The Arris and Gale lectures on the physiological factors involved in the causation of dropsy : delivered before the Royal College of Surgeons of England on February 17th, 19th, and 21st, 1896 / by Ernest H. Starling.

  • Ernest Starling
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: The Arris and Gale lectures on the physiological factors involved in the causation of dropsy : delivered before the Royal College of Surgeons of England on February 17th, 19th, and 21st, 1896 / by Ernest H. Starling. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the presence of a considerable transudation. Arteries, capillaries, and veins are bathed in the transuded fluid. The fluid transuded from the capillaries will, if a free outflow for it be absent, after a time attain a pressure near that ruling in the capillaries and higher than that of the venous pressure. The veins will therefore collapse, venous obstruc- tion will be produced, and the capillary pressure and trans- udation will be higher than ever, so that we have a vicious circle of events tending continually to increase the oedema of that part. Now, Klemensieu icz’s objections are true only under one condition—i.e., that the venous tubes should run freely through the lymphatic spaces of the tissues. If, how- ever, we consider a system in which the inner tube is con- nected at various points in its circumference to the outer tube by strands of inextensible fibres, it is apparent that a rise of pressure in the space surrounding the inner tube will only serve to extend this tube still further. No collapse will take place, but a back filtration will be possible. Now, if we cut sections of injected connective tissues we find that the capillaries are bound to sur- rounding parts by radiating fibres which might possibly prevent their collapse under high extravascular pressure. In the larger veins, on the other hand, the arrangement of the fibres of the adventitia is circular and not radial, so that a high extra-vascular pressure would- apparently cause collapse of the veins. From these anatomical facts <ne would conclude that a backwaid filtration is possible proiidtd that the extravascular pressure be raised only in the region of the capillaries. If, however, the pressure be freely propagated through the tissues so as to affect the larger veins draining them we shall have collapse ot the veins and increased CEdema. Here, as in so many other cases, we cannot get a decisive answer to our phy?iological questions by purely anatomical investigation, but must have recourse to physio- logical experiment. The question that we have immediately to decide is whether an increased tissue tension augments or leaves unaltered the flow of blood through the tissues or whether it causes venous collapse and so diminishes the flow. In the former case a back filtration would be possible and in the latter case impossible. I have investigated this point in various regions of the body, the connective tissues ot the leg, the tongue as a type of muscular tissue, and the submaxillary gland as a type of glandular tissue. In all these cases I have found that a rise of tissue tension above the piessure in the veins causes collapse of these veins, a rise of capillary pressure, and a diminished flow of blood through the part. In these regions of the body, therefore, absorption of lymph by a backward filtration is impossible. Hamburger, finding that serum and isotonic fluids are absorbed from the peritoneal cavities that bad been dead some hours, concludes that the life of the endothelial cells can-have nothing to do with the process and ascribes the absorption to processes of capillary and molecular imbibition.
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