Going into the Flame: Learning the Cardinal Signs of Inflammation

What is inflammation? New ways to turn off inflammation have revolutionized the treatment of arthritis and other illnesses, which begs the question.

Coming from the Latin words “into the flame,” like what bonfire sitters observe the moth doing on a summer night, inflammation is a natural phenomenon that can be harmful and almost evil. But there is much more to this story.

The Cardinal Signs

During the summers of my first four years of medical school, I was honored to spend time with the doctors of the Bartron Clinic in Watertown, where they generously provided an educational experience for me. I realize now at that level of training, how little help I was to any of them, but how much help their wisdom would eventually be to me.

One highlight on inflammation and the history of medicine came from pediatrician Dr. Ebehardt Heinrichs. While we were examining a young child with acute arthritis, he pointed out on her hands the four physical findings famously described by Celsus, a Roman who lived at the time of Jesus. “These are the cardinal signs of inflammation: “rubor” (redness,) “tumor” (swelling,) “calor” (heat,) and “dolor” (pain,)” he said.

What Inflammation Can Mean

A red, swollen, hot, and painful joint is not the only medical condition of inflammation I saw those Watertown summers. There were abscesses, appendicitis, tonsillitis, meningitis and sinusitis, all indicating benefits of the inflammatory response, where invading infections were fought off by the body’s white-cell warriors.

Also beneficial, we have recently learned that muscle growth comes as a result of a response to localized acute inflammation that follows exercise. Other new studies show that low-intensity training, like walking, can reduce destructive chronic inflammation. All-in-all, our bodies are protected and even sculpted by the yin and yang of balanced and healthy inflammation.

But seeing that young girl with arthritis, I realized there can be harm resulting from inflammation run amok. That summer in Watertown I also saw patients with asthma, poison ivy, psoriasis, Lupus, and rheumatoid arthritis—illnesses the result of too much inflammation.

Add to this, now we’ve learned certain cancers grow because of inflammation. And now we have medicine that can turn off small and harmful targets of inflammation. We can cool crippling arthritis, soothe devastating rashes, and even shrink growing cancers.

Rubor, tumor, calor, dolor… it can be a bad and a good thing!

Dr. Rick Holm wrote this Prairie Doc Perspective for “On Call®,” a weekly program where medical professionals discuss health concerns for the general public.  “On Call®” is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. “On Call®” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central, 6 p.m. Mountain. Visit us at OnCallTelevision.com. 

By Dr. Richard Holm

Internal Medicine Physician at Avera Brookings Medical Clinic

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