2. The Disease Extends To Remote Formations

The Disease Extends To Remote Formations, both similar and dissimilar. This mode of diffusion does not imply concurrent general disease, but proceeds, according to tolerably constant laws of sympathy, through the mediation of the nerves. It is greatly promoted, however, by a concurrent general disease, kindred in character with the local, causing it to increase, and multiplying the seats of the disease, as, for instance, in inflammation.

VII. The Originally Mere Local

The Originally Mere Local is enhanced into a general disease of the same nature, or gives rise to one of different attributes. The former contingency may arise from the alienation of the peripheric nerves, productive of the local anomaly, being transmitted to the nervous instruments presiding over the circulation, - in other words, to the nervous centres, and in particular to the spinal cord and the ganglia. Or else the conversion assumes the substantive form of infection, the noxious matter evolved by the original local disease, or its products, being received into the circulation. This last event occurs where the products of the local disease exhaust the blood of certain ingredients, for instance, of fibrine, of albumen, of serum, of salts. To this class belong, in like manner, the anomalies occasioned by mechanical disproportion, such as the venous diathesis, cyanosis dependent upon disease of the heart or lungs, etc.

VIII. The Presence Of General Disease

The Presence Of General Disease may be the more safely inferred:

1. The more widely extended is the local disease over several uniform or dissimilar formations, and the greater its intensity.

2. The less the products of the local process are conformable with the character of the normal structures;

3. The less the extent and nature of the local disease, or of the structures involved, however important in the organism, suffice to account for the general appearances during life and after death;

4. The more anomalous, compared with the alienation of the solids, are the secretions and excretions; and,

5. The more the totality of the organism, in the absence of actual anatomical disturbances, seems cachectic and impaired.

6. The more marked is some anomaly in the circulating fluid, with respect to the quantity or quality of its component parts.

IX. General Disease Engenders

General Disease Engenders in the most various organs and textures, according to their innate general or individual tendencies, either spontaneously or by dint of some overpowering outward impulse, a local affection which reflects the general disease in the peculiarity of its products. The general disease becomes localized, and, so to speak, represented, in the topical affection.

X. A General Disease Not Unfrequently Finds

A General Disease Not Unfrequently Finds in its localization a perpetual focus of derivation, with seeming integrity of the organism in other respects. Recovery may, after a lengthened process, eventually take place through the exhaustion of materials at the local vent. Forced extirpation, on the contrary, or insulation of the locality, generally aggravates to a high degree the general disease, multiplying its points of localization.

XI. The disease has, even anatomically speaking, its stages of inci-piency, increment, acme, and decline.

XII. The Terminations Of Disease

The Terminations Of Disease are, in like manner, subjects for anatomical research.

1. The issue of local disease in health consists either in the perfect re-establishment of the normal condition, or else in partial recovery; more or fewer important residua and sequelae of the disease, not incompatible with a tolerably fair state of health, remaining entailed. Thus the previously diseased organ may have lost substance, or more or less its natural texture; or it may have suffered changes in form or in position, or interruptions of continuity.

2. The issue of one general disease in another general disease [metaschematismus] is frequent. Anatomical research proves, and chemical analysis will still more clearly demonstrate, that it is far more frequent and varied than would appear from mere clinical observation. This is taught in an especial manner in the mutual exclusion of different morbid processes, which seem to succeed each other, when in full vigor, sometimes almost by a necessary sequence. Thus dropsy may succeed to the exhaustion of fibrine and the excretion of albumen, cancer to tubercle, etc.

3. Transition by so-called metastasis often becomes the subject of the scalpel. It comprises various conditions:

(a.) The localization of a general disease at an unusual spot. It has the character of a vicarious or supplementary crisis. Instances are afforded in skin eruptions, and especially in the secondary typhous processes.

(5.) Topical processes constituting the localization of a metaschema-tism, with which, as in the former instance, a general disease concurs. Such metastases occur more particularly in the sequel of typhus, and in the shape of inflammation, suppuration, gangrene, in both external and internal organs. They represent the localization of a general disease consecutive to the original typhous process.

(c.) Local processes, with the development of which the general disease is essentially abated, or thoroughly exhausted and extinguished. They are frequent, and deserve alone to be designated as metastases, - metastases in a restricted sense. They are either just sufficient vents for the general disease, and are only cured when the latter is subdued; or they heal spontaneously, the dyscrasis having, through their agency, become exhausted.

(d.) When, owing to whatever cause, a local disease has been checked in its development, it subsides only to reappear in another part, often with augmented force, and with the supervention of a new general disease, or the aggravation of one already existent.