The uninflamed ear dried  clear and transparent,
but the inflamed one dried thicker and mope opaque,  and
its  arteries were considerably larger."
   "From these circumstances it must appear that a much
larger quantity of blood passes through parts  when  in-
flamed than when in a natural state, which is  according
to the common rules of the animal economy.  For when
a part has more to do than simply to support  itself the
blood  is there collected in larger quantity."
   "As the vessels become  larger, and  the  parts become
of  the colour of the blood, it is to be purposed there is
more  blood in the part.  And as the  true inflammatory
colour is  scarlet, or the  colour of  arterial blood,  one
would from hence conclude that the arteries principally
were dilated, or if the  views  were equally distended,
that the blood undergoes no change in its passage fr-.m 
sa
the arteries into the veins, which I think is most proba-
bly the case; and may arise from the quickness of its
passage through those vessels."
  I must wield against Mr. Hunter's premises the facts
he has adduced to support them.  He says there is an
"increased action of a part in inflammation."  Does Mr.
Hunter mean an increased force or frequency of action?
He has not told us expressly;  yet  we must suppose he
means the latter.  For he says,  "There are strong proofs
that it is  not a contractile action of the coats, for in such
a sensible state of vessels (as  in inflammation) if they
contracted by their muscular power, the pain would be in
the systole, for we find in all  muscles which  are  in  a
state of great sensibility, that  they cannot act without
giving great pain: I should say therefore  that in inflam-
mation the muscular coats of the arteries do not contract."
But he says "that more blood than usual passes through
an inflamed part, and that the scarlet colour of such parts
is owing  to the  blood remaining  unchanged "from the
quickness of its  passage  through the arteries  into the
veins."  Mr. Hunter cannot have recourse here to any
other powers than those of the part itself.   "For, he says,
"The larger vessels may be considered as only the con-
veyors of the materials for the smaller to act  upon and
dispose of according to the  different  intentions."  Be-
sides his first  principle is, that there is "an  increased
action of the vessels of the part.  How is all this?  The
v> ssels are to act without muscular contraction.  They
are to send on their blood with more rapidity in that part,
than happens in any uninflamed part, and  yet they have
no muscular contraction, and  ^depend upon the  larger
vessels for the supply,  of the material" (or blood) which
they transmit.  If they have an increased action, on what
does it depend  or how effected.  If they transmit more
blood than in the natural state, yet depend upun the larger
vessels for supply, where do they get this increased quan-
tity?   The larger vessels, he says, are only conveyers of
the material, that is do not take part in fhe inflammatory
action; of course  send on to the  inflamed part only, a com-
mon quantity of blood.   The vessels of the part then if
they have an increased action, and it is not an action of in- 
37
creased/orce but frequency, must have lost a harmony with
the action of the heart and large arteries, and established
an independent rule of action.  The question again occurs,
where do they get the pover to act,  the material  to be
acted on?   Here  we are in a sad dilemma;  muscular
contraction (the only mode of action  with  which we are
acquainted) we have rejected;  we have also  thrown off
all connexion with the heart and large arteries:  let us see
what we can make of another principle or  power.  Ar-
teries, it is said have two capacities naturally, which an-
tagonize each other, muscular contraction,  and an elastic
property.  Let us examine the latter.
  Mr. Hunter says,  "The vessels, both  arteries and
viens, in the inflamed part  are enlarged,  and the part
becomes visibly more  vascular, from which we should
suspect that instead of an increased contraction,  there
was  rather what would appear an increased relaxation,
of their muscular powers,  being as we  might suppose
left to the elasticity alone. This would  be reducing them
to a  state of paralysis simply, but the power of muscular
contraction would seem to give way in inflammation,  for
they  (the vessels) certainly dilate more in  inflammation
than the elastic power would allow,  and it  must also be
allowed that the elastic power of the artery must  be  di-
lated in the same  proportion.  When  we  consider the
whole of this  (inflammation  as a necessary operation of
nature; we must suppose it  something more than a com-
mon relaxation: we must suppose it an action in the parts
to produce an increase of size,  to answer particular pur-
poses.  And this  I should call the action of dilation, as
we see the uterus increase in size in time of uterine gesta-
tion, as well as the os tincae in the time of labour, the con-
sequence of the preceding actions, and necessary to those
which are to follow."
  We have gained as  yet no clear view of this obscure
business.   The elasticity will not give  us the increased
action.   For as Mr. Hunter justly observes, before un-
common dilation can take place the elastic resistance must
be overcome; and  he might  have added, that if it  could
re-act upon the distending force,  the re-action and disten-
tion  would be simply proportionate,  the vessel could only 
38
gather up its natural capacity and size, and would not
give us increased action,  or  increased velocity of the
blood.
   The analogy which Mr.  Hunter supposes between
this action and the uterine condition in pregnancy is
false.  For the increase of the  uterus  at that  time is a
natural growth, and is attended by none of the phenom-
ena, none of the uniform and characteristic signs of in-
flammation.  We will admit too, that  inflammation is
natural, or takes place by the operation of  natural laws,
and were  we  even to concede that inflammation  was
healthy, as Mr. Hunter has imagined, neither one or the
other could aid his inference, for inflammation and  uter-
ine enlargement are sensibly  different in their actual
state, progress  and termination.   Mr. Hunter's position
indeed seems  to rest upon a presumption  that  a  thing
happens or takes place, simply because  it appears to him
to be necessary,  or  that it would  be useful.  This, in
my opinion, is a very uncertain basis; a species  of con-
jecture not to be resorted to till facts have failed us, or the
deductions from them are useless.
   We have still increased action without muscular con-
traction or elasticity, Mr. Hunter  says it occurs  from
neither,  and I know of no other power by which any
vascu-ar action is accomplished.   Mr. Hunter, it is true,
says  there is a third agent,  an action  of dilatation.  I
would not be  rude enough to assert that  this is  mere
fancy, but I very sincerely confess  I cannot  affix any
meaning to the term, and of course cannot conceive how
its existence is to be proved or rendered probable.
   Mr. Hunter has rejected the natural powers of the
vessels, (their muscular contraction and elasticity) as
agents in the  action of inflammation;  But I will en-
deavour to prove that he could not explain  its phenome-
na on liis principles, by retaining them.  We will  leave
 the action of dilatation out of the question; nnd for the
reason given by an old philosopher, who refused to exa-
 mine a child with two or  three heads.  When  told  in
reply that he would probably never have an opportunity
 of seeing &» like again, "It is on that account  said he
 I care inching about it." 
sg
  It is admitted on all hands that an inflamed part con-
tains more blood than it does in the natural state.  It is
asserted by Mr. Hunter and his advocates, that the blood
moves through such parts with greater velocity  than  in
the uninflamed condition.  On this supposition is. bottom-
ed the hypothesis of increased action of its vessels.
   On what does action depend?  I understand  it to be
the exertion of a capacity in obedience  to an agent  or
cause fitted to produce such exertion.  Is that capacity
natural? If it is, exertion or action cannot  be greater
than  the capacity;  if it is within the capacity, and  the
capacity is natural, so long as it (the capacity) continues,
nothing unnatural  can happen.   Now inflammation is
evidently an unnatural condition of a part.  How does
it take place?  Certainly not from the operation of a nat-
ural action, for this, while it excited, (I repeat) could only
keep the part more completely in the natural state, and
no change of condition would occur.   Yet we are told
that increased action is the essence of inflammation; that
the latter cannot exist without the former.  Again I ask,
what kind of action? An increase of natural action, and
yet an unnatural consequence resulting from it? A cause
and effect different, yet the one producing the other? If
this increased action is not the same (saving the augmen-
tation) as it was previous to the occurrence of inflamma-
tion, I should like to know whence  the action (and the
capacity it presupposes) were derived.   If it is  the same
action (only increased) then I should  be glad  to be  in-
formed how the increase is  supported, the action the
same, yet the condition of the part altered, and its func-
 tions injured or destroyed.
   If inflammation be increased action  (which if it means
any thing means increased vigor or energy of action) how
does it happen that it generally takes place,  not  in parts
that are highly vascular, and have naturally great action,
but in those which have ordinarily least action or capaci-
ty for action?
    Why do we find people in firm health and robust m
body, rarely the subjects of inflammation?
   Why are venereal, scorbutic, dropsical and scrofulous
 patients, afflicted with extensive and tedious inflammatory 
40
swellings and ulcers? Why did they not occur until those
persons were rendered feeble by bad health or illness?
   Why are the weak and emaciated generally, plagued
with protracted and extensive sores, from every scratch or
bruise?
  Why are drunkards not troubled with swellings and
inflammations till after a long course of debauchery?
   Why do those  who have been long confined to bed by
disease, suffer  inflammation,  with all its  worst conse-
quences, in the parts on which they lie, simply from the
weight of a reduced  body,  and the resistance'  of a soft
bed?
   Why does the  exposure of a part to severe cold,  sub-
ject it to inflammation and death?
   Why are very  old people so liable to the occurence of
inflammation, and how happens it that their ulcers heal
with such difficulty, and frequently not at all?
   Why are the extremities and surface more particular-
ly the seat of inflammation in all persons?
   Are all those facts to be accounted for  by uncommon
vigor and energy, i. e. increase of action?
   Let us attend for a moment to an inflamed part.
   Mr. Hunter says,  and every body agrees  with  him,
that the vessels of an inflamed part are dilated; their ca-
pacity for containing blood  increased.  How does  this
fact accord writh increased action  of those vessels ?  Mr.
Hunter says there is no muscular contraction  in inflamed
vessels; but possibly some of  his friends  think different-
ly; it  is hard to form  an idea of vascular  action distinct
from their  contraction.   Suppose then  the contraction
takes pbce;  and  if there is an increased action, there
must he increased contraction. Whither would this lead
us? Contraction  (I believe) means to lessen or draw to-
gether, not to expand or dilate.  If I am not in error, if
contraction of a vessel means  diminution  of its  calibre,
when the former is increased,  will  not the  diminution be
still greater? How then the dilatation? Increased force of
contraction, we find, will not answer; and of the dilatation
we are certain.  Let us try increased frequency  of con-
tra* tion.  If (for  instance) the vessels of a part  contract
in respect to the number of contractions, as three to two, 
41
in relation to the heart, how will this answer?  Is the con-
traction of the small arteries of the extremities, those for
example of the fingers and  toes, synchronous with the
action of the heart and large arteries, naturally? Suppose
their contractions increased in the ratio of one third more
than those of the heart and large arteries-   First then,
where  do they send their blood  when they  have  thus
broken the uniformity of circulation? But especially (for
this might be extravasated)  where do they get it? Not
from the heart (the only source I  know of)  surely, for
they have shaken off their dependence on it, and have set
on foot an action for themselves.  Increased force of con-
traction, it is plain,  will not give us dilatation; it seems
now, that increased frequency of contraction will not an-
swer alone; for if it could happen, it i? still contraction,
not dilatation.  We are yet embarrassed and must extri-
cate ourselves from the difficulty.   How? is the question.
Nobody, I am confident, will offer us the " action of di-
latation."
   Suppose, on the other hand, the natural energy and
vigour of action in  the vessels of a part was lessened;
that some cause had operated to weaken their tone of con-
traction, and capacitiy of resistance  to the  impellant
power from behind, viz. of the heart and large arteries.
Suppose too, this impellant power, remained in the nat-
ural state.   What would happen under those  circum-
stances? If the capacity  of  resistance in the vessels of
the part, to the force a tergo,  the column or current  of
blood  driven on by  the heart,  kc.  was uncommonly
weak,  and this force a tergo as great as usual, would not
those vessels give way, would they  not be forced open,
be dilated?  Or,  let  us apply the proposition  in  another
way.   Suppose that without any known cause of injury
or weakness to a particular part, the impellant power of
the heart and large  arteries, instead of remaining  as
usual,  was considerably increased, might not some part
which could bear the ordinary force of impulsion, now be
found relatively weak, that force being augmented? If so,
would it not yield to this additional force, and its  vessels
be dilated?
  We will now see how the doctiine of Mr. Hunter and
                  6 
                         43

