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CELL THERAPEUTICS.

BY THE SAME AUTHOE.
HEALTHY AND DISEASED STRUCTURE,

THE PRINCIPLES OF TREATMENT FOR THE CURE OF DISEASE
ESPECIALLY CONSUMPTION AND SCROFULA.

1 Vol. 8vo., with Platesj 12s.

CELL THERAPEUTICS.

WILLIAM ^DISON, M.D., F.R.S.

"If results derived from microacopical researches be incorporated in the science of
Physiology, and be received in explanation of appearances in morbid anatomy, they
must also be admitted into the domain of Thebapbutios." — Healthy and Diseased
Structure, S/c, 1849.

LONDON :

JOHN CHURCHILL, NEW BURLINGTON STREET,

MDCCCLVI.

■ LONDON :
J. PALMER, SAVOY STREET, STRAND.

ROYAL COLLECS 0!= PHYS40IA«3

1 DATfe

CONTENTS.

Page.

I. — Eeparation , - ... 1

II. — Cells and cell-growths (granulatioBS and pus) . 17.

III. — Blood distempers (small-pox, scarlet fever, gout) 20

IV. IftfiJ^AMMATION . . . .33

V. — The distinction between vascular tissue and

parenchymatous substances . . ^38
VI. — Organic disease and the process of repair (con-
sumption, cancer) . . . .44
VII. — Chronic inflammation . . . .58
VITI. — Conclusions . . . .66
IX. — Unity of Design, &c . . . .77

INTRODUCTION.

Undee the title of Cell Therapeutics we shall have
to. consider phenomena of cure and reparation in
connexion with the Cell Physiology. Not simply
the consideration of cure in mechanical injuries — a
department which has been ably investigated by
Mr. Paget— but methods of reparation in blood dis-
tempers and organic disease.

No great amount of argument is required to be
convinced that the principles of Medical Science,
those of pathology and therapeutics must follow in
the paths of physiology. Whatever is established to
account for the varied facts of the parent science —
for the normal course of life — must be held sufficient
also in explanation of phenomena observed in the
subordinate or collateral departments. That is to
say : — If cells and nuclei are of such generality and
importance as to take rank as agents in normal

viii

INTEODUCTION,

growth, SO that all healthy changes of structure and
function be referred to them, they can hold no
inferior rank, being present, in all therapeutical
reactions against injuries and diseases. The cell
doctrine has been gradually advancing its footing in
physiology for twenty years ; it has also gained a
strong hold in pathology, and it seems now required
that therapeutical changes in the qualities of the
blood should be shown to be either in harmony with
it, or capable of a rational explanation without it.

It has been elsewhere said that — " The microscope
having demonstrated the presence of nucleated cells
in the structures of plants, animals, and man, has
thereby occasioned a great change in physiological
doctrine, and in no case is this change more appa-
rent than with respect to secretion. Blood-vessels
and ducts used to be considered as secreting agents,
but it is 'now known that all vessels or ducts from
which a secretion is derived, are clothed with
nuclei or nucleated cells, and it is to these the trans-
formations constituting true secretion are referred."

In pathology, the microscope has shown in all
cases, that granulations, whether of a white colour

INTEODirCTIOlSr.

and springing from the interior wall of an abscess,
or red, as they appear at the surface of an outward
sore, are forms of nucleated cell-growth. And of
the matter termed pus, the former belief of its being
a secretion is negatived by the use of the microscope,
which proves that also to be another form of cell-
growth. Such being the case, minute researches
having brought into view elements common to
normal growth and disease, and having changed in
many important points both physiological and patho-
logical conclusions, we propose here to trace the
corresponding fitness of therapeutical doctrine. And
in order to sketch out, introductorily, what this
fitness is, let us take a brief review of some of the
more common facts upon which the cell-physiology
is founded.

Oxalic acid is formed in the leaves of some, and
oil of peppermint in the leaves of other plants. The
poisons of tobacco, digitaHs, and opium are pecuHar
to the respective plants. The colour scarlet dis-
tinguishes the blossom of some, and the colours
yellow and blue the blossoms of other plants. In
fruits and seeds how various are the qualities of the
different parts!

INTRODUCTION.

In animals and man there is not less of variety in
the different organs. Bile is the secretion of one
gland, milk, saliva, the tears, urine, &c., the secre-
tions of other glands, notwithstanding in each case
the organ derives its materials from a common
source, the blood.

In all these examples the differences are attri-
buted— in the doctrine of cell-growth — to the agency
of cells and nuclei, to the several ways in which the
exterior matters, absorbed by different kinds of cells,
are dealt with or changed in their interior ; or
attracted by nuclei, are altered outside them in their
vicinity. Nothing, it is said, can gain entrance into
the cells, whilst they are growing, but what is
specially admitted, and what is specially admitted is
changed in different ways by different kinds of cells.
In these operations, the materials outside the growing
cells undergo changes also, and necessarily, for what
is taken into the cells is taken from the matter
which surrounds them.

This physiological doctrine is now placed in the
van of science, and following it out we shall find
that the formation of an abscess and the dischai'ge of
sloughs without bleeding ; the opening of blood-

INTRODUCTION.

vessels for the junction of new ones ; the discharge
of poisons or injurious matter from the blood, and
sundry changes of texture observable in organic
diseases are phenomena referrible to the properties
of nucleated cells. And such being the case, we
may extend to Inflammation, views first propounded
in our work On Healthy and Diseased Structure, in
explanation of the phenomena of Sceofulous Disease.

It has been said with reference to the doctrine of
cell-growth, " How unlike, in the important parti-
cular of referring phenomena to general laws, is
Schwann's cell-theory of fermentation to Ltebig's
reference of that process to the contagious influence
of chemical action."'"' We do not admit the justice
of this animadversion, for as long as the distinction
between organic and inorganic matter remains, the
contagious influence of chemical action, however
widely instanced, can claim no more generality than
the laws of living matter.

A solution of salt and water and an infusion of
sage leaves placed aside together in summer, both
undergo changes ; crystals may be found in the one

* " Sequel to Outlines of Medical Proof," by Dr. Mayo.

xii

INTKODUCTION.

and animalcules (cells) in the other. In both cases
visible and regular bodies appear, and the fluids have
undergone changes; in both there has been a
species of attraction, decomposition, and growth.
The changes in the saline solution are in obedience
to physical laws ; those in the vegetable infusion are,
we think, rightly considered in subjection to the
laws of vital action, to the formative power and
metabolic processes of cells. A room full of air will
remain a long time unchanged, but if a multitude of
living individuals — plants or animals — be placed in
it, a change in the air speedily ensues. The indivi-
duals exhibit activity — the plastic power of cells —
and changes in the air, thus crowded with Hving
beings, are referred, not to mere chemical action,
but to the performance of vital acts, the metabolic
power of cells.

In the domain of Science there is a primary and
fundamental division into things possessing and
things not possessing life. As long as this classifi-
cation is preserved, the microscopical physiologist is
constrained to frame his theories in subordination to
it, to refer the chemical changes observed in the

INTRODUCTION.

xiii

structures of living beings, and those also which
living bodies effect in the matter which surrounds
them, and upon which they live to the principle of
life. The plastic power and the metabolic power
of cells are but subsidiary expressions, the one
comprehending the various changes observed in the
bodies of the cells themselves, the other, the changes
in the matter which is outside, but surrounds them,
both merge into the cause to which we attach the
idea of Life.

CELL THERAPEUTICS.

OF KEPARATION.

A PROPERTY of repair inherent in the human body
is proved by the heaUng of wounds and fractures.
This we propose for examination with reference to
inflammation and organic disease.

In scalds the part speedily becomes red, and the
cuticle rises into a vesicle filled with lymph. If this
be punctured with a fine needle, and the raised
cuticle smoothly replaced, new cuticle is formed, the
injured one peels off in flakes, and the wound heals
spontaneously. In burns, the body inflicting injury
is hotter, its influence extends deeper, and a portion
of skin is killed. At first, the dead skin adheres
strongly to the part beneath, but when a discharge
^ B

^ OF REPARATION.

of pus is established, ca line of separation appears.
The dead skin loosens, and may afterwards be easily
removed, as a slough. When the slough has been
detached, a new texture comes into view, in the
shape of innumerable red points, termed granula-
tions ; and, upon inspecting these through a lens,
new blood-vessels are to be seen in them. The
period during which the granulations may remain,
varies in different cases, but, gradually, they change
into a fibrous texture or cicatrice, which heals the
wound.

Case. — A forgeman was struck in the eye with a
small particle of iron wliich remained impacted in
the cornea. He had been suffering from the acci-
dent for four days. The blood-vessels in front of
the eye were extremely red, and there was a weeping
of tears, which, instead of being transparent, were
turbid, from a great number of colourless cells in
the secretion. Through a lens, the wound in the
cornea was seen filled with pus, and the particle of
iron was still sticking in the middle of the sore.
In fact, abscess and ulceration had taken place.
And that these formed part of the natural effort to
cast out the injurious foreign body in the manner of
a slough, was rendered almost certain, because, upon

OF EBPARATION.

the surgical removcal of it, the part healed in a very
short time. Moreover, when a thorn enters the
flesh, if it be not speedily removed, abscess and
ulceration will take place in the parts around, and
thus the offending body is often cast out. The
wound remains until the foreign body be thrown off,
but afterwards it heals spontaneously.

Case. — A young lady, aged nineteen years, suffer-
ing from fever, had been in bed fourteen days. At
the time I visited her there was a slough upon the
skin on the lower part of the back, as large as a
crown-piece. It was black and dry. It adhered
very firmly to the parts below, and a slight attempt
to remove it produced pain and bleeding. But when
a discharge of pus appeared the slough loosened and
fell off spontaneously without pain or bleeding.

Here there must have been severance of the bond
previously uniting the dead with the living parts.
The severance was concomitant with the establish-
ment of granulations and purulent discharge, and it
was accomplished without any loss of blood. In
these, and all other examples of reparation, lymph,
granulations, new blood-vessels, and pus, one or more,
take part in the operation. In slight accidents

B 2

OP EEPARATION.

lymph only may appear, as in scalds. In other
cases, lymph, granulations, and new blood-vessels.
But, in graver injuries, where the dead part is to
separate from the Hving, we see the whole series, —
lymph, granulations, new blood-vessels, and pus.

In Small Pox there are numerous pustules, or
little abscesses in the skin. With the ripening or
maturation of the pustules the disorder declines.
The liver, or kidney, is sometimes the nidus of a
parasitical creature, termed an " acephalocyst." In
such cases an abscess forms, and we see the outlet
of its contents barred from taking a dangerous
direction, by adhesions formed between contiguous
surfaces. At the same time, its evacuation is pro-
moted in another direction, by absorption of inter-
posing tissue. By these opposite, but concomitant
operations, the matter of an abscess is prevented
from discharge in a dangerous direction, and is, as it
were, conducted to some safer outlet, — the intestine,
— or perhaps the bronchial tubes of a lung. In the
lungs, if an abscess — the result of softening tuber-
cles— be near to the surface of the organ, and likely
to burst into the cavity of the chest, the accident is
provided against. Adhesions form between the wall
of the chest and the lung at the threatened spot, by

OF EEPAKATION.

which the escape of the matter in that dangerous
direction is very often prevented.

When a blood-vessel has been ruptured in the
brain, a clot is formed. Lymph is effused, and the
contiguous parts are softened by a species of abscess.
If all other circumstances be favourable to the pro-
gress of repair, the cyst or wall of the abscess
changes into fibrous texture. Absorption of a con-
siderable part of the clot ensues. What remains is
protected from the tender brain substance, and the
patient, in a great degree, recovers from the accident.

