ABNORMAL FORMS OF NUTRITIVE PROCESS INFLAMMATION. 455 



sen ting itself. On the other hand, there can be no doubt that many inflam- 

 mations have their origin in morbid conditions of the Blood, which, without 

 any other cause whatever, may determine all the other phenomena. This 

 is most obvious with regard to those of a "specific" kind; but it is also 

 probably true of the majority of the so-called spontaneous or constitutional, 

 as distinguished from traumatic inflammations. We seem, indeed, to be 

 able to trace a regular gradation between inflammatory attacks which are 

 entirely traceable to the introduction of a poison into the blood, and those 

 which result from causes purely local. Under the first head, we may un- 

 questionably rank such inflammatory diseases as are producible by inocula- 

 tion, the eruptive fevers for example ; and scarcely less thoroughly demon- 

 strated are the cases of rheumatism and gout, and many inflammations of 

 the cutaneous textures, which, when occurring in the chronic form, tend to 

 exhibit a regular symmetry ( 218). In all such cases, the local affections 

 are the external signs of the general affection of the blood, just as are the 

 inflammations produced by the introduction of arsenic or of other irritant 

 poisons into the circulation ; and they may in fact be reasonably attributed 

 to the impairment of the formative activity of the parts upon which these 

 poisons fix themselves, in virtue of their "elective affinity" ( 220), just as 

 the peculiar functional activity of the nervous centres is affected by narcotic 

 poisons. And this view of the really local action of what are primarily re- 

 garded as general or constitutional causes of inflammation, is confirmed by 

 the fact that the localization of the perverted nutritive condition is often de- 

 termined (as both Dr. W. Budd and Mr. Paget have remarked) by a pre- 

 vious or concurrent weakening or depression of the vital activity of the 

 part. Thus a part which has been the seat of former disease or injury, and 

 which has never recovered its vigor of nutrition, is always more liable than 

 another to be the seat of local manifestation of blood disease ; it is, in com- 

 mon language, the " weak part." 1 And it frequently needs such a concur- 

 rent operation of a local depressing cause, to fix and develop the action of 

 the constitutional cause, or blood disorder; thus, a rheumatic or gouty dia- 

 thesis may exist for some time (as when, to use a common expression, the 

 disease is "flying about" the patient), and yet the poison may not have 

 sufficient potency to produce an attack of acute inflammation, until the vi- 

 tality of some particular organ becomes depressed by cold, overexertion, or 

 some similar influence, which would not have itself engendered the diseased 

 action, had it not been for the concurrence of the morbid condition of the 

 blood. Thus we seem justified in concluding that, whether the causes of 

 Inflammation act directly upon the tissues of a part, or whether they act 

 upon it through the intermediation of the blood, their effect is to produce a 

 depression in its vital powers, which manifests itself in a deficient as well as 

 abnonnalli/ directed formative activity, and in an increased tendency to degen- 

 eration ; and that this is one of the primary and essential conditions of In- 

 flammation. 



373. This view is by no means inconsistent with the occurrence of other 

 manifestations of Inflammation which have been supposed to indicate "in- 

 creased action ;" and, in fact, it is in such striking accordance with the 

 phenomena presented by the movement of the blood, when these are inter- 



1 Thus Impetigo appears about blows and scratches in unhealthy children, and- 

 Erysipelas first attacks the seat of local injury in men with unhealthy blood. Per- 

 haps as good an example as any, is afforded by the uniform limitation of the inflam- 

 mation consequent upon the introduction of Vaccine matter into the blood, to tin; 

 spots in which the puncture was made ; notwithstanding that the whole mass of blood 

 is jiffucU'd by it, as is shown by its incapacity for subsequently developing ihe poison 

 of small-pox. 



