CONSTITUTIONAL OR REMOTE CAUSES OF INFLAMMATION.

This contains some ingenious hints mixed with much that must necessarily be familiar. We shall only pick out one or two insulated passages for

notice.

a. Speaking of sympathetic morbid sensations, Dr. Macartney remarks :—

"I remember a very curious instance, in which I discovered a stricture in the œsophagus, by the person feeling an acute pain in the little finger of the left hand every time he swallowed." 84.

b. It is well known that the suppression of natural secretions or of habitual discharges, may prove a cause of inflammation. The explanation generally consists in supposing that the blood or the system becomes charged with the peccant matter previously evacuated. But Dr. Macartney observes, that, generally speaking, the mischief occurs before there is time for the circulating fluid to become redundant, in consequence of even extensive secretions being interrupted; and in many cases, the discharge which is stopped, is so insignificant, as to quantity, as to be incapable of producing any influence on the mass of blood.

We must, therefore, he continues, adopt some other explanation for the suppression of secretion becoming the cause of inflammation, than the disturbance of the balance between the quantity of the circulating fluid, and that of the discharge which has been suspended. It is probable, that the interruption of the secreting function, in any one part of the arterial system, and especially on sentient surfaces, may, from the law of sympathy, which is so remarkable between the vascular system and these surfaces, become a direct motive to the arteries to assume, in certain places, an inflammatory state. This mode of explanation is rendered more probable, from the fact, that the removing very slight external irritation, or inflammations, which furnish very little or no pus, sometimes causes the most severe constitutional disturbance, which is removed by the recurrence of the local irritation.

We think there can be little doubt of the correctness of this explanation. It is not the mere suppression of discharge, but the alteration or repulsion of a mode of action that affects the system. Suppose some habitual vascular excitement or congestion in a given point. If that is suddenly repressed, some other part in the vascular circle, by the operation of the perplexing law of sympathy, becomes the seat of congestion or excitement. That vascular plethora is mixed up with this, seems however, to be proved, by the security which, under such circumstances, evacuant medicines offer.

"I have seen," says Dr. Macartney, "the most serious diseases endangering life, induced by the cure of that slight cutaneous affection of the cheek, which sometimes is a mere efflorescence, periodically throwing off a little furfur, or forming a crust. Dr. Jenner once shewed me a red spot on his wrist, that could be covered with a sixpence; he said, whenever it faded, his stomach and general feeling of health were affected." 87.

But in cases like Dr. Jenner's, it is more likely that the general disturbance was due to some modification of the state of the internal organs, than to the influence of so trivial a cutaneous eruption. The latter was in all probability a symptom. When present, it shewed a condition of internal organs

compatible with health. When a contrary condition of those organs ensued it subsided.

c. Dr. Macartney is eloquent on the subject of "taking cold." Of all parts of the body, he says, the back is the most susceptible of cold, thus insidiously applied, and the chilliness is sometimes even felt first along the back, although it may not have been the part immediately exposed. Perhaps this circumstance depends on the nerves of the skin of the back having so direct a communication with the spinal-marrow.

"

Dr. Macartney follows this up.

In the same manner, when a person is placed in the situation favourable to giving cold, the danger may be avoided, by turning the face instead of the back to the direction of the stream of cold and, damp air, observing the sensation caused by the impression, and voluntarily rousing himself to a feeling of resistance. In protecting the body by clothing, the back is the part chiefly to be regarded, and hence winter waistcoats should have the back made of at least as thick materials as the front. People commonly fall into the error of clothing the front of the body warmly, and expect to escape cold by muffling the throat. The Irish peasantry more wisely, expose the throat and breast, and defend the back by a warm great coat, which they seldom close in front."

89.

So that the idea of Pat's having “his coat buttoned behind to keep his belly warm" is a libel on him. He keeps his belly warm," by not buttoning his coat at all.

The LOCAL CAUSES OF INFLAMMATION form the subject of the next Chapter.

matter.

