570 OF NUTRITION. 



especially when this congestion is due to an obstruction to the return of the 

 blood ; whilst, again, it may be due to an altered condition of the albuminous 

 constituent of the blood, which favors its transudation ( 167). The so-called 

 serous effusions which are poured forth in inflammation do in reality contain 

 fibrin in solution ; but this fibrin may not manifest its presence by spontaneous 

 coagulation, until its passage into the solid state is favored by some extraneous 

 influence ( 26). The presence of fibrin in such an effusion, however, is not 

 in itself a sufficient proof of the existence of inflammation ; for it has been shown 

 by the experiments of Mr. Robinson, 1 that when the obstruction to the return 

 of blood by the veins is so great as to occasion an excessive pressure within the 

 capillaries, the fluid which transudes may contain enough fibrin to render it 

 spontaneously coagulable. The form of exudation which is most characteristic 

 of Inflammation is that which is known as coagulable lymph; it is much to be 

 desired, however, that some other designation should be applied to it, since the 

 term "lymph" can only be appropriately employed for the fluid contents of the 

 lymphatic vessels. The peculiar characteristic of this inflammatory exudation 

 is its capability of spontaneously passing into the condition of an organized 

 tissue, either fibrous or cellular, or a mixture of both ; and of thus forming 

 " false membranes" on inflamed surfaces, or solidifying the inflamed part by the 

 interstitial production 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 and the same thing, yet it really presents 

 various gradations of character, which are manifested in its different degrees of 

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

 as Mr. Paget has pointed out, 3 there are two typical forms, the fibrinous, and 

 the corpuscular , between which the others are intermediate. The former coagu- 

 lates 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 ab- 

 sorbent 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 exudation (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. 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 pointed out (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 in- 

 flammation. 



613. The condition of the blood, as determining that of the lymph, has been 

 carefully studied by Rokitansky; who has shown that the characters of inflam- 

 matory deposits in different diatheses 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 

 ( 196). And clinical observation fully confirms this doctrine by evidence of 

 another kind; that, namely, which is afforded by the different course of the same 



1 " Medico-Chirurgical Transactions," vol. xxvi. p. 51. 



2 "Lectures on Inflammation," in " Medical Gazette," 1850, vol. xlv. p. 1012. 



