604 



CICATRIX. 



granulations grow from the bottom of the wound, 

 that is, from the cellular tissue in contact with 

 the peritoneum ; but the contraction of the sur- 

 rounding parts now diminishes the circumfe- 

 rence of the ulcer very considerably by puck- 

 ering up this thin layer of membrane, so as to 

 give it externally an appearance as if a small 

 portion of the intestine had been taken up by 

 the forceps and tied with a ligature on the in- 

 side.* When the process of repair is com- 

 pleted, a fine web-like production from the 

 edges of the ulcer overspreads its base, and 

 forms fine wrinkles converging towards its 

 centre. This production is destitute of villi, 

 and slightly depressed. When the ravages of 

 the disease have been very extensive, the cica- 

 trix is covered by puckered cellular tissue, 

 formed of white thread-like filaments, crossing 

 each other in all directions, and leaving pitted 

 interstices.-)- When the ulcer was small, the 

 cicatrix has sometimes a considerable resem- 

 blance to the scar of small-pox.J 



That cicatrization takes place in the lungs 

 after tuberculous excavations, the observations 

 of Laennec and Andral|| among others, have 

 put beyond a doubt ; and since these patholo- 

 gists have made public their observations of 

 the fact, and pointed out the signs by which it 

 may be known, most observers have borne tes- 

 timony to the accuracy of their statements. 

 According to Laennec there are three ways by 

 which this desirable object is accomplished ; 

 one, by the walls of the cavity becoming lined 

 with a membrane of a semicartilaginous struc- 

 ture and smooth polished surface, which 

 seems often continuous with the lining mem- 

 brane of those bronchial ramifications which 

 open abruptly into the cavity. This state of 

 the restorative process constitutes a sort of in- 

 ternal cicatrix, analogous to a fistula, and is in 

 many cases not more injurious to health than 

 the species of morbid affection just mentioned. 

 The second mode of cicatrization consists in 

 the obliteration of the morbid cavity by adhe- 

 sion of its sides. In the complete state they 

 exhibit, when cut into, a band of condensed cel- 

 lular substance or of fibre-cartilaginous struc- 

 ture. The bronchial tubes which run towards 

 this structure are obliterated as they reach it, 

 and there is generally an unusual quantity of 

 the peculiar black matter of the lungs in the 

 parts bordering upon the cicatrix ; and where 

 this is the case, the structure of the lungs is 

 more flabby and less crepitous than natural. 

 These internal cicatrizations are indicated on 

 the surface of the lung by a depression of the 

 pleura, the depth of which corresponds with 



* Dr. Latham on the Disease of the General 

 Penitentiary, p. 51. 



t Dr. Hope's illustrations of Morbid Anatomy, 

 vol. i. p. '203. See also Billard's Recherches 

 d'Anat. Pathol. p. 534. 



f Bright's Medical Reports, vol. i. p. 182, where 

 are some very interesting illustrations of this por- 

 tion of pathological anatomy. See also on this 

 subject a valuable paper by M. Troillet in the Jour- 

 nal Gen. de Medecine. Reported in the Med. Chir. 

 Rev. vol. v. p. 192. 



On Mediate Auscultation, translation by Dr. 

 Forbes, 2d edit. p. 300. 



|] Clinique Medicale, torn. iii. p. 382. 



the size of the previous excavation, and is 

 sometimes so deep as to form a large over- 

 lapping prominence of the neighbouring sound 

 parts. Here we have another instance of the 

 same contractile tendency in newly formed 

 structures, which is so striking in cicatrizations 

 of the skin; a tendency resulting from the gene- 

 ral law by which the labour of restoration is, as 

 much as possible, spared to the animal system. 



The third species of cicatrix in the lungs is 

 that formed by the fibro-cartilaginous walls in- 

 creasing in thickness till they fill up the cavity, 

 thus leaving a blueish or greyish white mass, in 

 which large bronchi terminate abruptly as in 

 the preceding case. Cicatrices of the two last 

 kinds are not uncommon.* 



In the healing of common abscesses, whether 

 in the subcutaneous cellular tissue or in the 

 more deep-seated parts, the mode of cicatriza- 

 tion is much the same as in the second species 

 just described. As the fluid contents are re- 

 moved by evacuation, the cavity of the abscess 

 is diminished in extent partly by the contrac- 

 tion of the surrounding tissue and partly by the 

 granulations arising from the sides of the ca- 

 vity, and as the opposite sides are thus brought 

 in contact they adhere, and at length leave a 

 fibrous cicatrix, whitish and more dense than 

 the surrounding cellular tissue. It is remark- 

 able that few or no abscesses granulate till they 

 are exposed, and that after they are opened 

 there is one surface that is more disposed to 

 granulate than the others, which is the surface 

 next the centre of the body in which the sup- 

 puration took place. The surface next the 

 skin hardly ever granulates, but on the contrary 

 has an ulcerative tendency. The proximate 

 cause of this remarkable difference is not evi- 

 dent, but the utility of it in the healing of the 

 abscess is clear and striking.f 



We have now considered the processes by 

 which nature repairs the breach in the healthy 

 structure ; let us in conclusion shortly examine 

 the characters which mark the cicatrix when 

 completed. This new formation, though in 

 many points it resembles and fulfils the func- 

 tions of the old and perfect skin, yet differs 

 from it in many material respects. 



1 . It occupies, as we have stated, a smaller 

 space, having by its contraction drawn the 

 surrounding skin inwards, and thus, by the 

 wise economy of nature, diminished the surface 

 requiring new skin to cover it. This is of course 

 most strikingly seen in those parts where the 

 cellular texture is loose and yielding, as in the 

 scrotum, where a large loss of skin is often 

 healed with only a very small cicatrix. On the 

 contrary, parts that cannot so yield are healed 

 with a proportionately large cicatrix, as in 

 wounds of the scalp, &c. 2. The texture of 

 the cicatrix is frequently harder and thicker 

 than the natural skin. This circumstance varies 

 considerably, but we believe this variation will 

 be found to bear a pretty exact relation to the 

 degree of contraction, to the length of time 

 occupied in the cure, and to the irritation to 



* See Hope's Illustrations of Morbid Anatomy, 

 vol. i. p. 34. 



t Hunter on the Blood, p. 593. 



