INFLAMMATION. 615 INFLAMMATION. During the progress of an inflammation, when minute particles of foreign substances arc pres- ent in the tissues, or where there is decomposi- tion of tissue elements, certain cells, derived probably mainly from the white blood-cells, make their apjjcarance. These cells are known as 'phagocytes,' and have the power of taking up these particles of foreign matter or of disinte- gi'ated tissues, and either digesting them or carrying them off for deposit at other points. The healing of wounds is, in a pathological sense, an inllannnatory process. If after a clean- cut wound through tissues which have little vas- cularity, the sides of the wound be closely ap- proximated, there is a little oozing of serum which sticks the cut surfaces together, some of the more injured cells die and disintegrate, while of those which remain intact some proliferate and cross the line of the wound, new connective- tissue fibres are formed, and the whole becomes firmly united. Such healing is known as healing by first intention. If the injury to the tissues is greater, or if the wound is left open, healing takes jilaie in a manner essentially the same as just described, but somewhat more elaborate. Scrum is poured out upon the surface of the wound and intermingled with the serum are led and white blood-cells. If bacteria are present pus is formed. After a varying length of time minute red points begin to stud the svirfaee. These are known as granulations. Each granula- tion consists of loops of minute capillaries sur- rounded by newly formed connective-tissue cells. This tissue is called graniilation tissue, and its new thin-walled vessels allow it to bleed easily. Over this granulation tissue — if the wound be not too large — the skin slowly extends by growth from the edges of the wound, imtil eomplete re- pair takes place. Such healing is knoATi as healing by granulation or healing by second intention. In some eases the growth of new blond vessels is in excess of the production of the connective tissue, and the tufts of now and easily bleeding vessels project above the surface of the wound, Tliese are known as exuberant granulations, or 'proud flesh.' Young granula- tion tissue is composed almost entirely of small round or oval connective-tissue cells and blood- vessels, the intercellular substance being very small in amount. As the tissue becomes older the connective-tissue fibres appear, the cells be- come fewer and more like adult connective-tissue- cells. Finally the cells may almost entirely disappear, leaving dense white fibrous tissue, to which the temi 'cicatrix,' 'cicatricial tissue,' or 'sear tissu/ is applied. Under certain conditions, whether due to increased nutrition of the parts or to some little-imderstood factor we do not know, there occurs an active increase in the connective-tissue elements of some of the organs of the body. Tliis is known as productive inflammation. This pro- duction or new connective or interstitial tissue may be slight in amount. It may. on the con- trary, he quite extensive. Its proliferation is always at the expense of the parenchyma or functi<mating elements of the organ, and often results in cor.<iderable destruction of the latter. Xot easilv dill'erentiated from this productive inflammntion is the process known as replace- ment connective-tissue hyperplasia, in which the formation of new tissue is secondarv to decenera- tion of the parenchyma and for the purpose of its replacement. The significance of the inflammatory process and the relation which it bears to the normal physiological activities of the body are matters of extreme importance. If we exclude bacterial infection with the formation of pus and the pro- duction of large amounts of fibrin, which occurs in some cases — in other words, if we take such an example of inflanunation as we studied in the exposed frog's mesenterj- — we note that all the phenomena observed are but exaggerations of ntirnial physiological processes. Thus in nor- mal physiological activity the relations existing between the blood inside the capillaries and the tissues outside are extremely intinuite, and serum and white blood-cells, with probably some led blood-cells, have more or less free access to the tissues. The action of phagocytes also oc- curs as a normal physiological process. We have referred to the pathological identity of wound repair .and the inflanmiatory process. Such facts favor the consideration of inflammation, not as a destructive, but as a con.servative process, a reaction which healthy tissue presents against ex-ternal irritation. Even in the case of bac- terial infection with the formation of pus, the inflammatory reaction is essentially conservative, the white blood-cells acting as distinctly germi- cidal agents, destroying bacteria thera.selves by their pliagocvtie powers, and when dead disinte- grating and diffusing their germicidal substances throughout the scnim or pus. We must thus look upon the inflammatory reaction of tissues in the presence of bacterial invasion as of the nature of a rising of the body forces for purposes of defense against the invasion. ^^■llile very convenient, inflammation is an objectionable and indefinable term. It has been suggested by Dr. A. H. Smith, of New York, to follow the nomenclature of which 'tuberculosis' is a universally accepted precedent, and give to the process resulting from the action of a mor- bific agent in wounds and injuries the term 'traumosis :' to the process resulting from the local action of poisons in the blood the term 'toxosis;' and to the action and results of micro- organisms the term 'bacteriosis.' The adoption of these suggestions would relieve us of our present unfortunate position of recognizing in- flammation, instead of its cause, as an active process, and of allowing the inference that in- flammation possesses a separate pathological energy. Tbeatmknt. All sources of irritation and all causes of the condition must be sought anil re- moved; local action must be lessened, complica- tions must be avoided, or treated if present: pain must be relieved: and the patient's strength must be supported. Rest must be obtained. The patient in an exhausting case must l)e put to bed : inflamed parts must be supported with bandages, splints, slings, or cushions, securing proper position and slant. In many cases the application of cold is desirable, and this is se- cured by using an ice-bag or ice-coil, ev.aporating lotions, or irrigation with cold wafer. Heat may be desirable, to favor suppuration and en- courage 'pointing' of an abscess or a furuncle. But in the case of bacterial infection heat often does harm by lowering the resistance of tissue and inviting further spread of the micro-organ- isms. Poultices, especially, offer rich ground for
