Inflammation: John Hunter's "A treatise on the blood, inflammation and gun-shot wounds"

John Hunter's A Treatise on the Blood, Inflammation and Gunshot Wounds was published in 1794. Throughout the nineteenth century this was considered the most important study of inflammation and has been widely quoted since. After a section on the nature of blood and the circulatory system, in which he describes the vascular supply in detail, he passes on to an extensive survey of inflammation. This is based mainly on his wide clinical experience, including that as a military surgeon. He, however, supplements this with a number of experiments, some of which are classic. He bases his observations on the four cardinal signs of Celsus (redness, heat, swelling and pain). Inflammation is then divided into three main groups: adhesive, suppurative and ulcerative. He discusses the nature of pus and the formation and treatment of abscesses. He describes his experiments on the transplantation of tissues under the general heading of adhesive inflammation. This, he states, underlies the union of wounds and thus the union of tissues after transplantation. Although unaware of the role of infecting organisms as a cause of inflammation, he makes observations on inflammation in smallpox, venereal infections and tuberculosis. He relates these to his observations on inflammatory aspects of wound healing. Lister was particularly influenced by Hunter's observations in the development of antisepsis. As well as the local effect of inflammation, Hunter was concerned with the constitutional effects such as fever.