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

by Xavier Bichat

The exhalation of pus upon a cicatrizing surface and serous membranes, appears to me to have a great analogy with the whitish substance of some kinds of cysts.

Fourth period.

Suppuration gradually exhausts the whitish substance that fills the granulations; then their cells, which were at first swelled, insensibly diminish in size, they close by their contractility of texture; by degrees they adhere to each other, and from their adherence arise the following phenomena. 1st. All the fleshy tubercles disappear and there is a uniform surface in their place. 2d. This surface is a very fine membrane, because the thickness of the granulations arose not from the cells, but the substance they contained, and which being taken away, leaves them empty. 3d. This membrane has infinitely less width than the pellicle that first covered the granulations, because the cells in contracting, draw the edges of the cicatrix from the circumference to the centre; these approximate, and the breadth of the wound diminishes; the same granulations that in the beginning occupied a space of half a foot diameter, as for example in the operation for cancer, are often contracted to an inch or two.

When the adhesion is complete between all the cells that first form the fleshy granulations, the membrane of the cicatrix, the result of this adhesion, exists. Thus it is that all the flesh, the development of which astonishes us, and which amply repairs the loss of substance, is but a pellicle, reddish when the exhalants are full of blood, but afterwards white by the return of this blood into its vessels.

From this mode of origin of external cicatrices, it is easy to conceive, 1st. why they adhere intimately to the places in which they are found, and have no laxity in the integuments; 2d. why the skin approximates from all the neighbouring parts to cover the wound; 3d. why it wrinkles in approximating; 4th. why, where it yields the most, the cicatrix is the smallest, as in the scrotum, the axilla, &c.; and why on the contrary it is the largest, where it yields but little, as on the sternum, the cranium, the great trochanter, &c.; 5th. why the thickness of all cicatrices is uniformly in an inverse ratio to their width; in fact as there is only the same quantity of cellular granulations to form them, it is necessary that they should lose in one way what they gain in another; hence those that are broad are much more easily torn; 6th. why they have not a regular organization, do not partake of the functions of the cutaneous organ they replace, and why their texture is absolutely different from this organ. The cicatrization of wounds left to themselves, especially those with loss of substance, differs essentially from the union by the first intention, which is effected by the agglutination of the edges. In this last there is neither the second period, that of fleshy granulations, nor the third, that of suppuration, nor the fourth, that of sinking down. Union succeeds immediately to the first, that of inflammation.

We see, from all that has been said, that the cellular texture is the essential agent in the production of all cicatrices, that it forms their basis and their principle, that without it they could not take place, and that they depend especially upon the property it has of extending and increasing.

Influence of the cellular texture in the formation of tumours.

In the formation of cicatrices, the cellular texture grows but a few lines above the level of the place of division; the cells it forms in its reproduction are generally small. It is not so when there is a departure from the ordinary laws of cicatrization, when any accidental cause alters the vital properties; then we see a very extensive growth, which often has more of this texture than the parts from which it arises. All those different excresences, known by the names of fungous flesh, fleshy protuberances, soft flesh, &c. are but the result of this increase of the cellular system, being greater than what it should be by the ordinary laws of cicatrization; thus the cicatrices are not effected while these irregular productions continue; it is not until they are repressed that consolidation takes place. But it is especially in different tumours that we see this development, this remarkable growth of cellular texture. All the fungi, and productions that are developed exclusively in the mucous membranes, in the sinuses, the nasal cavities, the mouth and the womb particularly, and which differ essentially from those that have their seat on the fibrous membranes, the dura-mater for example, though they are compounded under a common name, all the fungi, I say, arise from the cellular texture, they are of a peculiar substance deposited there, which as it is more or less abundantly separated, leaves its primitive base more or less exposed.

Polypi, whether mucous or sarcomatous, tumours that are equally the attribute of the mucous system, have also the cellular texture for the primitive base of their organization. All the different kinds of cancers exhibit it in a manner more or less evident, in the swelling of the parts which they occasion. It would be necessary to notice almost all tumours, to point out those that the cellular texture assists to form.

We may then consider it as forming the general base, the nutritive parenchyma of almost all excrescences. It shoots up, and grows first at the part where the tumour is to be developed; then it is encrusted with different foreign substances, and their difference constitutes the difference of the tumours. These phenomena are precisely analogous to those of ordinary nutrition. In fact, all the organs resemble each other in their nutritive base, the parenchyma of nutrition, which is vascular and cellular; they differ in the nutritive substances deposited in this parenchyma. All tumours then are cellular, this is their common character. Their peculiar character is derived from the substances that the texture separates, according as the morbid alterations of which it is the seat, modify differently its vital forces and place it in relation with this or that substance; thus as we have said, all the internal cicatrices are similar in the first period, in that of fleshy granulations, and differ as the nutritive substance of the organ to which they belong, penetrates them.