566 OF NUTRITION. 



which was noticed by John Hunter, has been appropriately termed "secondary 

 adhesion" by Mr. Paget. The surgeon may frequently have recourse to it 

 with great advantage, when primary adhesion is impossible, and when the fill- 

 ing up of the wound with granulations would be a tedious process, and very 

 exhausting to the patient. In applying it to practice, it is essential to success, 

 first, that the granulations should be healthy, not inflamed or profusely secret- 

 ing, nor degenerated as those in sinuses commonly are; and secondly, that the 

 contact between them should be gentle but maintained; it seems desirable, also, 

 that the granulation surfaces should be as much as possible of equal develop- 

 ment, and alike in character. 1 



3. Abnormal Forms of the Nutritive Process. 



608. Under the preceding head, we have considered the chief variations in 

 the degree of activity that are witnessed in the ordinary or normal conditions 

 of the Nutritive process those conditions, namely, in which the products are 

 adapted, by their similarity of character, to replace those which have been 

 removed by disintegration. But we have now to consider those forms of this 

 process in which the products are abnormal being different from the tissues 

 they ought to replace. We shall confine ourselves to a brief examination of a 

 few of some of the most important of these states; and that which first claims 

 our consideration, on account of the frequency of its occurrence and the im- 

 portance of its results, is Inflammation. Although Pathologists have been 

 accustomed to look for the " proximate cause" of the phenomena which essen- 

 tially constitute the Inflammatory state, or, in other words, for the first de- 

 parture from the normal course of vital action, in the enlarged or contracted 

 dimensions of the bloodvessels of the inflamed part, or in the altered rate of 

 movement of the blood through it, yet it may now be safely affirmed that these 

 are only secondary alterations, depending upon an original and essential per- 

 version of that normal reaction between the blood and the tissues which con- 

 stitutes the proper Nutritive process. This perversion manifests itself (1) in 

 a diminution in the formative activity of the tissues, leading to their degenera- 

 tion and death ; (2) in a tendency to augmented production of the plastic com- 

 ponents of the blood; and (3) in the effusion of these components, either in 

 a state in which they may pass into a low form of organized tissue, or in such 

 a degraded condition that they are altogether unorganizable, and are fit only 

 to be cast out of the body. Each of these phenomena requires a separate 

 examination, both as to its causes and its consequences. 



609. Although it has been customary to speak of Inflammation as a state 

 of "increased action" in the part affected of which increased action the 

 augmentation in the bulk and weight of an inflamed part, and in the quantity 

 of blood which passes through it, together with its higher temperature and 

 more acute sensibility, would seem to furnish sufficient evidence yet all these 

 signs are found to be deceptive when they are more closely examined ; and the 

 conclusion is forced upon us, that the vital power of the part is really depressed 

 rather than exalted. For the increase in bulk and weight is not due to such 

 an augmentation of its proper tissue as would truly constitute Hypertrophy ; 

 on the contrary, even in the slightest forms of Inflammation there is such a 

 diminution in the rate of its nutrition as really constitutes Atrophy ; and such 

 augmentation of the solid mass as may take place, is produced by the passage 

 of the effused fluid into an organized tissue of the lowest kind, and this in 



1 On the whole subject of the Reparative Processes, see the admirable Lectures of Mr. 

 Paget, in the "Medical Gazette," 1849 ; from which many of the foregoing statements and 

 doctrines are adopted. 



