536 



SEROUS AND SYNOVIAL MEMBRANES. 



pared. The appearances of the pus present 

 the varieties met with in this fluid generally. 



In the most favourable cases, the fluid ra- 

 pidly diminishes in quantity ; and the pus-cells, 

 which are incapable of further organization, 

 disappear, the substances which compose them 

 being, in all probability, absorbed subse- 

 quently to the breaking up of their structure ; 

 while the remaining parts of the exsudation 

 become organized together with the adhering 

 walls of the cavity, and result in the complete 

 obliteration of the serous structure. 



In other instances, the suppurative process 

 takes a more unfavourable course ; the pus 

 assumes a sanious appearance and a very of- 

 fensive smell ; and, finally, after ulceration or 

 sloughing of the serous membrane, is dis- 

 charged through the opening into the cavity 

 of the viscus, or into a neighbouring serous 

 membrane, or on the surface of the body. 



Sometimes this process appears to be modi- 

 fied by the occurrence of a less complete ab- 

 sorption. The pus, deprived of certain of its 

 constituents, is slowly transformed into a 

 mortar-like mass, lining the membranous wall 

 by which it appears to be secreted. The 

 sandy or gritty consistence of this substance 

 shows that it contains chiefly the inorganic 

 constituents of the exsudation ; and sometimes 

 the fluid, gradually thickening, passes into a 

 eheesy pultaceous mass, and thence, by long 

 duration, into a cretaceous substance, resem- 

 bling that into which tubercle often degene- 

 rates. 



The so-called chronic inflammation presents 

 no differences which can be called essential ; 

 most of them chiefly referring to the duration 

 and intensity of the process, rather than to 

 any peculiarities in its nature and appearances. 

 For instance, if the general symptoms are less 

 prominent than usual, and the disease pro- 

 gresses slowly, with frequent remissions and 

 exacerbations, it is called " chronic." So, also, 

 the same name would be applied to a case 

 which, originally " acute " in the intensity of 

 its symptoms, and the rapidity of its progress, 

 had overpassed the violence of the first attack ; 

 the effusion remaining with diminished con- 

 stitutional disturbance. Or a recurrence of 

 the inflammation, pouring forth a new effu- 

 sion in and within the already dense and har- 

 dened layer of a previous exsudation, is called 

 chronic. In such a relapse, the unorganized 

 exsudation has been said to be the seat of (he 

 secondary inflammation ; but it may be ques- 

 tioned how far the inflammatory process can 

 occur in a tissue which is as yet unprovided 

 with vessels : and even were the absence of 

 these as complete as it seems to be, the in- 

 flammation of the lymph would scarcely be a 

 necessary supposition, since it would be dif- 

 ficult to deny the possibility of a physical 

 transudation of fluid, derived from the nearest 

 vascular surface, or that of the original mem- 

 brane. 



Besides these divisions of inflammation ac- 

 cording to its duration and results, there 

 are others, in which the process is compli- 

 cated_ by its occurrence in connection with 



other diseases, or by its dependence upon some 

 specific cause. Amongst these the " haemor- 

 rhagic " effusion, first recognised by Laennec, 

 holds a very conspicuous place. In this dis- 

 order the inflammatory exsudation is mingled 

 with more or less blood, which communicates 

 its colour and appearances to the whole mass, 

 in a degree varying with the quantity in which 

 it is present. By longer duration, it separates 

 into two parts : a peripheric layer of whitish 

 or slightly-coloured lymph, which covers the 

 serous surface ; and a fluid which contains 

 the greater part of the blood corpuscles and 

 serum, and is included in the cavity formed 

 by the plastic layer. This liquid portion is 

 only capable of a very slow absorption, and 

 prior to this event it passes through many 

 gradations of colour and appearance. Ge- 

 nerally, it slowly loses its red colour ; but in 

 the case of the haemorrhagic inflammations of 

 the peritoneum, it very frequently becomes 

 darker, and, finally, almost black ; a change 

 which seems due to the action of the intes- 

 tinal gases. This conjunction of inflammation 

 and haemorrhage occurs in many diseases, but 

 with the greatest frequency in tubercular ca- 

 chexia, in fevers, and in other exanthemata. 

 In all these disorders, the mass of the blood is 

 greatly affected, and in many of them suffi- 

 ciently so to exhibit marked deviation from 

 the composition and properties of the healthy 

 fluid. And in addition to these, the gene- 

 ral conditions of its occurrence, Rokitansky * 

 points out a local circumstance which greatly 

 favours its access ; viz. the previous existence 

 of a plasma, in which organization is com- 

 mencing. And he refers this aptitude for 

 haemorrhage to the probable state of its vas- 

 cular apparatus, which, in this early stage of 

 its development, offers simultaneously the 

 greatest delicacy in the texture of its walls, 

 and a deficiency of anastomosis with the 

 neighbouring vessels ; two conditions which 

 would respectively diminish its capacity of re- 

 sistance to any distensive force, and increase 

 the amount and duration of this distension. 

 And in illustration of this his opinion, it may 

 be pointed out, that a granulating surface on 

 the exterior of the body seems closely to imi- 

 tate these local conditions; while the resulting 

 haemorrhage, often traceable to the congestion 

 mechanically producible by posture, often de- 

 pending on exciting causes of a more recon- 

 dite nature, affords a parallel to some of the 

 effusions noticed above. 



The events of inflammation are mainly in- 

 cluded in the preceding sketch of the effusion 

 which constitutes its most important feature : 

 in this manner adhesion, suppuration, ulcera- 

 tion, and more rarely sloughing, occur. But 

 they also happen, though with less frequency, 

 as secondary affections of the serous mem- 

 branes, in connection with diseases of the 

 viscera or cavities which they cover. Thus, a 

 morbid process in the immediate neighbour- 

 hood of a serous membrane frequently causes 



* Handbuch der Pathologischen Anatomic, Band 

 ii. S. 28. 



