Chronic inflammation

“ Definition--Nature of inflammation from surgical point of view--Sequence of changes in bacterial inflammation--Clinical aspects of inflammation--General principles of treatment--Chronic inflammation.
Inflammation may be defined as the series of vital changes that occurs in the tissues in response to irritation. These changes represent the reaction of the tissue elements to the irritant, and constitute the attempt made by nature to arrest or to limit its injurious effects, and to repair the damage done by it. ”

“ The exudation in acute inflammation, if recovery takes place, is rapidly removed from the place of its origin, while in the chronic variety it tends to become a part of the region in which it lies, or, if removed, slowly disappears, and may be constantly replaced. Acute inflammations may become chronic, and the chronic variety is liable to acute exacerbations. ”

“ I cannot too often or too strongly warn every one against warm baths, who has the slightest degree of local chronic inflammation going on in any of the organs of the body, as evinced by white tongue, dryness of skin, accelerated pulse, evening thirst, or scanty action of the kidneys. The exciting mineral waters, taken internally or externally, will be almost certain to raise the chronic into a subacute, or even acute, inflammation, with a corresponding grade of constitutional irritation. ”

“ That such signs of chronic inflammation could exist without symptoms is not so surprising when one thinks of the startling immediate improvement seen after treatment or even in remissions without treatment. One is reminded of the crisis in pneumonia wherein clinical improvement takes place entirely independent of the mechanical conditions in the lung which just after the crisis remain as suppurative as before. ”

“ A third group of chronic inflammations are those that begin as an acute pyogenic inflammation, which, instead of resolving completely, persists in a chronic form. It does so apparently because there is some factor aiding the organisms and handicapping the tissues, such as the presence of a foreign body, a piece of glass or metal, or a piece of dead bone; in these circumstances the inflammation persists in a chronic form, attended with the formation of fibrous tissue, and, in the case of bone, with the formation of new bone in excess. ”

“ The former variety is not common among children, and when it does occur, it is the result of some chronic disease, as a tumour or a thickened state of the arachnoid or other membranes of the brain, resulting from a former inflammation. "Sometimes, adult patients wholly recover from chronic or sub-acute inflammation, which induced the structural disease, and this last becomes, at some future period, the occasional cause of the hydropic one." At other times, the chronic inflammation continues, and finally extends to the serous membrane, giving rise to the effusion. ”

“ An important clinical distinction is drawn with reference to the duration of an inflammation. Acute inflammations are those whose course is rapid, whose progress is associated with graver disturbances of function, and with a greater prominence of the cardinal symptoms. The chronic forms occupy more time in their progress, the functional disturbances, though severe, are injurious more from their protracted persistence, than their temporary violence, while redness, swelling, heat, and pain are symptoms of trifling prominence. ”

“ Carpenter is led to observe that "cold brings quickly to a fatal termination many maladies which it does not directly induce." Nay, the acute inflammatory attack, under such circumstances, is often enough the first intimation, to the patient, and perhaps to the physician, of the existence of organic change in the affected organ. A most common error, and, as far as I know, a universal one, is to date the real beginning of the disease from the acute inflammation, and ascribe any recognizable lingering symptoms to the acute attack having "lapsed into the chronic form;" ”

“ But with the diversity of these muscular, osseous, tendinous, cellular, nervous organs, &c. it requires a long time for all their lives to be placed as it were in equilibrium, and for these organs to agglutinate at their divided extremities. I have already observed that the division of inflammations into acute and chronic gives physicians an inexact idea; for the duration of the inflammatory phenomena in the organs is wholly relative to their degree of life. An inflammation of the cellular texture and of the skin is acute, when it lasts but a few days ”

“ Inflammation and AMH Abnormal inflammatory response is the major component of chronic airway inflammatory diseases. Such inflammatory response has been associated with AMH in airway diseases. Numerous studies have demonstrated that inflammatory stimuli and mediators/cytokines contribute to excess mucin synthesis and mucus secretion in airways. ”

“ The inflammation may vary in grade from simple hyperæmia, with increased irritability, to the most intense engorgement, exudation, and tumefaction of the membrane, and in activity from the most acute and rapidly-progressive to the most chronic and protracted in duration. ”

“ Inflammation terminates in resolution when the serum is reabsorbed by the blood-vessels and lymphatics, the living blood-cells find their way back into the circulation and the dead cells disintegrate and are taken up by the vessels. The time required for the tissues to return to the normal varies from a few hours to several weeks. An acute inflammation may end in the chronic form. ”

“ In subacute and chronic inflammations and in those acute forms in which the violence of the inflammatory action has been already subdued by soothing measures, blisters and other counterirritants may be employed to counteract the remaining inflammatory action. ”

“ Inflammation may result in resolution, suppuration, necrosis or sloughing, or in the establishment of a chronic state.
Resolution. Resolution is the termination of an inflammation by the gradual cessation of all the changes which have occurred. The pain subsides, the circulation becomes more normal, and the exudate is absorbed, or makes its [Pg 33] way to the free surface of the body, where drainage occurs either spontaneously or by incision. ”

“ Acute inflammation of various types, suppuration, granulation-tissue formation, &c., represent some of the complex resulting processes. The changes produced at a distance by distribution of toxins may be very manifold—cloudy swelling and fatty degeneration, serous effusions, capillary haemorrhages, various degenerations of muscle, hyaline degeneration of small blood-vessels, and, in certain chronic diseases, waxy degeneration, all of which may be widespread, are examples of the effects of toxins, rapid or slow in action. ”