his friends stands, with regard to increased velocity of
the blood's motion in an inflamed  part.  We have  al-
ready proved, (I think) that the vessels of a  part cannot
assume an action greater as to frequency than that of the
heart and large arteries,  and by this  simple argument
from fact, that they can have no action independent of
the heart and large vessels.  Take a part which is sup-
plied with blood by the branches of one trunk only, and
tye this trunk above  all  the branches  which  go to the
part, will the part die, or can the actions go on, whether
the part be previously in a natural  or inflamed state?
   But let us admit this augmented velocity of motion in
an inflamed part.   How  does it take place? Mr. Hunter
says, "the vessels are  dilated, but  do  not contract, that
the elastic power is  overstrained and relaxed."  Then
shall we  say  that the vessels  being enlarged,  there is
more  room for the blood's passage, and it  moves more
rapidly on this account? B.ut we forget that this is not in-
creased action of the vessels of a part,  that they are here
passive relaxed tubes.    But let us grant the increased
action of the vessels  also, and if it is wished, an increase
both of force and frequency of action.  Then we should
have increased velocity of the blood's motion,  no doubt;
but what shall we do with the dilatation of  the  vessels,
and their augmented contents? Does the blood move rap-
idly through the vessels,  yet remain in them? We have
arrived at  a pretty conclusion, a thing is and is not,
moves  rapidly, yet is at rest.
   Mr. Hunter armies increased velocity of the blood's
motion, from the colour of the part, and its increased vol-
ume.   The increr'5'.ed quantity must be disposed of by
augmented rapidity  of movement.  The red colour can
happen only from the blood's passing too quick to under-
go the venous change,  ergo increased velocity. But there
is an appendage to this doctrine  by Mr. Huuter, which
Ave will  here bring into view.  "The part inflamed (says
Mr. Hunter) I have already observed, becomes, to  ap-
pearance, more vascular, than when in the uninflamed
state; and it is probable that it is  really so, both from
new vessels being set up in the inflamed part as well as
the new  and  adventitious uniting  substance  becoming 
43
vascular.   Besides the vessels of the part are enlarged,
so that the red blood passes farther than common, which
increases those appearances."  The last member of this
 aragragh asserts what I believe to be true, viz. "that the
 lood passes farther than common"  into the  vessels of
an inflamed part; in other words,  the vessels which be-
fore contained only colourless fluid, are in inflammation
injected with red blood.   But this proves nothing as to
the velocity of the blood's movement; on the contrary, it
marks disability in those vessels, diminished  resistance
to a foreign force, and incapacity to give motion.  I deny
the "setting up of *new vessels as a part of the inflam-
matory process.  I shall endeavor to prove, in another
place, that the manufacture of new vessels, is a natural
act of restoration,  not taking place till after inflammation
has so far ceased  to exist,  that the part  has recovered
power to repair the injury sustained by its occurrence.
That it is in fact in all respects similar to the ordinary
act of nutrition and growth.  That the "adventitious
uniting substance"  is either an  uniting substance in
fact, or ever becomes vascular, I am compelled to think
is a mistake.   It is (I think) quite unphilosophical to
adduce the characteristic property of dead matter, (its co-
agulability) as a proof of its living capacities.   If every
adventitious effusion of blood, lymph and mucus, could
become vascular, we should have a great many unhappy
alterations and deformities of the body, for every effusion
of those materials into parts whence they  could not im-
mediately escape, thus forming tumors, would constitute
permanent additions to our previous structure. For this
consequence must result from their becoming vascular,
alias, living parts.
   We find that we cannot get increased velocity of the
blood's motion in inflammation from any thing we have
yet seen.   The last quotation from  Mr. Hunter  affords
us no light upon the subject, and is only a necessary fin-
ishing to his hypothesis.  All the rest of his positions
we have seen, were at war with  the existence of such
velocity.   Suppose then we say it does not  exist; and

