Licence: In copyright
Credit: Manual of surgery / by Alexis Thomson and Alexander Miles. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
71/856 (page 43)
![effort on the part of these tissues to overcome the invading organisms and their products. The chief danger to the patient lies, not in the reactive changes which constitute the inflammatory process, but in the fact that he is liable to be poisoned by the toxins of the bacteria at work in the inflamed area. Since the days of CeLsus (first century, a.u.), heat, redness, swelling, and pain have been recognised as cardinal .signs of in- flammation, and to these may be added, interference with function in the inflamed part, and general constitutional disturbance. Variations in the intensity of these signs and symptoms depend upon the acuteness of the condition, the nature of the causal organism and of the tissue attacked, the situation of the part in relation to the surface, and other factors. The heat of the inflamed part is to be attributed to the increased quantity of blood present in it, the actual temperature of the blood at the seat of inflammation being no higher than in other parts of the body. The more superficial the inflamed }>art the more readily is the local increase of temperature detected by the hand. This clinical point is best tested by l)lacing the palm of the hand and fingers for a few seconds alternately over an uninflamed anil an inflamed area, otherwise under similar conditions as to coverings and exposure. In this way even slight differences may be recognised. Redness, similarly, is due to the increased afflux of blood to the inflamed ]>art. The shade of colour varies with the stage of the inflammation, being lighter and brighter in the earlj, hyperiemic stages, and darker and duskier when congestion and stasis have occurred and the oxygenation of the blood is defective. In the thrombotic stage the part may assume a purplish hue. When a deep part, such as periosteum or bone, is the seat of inflammation, surface redness may be absent. The sivelling is due to the increased quantity of material in the affected part—circulating blood, effused serum and leucocytes, and proliferated tissue cells. The more oi>en the structure of the tissue of the part, the greater is the amount of swelling, witness the marked degree of swelling which occurs in such parts as the scrotum or the eyelids. In deep-seated inffamniations of rigid tissues or encapsuled organs, however, there is often a marked oedematous swelling of the overlying soft parts, due to direct or reflex interference with the circulation of the part. Pain is a symptom seldom absent in inflammation. Tender- ness—that i.s, pain elicited on pressure—is one of the most valuable diagnostic signs we possess, and is often present before](https://iiif.wellcomecollection.org/image/b21933194_0001_0071.jp2/full/800%2C/0/default.jpg)