Dr. Macartney's observations are both numerous and judicious. But they are scarcely suited for our pages, containing, necessarily, much familiar We may quote the following passage, with the expression of a hope rather than a confident expectation, that Dr. Macartney's ideas may not be of too sanguine a complexion. Speaking of the effects of dead animal matter introduced into the body or merely applied to the skin, he observes :— "Every anatomical class has annually furnished examples of the effects of this species of infection, except the dissecting class of the Dublin University, during the time it was placed under my direction. Very simple means of prevention were employed, with so much success, that no severe disease from wounds received in dissection occurred, (when the proper means of prevention had been employed,) during the last fifteen years that I held the Professorship of Anatomy in that University. The means resorted to consisted in immediately washing the wounded part, and afterwards keeping it wet for a few hours, with a solution of alum in water. Most probably, any other fluid, such as the liquor plumbi, solution of sulphate of zinc, &c., which would have the effect of coagulating the animal substance, would answer quite as well; but the solution of alum was always at hand, and, I believe, if immediately applied, would never fail in preventing infection." 104.

Dr. Macartney remarks very justly, that the two stages of decomposition in the dead body, which render the animal substance most dangerous, are, that which takes place immediately after death, and the extreme degree of putrefaction. The latter is most apprehended, but, it usually occasions only a diffused inflammation in the part wounded, without any serious sympathy of the constitution.

Some dead animal substances, he goes on to say, are more likely to communicate this dangerous disease, than others. The brain, in the recently

dead body, is extremely apt to produce it, even when no wound is received. The sero purulent fluid, found in the large cavities after death, (if no means of prevention be employed,) seldom fails to infect persons; and the most dangerous animal fluid is that contained in the cavity of the abdomen, after puerperal peritonitis, or the serum found in parts which have suffered diffused or gangrenous inflammation. The white cancer of the liver, and the substance of medullary tumors, are found to be very irritating, when merely applied to the hands, without a breach of surface. Dr. Macartney has several times had his hands inflamed from handling this morbid structure, even after it had for some time been preserved in spirit.

"Some persons are more susceptible of the infection from dead animal matter than others. I have heard of a student who never escaped it, after receiving a wound in dissection. I have, myself, so strong a tendency to be affected by the irritation of animal matter, that I formerly suffered more or less every year from this cause. Since, however, I adopted the means of prevention already mentioned, I never have experienced either local inflammation or constitutional illness, after wounds received in dissection. That there is no diminution of my susceptibility, is proved, by my still having red patches on my hands, which itch and smart, if I dissect a brain, without continually wetting my hands with the alum water.' 107.

We have only twice suffered severely from handling dead bodies. It is singular that each time it was after examining a person who had died from scarlet fever, and in neither instance was there the slightest evidence of our having received a wound. On the second occasion the local symptoms were succeeded by a sort of erythematous affection of the throat, a true secondary symptom.

He has never seen this But ill-conditioned abWe have twice seen, in

Dr. Macartney remarks that the secretions of the human body, when they are accumulated in foul clothes, occasionally produce a dangerous and obstinate inflammation of the hands of washerwomen. followed by more than common sympathetic fever. scesses may occur, and the limb may even be lost. washerwomen, and after washing suspected linen, inflammation of the deep cellular membrane of the hand, diffusing itself along the fore-arm, beneath the annular ligament, and between the muscles. Each case proved fatal.

Dr. Macartney goes on to observe that:-The dead substance of other animals, besides that of the human subject, although less dangerous, is capable of infecting somewhat in the same way. Persons who clean tripes are liable to a peculiar erysipelatous inflammation, which passes up one finger and down another. The same has occurred from paunching a hare, and horse-killers occasionally suffer severe diffused inflammation. The fluids of the recently killed animal are, however, much less irritating, than the same in an advanced state of putrefaction, and hence butchers seldom are known to suffer from wounds received in the practice of their business; although, as already observed, the greatest power of infecting, belongs to animal substance immediately after death with respect to the human subject.

Dr. Macartney does not mention, at least in this place, any special treatment for this affection. Sir B. Brodie recommends the oxymuriate of mercury. We have, on several occasions, seen small doses of blue-pill with saline aperients, and the application of a strong goulard poultice, remove the affection in a day or two.

We proceed to the

PROXIMATE CAUSE OF INFLAMMATION.

We must pass over the Chapter on this subject. There is much in it, which, if we discussed, we must dispute; and there is also much that is certainly ingenious and probably true. We must pass, too, over the succeeding Chapter on the SPECIES of INFLAMMATION, which contains nothing of consequence.

ON CONGESTION AS CONTRA-DISTINGUISHED FROM INFLAMMATION.

It is obviously of great importance to distinguish, during life or after death, the two pathological states of congestion and inflammation. Dr. Macartney devotes a short Chapter to the subject, and points out some criteria which he deems decisive.