These cases comprise the points for discussion : —
What are granulations and pus, and what are their
properties ? How is it that an abscess occasions
thickening and adhesions in the texture surrounding
one part of its circumference, and thinning of the
surrounding texture, with ulceration, at another
part ? What account can be given of the apparent
incongruity, that inflammation, after mechanical vio-
lence, seems necessary to the process of repair, and
on other occasions is looked upon as a disease ?
What are the relations of healthy to unhealthy
inflammation ?

The lymph of vesicles or vesications diff'ers from

OF REPARATION.

the lymph of blood only in the larger proportion of
water. Both contain colourless cells. Pus is well
known to be composed of cells ; and granulations
are groups of cells. Granulations and pus are, then,
two forms of cell-growth. Granulations a vascular
form — pus a deciduous form. The cells of granula-
tions, structurally united by their new blood-vessels
to the living parts, are, we know, susceptible of
change into fibrous texture. The cells of pus, on
the other hand, incoherent, and without any struc-
tural bond of connexion with the body, seem well
fitted for discharge, and to be the medium of sepa-
ration for sloughs. The new blood-vessels of granu-
lations are entirely surrounded by cells. We have,
on many occasions, examined the coats of the vessels
in newly formed granulations, and we find in them
neither the nucleated nor the outer fibrous coat of
the natural vessels. But new blood-vessels, thus
differing in structure from the pre-existing ones, and
which give evidence of this difference by bleeding, —
sometimes spontaneously, and always upon the
slightest touch, could not transmit onwards the
stream of blood without free connexions with the
older vessels. The fact of the circulation going on
through the new vessels is the proof of some
removal or absorption of the coats of the older
vessels. That is to say : —

OF CELLS AND CELL-GKOWTHS. /

Blood-vessels must have been opened before the
circulation of the blood could pass on in the new
vessels of granulations. But how are they opened
without any loss of blood 1

Now, if granulations and pus be two forms of cell-
growth, it is to the purpose to refer to some of the
most general properties of cells. For it may be
found that these will help to explain phenomena of
reparation, abscess, and ulceration; throw hght
upon the process by which the living part sepa-
rates itself from the dead, and openings are made in
blood-vessels for the junction of new ones, without
bleeding.

11.

OF CELLS, AND CELL-GROWTHS.

That the structures of all organic beings — plants
and animals — originate from minute cells, was first
announced by Oken, — the fact has been ably illus-
trated, and enforced by Schleiden, Schwann, Barry,
and other physiologists, and is now universally con-
curred in, as a truth of the highest interest to all
who would investigate phenomena of health, disease,

OF CELLS, AND CELL-GROWTHS.

and reparation. The cells here spoken of, are micro-
scopic objects, various in colour, and usually consist
of four parts : — 1, an exterior integument ; 2, a
nucleus ; 3, an interior, sometimes viscous matter ;
and, 4, granules or molecules. The exterior integu-
ment or cell- membrane is, for the most part, a thin
transparent pellicle, through which the interior con-
tents of the cell may be discerned. The nucleus is
apparently, a compact body, adherent to some point
of the cell membrane. And the viscous granular
matter and molecules are the ingredients to which,
in many cases, if not in all, the sensible qualities of
the cell must be referred. For in unripe fruits,
(the plum or cherry,) the cells of the pulp contain
an abundance of green granules — and the taste of

* Much more importance than is here indicated has
latterly heen attributed to " nuclei." But whether the inves-
tigations of Mr. Savoey on the development of sti'iated
muscular fibre, or those of Dr. G. H. Jones, on the liver, lead
ultimately to some modification of the cell doctrine or not,
will affect but little the facts and argument in the present
essay. For in all the examples we shall adduce ; "nucleated "
cells are present. And should it be proved that the " nucleus"
is the point or pole of activity, it will simply have the effect
of referring the active properties of nucleated cells to a defi-
nite pai't of their structure, — one to which tlie formation of
the cell is already attributed.

OP CELLS, AND CELL-GROWTHS.

the pulp at this time is sour and astringent, or very
much the same with that of the leaves. But when
the fruits have ripened, the cells are much larger,
they are now filled with a much blander and sweeter
fluid, and at this time nearly all the green granules
have disappeared. Again, the pith at the extremi-
ties of the young and tender shoots of the Elder
(Sambucus niger) is composed of cells nearly filled
with green granules, which gradually diminish in
quantity towards the older part of the branch ; and
where the woody tissue has formed, they are almost
altogether wanting. In the former situation, the
cells of the pith are green and have the strong
sensible qualities of the plant ; in the latter they are
white and quite insipid. The skeleton integument
of the cells and the nucleus remain, forming the
white pith, but the green matter and the qualities
which gave taste and smell to the green pith have
disappeared together. The same kind of observation
has been recorded by Schwann in the mature and
immature shaft of a feather. He has observed the
granulous contents of the cells in the immature and
growing part of the shaft, and the larger cells with-
out granulous matter in the perfected part of the
feather. *

* " Microscopical Eescarclics into the Accordance in the

OP CELLS, AND CELL-GllOWTHS.

That the cells of vegetable structure perform in-
dependent functions, and that the sensible qualities
(taste and smell) of plants are derived — not from the
cell-membrane, nor from the nucleus — but from the
interior contents, the green granules or granular
matter, further appears from the following : — If one
of the fleshy leaves of sedum acre be crushed with a
drop of water, between two slips of glass, numerous
cells with a thin transparent integument, and appa-
rently without any nucleus, but which contain an
abundance of green granules, will be seen. And the
biting quality of the plant seems to reside in the
green matter, for in autumn, when the leaves have
turned to yellow, the biting quality is lost. In a
parti-coloured petal, for example, the garden pansy,
each cell may be seen to possess its own colour,
without the least intermixture with that of the
adjoining ones. Cells filled with a rich purple pig-
ment are observed with a microscope in juxta-posi-
tion with others filled with a brilHant yellow, and
cells with these colours may be seen in apposition
with others of a pale primrose, or with others with-
out any colour. It is evident from these examina-
tions that, differences of colour, and other qualities,

Stmcture and Growth of Animals and Plants," page 82— plate
2— figs. 10 and ll.-Syd. Sec. Ed. 1847.

OP CELLS, AND CELL-GROWTHS.

in different groups of cells, — fruits, flowers, and leaves,
arise from an independent function in each cell of
the group. The purple pigment, or the bitter and
acrid principle, is formed in one cell, and the yellow
pigment, and other qualities, in another cell. In the
pansy there is no intermingling of colours, each
coloured cell is perfect in itself.'"' The same ob-
servations apply generally to those animal cells
from which the secretions, saliva, mucus, &c., are
derived.

In many kinds of vegetable cells a movement or
circulation of their contents may be seen. In the
hairs on the filaments of Tradescantia, the molecules,
by wdiich the circulation is detected, are exceedingly
minute, whereas, in the leaves of Myriophyllum, the
matter which circulates round and round the cells
is mixed with much larger granules, and the same
sort of granules appear incorporated with the cell-
membrane. In many kinds of animal cells, for
example, those of mucus, blood, saliva, and pus,
extremely active movements have been seen in tho
molecular or granular matter of their interior.
Moreover, many animal cells have cilia, moving to
and fro with great rapidity.

* " Experimental and Practical Eesearches on Inflammation
and Tubercles, &c." 8vo. Plates. ia43. ChurchilL

OF CELLS, AND CELL-GROWTHS.

" It is certain," says Lord Bacon, " that all bodies
have perception, for when one body is applied to
another, there is a kind of election to embrace that
which is agreeable, and expel or exclude that which
is ingrate, and whether the body be alterant or
altered, evermore a perception precedeth operation,
for else all bodies would behave alike to one another."

" I am prepared to admit," observes Dr. Faraday,
" that in water, a particle of hydrogen in combination
with oxygen is not altogether indifferent to other
particles of hydrogen, but to have an affinity to-
wards them, which, in many cases, produces effects
rising into considerable importance." If such be the
opinion of some of the greatest philosophers, if they
speak of " elective affinity" as a property of the
molecules of inorganic and amorphous matter, we are
the more prepared to meet with a conclusion of an
analogous kind in respect of nucleated cells ; bodies
which exhibit internal movements, and are always
present in the growth and changes of more complex
living structures.

And thus it is " selective absorption," that is to
say, the absorption of some things and the exclusion
of others, is assumed and accepted as a common
property of cells. It is said to be performed by the
one single cell of which each individual, among the

OF CELLS, AND CELL-GKOWTHS. 1^

lowest forms of animal and vegetable beings, consists.
And it is admirably illustrated in a parti-coloured
petal, where, as we have said, cells filled with one
coloured fluid are in apposition with cells filled with
another fluid of quite a different colour.

"Absorption,'' says Kollikee, "is manifested by
all cells. The cause of it, is not to be sought, solely,
in endosmose or imbibition, but, as Schwann has in-
dicated, in this :— that while the cell membranes
grow by attraction of material from the surrounding
fluids, by virtue of their porosity they allow sub-
stances to penetrate into their interior. This fiUing,
however, does not take place by the cells admitting
every kind of matter indiscriminately, but they ex-
hibit peculiar relations, so that they take up one
constituent, and reject another. And the consti-
tuents so taken up are altered, in some cells one
way, and in others in another way." In plants the
elements by which absorption and secretion are per-
formed no doubt consist of cells. And this is true
of animals. The agents in the absorption of fluid in
contact with the roots is neither the woody tissue,
nor the vessels it contains, but the succulent cells at
the growing extremity of the rootlets. Also, the
chief agents in the absorption of nutriment in contact
with the alimentary canal, are the cells or the cellos-

OP CELLS, AND CELL-GROWTHS.

form nuclei, of the villi distributed upon the mucous
coat of the intestine.

" Among the cells composing the germinal mem-
brane of the incubated egg, certain of them," says
Schwann, " throw out stellate processes which come
into contact and coalesce. The septa are then ab-
sorbed, and thus a network of canals, which become
capillaries, is produced." Here the removal of the
septa or partitions must be referred to cells or their
nuclei, for there are no vessels to which absorption
can be attributed. There is cell-growth over the
whole of the human ovum. At one spot of this a
placenta forms. And if the connexion between
placenta and uterus be carefully examined, it is
stated by Virchow, that the embryonic cell-growth
will be found to have penetrated through the coats
of the maternal vessels by absorption. If this be
so, it is an example of the opening of blood-vessels
by cell-growth without bleeding. In the plexus
choroides of the brain, and in the synovial fringes in
joints, there are special cell-growths. And that
these have relation to absorption, may be argued
from the extremely limited quantity of fluid existing
in health in the cavities with which they are con-
nected, as compared with the vejy large amount
that sometimes collects from injury or disease, and

OF CELLS, AND CELL-GROWTHS. 15

which is often very rapidly absorbed upon recovery.
There is, however, no necessity for arguing from
doubtful instances, inasmuch as it has been estab-
Hshed that —

"There is no essential difference between the
lowliest plant and the highest animal in regard
to the act of selective absorption, in both it is
accomplished by cells."

That the cells of granulations and pus should
exhibit pecuUar relations to the surrounding parts,
a property of selective absorption, would there-
fore be only a particular instance of a general func-
tion— a property established for these forms of cell-
growth, which is found universally in all other
kinds of such growth. What are the facts bearing
upon this inference An abscess is occasioned by
a species of cell-growth, it is a collection of Pus-cells
in a closed cavity ; and the interior surface of an
abscess is also composed of cells.

