432 MUCOUS MEMBRANES. 



at the disposal of the organism are inflammation and sappnra- 

 tion. We call this form of inflammation ^'reactive," meaning 

 thereby that it is supposed to respond, as it were, to tlie irritation 

 exercised on the surrounding mucous membrane by the diph- 

 theritic slough; some portion, ho^Yever, of the hyperagmia may be 

 interpreted as a collateral fluxion, occurring in harmony with 

 statical laws (^i.e. of a passive, not an active kind). The pus 

 collects between the slough and the healthy tissue ; the former 

 begins to separate at its edges or at its centre, according as the 

 fibrous bridges alluded to above, melt and give way in the former 

 or the latter order. When the separation is complete, an ulcer 

 is left, which tends speedily to cicatrise ; a recrudescence of the 

 morbid process not unfrequently occurs, a new slough is formed, 

 a renewed necessity arises for a sequestrating suppuration, the 

 resulting loss of substance being far more considerable than it 

 Avas in the first instance. The scars which are ultimately left 

 are very prone to contract, so that the risk of a subsequent 

 stricture of the mucous tube (particularly of the large intestine 

 after dysentery) is directly proportionate to the extent of the 

 previous ulceration. 



§ 371. It is worthy of note that diphtheria affects such 

 mucous membranes as are already in a state of violent catarrhal 

 inflammation, and whose surface is at the same time in ^^er- 

 manent contact watli putrescent, decomposing substances. In 

 dysentery, which begins as a simple catarrh of the greater 

 bowel, accompanied by excessive spasmodic contractions of its 

 muscular coat, the diphtheritic process primarily affects the free 

 borders of the mucous folds over the tceiiicu longitudinales and the 

 plkce sigmoidece ; also those natural flexures of the intestinal tube 

 where most resistance is offered to the passage of the faeces, sc. 

 three successive points in the sigmoid flexure, the coecum, the 

 hepatic and splenic flexures of the colon. Now the circumstance, 

 that at these points the inflamed mucous membrane is longest 

 and most closely in contact with putrid matters, must surely aid 

 in the localisation of the diphtheritic process. In much the same 

 way, diphtlieria complicates those catarrhal affections of the 

 urinary passages which are due to retention. Whether the 

 retention be caused by stricture of the urethra, by enlarged 

 prostate, by paralysis of the detrusor muscle, &c., the stagnant 

 urine becomes decomposed, and sets up a catarrh passing into 



