INFLAMMATION.
If we desire to get a general idea of the changes that occur in an
organ when it becomes inflamed, we must first have a knowledge of the
normal structure of that organ, even though that knowledge be but
superficial. Taking the intestines, for example, we see under the
microscope that they are composed of layers of different tissues,
called connective, epithelial, muscle, and nerve tissue; the first two
forming a large part of the structure.
In the connective (and fatty) tissues a great many blood-vessels are
found (varying in different parts of the organ), the existence of which
is necessary for the production of inflammation, since at the very
outset of the process, a discharge (or exudation) takes place from
these blood-vessels, accompanied by changes or degenerations in the
other kinds of tissue.
The process of inflammation is commonly associated with symptoms of
heat, redness, swelling and pain, in greater or less degree, combined
with which a change in the function of the organ is soon noticed.
Micro-organisms are considered the primary cause of inflammation in
many or even in most cases in which mechanical or chemical influences
may undoubtedly be responsible primarily; and then again, each of these
causes may be either external--that is, may originate from the outside
world--or internal, that is, may be produced in and by the body itself.
The first pronounced change occurring in an organ under inflammation is
an increase in the rapidity with which the blood circulates through the
vessels--a so-called hyperemia--which soon gives place to a diminution
(stasis) in the current together with an exudation from the
blood-vessels; the latter is due to changes in the structure of their
walls. This exudation soon occasions a cloudiness of the connective
tissues and at the same time a desquamation (shedding in scales) of the
epithelia (cells of the thin mucous surface). An irritation of the
nerves also takes place.
The varieties of inflammation can be best apprehended by considering
the different characters of the exudation. The exudation may be watery
(called serous) or dense, the latter either fibrinous or albuminous.
With a serous exudation there is swelling of the connective tissue and
a desquamation of epithelia--the latter usually slight in
character--which constitutes what is known as a catarrh; while with a
fibrinous or albuminous exudation there is usually more or less
destruction of the tissue itself, when, for example, we have "croup" or
"diphtheria."
When the changes in the epithelia are only slight and secondary, it is
spoken of as an interstitial (lying between) inflammation, which
strictly speaking denotes confined to connective tissue, and is
therefore a term not entirely correct. When the inflammation of the
epithelia is severe and may lead to their partial destruction, it is
called a parenchymatous inflammation; that is, one involving the soft
cellular substance. There is still another variety, the suppurative,
which is the most intense of all, and indicates the production of an
abscess and the entire destruction of the tissue implicated.
Beside these general grades of inflammation there are special sorts
produced by specific micro-organisms. In all general inflammation we
may expect to find such organisms, which in most cases belong to the
class of micrococci, such as staphylococci and streptococci. In
gonorrhea we have a special organism called the "gonococcus"; while in
tuberculosis--a variety of inflammation in which the blood-vessels are
completely destroyed and a change or degeneration called "cheesy" is
produced, leading to the production of a tubercle--a rod-like bacillus
is invariably found, the well-known and unfortunately too common
tubercle bacillus. In syphilis--another special variety of
inflammation--a specific micro-organism is also surely present, but of
this microbe science has not as yet discovered the exact nature.
The question of the origin of tumors or new growths is also an
extremely important one; and it is undoubtedly true that many tumors
arise where there was a previous inflammation, this being especially
the case in tumors of the rectum. Why such a growth should arise in
some cases and not in others is as yet unknown, though microbes are
held by many to play an important rôle.
When an inflammation has lasted for such a length of time that it has
become chronic, a new tissue will sooner or later be produced in
varying amount; and this newly formed fibrous connective tissue may
entirely replace previous normal structures. Through the exudation and
consequent changes in the normal tissue a large amount of mucus is at
first secreted, but this secretion becomes less and less marked the
more the inflammation causes a desquamation of the epithelia.