" An abscess," says Me. Lawrence, " is both a
secreting and an absorbing surface. It may be
regarded as a kind of new organ developed in the
body."

" In the first processes toward suppuration, where
the living surface is to separate from the dead parts,
wo may remark," says Mr. Hunter, " that nature

OP CELLS, AND CELL-GROWTHS.

Ccau carry on two operations at the same time, for
whilst the separation is proceeding by the absorbents,
the parts are forming themselves for suppuration."

An abscess, during the time pus is accumulating,
will make its way from the deeper parts to the sur-
face of the body by absorption of the overlying
integument ; and numerous small blood-vessels
have their continuity interrupted without bleeding.

In ulcers the natural texture is eroded or ab-
sorbed, and here numerous cells flow away in the
discharge. Blood-vessels, too, are frequently divided
by ulceration without any loss of blood.

In both abscess and ulceration there is evidence
of two simultaneous operations — first, cell-growth, —
and secondly, absorption or disintegration of the
vascular-tissue without haemorrhage. Appearances
are ver}^ different in an abscess as compared with
an ulcer — because, in the former, the new matter,
the new-growth, pus, being confined, its accumulation
causes swelling, and this hides from view the loss of
the existing texture by absorption, whilst, in the
latter, an ulcer, the new matter having a free dis-
charge, the loss or disintegration of the existing
texture is the most prominent feature. Truncate
an abscess or pustule, allow the pus to escape, and
an ulcer with a soft pyogenic surface, or with granu-

OF CELLS, AND CELL-GROWTHS. 1/

lation, remains. What, in these cases of abscess anc
ulceration, are the agents by which absorption ii
effected and blood-vessels opened without bleeding 1

Case. — An acute abscess, which rapidly came to
a head, was opened, and a quantity of cream-like
pus was discharged. The cells of the pus were
nearly uniform in size, figure, and appearance. In
contact with tepid water, they increased greatly in
size by absorption, and, within the enlarged cells,
numerous minute molecules were seen in active
motion.

Case. — A chronic abscess, which had existed a
long time, was opened, and the matter discharged
had a very different appearance. It was more fluid,
not so white, and there were many flakes and clots
in it. Upon examination, scarcely any entire or
perfect cells could be seen. The difference in these
two cases seemed connected with the qualities of the
pus-cells. For, in the acute abscess, where cell-
growth and absorption of the overlying integument
were both actively proceeding, the cells were found
uniform in figure and appearance, — " laudable pus."
Whereas, on the contrary, in the chronic abscess.

OP CELLS, AND CELL-GROWTHS.

where cell-growth and absorption of the overlying
integument were both extremely languid, or had
stopped, the cells were found fewer in number, more
broken, shrivelled, and otherwise irregular in shape,
— " unhealthy pus." Whatever the agents of absorp-
tion in thinning the integument over an abscess are,
the same, we must suppose, sever blood-vessels with-
out bleeding, and make ^openings in the older vessels
for the junction of new ones. And in cell-growth
there are agents having attributed to them proper-
ties which seem most fitted for the purpose. Messrs.
Tomes and De Morgan, in a paper in the Philoso-
phical Transactions, on the structure and development
of bone, distinctly refer the absorption of bone in a
case which they examined, to a granulation texture
composed of nucleated cells. " What the bone lost in
bulk," they say, " the cells gained ; the cellular mass
presenting a perfect cast of the surface of the bone,
suggesting to the mind that the soft was growing at
the expense of the hard tissue."*

In small-pox every pustule arises with inflamma-
tion, and becomes an abscess filled with cells ; — it
is a focus of cell-growth. Other persons will take
small-pox disorder by inoculation with matter from
the pustules. This is strong evidence that the cells

* Philosophical Transactions, 1853. Pait I. p. 129, iSrc.

OP CELLS, AND CELL-GROWTHS. 19

of the pustules have absorbed and conveyed inju-
rious matter from the blood to the vascular tissue
for discharge. In measles and scarlet fever, re-
covery from the disorder is concomitant with an
exfoliation of cell particles from the skin, and, that
these discharge poisonous matter from the blood
seems proved, by the contagious properties which
it is well known they possess.

In inoculated small-pox a poison is undoubtedly
introduced into the blood, — this produces illness in
the person and numerous little abscesses in the skin ;
with the maturation of the pustules, illness subsides.
Other kinds of poisonous matter may be absorbed
from wounds or sores, and this is often followed by
inflammation, abscess, and ulceration, not only in the
sore itself, but also in other distant parts of the
body. In these cases, it has been observed, that
with the discharge of the contents of the abscess,
the patient has recovered. In a paroxysm of gout
the attack passes off concomitantly with a copious
extra-exfoUation of cuticular particles from the skin,
and that matter, injurious to the blood, obtains an
outlet from the circulation at the part affected, is
presumable, from the nature of the material deposited
in the tissues around the disabled joint. From these
cases we are naturally led to follow up the inquiry

c 2

OF BLOOD DISTEMPER.

as respects absorption by cells, under the heading
of our next section.

III.

OF BLOOD DISTEMPER.

Blood may be injured or distempered by un-
wholesome food, by impure air, by suppression of
the natural secretions, and by sundry poisons.
What are the phenomena in such cases 1 To this
question we reply generally, some form of inflam-
mation. In local violence from mechanical injury,
the place of inflammation is determined. It appears
at the site of injury. In blood distemper, on the
other hand, the place of inflammation is not always
so precisely determined. In rheumatism, erysipelas,
and gout, it may shift its position. It may begin
in one part and pass over to another. Blood flowing
"in all parts of the body, and vascular tissue existing
wherever blood flows, elements of inflammation
would seem to exist no more in one spot than in
another. Yet, in discrete small pox, inflammation
always appears in spots on the skin, and the pustules

OF BLOOD DISTEMPER.

always stand out isolated and distinct. In scarlet-
fever and measles, the redness of the skin is always
more general. What in these cases determines
the difference

That poisons of various kind affect the blood, and
that some poisons act specially upon one organ,
others upon other organs, may be safely aflirmed.
Laudanum, and chloroform, act upon the brain.
The action of strychnine as a poison is shewn in an
especial manner by muscles ; and that of mercury
by the salivary glands, &c. In these cases, the
amount of injury, or gravity of the symptoms, is in
proportion to the quantity of poison, — at least it is
generally so. In epidemical disorders there appears
the same kind of special action from aerial poisons.
In some seasons, the air tubes of the lungs, or the
glandules of the skin, — at other seasons, the mucous
membrane of the bowels, or the substance of the
brain, is most affected. That is to say, sometimes
influenza or bronchitis, small pox or scarlet-fever, —
at others, diarrhoea, typhoid fever, or cholera, are
epidemic. How is this accounted for^ "We may
say, the miasm or aerial poison is specially deter-
mined to the part affected. But how determined 1
In all secreting organs, the parenchymatous elements
consist of different kinds of cells. In animals, as in

OP BLOOD DISTEMPEK.

plants, secretion is performed by the agency of cells,
which, in the former case, select from the blood the
materials it is their province to assimilate, and dis-
charge them into canals, by which they are carried
out of the system. The cells of secreting organs
have a property of selective absorption. And we
argue of small-pox, that the poison acts most upon
the glandules of the skin, in virtue of peculiar rela-
tions in the elements of that species of parenchyma
to that particular poison, in a way analogous to that
by which mercury affects specially the salivary
glands, viz. — by selective absorption. Such being
the case, and the glandules of the skin lying separate,
and distinct, with considerable intervals between
them, the spots of inflammation are distinct, and the
pustules distinct.

In scarlet fever, we argue in the same manner —
that the poison — in virtue of a property of selective
absorption — acts most, or primarily, upon the deep
cells of the epidermis or cuticle. And, these being
universally distributed upon the skin without inter-
vals, the redness, therefore, is general.

" That sores give rise to very difierent kinds of
pus," says Mr. Hunter, " is evident to the naked
eye, and that the difi"erent parts of which the blood
is composed will come away in different proportions

OF BLOOD DISTEMPEK. 23

we can make no doubt ; and we find that whatever
is in solution in the blood comes away more in one
kind of pus than in another." Again : " A person
shall have a sore upon the leg, which granulates
freely ; the granulations shall appear healthy, the
skin forming round the edges, and all shall be pro-
mising well, when aU at once the granulations shall
lose their life and fade away. New granulations
may afterwards spring up, and these shall undergo
the same process, and so they would continue to go
on, if some alteration in the nature of the parts be
not produced."

Differences in the qualities of pus and granulations
are here referred to differences in the quality and
composition of the blood. Things in solution in the
blood coming away more in one kind of ceU-growth
than in another.

It is not a new doctrine to say the blood is dis-
tempered by an aerial poison ; or that poisons are
determined to particular organs. Nor is it new
to argue that vesicles, pustules, abscess, or some
other critical discharge, cure the distempered blood.
The cause of fever, according to Hippocrates, was
some poison in the blood, which in a certain number
of days was brought into a state in which it can be
separated from the rest of the blood and expelled,

OF BLOOD DISTEMPER.

either by some increased secretion, or by eruption,
pustules or abscess.

" An epidemical disease," says Sydenham, " must
be regarded as an effort of nature to restore the
health of the patient, by the elimination of the mor-
bific matter, which would otherwise undo the fabric
of the body. During the febrile ebullition the ele-
ments which fret the blood are picked out, gathered
together, and made over to the fleshy parts of the
body for expulsion."

Now, selective absorption by^ic^s is an accepted
doctrine of physiology. If, therefore, we argue
special relations in the parenchymatous organs to
different poisons — aerial and others — in virtue of a
property of selective absorption in their component
cells, we do no more than put forward a well-known
and very general function of cells, as a vera causa
in a most interesting class of pathological and thera-
peutical phenomena : as the method by which opium
especially affects the brain, though received by the
stomach ; by which, in epidemical disorders, a parti-
cular part is peculiarly affected by a particular
miasm ; by which, in small pox, inflammation appears
in spots, and in scarlet fever is general upon the '
skin ; by which, in short, one poison or medicine
affects one organ, and another poison another organ

OF BLOOD DISTEMPER.

especially. And if, as appears to be the case, the
turning point of the symptoms — the crisis — in small-
pox and scarlet fever, be determined by the maturity
of cell-growth, then in other epidemical fevers there
is ground for arguing that the crisis of the disorder
is also determined by the maturity of cell-growth,
different sorts or species of cells requiring different
times. And it is to be observed in small-pox, as a
type of these cases, that the blood improves, or
becomes better fitted for its normal purposes as the
cells grow. For what are the facts 1 In small-pox
there are hundreds of little abscesses in the skin,
each one of them a focus of preternatural nucleated
cell-growth. The blood is continually passing the
pustules, and the growth of the cells and a change
in the quahties of the blood are concomitant effects.
We do not know what the change in the blood is,
further than it appears in the removal of injurious
matter, but it may be argued, that with the change
in the blood the conditions necessary to the cell-
growth are exhausted. The growth ceases and the
patient recovers.

Pursuing this line of argument, it follows, that the
cells of the pustules of small pox, which grow and
multiply by absorption from blood, tainted with the
poison of small pox, must differ in qualities from

OP BLOOD DISTBMPEE.

those discharged from a wound occasioned by mecha-
nical violence. And that this is so, seems proved,
inasmuch as has been said, the one kind of cells will
reproduce a specific disorder, which the other kind
of cells will not do. The pus of small-pox performs
a physiological or therapeutical function, or is
" laudable," if, discharging a poison from the blood
of one person, it be capable of producing small-pox
in other persons. And, in other cases, granulations
and pus are " laudable," not so much from a com-
parison with any fixed or ascertained standard, as
when their component elements perform the re-
quired function in particular instances. Such are
the separation of sloughs, the expelling foreign
matters by the safest channels, the elimination of
poisons from the blood, the establishment of new
blood-vessels without bleeding, and the repair of
solutions of continuity by the metamorphosis of
granulations into fibrous texture.

