Popular Science Monthly/Volume 22/March 1883/A Chapter in Transcendental Pathology
IN his address to the Pathological Section of the British Medical Association, on the occasion of its meeting at Worcester this year, the distinguished president of the section, Dr. J. Hughlings-Jackson, threw out the suggestion that inflammation should be regarded as a process of dissolution. His meaning will be fully intelligible only to those who have some knowledge of the system of philosophy which Mr. Herbert Spencer has given to the world. It may be interesting, both to those who are familiar with Mr. Spencer's writings, and to those who are not, if we somewhat expand Dr. Jackson's hint, and inquire briefly how far inflammation corresponds to Mr. Spencer's definition of dissolution. If we find that it is included in that definition, it may enable us to trace relations between inflammation and other allied processes—mineral, vegetal, animal, psychological, and social—which can not but enlarge and make clearer our views of it and them.
Evolution, our readers will hardly need reminding, is the process of growth and life; dissolution, that of decay and death. The definition of inflammation which is given by one of the most eminent writers upon the subject starts from the proposition that inflammation is the result of injury. We should, therefore, a priori, expect that changes which are the result of injury would have their analogues rather in the processes of decay and death than in those of life and growth. The definition of evolution which Mr. Spencer formulates is as follows: "Evolution is an integration of matter and concomitant dissipation of motion, during which the matter passes from an indefinite, incoherent homogeneity to a definite, coherent heterogeneity, and during which the retained motion undergoes a parallel transformation." Dissolution is the reverse of this. We have, then, to see if inflammation corresponds to a definition running thus: Dissolution is a disintegration of matter and concomitant absorption of motion, during which the matter passes from a definite, coherent heterogeneity to an indefinite, incoherent homogeneity, and during which the retained motion undergoes a parallel transformation.
The first thing which our definition asserts is, that inflammation is a disintegration of matter. This proposition needs little defense. Do we not find that inflamed parts are always softened, and that when the process is severe and continued they become liquefied, converted into pus? Inflammation clearly is a process which tends to the disintegration of matter. We learn, next, that the disintegration of matter is accompanied with concomitant absorption of motion. This, on consideration, will be found equally true, although, perhaps, not so obvious. In the process of evolution the motion of units (molecular motion) becomes converted into the motion of aggregates (molar motion); and in dissolution the reverse takes place. The latter we shall find hold good of inflammation. An inflamed part is not only softened—which means that its component molecules move more readily upon one another—but it is swollen. The particles previously integrated into a solid mass, occupying a small space, have most of them moved farther away from one another, and now occupy a comparatively great space. Besides this, it is hotter than natural, and heat is a mode of motion. There is thus an increase of molecular motion. With this, the functional activity of the part which, from our present point of view, is its motion as an aggregate (for all force is a mode of motion), is lessened. To take the most literal illustration: an inflamed muscle can not contract with the force of a healthy one. Seeing, then, that there is an increase of molecular motion in an inflamed part, we might be content with pointing out that this motion must have been obtained from somewhere. But we may go further. There is one remedy, the potency of which, in checking inflammatory change, can not be gainsaid. It can not everywhere be efficiently applied, and it is not always decidedly for the patient's benefit that inflammation should be too rudely cut short; but, when circumstances admit of cold being brought into play, there is no doubt that it will arrest or suspend inflammatory change. We find throughout the universe that cold everywhere arrests molecular motion. It makes fluids into solids, vapors into fluids; checks chemical as well as vital change. The inflamed part to which cold is applied is surrounded by a medium from which it can not absorb motion; and, if motion can not be absorbed, inflammation can not go on. Inflammation, then, is a change attended with the absorption of motion as well as with the disintegration of matter.
Proceeding with our definition, we find it next informs us that the matter (in the present case the inflamed part) passes from a definite, coherent heterogeneity to an indefinite, incoherent homogeneity. It is a general assertion that holds good of inflammation in every part of the body, that from the first stage to the last it tends to blend and confuse together, to destroy the distinctive features of the individual structures of the part affected. In the beginning we have infiltration with leucocytes, replacing with cells of indefinite type the muscular, nervous, fibrous, and other naturally well-defined elements of the part affected. Finally, we have every trace of the latter lost; the definiteness of structure, its coherence and heterogeneity have gone, and we have in place simply a collection of fluid homogeneous pus. The progress is clearly from the definite, the coherent, and the heterogeneous, to the indefinite, the incoherent, and the homogeneous. The last part of the definition asserts that the retained motion undergoes a like transformation. This we have partly touched on already. The healthy body contains structures which absorb, transform, and give out force—that is, motion—in different ways. By the intestinal canal, force stored up by plants and animals is taken into the body. By the lymphatic and vascular system it is transferred from the place where it is taken in to the place where it is wanted for use. By the nervous, muscular, and glandular apparatus it is converted into sensible motion of the organism as a whole, or into secretions capable of setting up various changes in the substances with which they come in contact, or of producing and nourishing a new being. We have, therefore, in the normal organism, motion given out in many heterogeneous forms, each form being definite, and each so related to the activity of the rest that the body forms a whole as coherent in function as it is in structure. When inflammation affects a part, these features of its dynamic activity disappear. Natural function is either lost, or performed only in an imperfect way. In place of the exertion of force in ways heterogeneous, but definite, we have the homogeneous molecular motion manifested by liquefaction, swelling, and warmth. Definiteness of function, as of structure, is lost; heterogeneity of tissue changes, as of the tissues themselves, is altered to homogeneity; and in place of the part fulfilling its function to the advantage of every other part, that is, in a manner coherent with functional activity elsewhere, it exercises only a perturbing, injurious effect—its functional activity has become incoherent instead of coherent.
The subject is a very large one; and in the space that we are able to give to it we can not do more than imperfectly indicate the analogies which inflammatory changes bear to those of dissolution generally. If our remarks should incite others to follow up the subject in a more exact and comprehensive manner, our object in making them will have been amply fulfilled.—Medical Times and Gazette.