  *An appendage to the Galenic doctrine.
t 
TO
the part evidently contains more blood than usual, let us
imagine that it moves with less velocity through its ves-
sels, than in the uninflamed state.
   We have proved, I believe, that a forcible action could
not take place in vessels  after their dilatation; as these
must  lose  their power of contraction, before distension
could occur.   It would appear probable also from what
has been said, that  if their power and action were in-
creased in inflammation,  none of  the appearance upon
which the presumption of quickened movement of the
blood has been founded, could exist.  That there is not
only an absurdity in the co-existence of increased power
and action of the vessels, and their dilatation at the same
time, but that if this  increased action were present, so far
from a fullness and redness in consequence of quickened
circulation, the vessels could not be  more full, and the
part must be paler or less red, than in the natural state.
If the action of the vessels  was  increased, they  must
empty themselves more completely. If the bloods motion
was thus quickened,it would be less visible,&n& of course
the part less red, without the quantity was greatly aug-
mented: and this could  happen only from the  vessels
being dilated; which last  could not take place, until they
bad lost their power, and necessarily their increased ac-
tion.
   Then let us revert to our position, that the blood mov-
ed with less velocity through the vessels than in the un-
inflamed  state.   The weakness before noticed, either
absolute or relative, being granted, we  should  have dis-
tension or injection  of the vessels.  From the same cause
too, the weakness, we should have feeble contraction  of
the vessels, imperfect transmission, or slow movement of
the blood.  If the premises be correct, no demonstration
of the correctness of the conclusion can be necessary.   It
is just because it is  inevitable.
   In this way we should have tamo1 of the part from
the distension  and fullness  of the  vessels:  and from
the augmented  quantity of  blood  sms  received, and
its imperfect  transmission,  on  octav  ed  movement, the
redness.
   Bnt as I am not fond of encountering difficulties, I will 
45
 leave none in the way, that it is in my power to remove.
 I may be told  that  as the vessels of  a part, cannot act
faster than  the heart aud large arteries, neither can they
 act slower.   To this I agree.  I did not say slower, but
feebler, or more feebly.   That it was an imperfect trans-
 mission of  blood, and  from want of power.   Again, it
 may be objected that it is contrary to the laws of hydrau~
 lies, that fluids should move more slowly when resistance
 is taken away, or the passage for them dilated, or enlarg-
 ed.   To this I reply, that the  blood  in a living  body,
 does not move by hydraulic laws.  That it moves by an
 inherrent propelling power in the vessels; and frequently
 contrary to the laws of  hydraulics, as we see  in the re-
 currents.
   Mr. Hunter and some other gentlemen, seem to think,
 that simple relaxation is too simple a condition to account
 for what they must have inflammatory action. Mr. Hunter
 says, that "simple relaxation would only produce palsy."
 Some of  his commentators remark, that if dilatation was
 the consequence of partial debility, paralytic limbs ought
 to be turgid with blood.  It appears to have been forgot-
 ten by those gentlemen, that relaxation or partial debility
 of those vessels, does not mean their death or total loss
 of action.  That their action continues, though weakened;
 and that the inflammatory  action or condition, with all
 its phenomena, may consist in an altered  state of parts,
 from the increased quantity of blood, and the properties
 of that blood, together with the relaxed, or weakened state
 of the vessels, and the  change of condition to which^ the
 part is thus subjected.  I hope those states and alterations
 of parts will be elucidated in the proper place. It would
 be improper to anticipate their examination.  I would
 observe here, however, that paralytic limbs have nothiug
 to do with the business.   Tb~ small vessels are the seat
 of inflammation.    The action  of the  trunk  or  large
 branches, supplying those small vessels is the force by
 which  they are injected.   And in paralytic limbs  the
 trunk and large branches are weakened, pari ratione
 with the small vessels.   It is almost  unnecessary to re-
 peat, that we  say inflammation consists in a lost balance
 of power. 
46
   We will now measure Mr. Hunter's experiment with
the  rabbits ears, by the rules  above laid down.  An
experiment very plainly, and I have no doubt, very cor-
rectly detailed.
   "I froze (says he)  the ear of a rabbit, and  thawed it
again.  This  excited a considerable  inflammation, and
increased heat, and a considerable thickening of the part.
This rabbit was killed when the ear was in the  height
of inflammation, and  the  head  being injected, the two
ears were removed and dried.  The uninflamed ear dried
clear and  transparent, the  vessels were  distinctly seen
ramifying through the substance.  But the inflamed  ear
dried thicker,  and more  opaque, and its  arteries wrere
considerably larger."
   In the first place then  was freezing the ear, likely to
increase or diminish, the action of its vessels? But sup-
pose  the action increased, then how came dilatation or
distension of the vessels about? For Mr. Hunter says the
vessels  were  larger and the part  thickened.   If  the
bloods motion was also quickened through this ear, more
rapid than in the nmnflamed one, how happened it that
there was more blood in this ear after drying, than in the
other? If the bloods passage was quicker and more free
through it, there ought to have been less.  For although
the thickening of the ear was in  part owing to the  en-
largement of the vessels,  yet this very enlargement was
effected by an  increased quantity of blood, and  both  the
opacity and density, were in a great measure  attributa-
ble to the presence of blood in  those small vessels, its
injection into  the minuter ones, and  probably  its effu-
sion among the membranes, &c. by the rupture of some
of them.
   It is vain to att.--.mpt an illustration of the thickening
of the part in  this instance, by the manufacture of new
vessels.  It is the  most unfit experiment that could be
selected for the purpose.  Mr. Hunter says, the ear was
taken off  in  the height of inflammation, say two or at
most three days after the  thawing.  Then I  contend,
(leaving ail other impediments out of the question,) that
there was not time for the formation of new vessels, in
plain language a growth of parts.  We know that a  tri- 
47
fling loss of substance from a slight cause, will require at
least a week for repair, under  the most favourable cir-
cumstances.  And  if experience is not a very  fallible
test, freezing is something more than a slight cause of
injury to the part.
   In this experiment too, Mr. Hunter speaks of increas-
ed heat after inflammation.  It is somewhat singular that
this should have been the only instance in which he met
with such a result.  For in other parts of his work on the
subject,  he has reference to supposed facts which would
tend to prove that no such thing ever  happened  in  in-
flammation.  And  he  has formally rejected  increased
heat in laying down the signs of inflammation.  I shall
endeavour to prove, when noticing the sensible  expres-
sions of inflammation, that as it respects heat, Mr. Hun-
ter was right in this instance,  and wrong in all the rest.
   But we will again look to  the rabbit's ear.   Having
shewn that Mr. Hunter's principles were totally inappli-
cable in explaining its phenomena, let us suppose upon
those I  have adopted, that the vessels of the ear were
lowered in their powers by freezing, that the force from
behind remaining the same, and now acting upon a dimin-
ished capacity for resistance in  those weakened vessels,
injected and dilated them; that  the smaller and  hitherto
colourless vessels also were forced open, receiving red
blood, and probably some of them giving way or rup-
turing, permitting some of this blood to be effused; would
not,  I ask any  unprejudiced mind,  such a relation of
agency  and consequence be  more satisfactory than any
other we can imagine?   Would  it not (with one excep-
tion) be entirely satisfactory, absolutely conclusive?   I
can find in my own  mind no doubt  upon the  subject,
nor can  I anticipate one in the understanding of another,
without it be objected that the doctrine is too simple and
rational.
   The exception alluded to, is the increased heat, I shall    4
be excused for postponing its consideration for the reasons
above assigned.  It  is a contingent affair, and has  no
immediate bearing on the principle just advanced, as to
enlargement and density of the parts.
   In the following paragraph,  Mr.  Hunter seems to 
48
have been very much disposed to adopt (in  effect)  the
position for which we contend.   But whether he was or
not, he there strikes a mischievous blow at his favourite
doctrine.   He says, "The force of the circulation would
seem to have sonje share in  this effect,  (dilatation)  but
only as a secondary cause;  for I could conceive a part to
inflame or  be in a state of inflammation) although no
blood were to pass."  A thing I confess very inconceiv-
able to me.  He goes on, "As a proof  of this,  we may
observe, that by lessening either the action of the heart
or the column of blood, inflammation is lessened."  Now
I would ask, if  the force of circulation has some share
in producing distension in inflammation, what is the ne-
cessary inference?  Surely  that the part must be first
weakened;  becaue the force  of circulation does not pro-
duce dilatatiou where there is no inflammation; or under
common circumstances.    "But  only  as  a secondary
cause," says Mr. Hunter.   About this we need not dif-
fer.   The first cause is the weakening agent, the second
one (we say also) the force of circulation.   The last
member of the paragraph too, suits our purpose exactly.
"As a proof of this (that the force of circulation dilates
the vessels)  we may observe, that by  lessening either
the action of the heart, or the column of blood, inflamma-
tion is lessened."  Our doctrine wants no  better prop than
this.  We  could use it successfully, I think,  in support
of all its positions.
  I have made the enquiry  in a preceding part of this
essay, why weakened persons wereparticularly subject to
inflammation; and why it occurred especially in the most
weakened parts;  the  surface and  extremities.   I must
be permitted to request  the reader to apply the theory
here opposed to Mr. Hunter in  the examination of  the
question, and he  will find that it fully  explains, what,
upon Mr.  Hunter's princples, never could happen.
  I will close the discussion of this  part of  the subject
by a quotation from Mr.  Hunter, in which (if he is cor-
rect)  he breaks down every pillar / may have left for his
doctrine  to lean  upon.   I suspect," says Mr. Hunter,
"that coldness  in disease, arises either  from weakness,
or a feel or consciousness of weakness in the whole con 
49
stitution or a part, joined with  a peculiar mode of ac-
tion."   That weakness, or a feel of weakness, produces
cold, is evident: Heat is a positive action, while culd is
the reverse,  therefore  producing weakness, and  often
arising from a diminished action of strong parts."
   Mr. Hunter here says,  that "cold produces  weakness,
arises from weakness, and often from a diminished action
of strong parts.   Is it not an  ample comment on the
whole doctrine of Mr.  Hunter,  to  say, in reply to this
position of his, and particularly to the last part of it, that
we know cold  is the most general cause of  inflamma-
tion."
   Mr. Hunter's general division of inflammation.   "In*
flammation may  be  first  divided,"  says Mr. Hunter,
"into two kinds,  as first principles, viz: the healthy and
 nhealthy."
  "The  healthy probably Consists on y of one kind, not
being divisible  but into its different stages,  and is that
which will always attend  a healthy constitution or  part,
is  rather to be considered as a restorative action  than a
diseased one, and would rather appear to be an effect of
