ABNORMAL FORMS OF NUTRITIVE PROCESS. INFLAMMATION. 569 



to the augmented flow of blood through the surrounding vessels ; and, so far as 

 it depends upon local changes, it obviously indicates a more rapid disintegration 

 of tissue, rather than a more energetic production of it ; since it is in the former 

 state rather than in the latter, that the conditions of the development of heat 

 (on the chemical theory) are supplied, as we see that the heat of a muscle is 

 the greatest when it is being disintegrated by active exercise ( 330), not when 

 it is being repaired by the formation of new tissue in the intervals of repose. 

 But, as Mr. Paget justly remarks, " this phenomenon is involved in the same 

 difficulty as are all those that concern the local variations of temperature in the 

 body ; difficulties which the doctrines of Liebig, however good for the general 

 production of heat, are quite unable to explain." (See CHAP, xm.) And 

 lastly, with regard to the unusual tenderness of inflamed parts, this is obviously 

 due to such a combination of causes, none of which can be legitimately held to 

 indicate an increase of its proper vital activity, that nothing can be rested on 

 this alone ; especially as we see an augmentation in the susceptibility of the 

 sentient nerves, under many circumstances (as in hysterical disorders), in which, 

 far from an augmented there is obviously a diminished activity in the parts 

 from which they spring. That neither an alteration in the circulation of a part, 

 nor a departure from the normal condition of its nervous supply, can be regarded 

 as one of the essential phenomena of inflammation, is obvious from this, that 

 the most important phenomena of inflammation may present themselves, as 

 results of injury or disease, in parts that have neither bloodvessels nor nerves : 

 this is seen in the deposition of lymph in the cornea, in the ulceration of the 

 cornea and of articular cartilages, and in other morbid actions in these parts, 

 which, if ever they are vascular, become so only after the effusion of lymph in 

 them, the new vessels being formed in this lymph, and not in the tissues them- 

 selves. Here it is obvious that the whole change consists in a perversion of the 

 nutritive actions which the tissues ought to carry on, at the expense of the ma- 

 terials which they draw from the blood of the surrounding vessels ( 253, 254). 



611. Of the alterations in the condition of the Blood in Inflammation, an 

 account has already been given ( 171-177) ; and it is here only necessary to 

 recapitulate them. The most characteristic is the augmentation either of the 

 organizable or plastic fibrin, or of the organized colorless corpuscles; the in- 

 creased production of these two components seeming to bear in some degree a 

 relation of reciprocity, the one to the other. The increase of Fibrin may be 

 considered as the alteration most characteristic of a previously healthy and 

 vigorous state of the system; and it is in the inflammations which occur in such 

 subjects, that the effusions are most strongly disposed to become organized, and 

 show the least tendency to undergo degenerative changes. On the other hand, 

 the increase of the Corpuscular element seems to occur in cachectic or otherwise 

 unhealthy individuals; and the inflammatory effusions, which partake of the 

 same character, are far less plastic originally, and are extremely prone to under- 

 go degeneration, either at the time of their effusion or subsequently. With 

 this increase in the proportion of fibrin and colorless corpuscles, separately or 

 in combination, there is a diminution in the proportion of the red corpuscles, 

 albumen, and salts of the blood. None of these changes, however, can be 

 legitimately regarded as originally or essentially characteristic of the inflamma- 

 tory condition ; they are, in fact, to be looked-on rather as the results of its 

 establishment, constituting that series of alterations in the circulating fluid, 

 which is of parallel order to that which occurs in the solid tissues wherein the 

 inflammatory action has been set up. 



612. The Inflammatory state is further characterized by the effusion of certain 

 of the components of the Blood, upon the surface, or into the substance, of the 

 inflamed tissues. The effusion of pure serum cannot be regarded as character- 

 istic of inflammation ; since it may take place as a mere result of congestion, 