Are we to suppose that the natural powers of re-
paration, which heal wounds — discharge sloughs
without bleeding, and produce new bone for the re-
pair of fractures through the medium, or by the
agency, of a nucleated cell-growth — stop there 1
On the contrary, we argue from the facts that these
powers are exercised in blood distemper and organic

OP BLOOD DISTEMPER.

disease, through the same medium,— the properties
of nucleated cells. The evidence, we contend, as
clearly proves that cell-growth will efifect a therapeu-
tical change in the quality of blood, as that it effects
therapeutical changes of texture in the common
cases of reparation.

That the poison of small- pox destroys, in the
very severe cases, the natural parenchymatous cells
of the glandules of the skin, is probable from the
pits which remain. Yet in the pustules we see new
preternatural cells which seem generated by the
poison. This is agreeable with the laws of nature.
Nothing is more common than lowly species of cells
growing upon weakened textures of a higher grade,
and flourishing under conditions which injure or kill
more complex structures. We may be unable to
discover, with the microscope, differences in different
kinds of laudable pus, that of small-pox, from that of
a common suppuration, but this is not to be won-
dered at. For different species of animal cells, unless
deeply coloured, are very much alike to one another,
and some kinds of animalcules which live in decom-
posing animal and vegetable infusions, would be
scarcely distinguishable from pus cells were it not
for their varied and spontaneous movements.

That there" is abundant evidence of a provident

OF BLOOD DISTEMPER.

intent and action in all cases of abscess and ulcera-
tion can scarcely be denied, when we contemplate
the vast solutions of continuity which occur, without
bloodshed, in the most highly vascular parts of the
body, from large abscesses and spreading ulcerations.
This provident action we designate by the term
CELL-THERAPEUTICS ; —a term which in its broad
physiological sense, is by no means to be limited to
cure and healing. For in every case of abscess and
ulceration, whether success or reparation be or be
not achieved — whether the patient recover or die —
nevertheless, the formation of the abscess and the
spreading of the ulcer, both furnish wonderful ex- v
amples of the provident properties of cell-growth.
Solutions of continuity are effected, dead and useless
parts slough off, and new blood-vessels are formed
which join on to the older ongs, without bleeding.
Surely, it is to take a very partial view of the salu-
tary operations of Nature, if we limit them by a tech-
nical idea, by the medical sense of cure or recovery.*
Arguing the absorptive and therapeutical properties
of cell-growth, in no way interferes with the function
of absorbing vessels. For instance : — Of an abscess
in a gland of the groin from ulceration in the foot,

* Vide the chapter on Etiology in Healthy and Diseased
Stmctm'e.

OF BLOOD DISTEMPER. 29

the argument is, that a poison, entering the circula-
tion by absorbent vessels, is arrested and discharged
by the cells of the gland in the thigh. The pheno-
mena being inflammation, abscess, and purulent dis-
charge. An indiscriminate absorption by vessels,
may thus be supposed, rectified by the discriminate
activity— the metabolic processes— of cells. We do
not presume to determine the office of the lymphatic
glands, but in support of our argument we may point
to their situation, properties, and connexion with
absorbent vessels. Glands composed of cells are
numerously placed along the course of absorbent
vessels, and they readily suppurate upon poisons
reaching them through the vessels. And this being
so, a basis seems laid for arguing the therapeutical
intent, if not always the therapeutical result, of puru-
lent cell-growth in such cases. And what is called
the vis medicatrix natures would seem referrible to
the properties of a nucleated cell-growth.

If the circulation of blood be observed with a
microscope in vessels of a transparent texture, the
stream is seen flowing so rapidly that it is impossible
to discriminate the corpuscles, except that here and
there a few colourless cells, slowly gliding along the
coats of the vessels, or adhering to them, become
discernible. But if the part under observation be

OP BLOOD DISTEMPER.

slightly injured or irritated, a much greater number
of colourless cells are seen separating from the red
stream, and becoming stationary upon the coats of
the vessels. A line of lymph is at the same time
visible between the blood current and the coats of
the vessels, and in this the stationary cells seem to
be embedded.

It has been said this appearance has no re-
ference to inflammation. We think, it is the first
phenomenon of new cell-growth in the vascular
tissue, the first act of a much more speedy change
in the coats of the vessels than occurs in natural
adult growth. The appearances certainly show a
disposition in the blood, circulating in the living
vessels, to separate into two parts, which are the
same with those observed in many cases of inflam-
mation after vencesection — that is, where a buflfy
coat forms. And if, from other facts, it can be
proved that the coats of the blood-vessels yield,
and are replaced by new cell-growth, then the
observation referred to, shows how the blastema
of such growth may accumulate, — the colourless
elements of blood being the first to occupy the
breach. And from these elements, composed, as
we know they are, of lymph, and cells, may proceed,
we argue, the further appearances and properties of
cell-growth.

OP BLOOD DISTEMPEK.

" The blood-vessels," says Mk. Hunter, " are pro-
bably the very first active parts of the system, for
we find them in action before they have formed
themselves into a heart, and in such a state of parts
we find them the only part that has any strength,
while the other parts are only preparing for action ;
this is so remarkable that we can dissect the vessels
of a chicken in the egg without injection, the other
parts easily giving way." In all cases of natural
growth the blood-vessels are among the first parts to
acquire strength or coherency. In inflammation we
find them the first parts losing strength or cohesion.
In natural growth the change in the coats of the
vessels is from nucleated cells to fibrous tissue. In
new cell-growth the change is from fibrous tissue
back again to cells.

We shall here state, in the form of propositions,
the spirit of the conclusions we aim at, and after-
wards the discussion will be resumed.

1. Reparation in the human structure is not
limited to wounds and fractures from mechanical
violence. It extends to injuries of the blood, and
to disease in the parenchymatous organs. It is
accomplished by a new or preternatural cell-growth,
in the common vascular tissue— and of this growth

OF BLOOD DISTEMPER.

there are two prominent forms, — the one a vascular
form, Granulation, the other a deciduous form,
termed Pus.

2. The Cells of granulations and pus exhibit
peculiar relations to the surrounding parts, — a pro-
perty of selective absorption. Those of granulations
open blood-vessels for the junction of new ones, and
are elements of repair in virtue of a capacity, in the
cells or cell-contents, of metamorphosis into fibrous
tissue. Those of pus are elements of repair, in
virtue of the deciduous mode of cell-growth. The
same sort of vital activity which causes leaves to
fall in autumn, discharges sloughs from sores, and
poisons from the blood, without bleeding.

3. During the formation of granulations and pus,
the natural blood-vessels undergo a species of retro-
grade metamorphosis, for the fibrous coat of the
vessels becomes the seat of new cell-growth. A
state of growth in which we know in the embryo,
blood-vessels bleed upon the lightest touch, and
multiply with great rapidity.

4. The formation of granulations and pus are
accompanied by phenomena termed inflammation.
That is to say, inflammation is the sign or signal of
a change commencing in the coats of the blood-ves-
sels, and thereby is distinguished from congestion,—

0¥ INFLAMMATJON. 33

in which there is no morphological change in the
coats of the vessels.

IV.

OF INFLAMMATION.

Inflammation is sometimes acute, sometimes
chronic. The argument is that inflammation is new
cell-growth in the common vascular tissue. The
term acute means rapid. Cell-growth is a rapid
growth.

" I once," says Mr. Hunter, " scraped off some
of the external surface of a bone of the foot, to see
if the surface would granulate. I remarked on the
following day that the surface of the bone was
covered with a whitish substance, and when I
touched it with a probe I did not feel the bone bare,
but only its resistance. I conceived this substance
to be lymph, thrown out from inflammation, and I
thought it would be forced off when suppuration
came on, but, on the succeeding day, 1 found this
very substance vascular, and appearing like healthy
granulations. Upon now touching it with a probe it
bled freely."

ON INFLAMMATION.

" I opened the tunica vaginalis of a young ram,
and the testicle was exposed. The surface, almost
immediately, showed great vascularity ; very soon
lymph appeared, and in twenty-four hours the matter
looked like common pus.

" A wound was made into the abdomen of an ass,
and a solution of salt and water was thrown in to
bring on inflammation. At the end of sixty hours
the animal was killed, and on examining the abdo-
men, the outer coat of the intestines had become
extremely vascular, the convolutions adhered to-
gether by lymph, and pus had been discharged into
the cavity of the abdomen.

" I have seen two granulations on the head — one
from the dura mater after trepanning, and the other
from the scalp, unite, having the bare bone between
them — so firmly in twenty-four hours that they re-
quired some force to separate them, and when sepa-
rated they bled."

In the egg of a chicken, blood and numerous
blood-vessels have formed by the end of the third
day of incubation. They are plainly visible to the
naked eye, or through a lens, on the fourth day.
In blood-distempers inflammation is reckoned acute.
Counting the first day of illness as one, small-pox
shews its pustules commencing on the third day.

OP INFLAMMATION.

By the tenth day they have arrived at their full
growth and maturity. In measles and scarlet fever
inflammation reddens the skin on the second or third
day, and the cuticle exfoliates on the ninth or tenth
day. The conclusion is that inflammation agrees
in time, as in other particulars, w^ith the quali-
ties of cell-growth — so that what is afl&rmed of the
one may be afiirmed of the other. For example : —

A person may suffer mechanical violence at a time
when the blood is unhealthy. New cell-growth
would arise at the site of injury, and the purulent
form of it would be proportional to the blood disqua-
lifications— the wound not healing until the qualities
of the blood be changed or improved.

Cells thus growing under very different conditions
of blood, must be supposed themselves to be difi'erent.
Things in solution in the blood — as Mr. Hunter
expresses it — coming away more in one kind of pus
than in another kind. And if there be varieties of
cell-growth from different states of blood, then are
there different kinds of inflammation.

Case. — At eight o'clock in the morning of the
28th December, a physician who was assisting at the
post-mortem examination of a lady who had died of
puerperal peritonitis, unfortunately pricked his

D 2

OP INFLAMMATION.

finger. At eight the same evening he felt some pain
and uneasiness at the part, and had it touched with
nitrate of silver. During the night, shiverings came
on, and he felt extremely restless. On the morning
of the next day, 29th, the finger was much swollen,
and red lines extended up the arm. Leeches, fomen-
tations, and poultices were applied. In the evening,
the symptoms not abating, there was great prostra-
tion of strength. On the 30th, the hand and arm
were greatly swollen, the finger had put on a hvid
appearance, the glands in the axilla were affected,
and the pain was very great. On the 31st, the
pulse was from 90 to 100, and the breathing irre-
gular, with torpor and drowsiness. In the evening,
all the symptoms were increasing, and now an erysi-
pelatous blush from the axilla extended over the side
of the chest. During the night the breathing
became more difficult, and the drowsiness gradually
passed into a deep stupor. Death took place at six
o'clock on the morning of the 1st of January, not
four days from the infliction of the wound.