stimulus than irritation."
   "Inflammation is capable of producing three different
effects, viz:  adhesion, suppuration and ulceration of the
parts.  The last, or ulceration, is properly speakiug, only
a secondary effect of  inflammation, not  being  performed
by the same vessels;  however it is possible it  may  keep
up inflammation, as it always keeps up a species of vio-
lence, viz: a  destruction of parts."
   "The two first do not take place in the same vessels
at the same time, but succeed one another, although all
three effects may  exist at  the same time in the different
parts of the same inflammation."
   "These three different modes of action, viz: the adhe-
sive, suppurative and ulcerative, when carried on per-
fectly are generally  the effects of a  good constitution,
seldom attending the  unhealthy;  they are what I would
call common  inflammation."
  "I have already observed  that common inflammation,
cither takes place in  parts that constitute the largest pail
of an  animal, which are  all the circumscribed cavities, 
50
all the cellular membrane, and  the  substance of every
part, the two last of which are the most universal, or upon
internal canals and  outlets, which are in common only
excretory ducts."
  It would seem unnecessary when we contrast the de-
structive consequences of inflammation with this position,
(of healthy inflammation)  to enter upon its refutation.
It must be  rejected upon this prima facie evidence.  But
I will  pay it some attention, because it is a necessary
auxiliary of increased action.  Increased action can re-
sult from capacity only, and capacity is inseparably al-
lied to health.
  Mr. Hunter says,  that "healthy inflammation attends
a healthy constitution or part, and is to be considered as
a restorative action, rather than a diseased one."  I have
before asserted upon the testimony offacts, that unhealthy
constitutions are most  liable to inflammation.    And
when inflammation has taken place in a part there is a
sensible change in the appearance and condition of that
part, differing from the common signs and state of health.
Its healthy functions also are impaired.  Mr. Hunter
himself, asserts in another place, that "unhealthy inflam-
mation is  spontaneous,  and arising  from constitutional
disease."   He also  declares,  that "when granulations
are forming, (in plain terms, the work of restoration go-
ing on,) inflammation has ceased."
  "Inflammation (common or healthy inflammation,  says
Mr. Hunter) is capable of producing three effects, adhe-
sion, suppuration  and ulceration;" the last, he says, is;
only a "secondary effect,"  however,  he observes, it may
keep up inflammation, as it always keeps up a species of
violence, viz:  a destruction of parts."  Here Mr. Hun-
ter makes one of the conditions of inflammation keep up
inflammation,  because it produces a species of violence,
viz:  "a destruction  of parts."   I should like to be in
formed upon what ground it is presumed that the injury
and destruction of a part are consequences of a healthy
action.  Yet Mr. Hunter asserts this unqualified contra-
diction, when he says, that inflammation depends upon a
"violence and destruction of parts," and is at the same
time healthy. 
51
  If it were attempted to give this paragraph a construc-
tion less inconsistent with Mr. Hunter's position of heal-
thy inj immation, from his reservation as to "secondary
effect," I answer it is still an effect of inflammation. And
the most liberal translation which could be thus  given it,
would amount to nothing more than that all diseased con-
ditions were  healthy when they did not kill.   An infer-
ence which would  fairly uproot our boasted science, and
place  Physicians  in something worse than a ludicrous
point of view\
  Mr.  Hunter also observes,  that it is "common (or
healthy) inflammation which takes place in  all circum-
scribed cavities," in the "substance of every part," and
upon internal canals and outlets."  Is  inflammation of
of the brain and lungs, the cavity of the thorax and ab-
domen, the stomach and intestines, a healthy condition of
those parts?   If so, it is  a very mischievous kind of
health, or we have grossly misapplied  the term health*
and must find  for it a very different signification from
the one we possess.
  Mr. Hunter says, in his  1st chapter on  inflammation,
"I  may observe that all alterations in the natural dispo-
sitions of a body are the result either of injury  or dis-
ease, Knd  that all deviations  from  its natural actions
arise from a  a new disposition being formed."
  We will take Mr. Hunter's comment  on* the first spe-
cies of inflammation, that arising from injury, which he
calls  healthy.  The latter, that from disease,  he says, is
too complicated to be healthy.
  "The parts," he says,  "so hurt, viz: by injury or vio-
lence, not being able to pursue their original  or natural
mode of action, are obliged to deviate from it; and this
deviation will vary  according  to  the nature of the vio-
lence^ the nature of the part, and the state of the con-
stitution."
  ^An alteration  in  structure  requires  a new mo^e of
action for its restoration;  as the restoration cannot be. the
same, with what was natural to the parts before any  al-
teration had taken place."
  Mr.  Hunter  here says, that in healthy inflammation,
the parts deviate from the natural action, not  being able 
52
to contiuue it.  That a new mode of action is necessary
which cannot be  the same,  which  v as natural  to  the
parts before the injury and inflammation.
   It is only necessary to enquire, in answer to all this,
whether the natural action of the part is a healthy one.
If it is, Mr. Hunter's  reasoning is conclusive against
himself.   Or we must admit that a part possesses a capa-
city  for two  different actions, a natural and  a healthy
one: and that is healthy  which is not natural.
   I  repeat then, if, according to Mr. Hunter, healthy in-
flammation is attended indifferently by one or all of the
conditions he has assigned,  viz:  adhesion,  suppuration
and  ulceration, that all inflammations are healthy, which
do not kill the body.  For this definition  comprehends
(properly speaking)  all the  states  of  inflammation.
What is ulceration?  Does  it not of necessity presup-
pose a partial death of the parts?  I  grant that a part
frequently recovers after  ulceration.   But what does this
amount to?   Nothing more,  I conceive,  than that  the
body possesses naturally a  limited capacity for re-pro-
ducing  parts that have  been destroyed by violence or
disease.   If the body were  not obnoxious to  such vio-
lence, it would be immortal.   If it did not possess a ca-
pacity for self-restoration, every  scratch would be fatal.
Yet  nobody, 1 suppose, ever thought that either suppur-
ation or  ulceration  (which mean  properly  the same
thing) were directly, or strictly, a means  of  recovery.
And every one Would be offended, if required to believe
that recovery from  the consequences of injury, and the
consequences thevnselves were one and  the same.  It is
very true that when the natural powers of a part are so
far injured that it must be lost by suppuration or ulcera-
tion, the sooner it is removed the better, but certainly the
same action which produces such a  loss or removal (the
inflammation) never can produce recovery also.
   I  should  transgress too far the customary limits of a
medical thesis, by investigating the more complex sub-
divisions of inflammation, which Mr. Hunter and others
have instituted.   Compressed and hasty as my notice of
the subjects embraced  has been, this essay already pro-
mises to attain a size for  which an apology is due.  Bui 
53
having proposed an attention to past and  present senti-
ments on inflammation, although I cannot hope to instruct,
I should have left it inexcusably imperfect to have  said
less.  I will notice briefly, Mr. Hunter's  third division,
die only remaining one of a distinct character.
   I think the term specific inflammation (the subdivision
alluded to) unnecesary  to any purposes of our know-
ledge on the subject  of inflammation as it appears to me
to have only a relative^ not a distinct signification.   In-
flammation, from whatever causes it may arise, I think, is
unique in its condition, I mean  the actual condition of the
part. The causes of fever, no doubt, are generically differ-
ent.  But in respect to fever alone, the small pox (if it
could exist under such circumstances)  would  afford us
no evidence of a condition different from  that produced
by simple synocha.  It is from adjunct circumstances,
the ultimate operation of the small pox fever,  an opera-
tion peculiar and  uniform, that we  recognize the  disease.
Contingent circumstances, and certain premonitory symp-
toms, common to  the incipient condition of that  disease,
may lead us to suspect its existence, but we cannot know
certainly that it does exist, until its peculiar effects have
been expressed.   The sensible signs of simple phleg-
monous inflammation, the variolus, and vaccine pustules,
it is true, are somewhat different,  but it is only in their
advanced and terminating stages, and the two latter give
us their specific character at that time, not in the inflam-
mation itself,  but in a certain  result or consequence of
general and local operation, peculiar, yet obscure  and
inscrutable in  its agency.   The  inflammation  in those
two states is particularly defined,  as to form and result,
but we have the common signs  of  common inflammation,
tumor, heat, pain and redness.
   The inflammatory tumor of lues venerea is also the re-
sult of a specific  agency, and may be  called specific in-
flammation.  But in its occult state, if a person in whom
we have  confidence  were to impose on us as to its cause,
we could not distinguish its nature, and should probably
refer its origin to some other cause known, to be capable
of producing  a similar  consequence;  a condition in ap-
pearance the same in all respects.  Even in its open or 
ifch
ultimate state, when the character and condition of  the
ulcer, presents us  the best proof we can  have of its real
nature, we cannot discriminate positively from its appear-
ance alone.  Nor is it from any peculiarity in the inflam-
mation, (as such)  that We form an opinion.   Our judg-
ment is made  up  from appearances  nearly uniform, in
that species of ulcer, and rare in any other;  appearances
knowrn to be local, not independent,  but  entirely in con-
sequence  of a systematic  affection.  We  acquire  the
ground of opinion as  to its nature,  not, I repeat, from
swelling,  heat, pain, &c. of the inflamed  gland or pari;
but from a habit of observation.   We have been accus-
tomed to  observe  an uncommonly unhealthy appearance
in such ulcers, together with  something unusual in  the
colour of the matter effused  or secreted.  Hence when
we meet such  appearances in an ulcer, we suspect vene-
real taint;  but we can never, by any examination of  the
part alone, be satisfied of the fact.  We must first receive
an assurance of exposure to venereal infection.   In  ad-
dition to all this, were we to inject the parts, in which what
has been called specific inflammation had been present,
I presume we should find the blood vessels, the great in-
struments  of  inflammation, precisely analagous in all
respects, to what they are found to be by the same test, in
all other inflammations.
   It appears to me also, that if this distinction is proper
in one instance, it  may be multiplied  ad  infinitum. The
causes of inflammation are infinite.  And although they
have been classed under certain general heads;  as irri-
tants, mechanical and chemical agents, heat and cold, yet
the individuals of most of those classes possess  something
peculiar in their form, qualities, and manner of application.
All causes of inflammation act upon the body by their own
properties and laws; yet the effects of that operation, are
eo nearly  allied in manner and amount in most of them,
that we have very justly supposed it an unnecessary work,
to investigate the precise sum and mode of each.  Mechani-
cal violence, chemical agents, heat and cold, under certain
circumstances, produce an effect on the living body which
we call inflammation;  and which  experience has taught 
55
us, was the same in kind, ly which soever of those causes
occasioned.


