Report on the present state of knowledge of the nature of inflammation / by T. Wharton Jones.

  • Jones, Thomas Wharton, 1808-1891.
Date:
[1844]
Catalogue details

Licence: Public Domain Mark

Credit: Report on the present state of knowledge of the nature of inflammation / by T. Wharton Jones. 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 frog. The explanation of these phenomena, therefore—their sequence and relations—is justly considered the key of the whole theory of inflammation. § 23. Is dilatation of the small vessels primary, and retardation of the flow of blood in them secondary, or is the contrary the case ? That dilatation is primary and retardation of the flow of blood the necessary physical result of the preceding dilatation, is maintained by most recent authors. And though they have good reason on their side, it is to be observed that, considering the peculiar vital en- dowments of the blood and the vessels, the fact of the case is not so unconditional as it might seem at first to be, judging merely from the flow of non-vital fluids in inert tubes. For, as accumulation and, lastly, stagnation of the blood soon supervene on the retarded flow, and as that accumulation and stagnation must, as will be shown, acknowledge some other cause than dilatation of the vessels, this retarded flow might be attributed, as is done by Vogel, to the commencing operation of that cause, whatever it is, which determines the accumulation and stagnation; and the dilatation itself to distension from the accumulated blood, and therefore secondary. To this it is to be replied, however, that dilatation of the vessels from distension by accumulated blood would be subsequent, by an appre- ciable interval, to the retardation of the flow of blood, which it is not; for there is already dilatation with coincident retardation, before accumulation has taken place to an extent sufficient to produce distension. ^ 24. The opinion, therefore, above stated as that entertained by most authors is to be considered just, but only so far as it goes, for it does not embrace the whole truth. The truth appears to be this:—Dilatation is primary, but the retardation of the flow of blood is in part only the physical effect of it, being greater than the dilatation is sufficient physically to account for. The other cause in opera- tion is the same as that which at last determines the accumulation and stagnation of the blood, as will be explained below. By the accumulation of the blood, how- ever, there is a secondary dilatation of the vessels—one from distension, but which more particularly implicates the capillaries—perhaps is the sole dilatation of which the capillaries proper are the seat, as will immediately be shown. This view is much the same as that entertained by Vogel in regard to certain ca.sesonly, viz., those in which common congestion passes into inflammatory congestion. It being Vogel’s opinion that it is in common congestion only that dilatation of the vessels is primary, and that in inflammatory congestion it is from distension alone, and al- together secondary. But there do not appear to be any grounds for this opinion. § 25. Having thus determined that there is primary dilatation of the vessels, the next subject of inquiry is the nature of the dilatation. Does dilatation depend on an active state of the walls of the vessels, or on a state of relaxation ? The prejudice that inflammation is a .state of increased action of all the parts con- cerned, which has led some (justly believing that constriction is the active state of the ve.ssels) to maintain that the vessels are constricted in inflammation, has led others (knowing that the vessels are really dilated in inflammation) to maintain that their dilatation is an active state. This vievv was most strenuously maintained by the late Professor Macartney of Dublin, and more recently it has been advocated by Lotze. (Allg. Pathologic und Therapie als mecanische Natur- wissenschaften, Leipzig, 1842, pp. 277-368.) Dr. Copland maintains that in sthenic inflammation the vessels .are actively dilated, and that a larger column of blood circulates in them with increased velocity. In asthenic inflammation Dr. Copland admits the dilatation of the vessels to be owing to relaxation, and that the flow of blood in them is retarded or arre.sted. John Hunter, while he admitted relaxation of the muscular powers of the walls of the vessels, spoke^ of the dilatation of the vessels as if it were an active state, believing it to be to a greater extent than could be permitted without force by the elasticity of the ves- sels. This, however, was evidently a mistake on the part of Hunter, produced by clinging to the prejudice of increased action. Eisenmann (Haeser's Archiv, 1841, pp. 239-349), and Heine (Physio-pathologische Studieb ; Stuttgardt und Tubingen, 1842, p. 156), again justly believing that constriction is the active state of the vessels, and at the same time aware that in inflamniation there is