Dr. James objects to the division of inflammation into the acute, sub-acute, or chronic. He says that in many instances these are merely different stages of the same disease. The arrangement into the adhesive, suppurative, ulcerative, or gangrenous inflammation he does not altogether approve, because it is merely founded on the modes in which either different, or, in some instances, the same kinds of inflammation terminate. Under the heads of phlegmonous, erysipelatous, and gangrenous inflammation, he argues that diseases of the most opposite nature have been indiscriminately brought together. The disposition to terminate in gangrene, he admits, will afford a basis for subdivision, but not for primary separation. He makes some judicious observations on the arrangement of the kinds of inflammation according to the elementary tissue in which they occur. The tissues in question are five, and the doctrine supposes that the inflammation of each is essentially different; the first, phlegmonous inflammation, which affects the cellular membranes, including the parenchyma of the several viscera; the second, inflammation of serous membranes; the third, inflammation of mucous membranes; the fourth, which is named erysipelatous, is inflammation of the skin; and the fifth, termed rheumatic, belongs to fibrous structure. That inflammations differ materially from the circumstances of their affecting one of those elementary tissues rather than another, Dr. James freely admits; but he makes the following objection to this system: -

I. Different kinds of inflammation are liable to occur in the same tissue.

II. The same kind of inflammation is often met with in different tissues.

III. The same inflammation may be transferred from one to another - an argument, however, on which he lays less stress, as being difficult of direct proof.

Now, although difference of structure accounts for some of the varieties in the appearance and character of inflammation, it has been objected to as the foundation of a nosological arrangement, not only for reasons pointed out by Dr. James, but because the common distinctions of inflammation at present in vogue (and some of them at least are striking) cannot be solved by reference merely to texture. Nor did this theory satisfy Dr. Hunter, who observed, that if it were true, we should soon be made acquainted with all the different inflammations in the same patients, at the same time, and even in the same wound. For example, suppose we have a deep injury inflicted whereby the skin, the cellular membrane, muscle, tendon, periosteum, the covering of bone, bone and marrow is cut, the skin should give us inflammation, the cellular membrane inflammation of its kind, the muscle of its kind, and so on. But no; we find it the same inflammation in them all However, although Dr. Hunter did not admit the possibility of referring the different kinds of inflammation to peculiarities of texture, his doctrines assign to this cause considerable influence over every form of the disorder.

But, subsequently to the time of this distinguished man, a great deal has been made out in regard to the peculiarities and different course and effects of inflammation, as it presents itself in the various textures of the body. Even in its acute, and still more in its chronic form, inflammation frequently spreads extensively, lasts long, and produces decided lesions in one texture, without in the slightest affecting others in its immediate vicinity. Repeated observations upon subjects that have died from pleurisy, bronchitis, peritonitis, as well as of more external inflammation, leave no room for doubt upon this point. Formerly, the diagnosis of different inflammatory diseases seldom extended further than the organs chiefly affected, and the functions of which were deranged; but now we consider the texture primarily affected to be one of the most important objects of inquiry, and to be frequently within the reach of careful scrutiny. In no case is the truth of these illustrations more beautifully displayed than in the varieties of inflammation to which the eye is subject.

Dr. Alison says: - "Not only have the effects of inflammation in the various textures been ascertained by dissection, but the characteristic symptoms resulting during life from these consequences of inflammation in several parts of the body, not open to inspection, have been clearly pointed out. Thus the usual effects of inflammation of the pleura and bronchi may almost always be recognised and distinguished by percussion and auscultation."

The existence of inflammation of the mucous membrane of the great intestines in all cases of dysentery, and of inflammation of the same membrane of the small intestines in a certain class of cases of diarrhoea, the diagnosis of inflammation of this membrane from those of the peritoneum, its remarkable tendency to ulceration, its frequent (though by no. means uniform) combination with inflammation of the liver, with continued fever, and the indications of its degree and of its stage, to be drawn from the evacuated material, are very important additions to our knowledge of abdominal inflammations. Enough, then, I think, has been stated to prove the practical use of attending to the effects of inflammation, as determined by texture.

This mode of reasoning, adopted by Dr. James, leads him to propose: -

1. The division of inflammations into two great classes, according to their disposition, either to be limited by the effusion of organisable coagulable lymph, or to spread.

2. The orders are established on the principle of the degree of connection of the organs with the vital functions of the animal. Another cause which exerts a predominant influence over the character of the inflammation, acts invariably in the same degree, the constitutional sympathy being in proportion to the danger, the difficulty of resisting that danger, and of repairing the mischief done.

3. The genera are founded on the original disposition of inflammation to have particular modes of termination; for some inflammations tend to suppurate, others to slough, and others to resolve. And this disposition is so strong, that it is very difficult to procure any other termination.

It may happen, however, that there shall be more than one mode in which the inflammation is disposed to terminate, as in either resolution, suppuration, sphacelus, or ulceration. Dr. James conceives "that these general principles will perhaps afford a sufficient basis for such arrangement as shall be both natural and useful in its application to all kinds of common inflammation, rheumatism, and scrofula, having peculiarities which require them to be separated. Also with respect to inflammations arising from external injuries, as they are more simple in their nature, may take place in sound constitutions, and are accompanied with disorganisations which do not exist in other cases." But the same authority purposely excludes from his classification inflammations of the organs of sense, and of the bones, the peculiarities in their structure and functions rendering them fit subjects for separate description. Dr. Hunter was well acquainted with the frequent usefulness of the adhesive inflammation in setting limits to disease. Yet he did not venture to refer the circumstances of every inflammation to this cause, or the spreading of the disorder entirely to its absence. Nor, indeed, does it seem essential that any cause should be assigned for the disposition of one class of inflammation to be limited, and of another to spread, the two facts themselves being sufficient for the basis of the division.