604 CICATRIX. 



granulations grow from the bottom of the wound, the size of the previous excavation, and is 

 that is, from the cellular tissue in contact with sometimes so deep as to form a large over- 

 the peritoneum; but the contraction of the sur- lapping prominence of the neighbouring sound 

 rounding parts now diminishes the circumfe- parts. Here we have another instance of the 

 rence of the ulcer very considerably by puck- same contractile tendency in newly formed 

 ering up this thin layer of membrane, so as to structures, which is so striking in cicatrizations 

 give it externally an appearance as if a small of the skin; a tendency resulting from the gene- 

 portion of the intestine had been taken up by rallaw by which the labour of restoration is, as 

 the forceps and tied with a ligature on the in- much as possible, spared to the animal system, 

 side.* When the process of repair is com- The third species of cicatrix in the lungs is 

 pleted, a fine web-like production from the that formed by the fibre-cartilaginous walls in- 

 edges of the ulcer overspreads its base, and creasing in thickness till they fill up the cavity, 

 forms fine wrinkles converging towards its thus leaving a blueish or greyish white mass, in 

 centre. This production is destitute of villi, which large bronchi terminate abruptly as in 

 and slightly depressed. When the ravages of the preceding case. Cicatrices of the two last 

 the disease have been very extensive, the cica- kinds are not uncommon.* 

 trix is covered by puckered cellular tissue, In the healing of common abscesses, whether 

 formed of white thread-like filaments, crossing in the subcutaneous cellular tissue or in the 

 each other in all directions, and leaving pitted more deep-seated parts, the mode of cicatriza- 

 interstices.f When the ulcer was small, the tion is much the same as in the second species 

 cicatrix has sometimes a considerable resem- just described. As the fluid contents are re- 

 blance to the scar of small-pox.J moved by evacuation, the cavity of the abscess 



That cicatrization takes place in the lungs is diminished in extent partly by the contrac- 



after tuberculous excavations, the observations tion of the surrounding tissue and partly by the 



of Laennec and Andral|| among others, have granulations arising from the sides of the ca- 



put beyond a doubt ; and since these patholo- vity, and as the opposite sides are thus brought 



gists have made public their observations of in contact they adhere, and at length leave a 



the fact, and pointed out the signs by which it fibrous cicatrix, whitish and more dense than 



may be known, most observers have borne tes- the surrounding cellular tissue. It is remark- 



timony to the accuracy of their statements, able that few or no abscesses granulate till they 



According to Laennec there are three ways by are exposed, and that after they are opened 



which this desirable object is accomplished ; there is one surface that is more disposed to 



one, by the walls of the cavity becoming lined granulate than the others, which is the surface 



with a membrane of a semicartilaginous struc- next the centre of the body in which the sup- 



ture and smooth polished surface, which puration took place. The surface next the 



seems often continuous with the lining mem- skin hardly ever granulates, but on the contrary 



brane of those bronchial ramifications which has an ulcerative tendency The proximate 



open abruptly into the cavity. This state of cause of this remarkable difference is not evi- 



the restorative process constitutes a sort of in- dent, but the utility of it in the healing of the 



ternal cicatrix, analogous to a fistula, and is in abscess is clear and striking.^ 

 many cases not more injurious to health than We have now considered the processes by 



the species of morbid affection just mentioned, which nature repairs the breach in the healthy 



The second mode of cicatrization consists in structure ; let us in conclusion shortly examine 



the obliteration of the morbid cavity by adhe- the characters which mark the cicatrix when 



sion of its sides. In the complete state they completed. This new formation, though in 



exhibit, when cut into, a band of condensed eel- many points it resembles and fulfils the func- 



lular substance or of fibro-cartilaginous struc- tions of the old and perfect skin, yet differs 



ture. The bronchial tubes which run towards from it in many material respects, 

 this structure are obliterated as they reach it, 1. It occupies, as we have stated, a smaller 



and there is generally an unusual quantity of space, having by its contraction drawn the 



the peculiar black matter of the lungs in the surrounding skin inwards, and thus, by the 



parts bordering upon the cicatrix ; and where wise economy of nature, diminished the surface 



this is the case, the structure of the lungs is requiring new skin to cover it. This is of course 



more flabby and less crepitous than natural, most strikingly seen in those parts where the 



These internal cicatrizations are indicated on cellular texture is loose and yielding, as in the 



the surface of the lung by a depression of the scrotum, where a large loss of skin is often 



pleura, the depth of which corresponds with healed with only a very small cicatrix. On the 



* Dr. Latham on the Disease of the General contrary, parts that cannot so yield are healed 



Penitentiary, p. 51. with a proportionately large cicatrix, as in 



t Dr. Hope's illustrations of Morbid Anatomy, wounds of the Scalp, &C. 2. The texture of 



d?A ' P t1 3 l' S 534 alS Recherches lhe cicatrix is frequently harder and thicker 



^BrigJ's Medical Reports, vol. i. p. 182, where than the natural skin " This circumstance varies 



are some vt ry interesting illustrations of this por- considerably, but we believe this variation wil 



tion of pathological anatomy. See also on this be found to bear a pretty exact relation to the 



suhject a valuable paper by M. Troilkt in the Jour- degree of contraction, to the length of time 



nal Gen. de Medecine. Reported in the Med. Chir. occupied in the cure an( J to t ] ie irritation to 

 Rev. vol. v. p. 192. 



$ On Mediate Auscultation, translation by Dr. See Hope's Illustrations of Morbid Anatomy, 



Forbes, 2d edit. p. 300. vol. i. p. 34. 



|| Clinique Medicale, torn. iii. p. 382. t Hunter on the Blood, p. 593. 



