122 INFLAMMATION. 



chronic congestion of the organ involved. Again, gradual hyperplasia 

 of the interstitial tissue takes place by the slow increase of cells and stroma, 

 without evidence of an active cell proliferation or marked involvement 

 of the blood-vessels. Finally, hyperplasia of the interstitial tissue may 

 be and probably usually is secondary to damage to or atrophy of the 

 parenchyma, as in the spinal cord after degeneration in nerve tracts or 

 in the heart after damage to the muscle fibres. In such cases it is ofteu 

 spoken of as r^?^w^j^e2^tZmL These forms of fibrous-tissue 

 hyperplasia will he considered with more detail in the sections dealing 

 with the special lesions of the viscera. They have all been usually re- 

 garded as marks of inflammation. Some of them unquestionably are 

 so; concerning others, doubt w r ill continue until our knowledge as to 

 their excitants considerably increases. In the mean time the term fibro- 

 sis is sometimes applied to the results of fibrous-tissue hyperplasia, though 

 this is still most commonly included among the inflammatory processes. 

 Those important phases of inflammation which are due to damage 

 from special forms of micro-organisms will be considered in detail in the 

 chapter of this book devoted to the Infectious Diseases. ' 



Special Phases of Inflammation. 



The several phases of the inflammatory process, which we have now 

 considered, are fairly typical of the reaction of the living body to various 

 forms and degrees of injury. If we look at them together and seek to 

 gather their dominant features, we find that the changes, varied as they 

 are in character as well as in degree, are mostly of three kinds : first, 

 those involving a greater or less amount of degeneration or necrosis ; sec- 

 ond, those involving local disturbances of the circulation, as well as 

 alterations in the distribution and character of the fluid and cellular 

 elements of the blood exudative changes ; and third, regenerative, produc- 

 tive, or reparative changes. 



Of these three groups of alterations in inflammation those involving 

 the blood-vessels and their contents are, in a clinical sense, most striking 

 and characteristic, and to many seem to dominate the inflammatory proc- 

 esses. But in fact all are closely associated. The various phases of 

 inflammation depend upon the nature and extent of the injury, the in- 

 herent reactive vigor of the cells, and the character and position of the 

 tissue involved. 



Special names have been attached to various forms of the inflamma- 

 tory process, descriptive of the feature which from the particular stand- 

 point of the observer seems most striking or important. Some of the 

 names are descriptive of clinical symptoms, some express the duration 

 or character or situation of the lesion, some seek to imply more or less 

 well-founded views of the nature of the process. Thus among the forms 



1 For a suggestive and interesting consideration of the relationship between inflam- 

 mation and various forms of "flbrosis" see Adami, Middleton Goldsmith Lectures, Metl- 

 cal Record, March 14 and 31, and April 4 and 11, 1896. 