THE RATIO SYMPTOMATUM OF INFLAM
                     MATION.

  I shall adopt the Galenic definition of inflammation,
because I have seen none  more correctly indicative of
the condition of the part.   "Tumor,  redness, increased
heat, pain, with a sensation of  throbbing in  and about
the part."
  In considering those symptoms, I shall confine my view
to local inflammation simply. Not that I entertain a doubt
as to the facility of illustrating upon the principles I have '
adopted any systematic condition, either prior or subse-
quent to inflammation, as its cause or  consequence, but
from an unwillingness  to violate  farther  than I cannot
avoid, customary  restraint.   I have neither the wish or
the confidence to engage in a greater  work, than the oc-
casion for such exercises contemplates.
   It is just and decorous to acknowledge our obligations
 to others.  On this principle, I shall be pardoned a mo-
 mentary digression.
   Mr. Wilson, of Edinburg,  with a degree of manly
 candour, which does him great credit, has given us the
 ground-work of a theory of inflammation; which he says,
 he believes to be the same adopted  and improved, (if not
 invented) by Doctors Lubbock and Allen.  At least, he
 remarks, it is the view of the subject impressed on his
 own m   4  by their  repeated  discussion and defence,  of
 their principles in his  hearing. Whether Mr. Wilson
 be correct as to the opinions of those two gentlemen, we
 cannot ascertain, and it is of little consequence.  I be-
 lieve the doctrine he has given us, is a correct one, and
 to his work I am indebted  for  the first (to my own mind)
 clear and satisfactory conception of the subject.   To Dr.
 Davidge's able management of this subject, when professor
 of the principles of physic, I am particularly obliged.
 His examination of Mr. Wilson's principles more in de-
 tail, the support and illustration he has given them, upon 
i)Q
 the ground of analogy and established facts, was fitted to
 obviate most or all the difficulties which might obscure
 their comprehension, to those whose situation as students,
 shuts them out from the great depositories of knowledge,,
 experience and close  remark.

