General Anatomy, Applied to Physiology and Medicine, Vol. 1 (of 3)

by Xavier Bichat

The cellular texture is distinguished from other organs by the faculty it has of throwing out a kind of vegetation, of elongating and re-producing itself, of growing when it has been cut or divided in any manner. It is upon this faculty that depends the formation of cicatrices, tumours, cysts, &c.

Influence of the cellular texture upon the formation of cicatrices.

Cicatrices may be considered under two relations, 1st. in the external organs, in the sub-cutaneous texture and skin particularly; 2d. in the internal organs. Let us examine them at first in the external.

Every wound that follows the ordinary periods, presents between its formation and its cicatrization, the following phenomena; 1st. it inflames; 2d. fleshy granulations are formed upon its surface; 3d. it suppurates; 4th. it sinks down; 5th. it is covered with a fine pellicle, red at first and afterwards becoming whitish. Let us trace these different periods.

First period.

Inflammation commences the instant the wound is made. This is the sudden result of the irritation caused by the instrument, the contact of the air, the dressings and surrounding bodies. Shut out until then from the contact of the air, most of the parts concerned in the solution of continuity, enjoy only organic sensibility; but then these contributing to form the surface of the body, ought to enjoy animal sensibility, that which transmits to the brain the impressions that are received. Now the effect of inflammation upon organs endowed only with the first kind of sensibility, is to raise it so much, that it ascends to the same degree as the second, and can like it, transmit to the brain its impressions; so that by it the parts divided by a wound become capable of performing the functions of the integuments. This is the first advantage, without doubt, of this inflammatory period of cicatrization.

Another advantage of this period is to dispose the parts to the development of fleshy granulations. In fact, inflammation always precedes this development; now the increase of life that it produces in the organs, appears to be necessary to animate the parts that are to be reproduced; by it the cellular texture, where the granulations are formed, is endowed with more sensibility and more insensible contractility; it raises it to a temperature above that of the neighbouring organs; it becomes the centre of a small circulating system independent of that of the heart. It is in the midst of this extension of the forces, that the fleshy granulations arise and increase, for the production of which the natural forces would have been insufficient. Hence the paleness and flaccidity of these granulations, when these different functions are weakened or cease.

Second period.

The production of fleshy granulations succeeds to inflammation. It presents the following phenomena; small reddish bodies, like tubercles, arise, unequal and irregularly disposed upon the surface of the wound; they are not fleshy, as their name, given, no doubt, on account of their colour, would indicate; they are little cellular vesicles, filled with a thick substance, like lard, which we are unacquainted with, and which it is important to analyze. This substance so fills the cells, that in blowing air into the texture subjacent to a wound, whether in a living or dead body, this fluid does not enter the granulations; they are raised up entire, but no one of them is developed or distended as the cells which this substance does not fill; the granulations remain the same in the midst of the general bloating. I have often made these experiments upon animals that I have wounded for the purpose.

In proportion as the granulations are developed upon an exposed cellular surface, we see them unite together, and form, by their union, a kind of provisional membrane, which absolutely prevents the contact of air upon the subjacent organs, while the true cicatrix, that which is to be permanent, is forming. This provisional membrane of cicatrices, this kind of epidermis destined to defend the parts during the work of cicatrization, differs from common serous membranes in this, that they are smooth and every where uniform, whilst the granulations produce here an unequal and rough surface. This inequality of the granulations and their separation, appear to be opposed to what I have said concerning the first state of cicatrices; the following experiment leaves no doubt upon the subject. I made a large wound upon a dog, and let it go through its first periods; the animal was then killed. I removed a portion of flesh upon which the granulations were developed; I distended it by a prominent body, placed on the side opposite to the granulations, so as to make the granulated surface convex, that had been concave; the tubercles were effaced; the provisional pellicle, stretched out, became very evident; it might have been taken for an inflamed serous membrane.