Editing Joseph Lister (section)

====1858 On the early stages of inflammation====
The focal study{{sfn|Lister|1858d}} was the longest paper of the three and the last to be published.{{sfn|Fisher|1977|p=87}} Like many of his colleagues, Lister was aware that inflammation was the first stage of many postoperative conditions{{sfn|Bohrer|2012|p=4}} and that excessive inflammation often preceded the onset of a septic condition.{{sfn|Fitzharris|2018|p=120}} Once that happened, the patient would develop a fever.{{sfn|Fitzharris|2018|p=120}} Lister had come to the conclusion that accurate knowledge of the functioning of inflammation could not be obtained by researching the more advanced stages, which were subject to secondary processes.{{sfn|Godlee|1924|p=47}} He therefore started in quite a different way from that of almost all his predecessors by directing his enquiry to the very first deviations from health, hoping to find in them "the essential character of the morbid state most unequivocally stamped".{{sfn|Godlee|1924|p=47}} Essentially, Lister performed these experiments to discover the causes of [[erythrocyte]] adhesiveness. As well as experimenting on frogs' web and bats wing,{{sfn|Godlee|1924|p=47}} Lister used blood that he had obtained from the end of his own [[Phalanx bone#Distal phalanx|finger]] that was inflamed and compared it against blood from one of his other fingers.{{sfn|Howard|2013|p=194}} He discovered that after something irritating had been applied to living tissues which did not kill them outright, firstly the blood vessels contracted and their [[Lumen (anatomy)|lumen]] became very small; the part became pale. Secondly, the vessels after an interval, dilated and the part became red. Thirdly, some of the blood in the most injured blood vessels slowed down in its flow and coagulated. Redness occurred which, being solid, could not be pressed away. Lastly, the fluid of the blood passed through the vessel walls and formed a "blister" about the seat of injury.{{sfn|Wrench|1913|p=52}} He found that each tiny artery was surrounded by a muscle, which enables it to contract and dilate. He found further that this contraction and dilation was not an individual act on its part, but was an act dictated to it by the nervous cells in the spinal cord.{{sfn|Wrench|1913|p=53}}

The paper was divided into four sections:
* The aggregation of red blood cells when removed from the body, i.e., which occurs during [[coagulation]].
:: This section deals with the aggregation of the [[blood cell|cells]] of the blood, which occurs during the process of [[clotting]]. It shows that when blood is removed from the body this aggregation depends on their possessing a certain degree of mutual adhesiveness, which is much greater in the [[white blood cell]]s than in the [[red blood cell]]s. This property, though apparently not depending upon vitality, is capable of remarkable variations, in consequence of very slight chemical changes in the [[blood plasma]].{{sfn|Godlee|1924|p=47}}
* The structure and function of blood vessels.
:: This section shows that the arteries regulate, by their contractility, the amount of blood transmitted in a given time through the [[capillaries]], but that neither full dilatation, extreme contraction, nor any intermediate state of the arteries, is capable per se of producing accumulation of blood cells in the capillaries.{{sfn|Godlee|1924|p=48}}
* The effects of irritants on blood vessels, e.g., hot water.
::This section details how the effects are two-fold
:::* firstly, a dilatation of the arteries (commonly preceded by a brief period of contraction), which is developed through the nervous system and is not confined to the part brought into actual contact with the irritant, but implicates a surrounding area of greater or less extent; and
:::* secondly, an alteration in the tissues upon which the irritant directly acts, which makes them influence the blood in the same manner as does ordinary solid matter. This imparts adhesiveness to both the red and the white blood cells, making them prone to stick to one another and to the walls of the vessels, and so gives rise, if the damage to the tissues be severe, to stagnation of the blood flow and ultimately to obstruction.{{sfn|Godlee|1924|p=48}}
* The effects of irritants on tissue.{{sfn|Godlee|1924|p=48}}
:: The fourth section describes the effects of irritants upon the tissues. It proves that those which destroy the tissues when they act powerfully, produce by their gentler action only a condition bordering on loss of vitality, i.e. a condition in which the tissues are incapacitated, but from which they may recover, provided the irritation has not been too severe or protracted.{{sfn|Godlee|1924|p=48}}

Lister's paper was able to show that [[capillary action]] is governed by the constriction and dilation of the arteries. The action is affected by trauma,{{efn|Defined as traumatic injury, sudden physical [[injury]] caused by an external force, which does not rise to the level of [[major trauma]]}} [[irritation]] or [[reflex action]] through the central nervous system.{{sfn|Howard|2013|p=194}} He noticed that although the capillary walls lack muscle fibres, they are very elastic and are subject to significant capacity variations that are influenced by arterial blood flow into the [[circulatory system]].{{sfn|Howard|2013|p=194}} Drawings made with a camera lucida were used to depict the experimental reactions.{{sfn|Howard|2013|p=194}} They displayed vascular stasis and congestion in the early stages of the body's reaction to damage. According to Lister, vascular alterations that were initially brought on by reflexes occurring within the nervous system were followed by changes that were brought on by local tissue damage. In the conclusions of the paper, Lister linked his experimental observations to physical clinical conditions, for example skin damage resulting from boiling water and trauma occurring after a [[surgical incision]].{{sfn|Howard|2013|p=194}}

After the paper was read to the Royal Society in June 1857, it was very well received and his name became known outside Edinburgh.{{sfn|Noble|1960|p=42}}

{{multiple image | header = Camera lucida illustrations from this paper| align = center | direction = horizontal | total_width = 200| float = none
|image1=Frogs web inflammed with mustard (light).png|caption1 = Frogs web that has been irritated with mustard|alt1=Frogs web that has been irritated with mustard
}}