In this case we should not attribute the fatal
event to inflammation, but to blood distemper. The
swelling of the glands in the axilla and the other
signs of inflammation, were they not eff"ort8 of

OF INFLAMMATION.

nature to arrest the progress of the poison, though
they failed ^ And thej failed, apparently, because
the blood was so much injured, that Hfe gave way
before the natural effort at relief could fairly come
into operation. This case seems analogous to one
of very severe mechanical injury, where the patient
dies from the shock, before inflammation has time to
become established. In mechanical violences we
conceive a difference between dangers from the
injury, and the danger from inflammation and suppu-
ration, incidental to the effort at repair. And in
such accidents as that related, it must be important
to separate, as far as can be done, the symptoms and
dangers referrible to some poison in the blood, acting
deleteriously upon a vital parenchyma, from the
symptoms and dangers really attributable to inflam-
mation.

In eruptive fevers — small-pox, for inst&,nce- — it is
contended that the locaF inflammation and pustula-
tion are not rightly to ' be ■ considered as the disease,
but rather as the expression of the ways of Nature
in setting free injurious matter in 'the blood in that
particular instance. !A:ftd- if this argument hold in
eruptive fevers, then we think it' may be (extended
not only to the case related, but to othei- cases of

OP THE BLOOD-VESSELS

external inflammation. In erysipelas and gout, the
disease is some disqualification of the blood, and
dangers may arise from that source ; the local action
is an effort at reparation, and dangers may arise
from that also. But we shall have occasion to recur
to the argument which touches upon the point of
remote and proximate causes. In the meantime, it
is very necessary the distinction between the vas-
cular tissue and the parenchymatous elements of
an organ, shown by the microscope in physiological
anatomy, should be clearly comprehended, with re-
spect to pathology and therapeutics. This will form
the subject of the next section.

OP THE BLOOD-VESSELS AN'D CONNECTIVE TISSUE; AND
OP THE DISTINCTION BETWEEN THEM AND THE PA-
EENCHYMA OP THE SEVERAL OKGANS.

In the structure of the human body three orders
of parts are readily distinguishable — blood-vessels, —
the blood, — and the different organs : brain, muscles,
liver, kidney, &c. Blood circulates through every

AND CONNECTIVE TISSUE.

part of the body in vessels termed arteries, veins,
and capillaries. What is the structure, and what
are the relations of the coats of these vessels 1

Case. — A young woman was struck with a stone
on the forehead, and some connective or areolar
tissue protruded from the wound. This was removed
and examined with a microscope. The texture was
composed of strands and bands of waved fibres, intri-
cately interlaced. The^ coats of the arteries and
veins, down to a magnitude not larger than the ^^th
part of an inch, consisted of a double — or of two
nucleated membranes. The " nuclei " of the inner
one were arranged with their length parallel — those
of the outer one, transversely to the axis of the
vessel. The outer or third coat of the vessels was
fibrous, and the fibres appeared identical with those
which formed the connective tissue.

The coat of the capillaries was a thin membrane,
with here and there nuclei attached to it at distant
intervals. An examination of the structure of blood-
vessels in other parts furnished the same results.
And in all cases — whether blood-vessels enter the
brain or muscles, or a secreting gland — in proportion
as the vessels diminish in size, the thickness of their

OP THE BLOOD-VESSELS

outer fibrous coat diminishes, until at last in capil-
laries, a thin nucleated membrane only is interposed
between the parenchyma of the organ and the blood ;
and in this membrane no interstices or outlets are
visible.

The connective tissue is as extensively diffused
throughout the body, in some form or other, as the
blood-vessels. It invests the exterior and enters
with the vessels into the interior of every organ.
Its elements everywhere blend with the outer coat
of arteries and veins. And in most parts, the
strength or thickness of its membranous expansions
bear a proportion to the strength and thickness of
the coats — or to the size, of the vessels. In the
dura mater, pia mater, and pericardium, the ele-
ments of the membranous texture are of the same
kind as those of the outer coat of the vessels. The
vascular membrane which adheres to the outer sur-
face of the bones, and that which penetrates to their
interior, are, both of them, expansions of connective
tissue. Both blend their elements — their fibrous
elements with the coats of the blood-vessels, and the
outer one — the periosteum — blends its elements
with those of fascias, ligaments, and tendons.

At the early periods of life the outer coat of the
blood-vessels and the connective tissue proceed in

AND CONNECTIVE TISSUE,

growth together, altering their forms almost simul-
taneously. When the outer coat of the vessels is
composed of cells, connective tissue is cellular also.
Sometimes — in embryo-growth — the coats of the
vessels are seen formed of a gelatinous and trans-
parent material ; in such cases the connective tissue
— the membranous tissue between the vessels — is
gelatinous too. And when in progress of growth
the coats of the vessels become fibrous and elastic,
the connective tissue is fibrous and elastic likewise.

These facts indicate a common nature in the outer
coat of arteries and veins, and the several forms of
connective tissue ; and a distinction between these
and the particular substances of the different organs.
For instance, we not only distinguish the brain from
the liver, and both these organs from the muscular
flesh, &c. But also in each organ — and this is the
point — we distinguish the vascular connective tissue
from the parenchyma not only in healthy, but also
in pathological anatomy. Let us substantiate this
point. In some birds the periosteum is almost
black, from radiating spots of dark pigment. In
these cases the tendons are tinged black, and the
outer coat of the blood-vessels is spotted black. In
cattle, where the skin and hair are patched with
black and white, we have seen the pia mater with

OP THE BLOOD-VESSELS

broad patches of pigment also; and in the dark
patches, the outer coat of all the blood-vessels was
deeply coloured with spots of pigment. In frogs,
spots of pigment are common to sundry forms of
the connective tissue, and to the outer coat of the
blood-vessels.

If a portion of muscle be torn away by an acci-
dent, or if a part of a lung be destroyed, cure is
effected not by a new growth of muscle or lung
substance, but by a new growth of connective tissue,
proceeding from cell-growth — granulations, or granu-
lations and pus. And when inflammation attacks
the brain, liver, or kidney — the skin or the eye, &c.,
it does not issue in any new parenchymatous ele-
ments, but always in a common cell-growth, lymph,
granulations, and pus ; so that whatever may be the
difference in parenchymatous elements, there is a
species of uniformity in the products of inflammation
in the different organs ; and whatever may be the
requirements of repair, there is a kind of uni-
formity also in the issues of the efforts made towards
reparation.

Upon these anatomical, pathological, and thera-
peutical facts, we ground the distinction between
inflammation and organic disease — between new
cell-growths in the common vascular tissue and idio-

AND CONNECTIVE TISSUE.

pathic degeneration or decay of the parenchymatous
substance of an organ. The exceeding minuteness
of the scale upon which vascular tissue and paren-
chymatous elements are associated, and the constant
presence of blood in the vessels make it almost a
hopeless task to discriminate upon post mortem in-
spection particular kinds of cells ; nevertheless, we
conclude the two classes of texture, — vascular tissue
and parenchymatous substances, — to be distinct in
nature, properties, metamorphosis, and diseases.

The argument substantiated by this anatomical
distinction, is this — that when parenchymatous de-
generation or organic disease so affects the blood-
vessels as to render bleeding imminent, new cell-
growth in the vascular tissue arises to anticipate or
prevent it. Signs of inflammation being combined
with the evidences of organic disease ; just as in
mechanical injuries signs of inflammation become
combined with the torn flesh or the fractured bone.

And if the facts related in the next section make
good this argument, it follows of the things seen in
organic disease, whether with the naked eye or with
the aid of a microscope, that some are elements
proper to the parenchyma ; others, elements of new
cell-growth in the vascular tissue. Some, ele-
ments of the diseased parenchyma, others, elements

OF ORGANIC DISEASE

of inflammation, and it may be, demonstrative of
efforts at repair— efforts limited no doubt within the
sphere to which reparation extends, — and this sphere,
we have said, does not extend to the reproduction of
a special parenchyma, though it clearly does to
the heaHng of blood-vessels and the reproduction
of vascular connective tissue, as we now proceed to
show.

VI.

OF ORGANIC DISEASE AND THE PROCESS OF REPAIR.

The chief organs of the body are then composed
of substances different from each other, and from
vascular tissue. The brain, liver, kidneys, and lungs
are examples. These are liable to idiopathic disease,
degeneration, or decay. Softening of the brain, fatty
degeneration of the liver or kidney, and tubercles in
the lungs are established instances of organic dis-
ease.

Tubercles in the lungs are a species of parenchy-
matous decay, which originates in the ' midst of
numerous capillary and other blood-vessels, in a pan

AND THE PKOCESS OF REPAIR.

of the body where venous blood changes into arterial.
Tubercles destroy these vessels, and fill up the air-
spaces. When they are small, there is no sign of
inflammation in the pulmonary texture around them^
but when they have increased in magnitude, and
have implicated vessels of larger size, inflammation
appears, marked, as in other cases, by efiusion of
lymph, granulations, new blood-vessels and pus.
Or, to use terras of the new physiology — marked by
the exudation of blastema and the growth of nucleated
cells. Some of the cells attached to the new blood-
vessels form granulations, others appear in the deci-
duous form of pus. This cell-growth softens the
tubercle, separates it from the more healthy portions
of the parenchyma, and forms an abscess, which con-
tains pus and the softened tuberculous material.
Abscess and ulceration deep in the substance of a
lung is seriously pathological, upon the same ground
as abscess and ulceration in a compound fracture, or
in the substance of the liver from the growth and
irritation of an " acephalocyst." But, the question
here entertained is, whether there is evidence de-
noting any relation to the process of repair, any
indication of a therapeutical operation.

A tubercle increasing, destroys blood-vessels of
increasing size. Bleeding from the lungs is some-

OP ORGANIC DISEASE

times one of the earliest signs of the existence of
the disease. Persons sometimes die of the hemor-
rhage. At the Brompton Hospital it has been
observed that a considerable majority of the cases of
haemoptysis occur before any sign of softening of the
tubercles can be detected with the stethoscope. The
process of softening, or new cell-growth, seemingly
being associated with prevention of haemorrhage.
This corresponds with what we have seen in ordinary
cases of abscess, ulceration, and sloughing, where
severance of blood-vessels and of bonds of union take
place without bleeding. In the case of advancing
tubercles in the lungs, the urgency of a provision
against bleeding cannot be known before-hand. And
the proclivity of hsemorrhage being unknown — the
signs which denote the commencement of new cell-
growth — those of inflammation, softening, and ab-

* "Dividing the disease into two periods, viz., 1st, that
characterized by the deposition of tubercular matter in the
crude state ; and 2nd, that, subsequent to the softening of this
matter or the formation of cavities, we find in 453 males,
that hsemoptysis occurred in the ratio of 73 per cent. ; and in
243 females, in the ratio of 72 per cent, in the first period.

These figures show unquestionably that haemoptysis

is much more frequent (nearly three to one) in the first period
of the disease, and nearly equally so in both sexes."— Medical
Beport of the Hospital for Consumption, 1849, p. 30.

AND THE PROCESS OF RKPAIE.

scess — intended as we argue to anticipate or prevent
it, may seem supererogatory and purely pathological.
On the other hand, a therapeutical view of the pro-
perties of abscess and ulceration, even in tuberculai*
disease of the lungs, seems corroborated by the great
rarity of bleeding from the walls of an abscess,
although very large blood-vessels may be destroyed
and severed in its track. Moreover, in the lungs
there is a double circulation. Thb one, paren-
chymatous or special, serving the function of respira-
tion, the other, the ordinary or general circulation as
it exists in other places. The disease called tuber-
* cles aflPects the parenchyma and the parenchymatous
vessels, whereas the cell-growth, which produces
abscess around tubercles is administered to by new
vessels, which form their connexions, not with those
of the parenchymatous circulation, which are the
ones diseased, but with the vessels of the general
circulation, which, in all other instances, furnish the
elements of repair.

