572 OF NUTRITION. 



But it would seem as if even the most perfectly fibrin ous lymph may pass almost 

 immediately into the condition of pus, when it is effused among tissues which 

 are passing rapidly into a state of decomposition ; and thus it appears to be, 

 that in a phlegmonous inflammation, the lymph effused into the parts where the 

 inflammatory process has been most intense (the stagnation of the blood being 

 the most complete, and the normal tissues most disposed to disintegration), does 

 not present the slightest tendency to a higher type of organization, but is de- 

 veloped from the first in the condition of pus, which fills the vacant space pre- 

 viously occupied by living tissue ; whilst, in the surrounding parts, the fibrinous 

 effusion produces a consolidation of the tissue, and thus forms the walls of the 

 abscess, by which the purulent effusion is limited. Whether the disintegrating 

 tissues are entirely removed by absorption (having previously undergone that 

 degenerative softening which is requisite for the occurrence of this 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 im- 

 pairs their nutrition, that a corresponding degradation takes place in the cha- 

 racters of the plastic material furnished for their assimilation ; and thus the 

 purulent effusion spreads without limit, and the tissues through which it perco- 

 lates undergo rapid degeneration. So, again, when gangrene is spreading by 

 contiguity (the proximity of the dead tissue tending to lower the vitality, and 

 even to occasion the death, of that with which it is continuous), it is only when 

 an inflammatory " reaction" takes place, or, in other words, when an exudation 

 of fibrinous lymph is poured into the substance 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 inflammation is to produce the disintegration of the part, the 

 ultimate tendency of the fibrinous exudation 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 

 the recovery of the organization proper to the part is more completely effected. 1 

 615. In persons of that peculiar constitution which is termed Scrofulous or 

 Strumous, we find an imperfectly organizable or " caco-plastic" deposit, or even 

 an altogether aplastic product, known by the designation of tubercular matter, 

 frequently taking the place of the normal elements of tissue ; both in the ordi- 

 nary process of Nutrition, and still more when Inflammation is set up. From 

 an examination of the Blood of tuberculous subjects it appears, that although 

 the bulk of the coagulum obtained by stirring or beating it is usually greater 

 than that of healthy blood, yet this coagulum does not consist of well elaborated 

 fibrin ; for it is soft and loose, and contains an unusually large number of 

 Colorless corpuscles, whilst the Red corpuscles bear an unusually small propor- 

 tion to it. We can understand, therefore, that such a constant deficiency in 

 plasticity must affect the ordinary nutritive process -, and that there will be a 

 liability to the deposit of caco-plastic products, without inflammation, instead of 

 the normal elements of tissue. Such appears to be the history of the formation 



1 The Author has pleasure in referring to Mr. Paget's " Lectures on Inflammation" 

 (Medical Gazette, 1850) as containing, in his opinion, the best exposition of the subject 

 yet made public ; and in acknowledging his obligations to them for much assistance in the 

 short view of it given above. The fundamental doctrines on which the Author would now 

 lay the greatest stress, however, are the same in all essential particulars with those which 

 he has taught in previous Editions of this Treatise. 



