HISTOLOGY OF INFLAMMATION. Inflammations of the various tissues assume different forms as far as the gross appearances are concerned, but the underlying condition is precisely the same. The various types of inflammations that are produced by one and the same process are of considerable scientific interest, but to the practical and inquiring reader, whose principal object is to obtain sufficient information to be able to cure herself, it would be confusing were I to attempt a description of their differences. There is no word that is so often employed as inflammation, as a designation of disease, and when we learn that there is only one kind of inflammatory process, whether of the brain, the lungs, liver, kidneys or bowels, the entire subject of inflammatory diseases at once becomes greatly simplified, because if you understand one you must understand all. I will in the subsequent chapters speak only, or principally, of inflammatory affections of the different organs that come within the province of this specialty, and I am convinced that if the reader will bear with me, so that I may take sufficient time and space to explain the most advanced scientific views of inflammatory processes, she will be more than compensated, by a clearer understanding of what will be said in succeeding pages. Inflammation comprises a series of phenomena, which partly take place in the vascular apparatus or blood vessels and partly in the tissues comprising the structure of the organ. Inasmuch as inflammation is not a single process, a definition of a few words is insufficient to convey to the Since the time of Galen, who lived two hundred years after Christ, inflammation was recognized by four cardinal symptoms, namely redness (Ruber), swelling (Tumor), pain (Dolor) and the increased temperature (Calor). To these modern pathologists have added a fifth symptom, which is lessened or diminished function (Functio LÆsa). The above five cardinal symptoms can be established in the majority of the acute stages of inflammation: in the chronic or subacute variety, one or the other symptom may be absent, or so obscured as to escape notice. The nature and structure of the tissue materially modify some symptoms and exclude others, so that redness, pain and even perceptible swelling may be absent. Galen already in his time attributed the redness to an increased blood supply and the swelling to an exudation of lymph or serum, through the walls of the blood vessels: this was as near the truth as scientists arrived, until within our own time. The discoveries in this field of science have been greatly enriched in the last twenty years through the researches of the German school. Various theories have been advanced from time to time, as to the probable causes or processes that are going on in the tissues while inflammation is active. One observer believed that he had found the solution of the inquiry in a supposed spasmodic contraction of the capillary blood vessels, another in their paralysis, while still another adhered to the belief of a neurotic affection. Professor Virchow, the father of the modern school of pathological science, ascribed the conditions of the tissues to an irritable state of the inflammatory process, inducing an exaggerated cell growth; while his former pupil, Cohnheim, through an extended series of newly-devised experiments, has conclusively proved that none of the theories advanced are supported by demonstrable facts. Our present thorough knowledge of the combined disturbances and phenomena, that play their part in the vessels and tissues, of the body during the inflammatory action in living tissue is due to the unremitting toil of Professor Cohnheim. He was the first to speak from facts, as they presented themselves to his eye under the microscope. It was he who had the genius that suggested the examination of the whole process of inflammation, in the living tissues under the microscope. This he accomplished by narcotizing a frog, and while alive, but insensible to pain, a portion of the peritoneum or mesentery, which is almost transparent, so that the circulation may be plainly seen, was fastened with pins upon an ingeniously-devised rack or stage. The inflammation is now excited by etching the membrane with a little acid and a sharp needle, and then the object is placed under the microscope. If the operator is careful, so as not to tear or crush the vessels or tissues, and preserves the moisture, by spraying with warm water from time to time, the circulation and the abnormal processes of inflammation that are going on, may be observed and studied with great exactness for several hours. I will now describe what may be seen in the field of the microscope. The first change to be observed is in the vascular system and within the vessels themselves; this begins with a widening of the small arteries, then of the smaller capillaries and veins. This increases the current of blood with greater velocity through the widened vessels. Sooner or later this rapidity of the current lessens; there is a marked slowness to be observed in the stream. The single or separate blood cells, which in the beginning of the observation could not be distinguished, can now be distinctly seen, especially in the veins and small capillaries, in which, from the slowness of the current, the blood accumulates. In the veins there now appears at the periphery of the current a pellucid plasmatic layer, in which there are white blood cells, that have separated themselves from the main current; the white cells either The first extravasated cells will soon be followed by others in great quantity, so that in six to eight hours veins and capillaries are surrounded with white corpuscles. In their normal destination these become organized into fibrous or granulation tissue; and for this reason, an organ that is the seat of chronic inflammation becomes immensely enlarged from this inflammatory accretion. We can now readily appreciate why the womb, liver or kidneys become augmented in size from inflammatory processes. Indeed, this applies to all growths and even to bone, and if a part is injured by a cut, accident or disease of some sort, precisely the same processes are at work to repair the lost tissue. It cannot fail to become apparent at once, that to understand the phenomena of inflammation is to possess the key that opens to our understanding the operations not only of most diseases, but of the healing processes of wounds and injuries. In the course of the experiment we see also red blood corpuscles transude, which are always accompanied with more or less fluid or plasma. The above detailed account seems to explain in a clear manner the different cardinal symptoms that have become recognized features of inflammation since the time of Galen. I made an attempt to initiate the reader into the science of inflammatory processes and if I have succeeded in making myself understood, then I am satisfied with having imparted a most useful lesson, because there is no process in the entire field of disease that is so general; it is almost safe to say that with the exception of functional diseases, there is perhaps no class of diseases with which an inflammatory process is not more or less associated. This is true of consumption, which is an inflammatory process excited by and around the bacilli or micro-organisms, and these inflammatory nodules are called tubercles. The growth of a cancerous tumor is associated with an inflammation. The development of a common boil is an illustration of an inflammation, breaking down or destroying part of the tissue which is inflamed. It is the same in inflammation of the lungs or pneumonia as it is in ordinary catarrh; the differences that are presented to the eye are only modifications of degree and peculiarities that are due to the difference of the tissues of which the organ or membrane is composed. |