ABNORMAL FORMS OF THE NUTRITIVE PROCESS. 567 



virtue rather of its own plasticity, than of the vital force which it derives from 

 the tissues which it infiltrates. That there has been an atrophy rather than a 

 hypertrophy of the proper fabric of the part, becomes evident enough when 

 the inflammation has passed away, and this newly-formed tissue undergoes 

 degeneration and absorption. The only tissues in which there is any appearance 

 of increased formation during the inflammatory state, are those which corre- 

 spond in their low type of organization with the new tissue thus generated ; 

 namely, the areolar and other simple fibrous tissues, and also the osseous, of 

 which the organized basis is of the same kind. When the Inflammation is 

 more severe, the tendency to degeneration in the proper tissues of the part 

 becomes very obvious ; for it is by their interstitial decay and removal, that the 

 cavity of an abscess is formed ; it is by their superficial death and absorption 

 or solution that ulceration takes place ; and it is in the death of a whole mass 

 at once, that gangrene consists. That a diminution in the formative activity of 

 the tissues is an essential characteristic of the Inflammatory state, further 

 appears from the study of its etiology; for whether the causes to which the 

 inflammatory attack may be traced are local or general, acting primarily upon 

 the tissues of the part, or first affecting the blood, their operation is essentially 

 the same. For the local causes are all obviously such as tend either directly to 

 depress the vital powers, or to elevate them at first, and then to depress them 

 by exhaustion. Of the former kind are cold and mechanical injury; also many 

 chemical agents, whose operation tends to bring back the living tissues to the 

 condition of inorganic compounds. Under the latter category are to be ranked 

 all those agencies which produce over-exertion of the functional power of the 

 part, amongst which may be named heat, when not too excessive to produce a 

 directly destructive effect. Now cold, heat, chemical agents, and mechanical 

 injury, when operating in sufficient intensity, at once kitt the part, by entirely 

 destroying, instead of merely depressing, its vital powers ; and it is on the 

 borders of the dead part, where the cause has acted with less potency, that we 

 find the inflammatory state subsequently presenting itself. On the other hand, 

 there can be no doubt that many inflammations have their origin in morbid 

 conditions of the blood, which, without any other cause whatever, may deter- 

 mine all the other phenomena. This is most obvious with regard to those of a 

 4 '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 unquestionably rank such inflammatory diseases as are producible by 

 inoculation, the eruptive fevers for example ;' and scarcely less thoroughly 

 demonstrated 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 ( 201). In all such cases, the local affections are 

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

 mations produced by the introduction of arsenic or of other irritant poisons 

 into the circulation; and they may in fact be reasonably attributed to the im- 

 pairment of the formative activity of the parts upon which these poisons fix 

 themselves, in virtue of their " elective affinity" ( 207), 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 regarded as general or 

 constitutional causes of inflammation, is confirmed by the fact that the locali- 

 zation of the perverted nutritive condition is often determined (as Dr. W. Budd 

 and Mr. Paget have remarked) by a previous or concurrent weakening or de- 

 pression 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 