Pronounced desquamation with new formation of connective tissue and no
fresh exudation will, sooner or later, occasion dryness--this dryness
being sometimes very pronounced. The longer the inflammation lasts, the
severer it will be; and the greater the amount of tissue it attacks,
the more will the normal tissue be destroyed and replaced by a new
connective tissue. A partial destruction will cause shrinkage of the
organ (so-called "cirrhosis"); while a complete destruction of certain
parts will result in what is known as "atrophy" (a wasting away of
normal tissue). In atrophy the blood-vessels as well as the original
connective and epithelial tissue are destroyed; while the newly formed
tissue leads to hypertrophy (excessive over-growth) of other portions
of the organ. Such a hypertrophy must not be confounded with an
induration that may be present later, or even at the very commencement
of an inflammation, due to modification of the blood-vessels and
surrounding tissues.
Chronic inflammation, sooner or later, leads to secondary
degenerations, that is, new products of the protoplasm, the most common
of which is fatty degeneration. In this form fat granules and globules
arise, which are at first minute, later on larger; these in certain
organs, such as the liver, may become so pronounced as to entirely
replace the original tissue. Another degeneration--which, however, is
found only in chronic systemic disturbances, such as tuberculosis or
syphilis--is the waxy or amyloid degeneration, a peculiar chemical
change the exact nature of which is unknown.
Various chemical changes are by no means uncommon.
An important question is the decision as to the length of time an
inflammation has lasted; and this at best can be determined only
approximately and after long experience. The older the inflammation,
the more the connective tissue has developed; this connective tissue is
at first soft, but soon becomes more and more dense; the result being a
varying degree of hardness of the organs.
Again, secondary degenerations are more pronounced in long-standing
processes. In comparatively fresh cases blood-vessels are still more or
less numerous and the tissue appears red, while in older cases these
vessels become completely obliterated, and the tissues take on a white,
glistening color, becoming harder and denser as the years advance. If a
process has lasted twenty or thirty years, the changes to the eye and
touch are practically the same as after forty or sixty years.
The changes, as here described, will be the same upon any mucous
membrane; and in the large intestine can be easily studied and are
perfectly characteristic.
Rarely does an infant escape repeated attacks of inflammation of the
integument of the anus and the mucous membrane of the anal canal. The
inflamed integument is treated and healed, but no attention is given to
the inflamed mucous membrane so that the inflammation in time becomes
chronic, involving the rectum also. Should the infant be so fortunate
as to escape inflammation (proctitis) of these organs during the
wearing of the diaper, there are numerous other exciting causes of
inflammation which it will not be likely to escape, hence the almost
universal symptom of constipation among civilized people; and hence
later in life you hear the familiar expression, "I have a touch of the
piles," and many other complaints of bowel ailments that are usually
the outcome of that deplorable inflammation.
I have endeavored to make clear the fact that inflammation destroys
normal tissues and blood-vessels, and that the newly formed tissue is
cicatricial in character, that is poor in cells and vessels, with a
tendency to contraction which of course lessens the bore of the gut.
When the hypertrophy or thickening is extensive the appearance of the
mucous membrane suggests the addition of one or more thicknesses of a
chamois skin added to the inner surface of the anal and rectal canals.
The hypertrophied or newly formed tissue may be limited to the rectum,
leaving the anal tissues comparatively exempt from the superabundant
cicatricial formation; or the hypertrophy may involve, to quite a
degree, only the anal tissues and the integument around the anal
orifice. The added connective tissue about the anus forms the skin into
tabs, or into a circle of elongated integument around the orifice, with
a mucous lining. These hypertrophied tabs or folds, like pruritus ani,
are symptoms of proctitis.
Proctitis (the inflammation of the anal and rectal canals) is the most
common and serious disease that afflicts man. The system is not only
poisoned by bacteria and filth through proctitis, but proctitis is also
the cause of the many annoying and painful local symptoms, such as
hypertrophy, piles, abscess, fistula, cancer, polypus, fissure,
pruritus, etc.
When the subject of proctitis is better understood by laymen they will
see to it that the rectums of children receive an examination before
the children are six years old, and thus obviate the necessity of
dosing them with all sorts of medicine that follow improper diagnosis.