SUGGESTIONS ON THE CAUSES AND TREAT

MENT OF INFLAMMATION OF

INTERNAL ORGANS.

BY PROF. A. B. PALMER, M. D., LL. D.

Mental activity and progress, the examination anew of the doctrines of the past, the breaking away from ancient traditions and maxims, and the upheaval of thought in which it takes new forms, constitute the leading characteristic of the present age. This characteristic pertains to regular medicine quite as much as to any other subject.

Should a physician, however advanced he might have been in the knowledge of his time, awake to-day from a sleep of twenty years, and should the lights or the shadows, the truths or the fictions, the facts or the fancies, the discoveries or the speculations, now prevalent, burst upon him, he would be as much surprised and bewildered as was Rip Van Winkle when he awoke from his nap and witnessed the social and material changes in the valley of the Hudson.

Inflammation, though the same pathological condition with which every physician, surgeon, obstetrician and specialist has had constantly to deal from the beginning of medicine to the present time, yet from the many facts respecting it which modern investigation has discovered, and modern thought and speculation have suggested, presents an aspect to the pathologist and therapeutist vastly different from that which it bore one hundred, or even twenty years ago.

I do not propose to trace the various changes of that aspect fully, but it may be well to give a few of the numerous names

and definitions which have been proposed by different writers and at different times, and which are suggestive of the manner in which it has been viewed.

The term inflammation indicates the burning heat which constitutes a visible feature, and the ancient definition of rubor, tumor, calor et dolor (redness, swelling, heat and pain) of a part, retained for generations until it became classical, was thought till near the present time to sufficiently indicate the nature of the diseased state. As seen by the superficial observer, this definition is still a correct picture of the ordinary external or more grossly perceived phenomena. But as the process began to be studied more minutely, and by the aid of modern instruments of precision and the exacting methods of modern thought, it has been proposed to call it by different names, and different definitions have been given. Stasis, from the stoppage of the circulation of blood in the part most affected; exudation, from the pouring out from the vessels of serum, pus, and lymph; cell-proliferation, from the rapid multiplication of cells; and change of nutrition, from the perversion of that vital process, etc., have been proposed as better names to designate its more essential nature. The original name and the classical definition, and all these more modern terms, give certain views of its phenomena.

But soon it came to be spoken of as a succession of changes in a living part, produced by some injury, but one which was not sufficient to destroy its vitality.

This injury it was found might be produced by various irritants-mechanical, chemical, or specifically poisonous; and the processes induced were found to be complex and varied, according to the character and amount of the irritant and the susceptibility of the patient, and of the part irritated or injured. These particular processes I do not now, in detail, propose even to name. But the last definition and theory of inflammation which has come to my notice I propose very briefly to sketch. This account, if found to be true, may tend to afford some explanation of the efficacy of the few items of treatment I propose to discuss.

J. Bland Sutton, F. R. C. S., assistant surgeon of the Middlesex Hospital, London, in the Erasmus Wilson Lectures recently delivered, says:

"Inflammation may be defined 'the method by which an organism attempts to render inert noxious elements introduced from without or arising from within."" These noxious elements are called irritants, and are thought to be necessarily present when the process of inflammation is excited. Vascular disturbance results from these irritations, and the white blood corpuscles are declared to play a most important part in the inflammatory condition. These active motile cells have three functions which are brought into requisition in the inflammatory process.

1. Certain cells, among them the leucocytes, have the capacity to change their place and form.

2. They have the power of taking substances into their interior. 3. They are capable of decomposing organic material when taken into their protoplasm, or of performing intercellular digestion. Thus and otherwise they cause metabolic changes.

Metschnikoff, a Russian biologist, has made a particular study of this subject in the lower forms of animal life, and has found that some cells devour the dying elements of organs. Some receive bacteria into their interior and destroy them. They are even seen to pursue the bacteria, sieze upon, envelop, and digest them.

It is alleged that tadpole's tails and gills, which so mysteriously disappear, are absorbed by amoeboid cells; that not only partly digested fragments of such tissues are found in the cells, but fragments of bacteria also, and that when a single cell is not strong enough or large enough to dispose of a bacterium, several will combine, surround the microbe, and uniting, subdue it, and then constitute a giant cell. These giant cells are eaters"phagocytes"-as well as the smaller cells.

According to these assertions, based, it is said, upon microscopic observations, cells destroy various irritants introduced from without or developed from within. The process is physiological and

useful when moderate, and pathological and injurious when excessive. Much disturbance in the part and in the organism is produced when these processes are actively going on.

An inflammation is simple, or as I would say, non-specific, when reaction follows mechanical, thermal, or ordinary chemical irritants; specific, when particular poisons are the irritants, as the poison of variola, glanders, syphilis, and other infections. These poisons are organic, transferable, cultivatable, and, often at least, bacterial. It is possible, perhaps probable, that they induce changes of a chemical character in the body, producing ptomaines, or leucomaines, now coming into notice and becoming subjects of special study, which may play an important part, by poisoning the whole system, in the production of various diseases.

By the action of cells, it is alleged that noxious tissues are incapsulated and thrown out of the system, and that bacteria are thus expelled.

The author of the lectures referred to states that, read zoologically, in the light of the discoveries which are alleged to have been made, inflammation is a battle, and the contending parties are the wandering cells on the one side and the irritant materials on the other. The leucocytes are the defending army, the ordinary number in the healthy state the standing army. The roads are the blood vessels, and I would suggest the lymphatics are the waterways. When the organism is invaded by irritants of whatever kind-mechanical, chemical, ptomaines, leucomaines, organic, living bacteria, etc.,-a telegram is sent to headquarters by the vaso-motor nerves, the leucocytes assemble, and the standing army of them is recruited by a rapid multiplication of their numbers, often thirty-fold, in a short time. The defending cells of the system now become the attacking parties, and are slaughtered in the conflict as well as the invading enemy. sometimes happens in the confusion of an engagement, those of the same party often fall upon each other. It is stated that the cells which are slain or suffer from the enemy are eaten by other cells. The slaughter is often so great as to obstruct the roads