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The Kinds of Inflammation

body, gouty, membrane, rheumatic, serous, surfaces and process

THE KINDS OF INFLAMMATION.

Wherever it occurs the process of inflam mation is essentially one and the same ; what ever differences occur are due rather to the situation of the process, or its duration, or to such causes as have been already discussed, depending upon the intensity and character of the injury or irritation. But it is necessary briefly to explain a few terms not yet re ferred to.

Serous Inflammation is inflammation of a serous membrane. This is the membrane which lines the closed cavities of the body, of which the best example is a joint, the serous membrane being there called synovial (see p. 64). The pleural sac surrounding the lungs is lined by a serous membrane (see p.344), and so also is the similar double sac round the heart (see p. 298). The feature of inflammation in such membranes is the exudation of large quantities of fluid—serous fluid,—which sepa rates the two layers of the membrane, and to this is due the dropsy that occurs in inflamed joints, the effusion that occurs in pleurisy, and the dropsy that may take place round the heart. But this is just an exaggeration of the oozing referred to as one of the occurrences from the blood-vessels of inflamed areas.

In such situations also the surface of the in flamed serous membrane may be covered with coagulable material, and if the effusion be not great, or be absorbed, then the opposed surfaces tend to become glued together or adherent to one another. As a role suppuration does not occur in such cavities unless they have been infected by septic organisms from without.

Catarrhal Inflammation occurs on sur faces which are not shut off from the outside, surfaces lined by mucous membrane—the nose, throat, bronchial tubes, stomach, bowel, bladder, womb, &e. Such surfaces are lined by cells which secrete a material, called mucus, which maintains the moisture of the surface and is viscid enough to protect it also. When such surfaces are inflamed, the increased flow of blood causes great increase in the mucous secretion, and thus there is an actual flow from the surface, typically seen in catarrh of the nose and in bronchitis, which is a catarrrhal inflammation of the membrane lining the bron chial tubes. Such inflamed surfaces, being open to the air, arc, of course, open to the deposit on them of organisms, so ticat such a catarrh readily becomes transformed from a mucous into a purulent one.

These two terms jest described refer, we have said, to inflammation characterized by features due to the situation of the inflamma tion. Other terms applied to inflammation may rather serve to indicate their cause.

Rheumatic Inflammation, for instance, merely indicates that the real cause of the in flammatory process is the rheumatic poison.

Gouty Inflammation similarly indicates that it is the gouty tendency, the uric acid poison, that is at the root of the inflammatory process. But so little do these terms necessarily indicate any essential difference that a serous inflammation may be rheumatic or gouty in origin, and so also may a catarrhal inflamma tion.

For a fuller discussion of the nature of rheu matic or gouty inflammations the reader should refer to pp. 552, 554.

To simplify the discussion of inflammation, we have gone on the assumption that its causes are always introduced from without by a wound or the introduction of a poison, and so on. We may now add that the cause of inflammation may arise from within the body. The poisons of rheumatism and gout, just referred to, are cases in point. They are produced within the body, and by the blood are carried to all parts of the body. Microbic poisons may, similarly, be carried by the blood stream to every part of the body and may thus provoke inflammatory changes of one kind or another at situations very distant from one another.

In a word, the gouty or rheumatic person produces in his own body the material that, distributed by the blood stream all through his body, sooner or later injures or irritates one tissue or organ or another. This is the explanation of the fact that such a person may one day have a rheumatic or gouty inflam matory attack of a joint, another day of an eye, another time of the throat, and so on. In every case, whether it can be identified or not, the reason for one organ or tissue being the seat of attack at one time, and another organ or tissue at another, will be that that particular organ or tissue has been subjected to some unusual or undue strain, has had its vitality temporarily depressed, and so its re sistance to the gouty or rheumatic poison, ever more or less flowing through it, has yielded to the strain.

In all such cases, however, the inflammatory process is essentially that which has just been fully described.