On the healing of wounds in articular cartilages, and on the removal of these structures after amputations at the joints : with remarks on the relation which exists between the diseases of cartilage and ulceration and inflalmmation in other textures / by P. Redfern.

  • Redfern, Peter, 1821-1912
Date:
[1851]
Catalogue details

Licence: Public Domain Mark

Credit: On the healing of wounds in articular cartilages, and on the removal of these structures after amputations at the joints : with remarks on the relation which exists between the diseases of cartilage and ulceration and inflalmmation in other textures / by P. Redfern. Source: Wellcome Collection.

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    mation in tissues furnished with blood-vessels, part of the inflamma¬ tory exudation, consisting of blastema, granules, and cells, is thrown off, together with the disintegrated elements of the part, and these constitute together a very evident discharge.1 The cure consists in the conversion of the nucleated cells of the inflammatory exudation into the white and yellow fibrous tissue of the cicatrix, the cells splitting to form the white, and the nuclei elongating to form the yellow fibres. The process of ulceration in cartilage, and other tissues, is, there¬ fore, precisely the same if we regard merely the actions of the essen¬ tial elements of the textures;—in both, softening and disintegration occur, with ejection of the molecular or granular matter into which the part has been reduced; in both, small particles of the tissue are thrown off, and are capable of recognition by the microscope; in both, larger portions of the texture, visible to the naked eye, are at times detached, in the one case, in the form of sloughs of dead tissue, in the other, in that of large portions of much less changed cartilage; lastly, in both instances, the process may go on with extreme rapi¬ dity, or it may make scarcely perceptible progress for a very con¬ siderable period. The points of dissimilarity are these,—articular cartilage contains no blood-vessels, consequently ulceration and other changes of struc¬ ture confined to it are never complicated by inflammatory exuda¬ tions, pus, &c., and can be examined very satisfactorily; ulceration in tissues containing blood-vessels is almost always complicated with inflammation, and the ejected particles of the tissues having under¬ gone a very complete degeneration, and become mixed with a mass of structures formed in the inflammatory exudation, also degenerate, are, therefore, very difficult to recognise. Ulceration or other dis¬ ease confined to articular cartilage has in no single instance been shown to be productive of pain,2—no doubt for the very simple 1 For a very excellent view of the whole process of ulceration, I would refer to Professor Paget’s fifth Lecture on Inflammation, Professor Miller’s “ Principles of Surgery,” Ed. 1850, p. 143, and to Professor Bennett’s Treatise on Inflammation, Ed. 1844, p. 46. 2 It is somewhat gratifying to find that the decided statements formerly made regarding the diagnosis of disease of articular cartilages have recently undergone modification, in two very important quarters at least. Sir B. C. Brodie, at p. 192 of the fifth edition of his work on “ The Diseases of the Joints,” April 1850, in speaking of the pain which exists during ulceration of arti¬ cular cartilages, adds, “ Still I am myself more inclined to the opinion, that the increased sensibility in these cases is in the bony plate beneath the cartilage rather than in the cartilage itself, and that the presence of severe pains, with involuntary startings of the limb, is always to be regarded as a sign of the bone partaking of the disease.” And Professor Miller, at p. 510 of the second edition of his “Principles of Surgery,” 1850, says, that simple destruction of cartilage leads “ to little pain, or perhaps none, if the cartilage alone be involved; ” and again, at p. 512, after repeating his former statement, that “ the symptoms of destruction of cartilage, although invariably indicative of that affection, are not
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