462 OF NUTRITION. 



In some instances the puriform fluid appears as a discharge on the surface of 

 the membrane, as of the Urethra in Gonorrhoea, or of the Conjunctiva in 

 Purulent Ophthalmia ; in others it appears in the substance and between 

 the ultimate textural components of the tissues themselves, and then consti- 

 tutes an abscess. The anatomical changes that take place in a very well-de- 

 fined though small abscess, that namely of the small-pox pustule, have been 

 made the subject of special study by Dr. Klein, 1 and his observations show 

 that the principal seat and origin of the changes occur on either side of the 

 well-defined line which separates the rete Malpighii from the vascular tissues 

 forming the papillary layer, the inflammation being apparently excited, or 

 at least accompanied by the development in the finest lymphatics of a kind 

 of fungus, consisting of a feltwork of delicate-branched filaments, giving off 

 acrospores or conidia at the growing ends, like the fungi of the penicillium 

 group, and which may be regarded either as resulting from the development 

 of the poisonous agent to which the whole series of phenomena is due, or as 

 some fungoid vegetation introduced from without and developing at this 

 spot, because the conditions are favorable, coincidently with, or very soon 

 after the appearance of the mycelium. The cells of the rete rapidly germi- 

 nate and some enlarge, become vacuolated, and unite with others to form 

 cysts and cavities. The cysts are at first filled with clear fluid and granules, 

 but subsequently with pus-cells and germinating fungus. Similar changes 

 take place in the corium, and the whole tissue becomes infiltrated with leu- 

 cocytes. When such a small abscess as this bursts, or when the discharge 

 from the surface is accompanied by softening and breaking-down of the sub- 

 jacent tissues, an ulcer is produced; but whether the disintegrating tissues 

 are entirely removed by absorption (having previously undergone that de- 

 generative softening which is requisite for the occurrence of such process), or 

 whether they are broken up and dissolved in the purulent fluid, is a point 

 not yet determined. The conservative nature of the fibrinous exudation, and 

 the consequent importance of fibrin as an element of it, are well shown by 

 the results of its deficiency. Thus if there be no "sac" formed around a 

 collection of pus, this fluid infiltrates through the tissues, and by its mere 

 presence so impairs their nutrition, that a corresponding degradation takes 

 place in the characters of the plastic material furnished for their assimila- 

 tion ; and hence the purulent effusion spreads without limit, and the tissues 

 through which it percolates undergo rapid degeneration. So, again, when 

 gangrene is spreading by contiguity (the proximity of the dead tissue tend- 

 ing to lower the vitality, and even to occasion the death, of that with which 

 it is continuous), it is only when an inflammatory "reaction" occurs, or in 

 other words, when a development of fibriuous lymph takes place in the sub- 

 stance of the tissues bordering on those which have lost their vitality, that 

 a line of demarcation between the dead and the living parts is formed. 

 And generally, it may be said, that, as the ultimate tendency of Inflamma- 

 tion is to produce the disintegration of the part, the ultimate tendency of the 

 fibrinous material developed is to keep its elements together, and to repair 

 the losses which have taken place, although with a very inferior material. 

 It is only, however, with the subsidence of the inflammation, and the return 

 to the ordinary type of nutrition, that the highest development of the lymph 

 can take place ; and it is in proportion as this occurs more speedily, that 



1869), and Emminghaus (Ludwig's Arbeitcn, 1874), that section of the nerves of a 

 limb increase the flow of lymph, and lastly, of Hammiirsten (Ludwig's Arbeiten, 

 IST'J), that dogs from which much lymph has been withdrawn contain a larger amount 

 of oxygen in their blood. 



1 Sue Dr. .Sanderson's Lectures, British Mod. Journal, 1875, p. 405. 



