12 PRACTICE OF PHYSIC. 



with the serum effused, which it operates upon more powerfully 

 while the serum is stagnant and retained in the heat of the 

 body : but it may also arise from the peculiar nature of the 

 matter effused being disposed to putrefaction ; as particularly 

 seems to be the case of the red globules of the blood effused 

 in a large quantity. In a third manner also, a gangrene seems 

 frequently to arise from the violent excitement of the inflamma- 

 tion destroying the tone of the vessels ; whereby the whole 

 fluids stagnate and run into putrefaction, which, taking place in 

 any degree, destroys still further the tone of the vessels, and 

 spreads the gangrene. 



CCLVII. In inflammation, the tendency to gangrene may 

 be apprehended from an extreme violence of pain and heat in 

 the inflamed part, and from a great degree of pyrexia attending 

 the inflammation. 



The actual coming on of gangrene may be perceived, by the 

 colour of the inflamed part changing from a clear to a dark red ; 

 by blisters arising upon the part ; by the part becoming soft, 

 flaccid, and insensible ; and by the ceasing of all pain while these 

 appearances take place. 



As the gangrene proceeds, the colour of the part becomes 

 livid, and, by degrees, quite black ; the heat of the part entirely 

 ceases ; the softness and flaccidity of the part increase ; it loses 

 its consistence, exhales a cadaverous smell, and may then be 

 considered as affected with sphacelus. 



CCLVIII. Gangrene is thus a third manner in which in- 

 flammation terminates ; and the schools have commonly marked 

 & fourth termination of inflammation, which is by a scirrhus, or 

 an indolent hardness of the part formerly affected with inflam- 

 mation. This, however, is a rare occurrence, and does not 

 seem to depend so much upon the nature of inflammation, as 

 upon the circumstances of the part affected. It is in glandular 

 parts chiefly that scirrhosity is observed ; and it is probably 

 owing to the parts readily admitting a stagnation of the fluids. 

 I have observed, that inflammation seldom induces scirrhus ; 

 but that this more commonly arises from other causes; and 

 when inflammation supervenes, which it is sooner or later apt 

 to do, it does not so commonly increase as change the scirrhos- 

 ity into some kind of abscess. From these considerations, it 