                      TUMOR.

   When any cause capable of producing  inflammation,
 operates on a part in such a degree,  as  to  interrupt and
 weaken its  natural capacities and actions, three conse-
 quences accrue from that  operation, from whose correla-
 tive existence, tumor or swelling takes place.   The na-
 tural power (both contractile and elastic) of  the vessels
 being  reduced, the capacity of  resistance to the force a
 tergo diminished, they are  distended or dilated by the
 impellent force of the column of blood,  sent  on by the
 heart and large vessels.   The first series  of  vessels on
 which this force acts giving  way, it impinges again-i the
 second, and so on to the minutest capillaries of the part.
 All are dilated in turn, and  of course all acquire an in-
 crease of volume or bulk.  The larger vessels  of the part
 are not only dilated, but their coats also are  thickened.
 For  those  coats are  vascular, and all the vessels of a
 weakened part,  suffer from the impellent force.   As the
 vessels of a part are dilated, their distension presupposes
 the presence of the  dilating agent.  This  is  the blood.
In  proportion to their distension, will be  the increased
 quantity of contained blood.  Those two, the augmented
 volume of the vessels, and the increased quantity of con-
 tained b'oml. are the principal causes of the enlargement
 of an inflamed part.   But there is a  third cause, which
 frequently, though not perhaps necessarily, makes a part
 of the swelling or tumor; particularly in  the advanced
 stage of inflammation.  In  most inflammations  we find
 after a greater or less time, an uncommon quantity of
fluid different  from blood, present  in the part.   Some-
times this takes place to a very considerable degree,  as in
hydrocephalus, hydrothorax, pneumonia, anasarca, rheu-
matism, &c.  All parts of the body are kept moist natu-
rally, by the separation of a limited quantity of fine fluids 
                         57

from the blood, and whether this uncommon quantity of
fluid material in inflammation,  (I  am  not  speaking of
pus) be simply the natural fluid increased in quantity,
and  somewhat changed by  the  altered condition of the
part, or whether it is a secreted  material peculiar to the
inflamed state, and modified by the degrees and succes-
sive changes of that state, it is perhaps, impossible to
ascertain.   But  whatever be the nature of the material,
or however produced, it is in most  instances present in
a part, as a consequence of the  inflamed condition; and
occupying (where there is  no out-let for it) the intermus-
cular and membranous spaces,  it will contribute in the
relation of its quantity, to the volume  or swelling of the
part
   An argument in favour of the presumed  increase of ac-
tion in inflammation, has been drawn from this fact.  It
has been called a secretion, and said to indicate an action
greater than  that natural to the part.  But this argument
appears to me destitute of any firm ground to rest upon.
While the parts are living, some action is going on, and
consequences  different from the natural ones,  may occur
without the action being necessarily greater.   In fact we
find that in hydrothorax, acites, anasarca, and rheuma-
tism, fluids  are excreted  in largest  quantity, after the
general powers of the body have been very much lower-
ed in their tone.  In all parts too, from which the usual
supply of blood, (the natural stimulus of the part) is in
any manner cut off, we  shall have  this effusion of fluid,
and it  will go on to increase, until some channel of ade-
quate  supply has been opened to the part.   From all
sinuous and ill-conditioned ulcers,  also where all admit
defective action, a copious quantity of fluid is discharged.
It becomes thicker and less in quantity, as the part rises
in action to the natural standard of vigour.
   Sometimes this fluid is  the so  much talked of coagu-
latiug  lymph, the boasted bond of union between inflam-
ed and separated parts.  But beyond  a certain quantity
and quality of fluid,  the (natural fluids of the part) all of
them are dead matter, extraneous and foreign to the state
and economy of the  part.   If it possess an adhesive or
connecting property, it is as foreign  matter, and but  for a
                  8 
58
time.  While it exists it prevents natural reunion.   And
before the  part  can be assimilated to other parts, or to
its own state previous to injury,  this material must be
melted down,  absorbed, or discharged.

                    REDNESS.