We have often examined the lungs of those who
have died of pulmonary consumption, and have seen
in the same lung small hard tubercles, larger and
more irregular tuberculous masses partially softened
— ^small abscesses filled with pus — and larger cavities,
half filled with air and half with pus, and softened

OP ORGANIC DISEASE

tuberculous matter. We have also seen blood-
vessels of almost all sizes, as it were, cut across by
the disease, but we never recollect meeting with any
escape of blood into an abscess, except in those cases
where haemoptysis had been present as a symptom
during Hfe. In some of the abscesses a soft cell-
texture, with new blood-vessels — a granulation tex-
ture— formed the interior or pyogenic surface ; in
others, this surface was firmer and more fibrous,
and the contained matter was less purulent, more
gelatinous and mucus-like. And where these con-
ditions existed, the parts were certainly advancing
towards cure.

In the largest cavities it was usually evident, from
the appearance and character of their walls, from
their hard, dry, and brittle properties, that the
original tuberculous disease and phenomena of in-
flammation had long proceeded together, that many
successions of granulation-texture had arisen and
faded ; the new cell-growth and the contiguous
portions of lung substance having both changed into
tuberculous matter. Nevertheless, even in these
instances, there was always abundant evidence of
therapeutical operations in the large size of the
blood-vessels which had been broken up by the
disease, but which had been effectually sealed further

AND THE PROCESS OP REPAIR.

in, in the more healthy parts of the substance of the
lung, against hjeraorrhage. *

* " The pulmonaiy ai-teries and veins as they approach the
larger vomicee are suddenly contracted : a blood-vessel which,
at its beginning, measured nearly half an inch in circum-
ference, sometimes (though it had sent oflf no considerable
branch) could not be cut up farther than an ^ inch ; and when,
outwardly, they are of a larger size, yet, internally, they have
a very small canal, being almost filled up by a fibrous sub-
stance; and fi-equently, as they pass along the sides of
vomicse, they are found quite detached, for about an inch of
their com-se, from the neighbouring parts. That the blood-
vessels ai-e thus obsti-ucted, and that they have little or no
communication with the vomicse, is rendered still more
evident by blowing into them, or injecting them . By blowing
the air does not pass into the vomicae, excepting very rarely,
and then only by some imperceptible holes. And after
injecting the lungs, upon cutting into the sounder parts,
numberless small vessels may be seen filled with the wax ;
but in the diseased parts there is no such appearance. The
injected vessels in the sounder parts may be traced a long
way dividing into smaller branches, but those which lead to
tubercles and vomicae, a very short way, and only to their
principal branches. The wax was rarely found to have
entered the middling sized vomicae, and never the smaller or
larger ones." — Morbid Anatomy oj the Lungs in Tubercular or
Pulmonary Consumption. By William Stark, M.D. From Pos-
thumous Works. London, 1788. Edinburgh Medical and
Surgical Journal, Vol. 45, 1836.

50 OP ORGANIC DISEASE

Laennec — to whom belongs the high merit of
having first pointed out the evidences of cure in
tubercular consumption, says— " I had often observed
marks, puckering and cicatrices in the lungs, without
knowing to what to attribute them, and without
attaching much importance to the appearances.
But after I was convinced of the possibility of cure
in cases of ulceration of the lungs I began to fancy
that nature might have more ways than one of
accomplishing this end, and that cavities in the lungs
after the discharge of their contents by expectoration
and absorption might cicatrise in the same manner
as solutions of continuity in other places."

The argument is, that parenchymatous or organic
disease is an injury, influencing the common vascular
tissue in the same way as other injuries. That is to
say, degeneration or decay of parenchymatous struc-
ture calls forth new cell-growth in the common
vascular tissue, in like manner and for the same
end as do wounds, fractures, and distemper of blood.
The cause of the disease, and the disease itself
which brings on inflammation .being quite distinct.
For example : In mechanical violences we know
there to be, first, the cause of the injury — some
outward object; second, there is the wound, fracture,
or injury which it has occasioned ; and third and

AND THE PROCESS OF REPAIR. 51

last, arises the process of repair. In a burn the
immediate antecedent of inflammation is not the
hot body, but the wound, the spoilt integument, the
injury inflicted. The heated substance inflicts the
injury, and from the injury arises inflammation.
The liot body is one thing, the injury inflicted is
another thing, and inflammation, with its attendant
consequences, is a third thing. And the second
event interposes between the first and third.

In many cases of mechanical injury inflammation
does not set in until hours have elapsed from the
application of the cause of the accident. Again, in
epidemical disorders, eruptive fevers, &c., we recog-
nise the same sequence. There i^, first, some evident
or assumed outward cause ; we call it an aerial
poison — an impure air ; upon this follows, secondly,
blood distemper ; and thirdly, from the blood dis-
temper arises (in the manner already pointed out),
inflammation.

If an aerial poison were the immediate ante-
cedent of local inflammation, we should expect
this to show itself either in the skin or lungs,
these being the parts to which the air has access.
Whereas, in epidemical fevers, inflammation often
occurs in parts of the body, which can be in-
jured by an aerial miasm only through the medium

E 2

OF ORGANIC DISEASE

of distempered blood. We have striven to express
clearly our meaning, because the conclusion is, that
neither heat nor cold, nor poisonous air, occasion
inflammation, directly. These are not the logical
antecedents of inflammation or fever. They occa-
sion injury to the soHd parts or the blood, and from
the injury arises the inflammation. Extremes of
heat and cold and poisonous air are dangerous to
life, and reaction, in all these cases, is denoted by
some form of inflammation.

In like manner with cases of tubercular consump-
tion— the cause of tubercles is distinct from tuber-
cles, and increasing tubercles are causes of inflam-
mation. Tubercles commence and spread before
inflammation appears. If, therefore, the first cause
in the series, — that which originated tubercles, —
continues in operation, then abscess and ulceration
do not stop the march of the disease.

New cell-growth in the common vascular tissue,
progressing with parenchymatous decay, may, in
tubercular consumption, from what we know of its
properties on other occasions, provide against immi-
nent contingencies, anticipate bleeding from the
diseased vessels, prevent the bursting of an abscess
into the cavity of the chest, separate the diseased
from the more healthy parts of the lung, and thus

AND THE PEOCESS OF EEPAIR. 53

prolong life without our knowing it. Yet if the
original cause of the disease, continue in action,
the completion of the therapeutical intent is de-
feated,—the new cell-growth fails of saving the life
of the patient. On the other hand, if, bj some
happy change, by epoch of life, by change of air, diet,
or habits, or any other means, the first cause or
antecedent of the parenchymatous decay be arrested,
then abscess, ulceration, discharge, and cicatrisation,
do effect the cure. New cell-growth softens and
separates the diseased from the healthy parts, to
be expelled by cough or removed by absorption,
and replaces the lost portions of the lung by connec-
tive tissue.

In the disease of the liver termed cirrhosis,
there is slow wasting or decay of the parenchyma-
tous cells of the organ, without bleeding, and as
gradual a replacement of the lost parenchyma by
a growth of fibrous connective tissue which occupies
the void.'^''' Here, we argue, there is reparation to
the extent to which reparation goes in other in-
stances. A secreting parenchyma wasting or de-
stroyed, in no case is restored or reproduced by the

* Wedl's Pathological Histology. New formations of con-
nective tissue in the liver. § 7. Liver, p. 438, &c. Sydenham
Soc. Ed., 1855.

OF ORGANIC DISEASE

process of repair. Therefore, although in cirrhosis
of the liver the continuity and outUne of the oi-gan
may be preserved, hsemorrhage prevented, and some-
what of the bulk of the liver remain from an in-
creased growth of connective tissue, occupying the
spaces occasioned by the parenchymatous decay,
still, as there is no restoration of the parenchyma-
tous elements, the special function and secretions of
the organ must gradually fail or diminish. Dimi-
nished or impaired secretion is a cause of blood
distemper ; and from blood distemper thus occa-
sioned, secondary disorders and local inflammation
in other parts, may arise.

Morbid growths not unfrequently present them-
selves in the body, the structure of which is com-
posed of cells distinct from those of any of the
normal textures ; and it is interesting to remark in
Cancee, that blood-vessels cannot be traced in it at
an early period of its formation, but that they make
their appearance, as in the normal development of
the tissues, at a later date."^'' When a natural organ
commences to grow, parenchymatous cells are the
first to make their appearance, after them follows the
blood, and after blood, the vessels and connective

* Human Physiology, by Dr. Cai-penter. Third Edition,
1851, p. 18J.

AND THE PROCESS OF EBPAIR.

tissue.* Likewise in cancer, the same subordination
of vascular tissue growth to the specific growth is
observed. The relations of antecedent and conse-
quent are the same in the morbid as in the natural
growth. Cancer destroys the normal tissues, in the
midst of which it may be developed, and when it
has a power of rapid increase, the growth is said to
be malignant.

Now, in tuberculosis of the lung, new cell-growth
is excited in the common vascular tissue by degene-
ration or decay of the parenchyma. In cirrhosis of
the liver there is increased growth or hypertrophy
of the connective tissue, occasioned by atrophy or
wasting of the parenchyma. In small-pox, new
cell-growth arises in the vascular tissue of the glan-
dules of the skin, from the circulation of distempered
blood. The presence of other poisons in the blood
will occasion abscess in the lymphatic glands. And
in burns, carbuncle, &c., where the living parts are
to separate themselves from the dead, new cell-
growth arises in the vascular tissue. If in these
cases it can be established as the rule, that the phe-
nomena are those of a therapeutical reaction on the

* On the Containing Texture of the Blood. Loncl. Med.
Gazette, June and July, 1850. Figs. I and 2.

Oi<' OKGANIC DISEASE

part of the common vascular tissue— as a distinct
and, in some measure, independent texture — against
the dangers threatening Hfe, from disease or decay
in anothei- or parenchymatous texture, then there is
ground for the inference, that fungosities, ulceration
and discharge from a cancerous sore, are also phe-
nomena of reaction on the part of the vascular tissue
— therapeutical efforts to circumscribe, and, if it
were possible, throw off a specific morbid growth,
which by its increase destroys the normal tissues
in the midst of which it has been developed.
Especially is this inference corroborated when the
fungosities or granulations alternately arise and
fade away, new blood-vessels forming in all direc-
tions without bloodshed, and evident though un-
availing efforts are made at the cicatrisation of the
wound.

A specific and parenchymatous disease may be of
rapid or quiescent growth ; and growth in the
vascular tissue around it may also be rapid or
quiescent — acute or chronic. A malignant cancer-
ous growth is in its own nature active, and
when inflammation arises there is activity in the
vas'cular tissue also, — a double activity — a specific
morbid growth conjoined with inflammation growth.
Tuberculosis of the lungs, on the other hand,

AND THE PllOCESS OF REPAIR.

is of very giadual or quiescent growth, and until
inflammation is aroused the vascular tissue is
quiescent also. Therefore, in organic or specific
diseases, there may be a double activity or a
double quiescence, and phenomena will vai-y ac-
cordingly.

Physiological science forms as yet no reliable
speculation as to the manner in which normal cells
produce from common materials the manifold results
they do, further than referring them to the vital or
metabolic properties of the cells or their nuclei.
There can be no expectation of going beyond the
physiological interpretation in pathology or thera-
peutics. But if in natural growth the distinction
between the common vascular or connective tissue
and parenchymatous substances be established, the
fact cannot be disregarded in phenomena of disease,
or in morbid anatomy ; and also, it must be ad-
mitted, in any endeavour to interpret the natural
methods of cure.

