602 



CICATRIX. 



CHYLIFEROUS SYSTEM (Human Ana- 

 tomy). See LACTEAL. 



CICATRIX. (Fr. Cicatrice; Germ. Narbe.) 

 When from accident or disease a portion of 

 any organ in the body has been destroyed, 

 a process is set up by Nature for the repair 

 of the breach, a new structure is generated, 

 which possesses many properties of conside- 

 rable interest and importance both in a phy- 

 siological and a pathological view. The new 

 formation constitutes what is termed a cicatrix, 

 and the process by which it is completed, the 

 process of cicatrization. We shall in this 

 article give a general view both of the mode of 

 of repair and of the product when completed. 



The restorative process, when a part of the 

 skin has been destroyed, is extremely in- 

 teresting. The first stage varies according 

 as the part is removed at once, as by exci- 

 sion, or secondarily, as by sloughing. The 

 immediate effect of removing a portion of skin 

 is, that the surrounding integument, by its 

 inherent elasticity, retracts, arid to a certain 

 extent, enlarges the breach made by the wound. 

 In a short time after the infliction of the injury 

 inflammation and suppuration take place. 

 As the next step, fibrine is effused, which very 

 shortly becoming organized, constitutes those 

 red, soft, roundish elevations known by the 

 name of granulations. As these form, a con- 

 traction of them occurs, by which the edges 

 of the sore,which had at first retracted, are now 

 brought back again towards their original si- 

 tuation. 



John Hunter informs us that this contracting 

 tendency in the granulations is in some degree 

 proportioned to the general healing disposition 

 of the sore, and the looseness of the parts on 

 which the granulations are formed, for when 

 there is not a tendency to skin, the granulations 

 do not so readily contract.* The contraction 

 continues till the whole is healed over, but its 

 greatest effect is at the beginning ; one cause 

 of which is that the resistance to it from the 

 surrounding parts is then least. 



While this is going on within the circum- 

 ference of the sore, and immediately pre- 

 ceding the commencement of actual cicatri- 

 zation, the surrounding old skin, close to the 

 granulations, becomes smooth and rounded 

 with a whitish cast, as if covered with some- 

 thing white, and the nearer to the cicatrizing 

 edge, the more white it is. At this moment 

 the process of cicatrization is actually begin- 

 ning, and the new cuticle may now be ob- 

 served to be spreading from the circumference 

 of the sore towards the centre, not uniformly, 

 but creeping irregularly over the granulations, 

 or rather formed irregularly from them, but 

 always, in recent sores, spreading in a con- 

 tinuous surface from the circumference. In 

 large and old ulcers, however, in which the 

 edges of the surrounding skin have but little 

 tendency to contract, or the cellular membrane 

 underneath to yield, the old skin also having 

 but little disposition to skinning in itself, the 



* On Hie Blood, 8vo edit. 



nearest granulations do not receive from it a 

 cicatrizing tendency. In such cases new skin 

 forms in different parts of the ulcer, standing 

 upon the surface of the granulations like little 

 islands. The rapidity with which the skinning 

 process takes place in this stage is but an un- 

 certain criterion whereby to judge of the time 

 that will be occupied in the cure. Generally 

 speaking, the latter stages of the process are 

 much slower than the earlier, particularly when 

 the breach of surface has been large. 



And here a question arises : is the new skin 

 that is formed the result of an altered state of 

 the granulations themselves, or is it an entirely 

 new product from them ? Bichat inclined to 

 the former opinion, holding that the granu- 

 lations having discharged their fluid contents, 

 collapsed, and uniting one to another, became 

 converted into the uniform smooth membrane 

 in question. Hunter, on the contrary, con- 

 sidered the new cutis as a new product, the 

 secretion of the granulations. Our own ob- 

 servations lead us to adopt the opinion of 

 Bichat. It seems that, as soon as the surface 

 of a granulation is covered over with epidermis, 

 which is often the case before the least shrink- 

 ing or collapse of the granulation occurs, then 

 the secreting orifices of those numerous vessels 

 of the granulation which had hitherto been 

 pouring out pus are now sealed up, and 

 having no longer any use, the same change 

 takes place which occurs in other parts of 

 the system similarly circumstanced : an or- 

 gan no longer in use shrinks and the fluid 

 parts become absorbed, and the elevated soft 

 and spongy granulations shrink into the thin 

 and somewhat dense fibrous structure of the 

 cicatrix. We cannot agree with the opinion 

 of M. Dupuytren, that the chorion is formed 

 first, and the epidermis added subsequently, 

 since we have often detected the epidermis 

 creeping over granulations so little altered in 

 appearance that its presence could only be dis- 

 covered by placing the part in such a light 

 that its dry shining surface could be distin- 

 guished from the soft villous appearance of the 

 neighbouring granulations. The process of 

 con traction, we believe, generally, if not always, 

 does not precede but follows the formation of 

 the cuticle, and consequently the cutis formed 

 by this contraction does in the order of time 

 follow the cuticle. The reason of this we can- 

 not explain, but of the fact we cannot doubt; 

 and this fact accounts for the very slow 

 formation of the cuticle in the first healing 

 of an ulcer where that membrane is formed from 

 the granulations. The organization of these 

 bodies may be said to be much inferior to 

 that of the cutis when completed ; hence, when 

 the cuticle of a cicatrix is abraded, it is readily 

 formed again, because it has now a more perfect 

 organ to secrete it. 



As the new cuticle covers the granulations, 

 then, these two striking changes immediately 

 take place in their state ; the secretion of pus 

 is stopped, the surface becoming dry, and that 

 process of shrinking or contraction begins 

 which we shall find to continue for a conside- 

 rable period after the whole sore is apparently 