   The redness of an inflamed part is evidently owing to
an increased quantity of arterial  blood.   An increased
quantity is present in the part, because  the capacity of
the vessels to receive it is enlarged, and because its move-
ment through  the part is less rapid and  perfect than natu-
ral, in consequence of the weakness of the vessels, the
great instruments of the blood's motion.   When  the ac-
tion  of the vessels shall  have been so  far diminished,
 either by the  original weakening agent, or the secondary
 operation of the vis a tergo, that they have ceased  almost,
 or altogether, to carry on the circulation; the part loses its
 red colour, and in proportion to the defect of  action, (af-
 ter it has  fallen below a certain degree) becomes  dark or
 black.  The life of the part under  those circumstances,
 is either very much lowered, or has ceased entirely.
   In parts which have great living capacities, in conse-
 quence of their vascularity and proximity, to  the source
 of circulation, the redness is florid and continues for a
 long time. Without the weakening agent (either  primary
 or secondary) has been very great, the  vessels  though
 weakened to a  degree,  resist  such a loss of power as
 would deprive the blood of its red colour, and  the part
  of life.  On the  contrary, when the living capacity is
  comparatively low, as in the extremities, the colour is
  less bright, and  the resistance of the  vessels less in de-
  cree and duration.  The dark colour is induced, and the
  life of the part  lost more readily than in the  previous
  instance. In inflammations of robust and vigorous bodies
  also,  we have the florid redness.  The  inflammation is
  circumscribed, and the resistance to the excess  of injury
  or death, very  great.  Or should  partial death by sup-
  puration or sloughing take place, such mischief is de-
   fined and limited.  In weak and feeble habits however,
   the reverse occurs.  The inflammation is darker, more 
59
diffused, and sphacelus and  sloughing, irregular  and
extensive.
  W hile the circulation through an inflamed part is im-
peded or retarded,  not  arrested, the  change by which
the blood loses its vermillion colour, goes on more slow-
ly.   And from this cause, together with the augmented
or uncommon quantity in the  part, we have the bright
red of the early stages of inflammation.
  When vascular action has  become very feeble, or no
longer exists, and the circulation partial in the extreme,
or entirely arrested,  the blood loses in  proportion its
oxydated condition, and of necessity its vermillion  hue.
We  have in the part the modeua complexion, or the black
colour of extravasation.   From the latter cause,  too, the
blood loses another quality, and the part undergoes a change
or condition, of both which we shall speak presently.
   It has  been attempted to account  for the redness,  as
well as the swelling of  an inflamed part, by the growth
of new  vessels, imbedding  themselves in an effused co-
agulating lymph.  The effused lymph can give no red-
ness to  the part, for it is not itself red.  The manufacture
of new vessels, I think, is never the work of inflamma-
tion.  It is  the business of inflammation to destroy, not
to nourish a part.  The natural actions of a part  must
be recovered, before new  vessels  can be made, or a
growth of parts take place.   Besides redness commen-
ces with the inflammation.  There is not time for  their
manufacture, before the symptom occurs.
   Admitting for  a moment that the supposition was cor-
rect, if, according to the doctrine which is authority for
it, their action was increased (greater than natural  to
the  part) we should have at most but partial increase of
natural colour in the part, not the redness of  inflamma-
mation.

                        HEAT.

   When the motion of the blood was supposed to be the
 only cause of  animal heat, it was  a rational  deduction
 from such premises, to suppose, that the temperature of
 a part  would be commensurate with the velocity of the 
60
blood's movement through it.  But experiment destroy-
ed the ground-work of this doctrine, by proving that there
was little or no difference, as to the rapidity of circulation
between many of the cold and warm blooded  animals.
And as Mr. Wilson has  correctly  observed,  this fact
ought to have overturned every part of the superstructure
built upon the presumption of a natural relation  between
motion and heat.
  The  evolution of heat from the blood depends upon
the degree of oxygenation, not its velocity of movement.
And whenever the quantity of blood in a part is much
greater than natural, although its  motion is retarded and
its access to the source of oxydation less free than usual,
from imperfect circulation through the part; nevertheless
so long as the blood  continues arterial, caloric will  be
evolved, and the quantity  of blood being much greater
than natural, the temperature of the  part will rise above
the ordinary degree.
  When the quantity of blood in an inflamed  part has
not been so long and  so completely  thrown  out of the
circulation, as to have  lost entirely the principle on which
its evolution of caloric depends, (in which case the part
becomes cold and dies) the evolution of  heat from any
given quantity of blood will be less  than natural, or in
the absence of inflammation; but the circulation  still con-
tinuing, though less  perfectly than in  health,  and  the
quantity of  blood in the part being augmented eight or
ten fold, the aggregate amount of  heat evolved,  will give
a considerable increase above  the  natural standard.
  It would appear from the experiments of many gentle-
men, that a part acquires in inflammation a maximum of
temperature at a few degrees only, (five or six) above the
ordinary heat of the blood.   This may be true,  and pro-
bably is in  great  part correct. But I suspect  that it is
impossible  to make a strictly accurate measurement of
the real heat of an inflamed part.   It is difficult if feasi-
ble, to insulate the part and the thermometer so complete-
ly, as  to subject  the  instrument to the  full effect of the
caloric, evolved  from the former.  Generally speaking,
the surrounding air will  have considerable influence upou
both the instrument and the part; and subtract so mucli 
61
from the heat communicated, as to produce  error or un-
certainty, with regard to the quantity generated.
   Those experiments too, have regard to the comparative
heat of an inflamed part, arid of the blood at the source
of circulation, or in some internal part.   Whereas I con-
ceive the only proper criteria, consists in the  relative heat
of the same part, in inflammation and in health.  If the
the temperature of the part rises in the inflamed state,
considerably above what it was, in  the  uninflamed con-
dition, I can see no  necessity for any stronger evidence
of increased heat resulting from inflammatiou.  The part
possesses naturally, a certain standard of temperature. If,
when  inflamed, it rises uniformly  above  that standard,
inflammation, of course, causes the increase.   That in
parts accessible to examination (external ones)  the heat
is greater than in health, cannot be doubted:  and is all
the proof of heat from inflammation, which can be neces-
sary.  The fact establishes the demonstration.
   But admitting, in conformity with the inferences from
those experiments, that the temperature  of an inflamed
part,  rises but five  or six degrees above  the  blood's
natural heat, it is sufficient evidence of increased heat in
inflammation.  That the  temperature  of inflammation
does not progress to a much greater elevation, may, 1 con-
ceive, be accounted for, on the ground that before a quan-
tity of blood sufficient to produce this effect,  could be re-
ceived in a part, its condition will  be altered; an injury
of structure would take place,  and  extravasation or par-
tial death of the  part  occur.   Those  causes we know
arrest increase of temperature, and that all parts  are sub-
ject to their interference we may presume.  Since expe-
rience  has taught us to judge with much accuracy of the
sum of inflammation, capable of producing injury of struc-
tion, as  suppuration and  sphacelus.  The capacity of
the part to bear inflammation, is sufficiently well under-
stood to indicate a correct judgment, as to the consequence
or termination.
   It has been said that the feeling of heat in an inflamed
part, 4s probably  a  deceptive  or  imaginary  sensation.
But it might with equal justice be contended, that pain
and every kind  of [information communicated to the mind 
                          62

