The principles and practice of medicine / [John Elliotson] ; edited by Nathaniel Rogers and Alexander Cooper Lee.

  • John Elliotson
Date:
1842
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Licence: Public Domain Mark

Credit: The principles and practice of medicine / [John Elliotson] ; edited by Nathaniel Rogers and Alexander Cooper Lee. Source: Wellcome Collection.

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    in a part; when it is actively inflamed, “ active hyperemy ”; and when a passive state occurs, he terms it “ passive hyperemy.” Thus he gets rid of the difficulty altogether, by no longer using the word “ inflammation ; but by using a word signifying “ congestion of blood ”, and applying one epithet (“ active ”) or another (“ passive ”) to it. QIn prosecuting our enquiry to the ultima ratio of heat, as a feature of inflammation, it is necessary to the proper understanding of the subject, to embrace in the estimate several elements or conditions. For while it is freely admitted that the nervous system exerts no inconsiderable influence upon the functions of the capillary system, as established by the experi- ments of Wilson Philip, and subsequently verified by the observations of Muller; we cease to regard the operation of the nerves as essential to the production of inflammation, when this state is often unequivocally mani- fested in paralysed parts;—and in parts in which the sentient and motor nerves have either undergone destructive disease, or been submitted to a surgical operation. The physiological truth of this statement, was painfully exemplified by a case which I attended with Mr. Pilcher; in which it was found, post mortem, that caries of the petrous portion of the temporal bone had, by extension inwards in the direction of the base of the brain, disintegrated (by gangrenous ulceration) the whole substance of the casse- rian ganglion, involving the sentient and motor portions. The walls of the tympanic cavity, also, presented a necrosed and carious appearance; which, on closer examination, was found to have destroyed the facial nerve, while in its course through the canal of Fallopius. A few weeks before the occurrence of death, inflammation—distinguished by heat, swelling, and redness, but no pain—came on, and proceeded to diffusive ulceration. It is, therefore, unquestionable, that in calculating the pathological circumstances to which the beat of an inflamed part is due, it is essential to correctness, to compute the value of each condition in its separate influence, and the compound result of all, in their aggregate agency. It is now conclusively established, that the quantity of blood contained in affected capillaries, is not only increased in consequence of an enlargement of their diameter; but that, in addition, an absolutely augmented quantity of blood passes through the inflamed part, in any given time. Nor is there wanting another con- dition, which contributes much towards the production of beat. It is a recognised fact, that in every species of inflammation, effusion occurs, to a varying extent, of albumino-fibrin,—or this modified by constitutional influence. Now it has suggested itself to me, that the rapid elevation of temperature which happens in some acute inflammations, may be satis- factorily explained on the supposition that this effused material, acquiring the solid form with different degrees of rapidity, will proportionately evolve heat. It is a circumstance which falls under the common physical law, that the increase of beat bears a certain direct relation to the rapidity and extent of the contraction and solidification of a liquid. This affords the most rational explanation of the pungent beat which occurs in extensive pneumonia. Extensive effusion happens, and red hepatization; at which stage, being the one of maximum condensation, authors state the pungency of surface to be greatest.— T. Williams.] Swelling.—If we consider the third of the symptoms (swelling), Ave shall find that it also may exist without any inflammation. Swelling, although frequently a symptom of inflammation,—more frequently than not,—may (just like an increase of temperature, or an increase of redness) exist with- out inflammation. Any injury produces a swelling. The mere displace- ment of a part (the dislocation of a bone, or hernia), the effusion of
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