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

Paget, James, Sir, 1814-1899.

Date:: 1849

Credit: Lectures on the processes of repair and reproduction after injuries : delivered at 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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$particulars evident, and especially in that both manifest, by their spontaneous coagu- lation, that they contain fibrine. The coagulum which is spontaneously formed in reparative material is, in microscopic cha- racters, identical with that of fibrine : che- mically, too, they appear the same; and the organization of the fibrine of the blood in the complete clot, as well as all the other circumstances which lead to the opinion that fibrine is the principal material for organiza- tion into tissues,* justifies the belief that the lymph effused for purposes of repair has fibrine for its principal constituent. How- ever, when we speak of fibrine as the chief reparative material, we must not have in mind the pure organic compound that mi- nute chemistry might obtain, but rather that which exists in the natural, and seemingly rough, state,—as fibrine, with some fatty matter, and some incidental saUne consti- tuents ; for all these are found in all the specimens of coagulable lymph that have been examined; and doubtless they are essential, as the so-called incidental principles always are, to the due construc- tion of the substance to be organized. Regarding its vital properties, the essen- tial character of the coagulable lymph is its tendency to develope itself,— a tendency which it has of its own properties. It thus displays itself as a plasma or blastema—a fluid to be classed with those others that manifest the capacity to assume organic structure,—such as the lymph and chyle that develope themselves to blood; the semen, which, at first fluid, gradually deve- lopes itself into more and more complex structures. The natural tendency of coagulable lymph is to develope itself into the fibrous, or the common fibro-cellular or connective, tissue— the lowest form of vascular tissue, and the structure which, in nearly all cases in man, constitutes the bond by which disunited parts are again joined. This is commonly formed, whatever be the tissue upon which the lymph is i)laced, whether containing cellular tissue in its natural structure or not. This, therefore, we may regard as the common or general tendency of lymph ; but in certain cases the development of lymph passes beyond this form, or deviates from it into another direction, in adaptation to the special necessity of the part to be repaired. Thus, for the repair of bone, the lymph may proceed a certain distance towards the deve- lopement of fibrous tissue, as if for a common healing; but this fibrous tissue may next ossify; or, notforming fibroustissue at all, the lymph may proceed at once to the formation of a nearly perfect cartilage, and this may * Scfe especially Carpenter's Physiology, page 81, &C. ossify. In general, moreover, the character of the connective (issue that is formed in repair is adapted to that of the parts that it unites. The bond for the union of a tendon is much tougher than that for a common scar in the skin ; that in skin is tougher and less pliant than that in mucous mem- brane, and so on. It has been thought a nice question, whe- ther these variations in the developements of the same material—i. e. of the lymph—in adaptation to the purposes it has in each case to serve, be due to the assimilating in- fluence of the parts among which it is de- posited, or to a specific power, like the germ- power, which determines in each case the special result, as in embryonic developement it determines the formation of the several dissimilar organs out of similar materials. I have little doubt it is such a germ-power. In favour of this view, are all those general facts concerning the continuousness of its operation from the germ onwards, which I mentioned in my last lecture ; and we may commonly observe that the developement of special structures in the reparative material takes place at considerable distances from the structures by whose assimilative force some have supposed the developement to be determined. Thus, e. g. in the repair of fractures, one may find, sometimes, plates of bone formed in new fibrous material ex- ternal to the periosteum of the old bone ; and in the formation of the tough fibrous tissue which is made for the repair of ten- dons, one may always notice that the deve- lopement is equal and commensurate through the whole length of the new bond of union. Such a developement cannot be determined by the contact, or even by the contiguity, of the original tendinous structure, or by any- thing like an assimilative force issuing from it. But, passing by, for the present, the in- stances of special developement of the re- parative material, in adaptation to special purposes or injuries, let me speak of its developement into fibrous, fibro-cellular, or connective tissue. I have said that, in its first production, the reparative material is like the lymph of inflamed serous mem- branes,—at least, no characteristic difference between them is yet known ; neither are there yet any observations to show a diff'er- ence in the characters of the materials eff'used for the repair of injuries of different parts, or in different circumstances; and yet such a difference, in even the original characters of the lymph, is indicated by the fact that in different circumstances it may proceed to the same end—the formation of fibrous tissue—Uy two different ways of de- velopement. The lymph, or new material, which is produced for the repair of oi)en wounds, generally developes itself into fibra-$