“ For the object of the treatment, in these cases, is not to remove, but to avert the inflammation, and which, from the strong disposition to it, conferred by the organic disease, can only be effected by avoiding, not merely the causes of inflammation, but likewise, all those agents, which are calculated, in any way, to increase the momentum of the circulation. ”

“ The biological hygienic treatment desires to moderate inflammation only, to the degree that it should lose its dangerous character, but it leaves to the body its power to remove, through the process of inflammation, alien and diseased matter, and to absorb and gradually carry away the products of inflammation through the blood current. ”

“ The remedies which we employ, with the intention of abating and removing the inflammatory action, are either general or topical.
General remedies are perhaps only useful, or have only a superiority over topical ones, when a general disease, or fever, accompanies the local inflammation. Topical ones are only to be trusted to alone, when the disease is entirely local. ”

“ It is rarely seen in children, but it attacks adults of both sexes. It comes on without apparent cause in many cases, but a blow or exposure to a cold and cutting wind may be predisposing causes of the inflammation. The inflammation itself is produced by a micro-organism growing in the skin. ”

“ Interestingly, many of the veterans coming back have these kinds of symptoms and the acute skin inflammation is very common. Reactivated infection usually involves the lungs, the brain, spinal membranes, heart, peritoneum, and the adrenals. ”

“ The peculiar and primary affection of the nervous system, which is here assigned as the cause of inflammation, does not become identical with inflammation, but superadds the morbid condition of inflammation to its own ”

“ The most advanced works on pathology admit the constructive and beneficial character of inflammation. However, when it comes to the treatment of acute diseases, physicians seem to forget entirely this basic principle of pathology, and treat inflammation and fever as though they were, in themselves, inimical and destructive to health and life. ”

“ The lymphatic glands are to be prevented from inflaming, by avoiding exposure to cold, and to the other common causes of inflammation, but especially by preventing the absorption of irritating matter, such as matter from sores, and the like. ”

“ Every one ought to understand, that those practices which are commonly called strengthening, are, in other words, stimulating, and that to apply stimulants where the system is already in a state of health, will produce too much excitement. The young, from the natural quickness of their circulation, are particularly liable to this excess of action, which is inflammation. This general inflammation, in time, settles into some form of acute disease, so that in fact, by blindly attempting to strengthen, we inflame, disease, and enfeeble to the greatest possible degree. ”

“ Whatever, then, operates on the surface, and prevents the progress of the inflammation, or cures the part which is already inflamed, will tend to check the extension of the disease, especially if the proper internal remedies be made use of with a view to prevent the extension of the action of descent. ”

“ Inflammation of the Lungs and Organs of Respiration, is a frequent inflammation in northern climates; and most so in spring, autumn, and winter; when the body, hydraulick canals, and blood are in a state of inflammatory diathesis: it generally encounters the robust vigorous constitution, those of strong muscular fibre, and dense rich blood; the athletick rustick, manufacturer, and artizan; those in the prime, and in all the intervals between twenty and the decline of life: it is very rare in infancy, as in idiopathick disease, and seldom under puberty, or in old age. ”

“ In these systems, as will presently be observed, almost every disease is different, in some points, from the same disease when it occurs in a healthy person; but the action which more decidedly manifests this modification, is the inflammatory, insomuch, that, by some, scrophula and scrophulous inflammation have been confounded ”

“ Nevertheless, to prevent confusion, and the quibbling of some of the opponents of the theory of inflammation in dropsy, we are inclined to believe, that it is better to substitute the word irritation, whenever there is merely an increased secretion, and reserve the word inflammation, to designate those cases, in which there are decided marks of local excitement and congestion, attended or not with general fever. ”

“ Besides the common exciting causes of inflammation, the particular formation of organs may induce this disease, or at least make very slight causes produce it. Thus, for instance, in people with a very small narrow chest, the circulation of the blood must be performed with greater action than in other circumstances, and thus may tend to induce an inflammatory state. ”

“ When scrophulous inflammation is excited in the vicinity of a part already possessing this action, it occasionally removes the action from that part, in the same way as inducing simple inflammation by a blister in one part cures the same disease in another part in the vicinity. ”

“ Inflammation may be defined to be, an unnatural or perverted action of the capillary blood vessels of an organ or part of the body, attended with redness, throbbing, swelling, pain, heat, and disorder of function, as well as with more or less disturbance of the system.
Every part of the body is liable to inflammation ”

“ In other cases, however, a remarkable tendency is developed to the progressive spreading of the inflammation from one point or surface of the body to another, the parts first affected paling as the disease passes on to involve those in the vicinity, or being yet deeply involved while the process of peripheral extension is in progress. ”

“ The chief characteristic is the cause, micro-organisms, which, introduced into the body, produce, through their dissemination and development, multiple growths of tissue like those resulting from persistent inflammation. As their structure corresponds with the productive results of inflammation, and their cause is analogous to the infective causes of inflammation, these morbid growths are closely allied to inflammatory disturbances. ”

“ They are not brought to their patient to show how much they can do in the way of cutting and probing; it is their duty to administer relief, and act so as to prevent and abate the inflammatory action, which they will often do most effectually by letting their patient alone, and throwing aside their ball-screws and forceps.
The circumstance of being in an unusual situation, in which the natural action cannot possibly be continued, is also a very frequent cause, producing inflammation, and preventing its resolution. ”

“ The irritability of a wound frequently appears nothing else than a series of attempts to bring about an action, which it has not the power to accomplish: as soon as that is fulfilled, which the necessity of the parts demands for their healthy condition, irritation will cease. In such cases, everything that will confer strength to carry out the intended action, will prevent inflammation. ”