Lectures on the processes of repair and reproduction after injuries: delivered at the Royal College of Surgeons of England / [Sir James Paget].

  • James Paget
Date:
[1849]
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the processes of repair and reproduction after injuries: delivered at the Royal College of Surgeons of England / [Sir James Paget]. Source: Wellcome Collection.

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    the cells, and, yet more evidently, their higher organization into cellular tissue and cartilage, ensue only while the signs of in¬ flammation are absent. They are manifestly hindered or prevented when signs of inflam¬ mation are distinctly present, or when its existence may be suspected in consequence of the presence of some irritation, as a foreign body, dead bone, or the like. The continuance of suppuration during the pro¬ cess of healing is no proof of the continuance of inflammation, if the account that I have given of pus be true. In these modes of healing, therefore, we may conclude that inflammation is only par¬ tially, and at one period requisite ; and that, in regard to its requisite degree, the least amount with which an effusion of lymph is possible is that which is most favourable to repair. Lastly, for the process of healing by scabbing, the absence of inflammation ap¬ pears to be essential: indeed, the liability of our own tissues to the inflammatory pro¬ cess, and to the continued effusion that it produces, appears to be that which prevents their injuries from being healed as easily and surely, by the scabbing process, as nearly all open wounds are in animals. Such may be regarded as the relations of the reparative process to that of inflamma¬ tion, as it is commonly understood; but, I repeat, such a comparison can be made only for the sake of deference to the general state of opinion in matters of surgical pathology. In truth, we know less of inflammation than of the reparative process. But, admitting the share which inflamma¬ tion has in the repair of injuries to be such as I have expressed, it appears necessary to consider next how such a process can be made to minister to repair;—what is the power that determines its results to be such, or of such a kind, as are required for the re¬ storation of the perfection of the injured part ? The mere act of inflammation in a part would not heal its wounds : it would only produce a material which might be de¬ veloped into cellular tissue and cuticle, and in which blood-vessels might be formed. Some other power must inform the course of the inflammation, and determine its result towards the healing of the wound. And so with all the other special acts of which each process of repair consists ; whether we as¬ sume the operation of an assimilative force, or detect germs of tissues, or productive cells, which we may regard as centres of power,—still we must admit, I think, that the reparative process is determined in every act according to the same law, and by the same powers, as those which actuated the developement of the germ. For in the re¬ pairs of even the highest animals we may discern all those features which I enumerated as characteristic of the power of the germ, and as distinguishing it from any force of assimilation, or any other force assumed in the explanations of the maintenance of the body by nutrition. Thus—1st, the material for the repair of an injury is constructed according to no present model, such as is assumed for the hypothesis of assimilative force : it is deve¬ loped from no tissue-germ left by the damaged part for the construction of its suc¬ cessor. In the repair of a .divided tendon, the whole length of the connecting bond is deve- loved equally ; or, if there be a difference, it is that the mid-space is in advance of the rest. No assimilative force in the ends of the original tendon can be imagined thus equally diffused, nor could germs for the growth of tendon have been strewn along the space left by the retraction. So, in the repair of fractures, the new bone is com¬ monly formed first in contact with the original shaft, as if it were an out-growth from it; and here the assimilative force may have effect: but it is also often formed in detached parts, even outside the periosteum, at such distance from the old bone, and with • such intervening tissue, that no act of an assimilative force can be reasonably imagined sufficient for the result. What, then, can determine such a recon¬ struction of parts as this ? Surely nothing but such a power as that which determined their original construction from the germ. The identity of the power is, in the second place, manifested by its mode of operation. Whatever be the structure to be reproduced, it is constructed through the same stages as were traversed in its first developement. Witness the cases that I have referred to : in the two modes of developement of nbro- cellular tissue for repair, both equally imita¬ tions of a natural developement,—in the two modes for the production of new bone, both alike repetitions of the natural developement of bone,—in the mode of developement of vascular loops, and of the walls of the blood¬ vessels. So, that, various as are the con¬ ditions in which we watch the process of re¬ pair, and various as the degrees of its per¬ fection, yet is there no real variety of plan ■—no deviation from conformity with the law according to which the new structures are developed in the germ. Observe, 3rdly, how, as in the germ, many independent developements concur*to the attainment of the end. In the several layers of granulation-cells, while, one portion are forming themselves to cellular tissue, another are constructing cuticle, and others are per¬ mitting and concurring in the progress of new blood-vessels. Or, in a wound involving many different tissues, we may discern the