Lectures on inflammation, (delivered in the theatre of the Royal College of Surgeons of England) / by James Paget.

  • James Paget
Date:
1850
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Licence: Public Domain Mark

Credit: Lectures on inflammation, (delivered in the theatre of the Royal College of Surgeons of England) / by James Paget. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    But it is characteristic of indammation, tliat, while the inflamed part itself suflcrs deterioration, there is a production of material wliich may be organized. Here, therefore, may be an evidence of increased formation, of increased action. Doubtless, m relation to the productive part of the inflammatory process, the expression ' increased action' may be in some sense justly used; for the weight of an inflamed part, or of the material se- parated from it, may bo much increased by the formation of organized matter. But the quantity of organized matter formed in an inflammation must not be uncondition- ally taken as the measure of uicreage in the exercise of the vital forces : for it is to be observed, that the material formed pi'csents only tlie lowest grades of organization, and that it is not capable of development, but rather tends to degeneration, so long as the inflammation lasts. It may be but a vague estimate that we can make of the amomit of vital force ex- ercised in any act of foraiation; yet we may be sure that a comparatively small amount is sufficient for tlie production of low or- ganisms, such as are the fibrinous and cor- ]5uscular lymphs of inflammation. The abundant production of lowly organised structm'es is one of the featm-es of the life of the lowest creatures, in both the vegetable and anunalkingdoms. And,inoiuowncases, a corresponding abundant production is often noticed in the lowest states of vital force; witness the final inflammations, so freqiient in the last stages of granidar' dege- neration of the kidneys, of phthisis, of cancer, and other exhausting diseases. In aU these, even large quantities of the lowly organised cells of inflammatory lymph may be formed, when life is at its last ebb, And with these cases correspond those that show the most rapid increase of tubercle and cancer, and other lowly organised tmnors, when the health is most enfeebled, and when the blood and all the natui-al struc- tures are wasting. From these considerations, wemay conclude that the productive part of the inflammatoiy process is not declaratory of the exercise of a large amount of vital, or organising, foi'ce; and this conclusion is confirmed by ob- serving that development, wliicli always re- quires the highest and most favoured exercise of the powers of organic hfe, does not occiu- whOc inflammation lasts. The general conclusions, therefore, may be, as well from the productive, as from tlio de- stnictive, eflbctsof tlic iiiflammatoryprocess, that it is accomplished with small expendi- ture of vital force, and tliat even wlien large quantities of lymph are formed, such an expression as increased action cannot bo safely used, unless wc can be sure that tlie defect of the fomative power exercised in the proper tissue of the inflamed part is more than counterbalanced by the excess of power manifested in the production and low organisation of lymph. It may be said tliat the signs of inflam- mation are signs of increased action. But these are ikUacious, if, again, by increased action be meant any increased exercise of vital force. The redness and the swelling of an inflamed part declare the presence of more blood; but this blood moves slowly ; and it is a quick i*enewal of blood, rather than a large quantity at any time in a part, that is significant of active hfe. An abundance of blood, with slow movement of it, is in no case characteristic of activity in a part; it more often implies the contrary, as in the erectile tissues, and the cancellous tissue of bones. Tlie sign of heat in the inflamed part is equally fallacious. The source of the locally increased heat cannot, I believe, be satis- factorily explamed. Tliis phenomenon of inflammation is involved in the same difficidty as are aU those that concern the local variations of temperature in the body : difficulties wliich the doctrines of Liebig, however good for the general production of heat, are quite unable to explain. But, from the fact that the general supply of heat in oiu- bodies is derived from oxydation or combustion of wasted tissues or of surplus food, we may assume that, in local augmen- tation of heat, the source is rather from some similar destruction of organic sub- stances, than from increased formation of them. This can, indeed, be only assumed ; but, if there be httle evidence for it, there is as little for any assumption that the in- creased heat of an inflamed part is an indi- cation of an uicreased formative action. The full heat of an actively growmg part may be compared with the liigh tempe- ratiu'e of one which is the seat of deter- mination of blood, or of active congestion; for, ui both cases, the heat is high because the blood, brought quickly from the heart, is quickly removed ; but, in an inflamed part, the blood is not so re- newed ; it moves more slowly. In thus endeavouring to estimate the difterence between the nonnal and the in- flammatory modes of nutrition, in rcgjird to the quantity of formative or other vital force exercised in them respectively, I have also stated the chief diflerences between them in relation to the quality or method of nu- trition. The most general peculiarity of (he inflammatory method, ni its simplest form, is the concurrence of these two distinct and indeiiendent, though usually coincident, events: namely, 1st, the impairment or suspension of the nutrition of the proper.