OP CHRONIC INFLAMMATION.

Vll.

OP CHRONIC INFLAMMATION.

There are tlien three causes of new cell-growth
in the common vascular tissue 1. Mechanical vio-
lence. 2. Blood distemper. 3. Organic disease.
In mechanical violence and organic disease the
injury and inflammation are. local. In epidemical
disorders the injury which calls forth inflammation
is referred to the blood : and inflammation locallv
appearing, discloses the • parenchyma first or most
affected by the circulation of the distempered blood.
The signs of inflammation commencing are in-
creased heat with hypercemia, and the coats of the
blood-vessels yielding, lymph exudes. To lymph
succeeds cell-growth, granulations, new Uood-vessels,
and also in many instances pus. Lymph beneath
the cuticle forms vesicles. Pus confined forms pus-
tules and abscess. Granulations in exuberance are
iQvmQdi fungosities, and sometimes popularly, "proud
flesh" But when granulations lose their life and
fade away ulceration remains.

A slough upon the skin or surface of the body,

OF CHRONIC .INFLAMMATION. OV

is thrown off solid aiid entire, without difficulty and
without bleeding. And we may conclude, in healthy
persons, that we see the process — granulation, ulce-
ration, and suppuration— which removes the slough,
under the best circumstances. In all other cases of
sloughing, difficulties interpose. In carbuncles, the
dead areolar tissue is beneath the still living skin,
and in necrosis of bone, the dead bone lies deep
beneath the living muscles and skin. The process
of separation and discharge is therefore chronic or
protracted, until free outlets for the dead matter
have been made, either slowly by the natural efforts,
or, in a speedier way, by the caustic or knife of the
surgeon. In the case of injured cornea before re-
lated (p. 2), experience teaches that inflammation,
ulceration, and abscess, there observed, would have
been protracted until the foreign body was expelled.
In common issues, — granulation, suppuration, and
ulceration are kept up or made chronic, by retaining
the peas in the wound. In all these instances there
can, we think, be no ground for misinterpreting the
intention of the natural efforts — no doubt of the
therapeutical end, the cure attempted — though the
process is chronic and may fail through difficulty.

Again, in abscess of the liver or kidney from an

OP CHRONIC INFLAMMATION.

aceplialocyst, difficulties arise from the conforination
of tlic part. " Occasionally, says Sydenham, and he
is speaking of epidemical diseases, " the process by
which nature strives to expel the morbid influence,
fastens upon a part wholly unable to get rid of it at
all, and this may arise from the conformation of the
part itself, as is the case with morbid matter impacted
in the brain or nerves of paralytics, and with pus in
the cavities of a thoracic empyema."

Tubercular consumption ranges in this category,
for there are hindrances to the discharge of the con-
tents of a' pulmonary abscess, from the conformation of
the part. The matter of tubercles cannot be got rid of
except after complete softening and fluidity, and
then only by cough and expectoration through open-
ings made by ulceration in the bronchial tubes. The
morbid material which is softened and separates
from the more healthy part of the lung, is deeply
seated in the interior of a vital organ. With these
contingencies, that the process of sloughing, soften-
ing, discharge, and reparation, should be protracted
and fail, is no more than what we see in other, and
seemingly much less complicated cases. But the
word fail is scarcely appropriate. For, as we have
said, abscess and ulceration, though unequal to the

OF CHRONIC INFLAMMATION.

task of expelling the morbid matter, have yet pre-
vented hasraorrhage.

Sometimes the simplest wounds fester and ulcerate,
trifling bruises run on into abscess, sprains bring on
scrofulous affections, and common fractures will not
unite by bone. Let us illustrate these general re-
marks by a few examples.

It has been observed at the hospital, St. Louis, in
Paris, when the wind sets in from the slaughter-
houses in Montfan§on, that the healing of the
wounds and sores of the patients is arrested, — they
assume an unhealth}'" appearance, which continues as
long as the wind blows from that quarter. It some-
times happens in a hospital, that the first part of the
process of repair in a fractured bone proceeds satis-
factorily, but completion of cure is arrested, the
union remains soft, yielding, and flexible. In such
cases, cure has been completed by sending the patient
out of the hospital into the purer air of the country.
Places which are notorious for the prevalence of
epidemical diseases, and a high rate of mortality
among infants and children, are also notorious for
scrofulous affections — chronic forms of inflammation.
Sailors at sea in hot cHmates are accustomed to
tramp about the ship without shoes or stockings, and
their feet and legs are consequently bitten by mos-

OF CHRONIC INFLAMMATION.

quitoes. The bites generally ulcerate, but mucli
more so in some seasons than in others, and the ulcers
frequently continue to enlarge, sometimes quickly —
in a few days attaining considerable magnitude — at
others slowly for weeks, and in spite of medical
treatment, so long as the ship remains in the same
latitude. But upon cruising in a different atmos-
phere and more temperate climes, the ulcers heal
speedily, and without further trouble. In a large
infirmary in London," when a piece of ornamental
water, which was formerly stagnant, in front of the
edifice, had a green scum upon it, surgical operations
were not so successful as at other times, and a flow
of fresh water has been introduced to prevent the
miasm.

In these cases the process of repair is irregular
or protracted, not from mechanical hindrances in the
part itself, nor from the conformation of the parts,
but from conditions of the general health removable
by change of air and habits. And we argue of
blood distempers, besides those of graver kind which
create fever, inflammation, and critical discharge,
that there are others of more lenient form, which,
not marked by any special illness, are yet a cause
of hindrance to new cell-growth estabhshed for
the cure of local injury. That is to say— a

OF CHRONIC INFLAMMATION. bcJ

minor disturbcance of the qualities of blood, com-
patible with healthy functions in all the natural
organs, may cause a new and tender cell-growth
springing up for repair of local violence to fade ;
the new growth being the first to show the effect
of the blood deterioration. And if this minor dete-
rioration of the qualities of blood be kept up or
continually accruing^ — as we suppose it would be —
by hving in an unwholesome air, or by persevering
in unwholesome habits, then forms of inflammation
become chronic. " Granulations lose their hfe and
fade away. New granulations may afterwards spring
up, but these fade also, and so they continue to do
until some alteration, be made/' An alteration in
the properties of the cell-growth, by an improvement
in the qualities of the blood.

Cell Therapeutics, then, may be protracted and
fail. First, from mechanical hindrances in the part
itself, which may be surgically removed : thorns in
the flesh, peas in an issue, dead areolar tissue beneath
the still living skin, dead bone beneath the muscles
and skin, &c. Secondly, from the conformation of
the parts and their situation beyond manual control,
so that matter which would be easily discharged,
could an exterior outlet be made, cannot get away :

64 OF CHRONIC INFLAMMATION.

a clot of blood upon the brain, abscess in an internal
organ, &c. Thirdly, from a minor distemper of
blood, one removable by change of air, diet, or
habits : chronic or scrofulous ulcers healing by a
better quality of food and water, or by a change of
residence and habits. And, fourthly, in organic
disease, therapeutics fail : when parenchymatous
decay continues in progress. The reproduction of a
parenchyma — such as brain, liver, or lung substance
being beyond the province of repair.

These difficulties and hindrances we contend,
furnish no valid ground of opposition to our argu-
ment : — That cell-growth in the vascular tissue is the
general agent of repair ; that- suppuration in small-
pox, around tubercles and in other cases, has a
therapeutical mission, though in some instances there
may be insuperable difficulty. But why, such being
the argument, it may be asked, is not cell-growth
extinguished, if difficulties be insuperable, rather
than it should happen that a process intended for
repair goes on to be a cause of death 1 This ques-
tion can be solved only by assigning a reason for a
general law of growth.

In natural growth a rule of normal form or sym-
metry exists — a certain order, hmitations, I'egular
stao-es, and fixed periods. Nevertheless, the rule

OF CHEONIC INFLAMMATION,

is far from being an inflexible one. Monstrosities
are produced which cannot live an hour in the
world. Also infants are born with one hand, or with
more than the natural number of fingers or toes,
without fingers or feet, with club-foot, hare-lip,
divided palate, and numerous other more or less
obvious irregularities.

In the embryo, growth once started does not cease
because of irregularity, or because it is taking a
wrong direction. The monstrosity without a brain —
with an imperfect heart — without limbs or shape, goes
on growing, though it must die as soon as born. In
these cases, we cannot tell why growth goes on,
when the failure of its purpose is decided, all that
can be said is, that the rule extends to new cell-
growth, arising for repair, which we know in many in-
stances— in compound fractures or crushed joints
for instance, — when once started, is not extin-
guished, by insuperable difficulties. That is to say,
of both cases — of natural growth degenerating into
monstrosity— and of new cell-growths in the vascu-
lar tissue assuming the characters of disease, they
may cease only with the life of the individual.

There are those who argue that monstrosities are
so from the very first, independent of exterior
causes. But there are others who take another

CONCLUSIONS.

view of monstrosities, and argue : — That nature
decreed the perfect form, though imperfections may
arise earher or later from unsuitable exterior con-
ditions. Persons who hold the latter alternative
■with respect to monstrosities, may agree with us,
that irregularity, exuberance, chronicity, &c., as
applied to inflammation, denote hindrances and
difficulties in a process of repair.

VIII.

CONCLUSIONS.

We might have amplified the basis of our argu-
ment by embracing other examples of cell-growth,
reparation, and disease. But enough, we think, has
been adduced to warrant the followiug conclu-
sions : —

First : — That cell-growth in the common vascular
tissue is the natural method of repair, which, Hke all
other growths, may succeed or not, according to con-
tingent circumstances. Regularity or conformity to
natural growth and success, entitle it to be called the
process of repair, healthy inflammation, or cell-

CONCLUSIONS,

tlierapeutics. Irregularities, exuberance, protrac-
tions, and failure rank under the term unhealthy
inflammation, and are placed in the class of diseases.

Second :— This new growth appears in two pro-
minent forms — granulation and pus. The former
united to the texture from which it grows bj new
blood-vessels, repairs solutions of continuity by
metamorphosis into connective tissue. The latter,
a deciduous cell-growth — discharges sloughs, and in
virtue of the property of selective absorption in the
elementary cells — eliminates poisons from the blood.
Vesicles, pustules, abscess, suppuration, ulceration,
and fungosities are varieties, and may denote irregu-
larities of cell-growth.

In support of these conclusions, the following
reflections occur. In mechanical injuries the process
of repair has at first a pathological aspect. We say
inflammation arises. On the other hand, in gout,
small-pox, scarlet fever, and measles, inflammation
vindicates its therapeutical purport by the Kmita-
tions it observes, by the order and regularity of its
times and stages, and by the recovery of the person
concomitantly with a discharge of morbid secretion
or preternatural cells at the sites of inflammation.

r 2

CONCLUSIONS.

Cell therapeutics, after mechanical injury, has then a
mixed pathological and physiological aspect. The
pathological part is the first part. The injury has
been inflicted and there is need of reparation.
This is responded to by new cell-growth in the
vascular tissue, the primitive form of growth of that
tissue. The new growth requires for its support
new blood-vessels, and new blood-vessels appear.
But these new vessels cannot carry on the circulation
without joining to openings in the older vessels.
The openings are made by the absorptive property
which all cell-growths possess. And thus the new
growth establishes itself at the expense of the exist-
ing vascular tissue. The proper healing or repairing
part of the process cannot be said to have com-
menced while these operations are in progress —
while cell-growth and new blood-vessels are increas-
ing. It is only when these have accomplished their
part — when cell-growth is beginning to give place to
fibrous connective tissue, and new blood-vessels are
diminishing in number — that regularity and success
entitle the phenomenon to rank as the process of
repair.