It is

Congestion, he rightly observes, belongs to the venous system. caused by any mechanical impediment to the free motion of the blood in the veins such as obstruction to the circulation of the blood in the liver, the lungs, or other important organs, or by pressure on the trunk of any vein. It is also brought on by the suppression or diminution of natural secretions, and by supplying the body with more nutriment than is expended in growth or secretion. It is sometimes induced, and always favoured by dejection of mind and sedentary habits, which serve to accumulate the blood in the venous system, and to embarrass the circulation.

Every impediment to the passage of the blood through the small veins, necessarily renders its passage slow. But the blood appears to be also very fluid, at least it transudes in many cases through the coats of the veins into the neighbouring cellular membrane. The blood, in congestion, is either purple, or still darker; in melæna, the blood poured out is black.

"The most remarkable circumstance, with respect to congestion, and the one which has not hitherto been described, is, that arteries found in a congested part are smaller than their natural size." 140.

After a few other observations, Dr. Macartney goes on to remark:

"In order to ascertain the direct effect of venous congestion, on the arteries of the part concerned, I made the following experiment: I put ligatures on both the jugular veins of the rabbit; the animal died apoplectic, and upon examining the state of the vessels of the ears, I found the veins, which lie towards the outer edge of the ear, greatly enlarged, and gorged with dark blood; but the artery, which runs in the centre of the ear, was reduced very much below its natural size, so that it appeared as a mere line. The result of this experiment made me wish to see what would be the instantaneous effect of arresting the venous circulation. I accordingly exposed the mesentery in a young rabbit, and having tied the trunks of several mesenteric veins, their corresponding arteries contracted immediately, in the most palpable manner, and to a very small size; as if taught by their organic instinct, that blood should not be permitted to go where it must immediately return.

:

From the description just given, congestion never should be confounded with inflammation. They are essentially different in all respects the uniform and dark red colour of a part in a state of congestion, as contrasted with the brighter red colour, and distinctly ramified arteries in inflammation, ought at once be sufficient to point out the difference between these two affections."

141.

Dr. Macartney concludes by laying down the distinction between congestion and determination of blood.

When blood, he says, is sent in too great quantity to any part, it is because the arteries of that part dilate beyond their natural state, in consequence of some excitement of particular organs; and therefore the sensibility, temperature, and bright red colour of the parts are increased: whereas in congestion neither the sensibility nor temperature is augmented. Determination of blood may itself be easily distinguished from inflammation, by the general appearance, by the causes, by the absence of any of the consequences of real inflammation, and especially by the want of the peculiar pain, which would belong to the tissue concerned, if its turgescence or fulness of blood had arisen from inflammatory action.

It appears to us, that determination of blood to an organ, is a state by no means accurately defined, or definable. If Dr. Macartney's account be correct, it is difficult to say in what determination of blood differs from the earlier stage of inflammation. Probably determination of blood is a state which may end either in inflammation or congestion, as concurrent circumstances may determine. The phenomena of several cerebral affections appear to point out a much closer connexion between determination of blood and congestion than Dr. Macartney is willing to allow. We proceed to the last Chapter of the work, which treats :

OF THE REMEDIES FOR INFLAMMATION.

Dr. Macartney classifies these remedies under the following heads :— 1st. Remedies which diminish the force of the heart, and give the disposition generally, to the small arteries to go into the contracted state.

2nd. Means that effect a diminished size of the arteries, or reduce the sensibility in the inflamed part.

3rd. Medicines that augment or reproduce the natural secretions, and thereby abate the circulation, or lessen the effusions made into inflamed parts. 4th. Counter-irritations, secretions, or impressions made in different parts from those which are inflamed.

5th. Lotions or fluids which exert sedative and astringent power.

6th. Meats for affecting in an agreeable manner, the sensations of inflamed parts.

7th. Causes which produce an easy or satisfied state of feeling, on the sentient surfaces, or in the individual.

Speaking of tartar emetic, Dr. Macartney professes himself unable to understand on what grounds, the very large doses of the medicine, now so fashionable, are prescribed. Small and frequent doses, he contends, are sufficient to produce all the effects that are desirable. If one grain of tartar emetic be dissolved in a pint of water, and a table spoonful of this solution be administered every half-hour or hour, an extreme degree of nausea will certainly be excited, with a reduction in the strength and frequency of the pulse, and usually some perspiration. The good effects of nausea depend on its being kept steadily up for some time. But, as Dr. Macartney observes, preparations of antimony act on some peculiar constitutions as a mineral poison, producing an alarming degree of prostration and distress. He has