by the organs of sensation, was deceptive and imaginary.
The sensation of pain, heat, or cold, can have  no exist-
ence but when they are perceived.  By the same rule,
when they are distinctly perceived, (if the organ and the
mind possess  their natural  capacities) they exist.  The
knowledge we  derive from the sense of touch, does not
depend upon  custom, reasoning  or judgment; it results
from the natural laws of our constitution, and while those
laws are in operation, is  uniform and accurate.  It  is
true the sensation is in the mind, not in the part, but by
the laws of our constitution, the perception (which con-
stitutes the sensation) has a correct reference to the part
affected.  Were not  this  the  fact, the  sense of touch
would be useless.  We could only guess at the seat  of
pain, and might mistake an affection of the  toe, for a dis-
order of the head.
   The chief cause of increased heat then, in an inflamed
part, is the evolution of caloric in the manner pointed out
from  an augmented quantity of  blood.   But I imagine
there are other causes which contribute to the increase  of
temperature, besides the  simple  augmentation of  blood
and evolution of caloric. While the body possess a capa-
city for generating  heat, its functions  appear destined  to
controul the quantity, and  to keep it at  a standard con-
sistent with health.  In external parts  the function  of
perspiration (and in internal ones the  natural secretions)
disposes of the caloric, which is unnecessary, and would
probably be unfriendly to the purposes of the body.   In
inflammation however, this relief is denied the part. The
function of perspiration  in external parts, and of natural
secretion in internal ones, is for a time suspended.  The
vessels of the part affected, are too far debilitated to per-
form a healthy  office,  and  are under the  controul of a
morbid cause.  The impression of the latter must be in
great part overcome, before  the healthy office  can be re-
established.  Perspiration rarely goes on in an inflamed
surface; secretion  sometimes  attends  inflamed organs.
But when one or the other does exist  consequential of a
diseased action, they differ from the healthy function,
and fail to effect that object, in  the economy for which
they are naturally fitted. We should  have  then not only 
63
an augmented quantity of calorific material brought to an
inflamed part, but from the cause just referred to, there
would be an arrestation of the evolved caloric, rendering
it more sensible, and the natural out-let being barred, its
only means of escape would be the capacity of the cir-
cumjacent medium to take it from the part.

                       PAIN.

  Most writers have concurred in a sentiment respecting
the  pain of inflammation, which  to my understanding
has no better  foundation than awkward conjecture, and
is far from  satisfactory.   We have  been  referred  to
Spasm  for  the  immediate cause of pain; and a defence
of the position is rested upon the ground of presumed
analogy.
   Mr. Hunter,  after asserting that  pain was owing  to
spasm, observes,  "By spasm I should understand a con-
traction  of  a* muscle, as of the leg, called  the  cramp,
which gives considerable pain, often violent, as also the
tetanus and when in a less degree it only gives sensation
as in the twinkling of the eyelid."
   Persons who have been assailed by spasms or crampj
and have also  suffered inflammation, need scarcely  be
told, that the sensation of one and the other is altogether
different. The sensation produced by either, cannot per-
haps, be well or clearly described, but no person who has
felt  both, will be in danger of confounding them.  Each
conveys to the mind its distinct and peculiar  impression.
There is moreover a sensible  and definable  discord of
signs in the two states.  Spasm attacks suddenly and
violently;  pain from inflammation comes on slowly, and
is at first moderate.  Spasm intermits, and the intermis-
sion is followed by immediate and total absence of pain;
the  pain of inflammation has  no intermission.   It has
its degrees  of subsidence,  as well as  of increase, both
gradual; its decline is an abatement, not intermission.
   But there is  one argument, which of itself,  is abso-
lutely conclusive on this head.  Spasm  necessarily pre-
supposes muscular  structure  and action.     With  a
kuowledge of this fact, we need only  enquire  whether 
64
parts, not muscular, give the sensation of pain when in-
flamed.   It will not be denied,  I presume, that the
lungs,  brain, liver,  kidneys, testes, &c. are the seat of
great pain, when inflamed; yet those  parts are known
to be without muscularity.
   Much has been said about new  actions or motions, of
parts in inflammation, and  the  tendency of such altera-
tions of action, or new  modes of action, to produce pain-
ful sensation.   But  as  those ideas are to me incompre-
hensible,  and appear to be entirely visionary, I cannot
engage in an examination of  what I do not  understand,
nor rationally  combat what I believe to be a chimera.-—
Supposing an action different  from the natural  one to
occur in a part, I can readily conceive  that unnatural or
disordered sensation would ensue, but we must know in
what the change  consists of, or what the  new action is,
before we can  argue about the consequences it  is capable
of producing.
   It appears to  be a law  of the  animal economy, that
when parts are w eakened, or have suffered a certain de-
gree of violence, their susceptibility or sensibility  to im-
pressions, becomes increased.  In this  state  ordinary
agents  act with superordinary effect, and produce sensa-
tions answering to the force of the  cause, in parts, which
in the  natural condition, and  with the  natural action,
present no distinct sensation to the  mind.   As  inflamma-
tion progresses, both the condition  of the  part, and the
action by which  it is affected are  changed, or there is a
change of condition, the action remaining the same.  The
parts in this unnatural state acquire unusual sensibility,
and the increased heat of the inflamed part, its uncommon
fulness, and the impellent force of the heart and arteries,
acting in their appropriate modes, upon this accumulated
sensibility, become a three-fold cause of unnatural sensa-
tion or pain.
   Unwilling to indulge in  prolixity  of detail, I would
only observe, that  experience gives countenance to this
exposition.  If we can abstract from the heat of an in-
flamed part; or diminish its fullness by  local evacuation;
or subdue the impellent action of the force a tergo, in ef- 
6.1
fecting either, or all those objects, we succeed in dimin-
ishing the sum of pain.

The sensation of throbbing or pulsation in and about the
                        part.

   It appears to me probable that this effect is produced
in one of two ways; generally perhaps by their conjunct
agency.
   1st. The augmented sensibility we have presumed to
exist in an inflamed part,  not being confined to the imme-
diate seat of inflammation,  but extended in a greater or
less degree to the neighbouring parts, renders the arteries
which have their course in the vicinity of  the inflamed
part, more excitable  and active.  Perhaps too the unu-
sual heat of the inflamed part may extend its operation to
those vessels as a local stimulant. We should thus have
increased force of  contraction  in those  vessels, which
taking  place in the neighbourhood of parts preternatu-
rally sensible, this contraction,  or a feeling of pulsation,
would be communicated to the mind.  Or,
   Sndly. Without supposing as above, that the  arterial
trunks in the neighbourhood of  the inflamed part, are
rendered more excitable and active, the part may become
capable  from  the  increased sensibility  of  the  inflamed
state, of communicating to the mind a distinct perception
of the ordinary action of the vessels which are  distributed
to it.  In both these cases, the sensation (to use the com-
mon language) is in the part. Simply I presume,  because
the part has acquired an increased sense of touch or ca-
pacity of communicating sensation.
   For the first of those positions we have the fact, that in
paronychia we have pain as high as the shoulder.  And
not only the digital arteries, but the radial, or even bra-
chial artery, possess more activity, that  is,  greater force
of contraction, than in the opposite and uninflamed hand
and arm.
   For the latter we know, that in inflammation about the
head, &c.  we experience  the pulsation,-or sense of throb-
bing in the part, where the general action is but little, or
not at all increased.
                   9 
66
  It cannot be necessary to engage in a notice of the re-
mote causes, or the treatment of inflammation.  The first
are well known, and gross ignorance only can fall into
error, with regard to the latter.  In a diseased condition
of so frequent occurrence,  ordinary capacity will  de-
rive from experience a corrective,  for the mischiefs of
erroneous pathology.
THE END. 
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