458 OF NUTRITION. 



on inflamed surfaces, or solidifying the inflamed part by the interstitial pro- 

 duction of similar lowly organized textures. Although it has been too much 

 the habit of Pathologists to speak of " coagulable " or " plastic lymph " as 

 if it were always one aud the same thing, yet it really presents various gra- 

 dations of character, which are manifested in its different degrees of orgauiz- 

 ability, and in the diverse nature of the tissues developed from it; and, as 

 Mr. Paget has pointed out, 1 there are two typical forms, the fibrinous, and 

 the corpmcular, between which the others are intermediate. The former 

 coagulates into a fibrous clot, resembling that of healthy blood, but usually 

 showing a more distinct fibrillation. The latter (the " croupous " exudation 

 of Rokitansky) is characterized by the want of any proper coagulation, the 

 fibrous clot being replaced by an aggregation of cells, which in their first 

 appearance resemble very nearly the primordial condition of the corpuscles 

 of the fluids of the absorbent vessels, and the colorless corpuscles of the 

 blood. It is seldom, however, that either of these typical forms of lymph 

 presents itself in a state of complete isolation from the other ; they are 

 much more commonly blended in various proportions, so that one or the 

 other predominates; and it is mainly upon the preponderance of fibrin, that 

 the "plasticity" of the fluid (or its capacity for organization) depends; 

 whilst according to the preponderance of corpuscles, will be its tendency to 

 degeneration. Thus the exudation of fibrinous lymph is the symbol of the 

 "adhesive" inflammation ; whilst that of the "corpuscular" is similarly 

 characteristic of the " suppurative " inflammation. 



376. It is obviously of great consequence to ascertain the conditions which 

 determine the production of one or other of these states ; and these, as Mr. 

 Paget has remarked (loc. cit.), may be considered under three heads, (1) 

 the previous state of the blood, (2) the seat of the inflammation, and (3) 

 the degree and character of the. inflammation. The condition of the blood, 

 as determining that of the lymph, has been carefully studied by Rokitansky, 

 who has shown that the characters of inflammatory deposits in different diath- 

 eses, correspond very generally and closely with those of the coagula found 

 in the heart and pulmonary vessels after death. The results of Mr. Paget's 

 experiments on the same subject have been already cited ( 217). And 

 clinical observation fully confirms this doctrine by evidence of another kind; 

 that, namely, which is afforded by the different course of the same specific 

 disease, in different individuals, according to the previously healthy or ab- 

 normal condition of their blood. There can be no doubt that a very large 

 proportion of what are called " unhealthy inflammations," especially those 

 of the erysipelatous type, are to be regarded as owing their peculiarity to 

 the low vitality of the components of the blood ; which seems to be favored 

 by the presence of decomposing matters, whose accumulation in the blood 

 acts in many ways so prejudicially on the system at large,' 2 and though the 

 evidence is as yet very faulty there is much reason for believing that the 

 special form assumed by the inflammation in certain forms of disease is due 

 to the development of the spores of various fungi and other low organisms 

 which from their lightness are readily carried by the currents of the air, or 

 may be ingested in drinking-water, and are ever ready, when the conditions 

 are favorable, to germinate. 3 That the quality of the local product is in 



1 Lectures on Surgical Pathology, vol. i. p. 332 



'-' Sec Mr. Brooke (Jallwey's papers on Unhealthy Inflammation, in the Lancet for 

 184!)-f>o, and the Medical Gazette for 1850-51. 



See Hi,- olervations of LaptschinsUy (Centralblatt f. cl. Mod. Wiss., 1875, p. 84) 

 on the nccurrcMce of Spirilla in the; blood of patients suffering from recurrent fever ; 

 of Li-wi> on the presence of Ilu-mafo/oa in Human blood in (jhyluria (Report of the 

 Sanitary Commission in India, 1872), and the numerous papers that have been pub- 