In like manner, in blood distempers the pheno-
mena have a mingled pathological and physiological
aspect. In small pox, the pustules arise with in-

CONCLUSIONS.

flammation. These are pathological to the vascular
tissue ; they alter the form and properties of the
blood-vessels. But the new cell-growth performs a
therapeutical act as respects the blood, the cells of
the pustules transferring injurious matter from the
circulation to the sohd texture for discharge.

Cell-growth in the vascular tissue or inflammation
— whichever term we employ — is at all times, and
from whatever cause arising, a thing of mingled
good and evil, even when accomplishing the process
of repair with success. And we may agree, when
the good purpose is evident and in course of fulfil-
ment, to call it the process of repair, and when the
evil predominates, a disease. This would be a con-
sistent and intelligible distinction. But, to call
inflammation when it observes a regular order, strict
limitations, fixed periods, and is followed by cure, as
in small-pox, scarlet fever, measles, and gout — a
disease, when the distemper is in the blood — and
inflammation and suppuration in burns and com-
pound fractures, often greatly more protracted, more
dangerous and exhausting to the patient the process
of repair, as though they had nothing in common
with each other, seems " an inappropriate form of
mental apprehension to apply to the facts which
cannot give rise to any exact or substantial know-

CONCLUSIONS.

ledge." Whereas, if the evidence produced shows
that forms of inflammation — described by Mr.
Hunter as adhesive, sujDpurative, and ulcerative —
and the process of repair, are both resolvable into
forms of new cell-growth in the common vascular
tissue ; that granulation, suppuration, and ulcera-
tion in burns, compound fractures, necrosis of bone,
tubercular consumption, &c., separate the dead from
the living parts, sever bonds of union, interrupt the
continuity of blood-vessels and create new ones
without bleeding ; — that vesicles, pustules or abscess
are appointed means for the discharge of poisons
from the blood, then the subject assumes altogether
a physiological aspect, and therapeutical operations
are based upon the properties of cells.

The first rounds of the ladder by which the loftier
heights of science are attained, must not be over-
looked, trite and common as they are. Water, air,
and food are necessaries of life. Yet water will
choke, a little air in the heart will kill, and the most
wholesome food in excess will distemper the blood —
in deficiency will starve. Opium will lull to sleep,
mercury will stop diseased growth, and antimony
relieve an over-charged stomach. Yet opium, mer-
cury, and antimony are poisons. Growths may be
symmetrical and normal, or uusymmctrical and

CONCLUSIONS.

monstrous. And new cell-growth or inflammation
may be a process of repair or a disease. Things
which in their proper place and quantity are right,
or contribute to health : — misplaced, excessive, or
deficient without alteration in their nature, are
wi'ong, and constitute disease. New cell-growth in
the vascular tissue is, we contend, the natural pro-
vision which severs and opens blood-vessels without
hemorrhage. Granulation, the natural provision for
the repair of solutions of continuity ; and pus, for
the throwing off of sloughs and poisons. If granu-
lations are wanted, and they appear, they belong
to the category of therapeutics. If they be in
excess, so much of them as is in excess belongs to
pathology, the rest are physiological. If pus be
required to loosen and discharge a slough, and pus
appears and performs the task, it belongs to the
category of therapeutics ; but if pus, having per-
formed its office, continues to form and be discharged
when it is not wanted, we treat it as we would any
other pathological growth — not by encouragement
but repression. And thus it is that inflammation
has two bearings.""''

In mechanical violences the surgeon sees the

* See the subject more fully treated in Healthy and
Diseased Structure, p. 69, &c.

CONCLUSIONS.

amount of injury, whether simple contused, lace-
rated, or comminuted. And before the first part
of the process of repair, — inflammation and suppu-
ration,— has commenced, he has opportunity to form
a judgment of the course and time it is likely to
take. He views with dread a comminuted com-
pound fracture, or a crushed joint, and perhaps
doubts whether the case should be trusted to the
natural efforts for cure even when assisted with all
his skill. If his decision be in the affirmative, he
prepares himself and his patient for granulation,
ulceration, and suppuration, and the probable use
of caustics and astringents to control the exuberance
of cell-growth — holding in reserve, should any un-
manageable excess or irregularity endanger the
powers of life — the removal of the limb.

On the contrary, in blood distemperature and
organic disease, the physician cannot know the full
extent of injury, or foretell the amount of inflam-
mation which may ensue. And when this has com-
menced, if the site be internal, — the spreading or
limitation, the regularity or irregularity, the acute-
ness or chronicity of it, — has to be determined not
by direct observation, but from symptoms, — the
pulse, countenance, complainings, bearing and man-
ner of the patient. And for exuberance or defi-

CONCLUSIONS.

ciency producing exhaustion or danger, though he
may employ interfering agents successfully in some
cases, yet should these fail he has no amputation in
reserve.

In the treatment of a burn, or other mechanical
injury, if inflammation be only in the right propor-
tion, the surgeon does not interfere, except to favour
or promote the oncoming granulations, as upon these
he is dependent for the separation of the slough,
and the healing of the wound. When the slough
has been detached, he expects the granulations to
heal or give way to the fibrous cicatrix. If they do
not, he no longer treats them with care and encour-
agement. On the contrary, strong pressure and
caustics are used to arrest their luxuriance, or
stimulants applied to awaken their inactivity.
In surgical cases, these interferences are not the
cure, but they open the way for cure. Analogously,
in medical treatment, there are many medicines
employed which are poisons ; and it is a result of
microscopical investigation, that in order to be bene-
ficial they must partake of this character, inasmuch
as they are employed to stop cell-growth. The
principle upon which this is effected before disturb-
ing healthy functions appears to be this : — The
growth we wish to stop has the embryoniform type

CONCLUSIONS.

— it is the youngest or last formed, the tenderest or
most succulent, and therefore the first to fade upon
the presence of unsuitable conditions — of alterative
agents given for the express purpose of its removal.
And the principle here seems to be the same as that
before referred to in the case of the sailors, as keep-
ing up chronic ulcerations. The sailors, in a hot
climate, and living on salt provisions, had chronic
ulcerations for weeks from some cause, which pre-
vented healthy granulation, though it did not visibly
affect their general health. Here therapeutics re-
quired a granulation cell-growth, and that which
prevented it was the cause of the continuance of the
ulcers. In the cases we are now speaking of, on the
contrary, we want imjnediately to stop a granulation
cell-growth. And some interfering agent is resorted
to, to produce just so much qualitative change in
the blood as shall stop it. The Art seems to consist
in the selection of the proper agent, and the appor-
tionment of it in such quantities, that a minor dis-
temper of blood, sufficient to extinguish the morbid
growth without materially interfering with healthy
functions shall be produced. Just so much, in
fact, as in the sailors mentioned, kept the chronic
ulcers from healing.

The adult man resists influences which disorder

CONCLUSIONS.

the child, and would altogether stop growth in the
embryo. And so the natural organs appear able to
resist the action of a medicine or a poison which
will interfere and stop a new or recent embryoni-
form cell-growth. For what are the facts 'i All
the principal organs of the body are composed of
cells and vascular tissue. And when inflammation
occurs, the vascular tissue becomes the seat of cell-
growth. All these cells, natural and preternatural,
take from the blood the materials of their growth.
There is then, on the one hand, all the natural cell-
organs to be cared for, and on the other, the ex-
uberant new cell-growth in the vascular tissue to be
arrested.

And the problem of cure seems to consist in select-
ing a medicine or a surgical application which shall
prove remedial by stopping the abnormal cell-growth
before producing an injurious influence upon any of
the natural organs.* If microscopical research lead
to the conclusion that all therapeutical operations
are accomphshed through the medium of a nucleated
cell-growth, and if experience prove that mercury
will check the progress of a preternatural cell-growth
before producing salivation, surely we may endea-

* Vide Healthy and Diseased Structure, &c., Ch. III.
Therapeutics and Cure, p. 222, &c.

CONCLUSIONS.

vour to interpret the medical, by the physiological
fact. And if we accord to physiological cell-
growth and "nuclei" the property of selective
attraction or absorption, no reason has yet been
shown why it should be denied to pathological
cells and nuclei. Nor can any such reason be
shown, if a physiological cell-growth becomes
pathological without alteration of nature, simply
by deficiency, protraction, and excess. On the
other hand, the necessity for the exercise of
medical and surgical skill and art in all cases is very
apparent. And let us agree to rest the necessity
upon the right basis. ^

The most anxious care and watching is required
or befits a growth of the most tender yet active
nature — an embryoniform cell-structure, which may
arise in twenty -four hours (p. 33), estabhsh itself in
the vascular tissue, acquire blood-vessels, absorb the
surrounding texture, and bleed in two days (p. 34) : —
Which is Hable from numerous circumstances to irre-
gularity, exuberance, or premature decay : — Which,
if languishing, — struggling with difficulties, or in
deficiency, may be assisted by manual and medical
art, — may be aroused by stimulants, and cherished
by warmth, moisture, and soothing appliances. But

CONCLUSIONS.

which, if outstepping, the therapeutical limit must be,
and is repelled by depletion and hostile interferences,
or destroyed by caustics, poisons, and the knife.

Future discussion must decide upon the merit of
the views we have here put forth. In the mean
time, the Cell Physiology as at present established,
though it places inflammation in a new aspect,
nevertheless elucidates and confirms the principles
of Medical Art.

IX.

OP UNITY OF DESIGN AND THE PHYSIOLOGY OF
INFLAMMATION.

The most satisfactory evidence of Unity of
Design is derived from the study of the development
of living beings. When we go back to the very
commencement of growth, we observe that the evo-
lution of the germ in the highest animals, as in the
lowliest plants, begins by the multiplication and in-
crease of nucleated cells. And it is not until this
has proceeded to a considerable extent that it could
be stated with certainty, from an examination of the

OP UNITY OP DESIGN

germ alone, whether it is that of a plant or of an
animal. And when, again, the distinctive charac-
ters of the animal class first present themselves, it
could not be predicated whether the germ is that of
a Radiated, Molluscous, Articulated, or Vertebrated
animal. The special organs, in every case, arise by
a gradual change from the more homogeneous mass
of cells, — the form and arrangement of the organs
depending on the circumstances in which the Being is
destined to exist. In the highest class of animals these
special organs become more and more numerous and
various in proportion to the complexit^f the nutritive
processes ; still all those most appropriately styled
Glands, or secreting organs, have the nucleated cell
structure, and differ only in the peculiar adaptation
of the cell elements of each, to separate preferably a
particular constituent of the blood.

It may be more difficult to trace a fundamental
Unity in relation to the functional character of the
special glandular organs considered as instruments
for particular ends, concealed as this is by that
extraordinary variety which is the chief source of
the diversity of forms presented by living beings.
But, if in place of looking at the origin and con-
nexions of the parts, we regard them with reference
to the acts to which they are subservient, we shall

AND THE PHYSIOLOGY OP INFLAMMATION. 79

find in the higher orders of animals, organs specially
set apart for the functions of absorption, secretion,
excretion, and reproduction, whilst in the germ all
these acts are traceable in the homogeneous cell
mass which composes the germ organism. But this
setting apart a particular organ for a particular
function does not proceed to the extent of taking
away entirely from the special organ the capacity
for sharing in other functions. On the contrary, it
is concluded by those entitled to speak on the sub-
ject, that the whole structure retains more or less of
the primitive community of function. It is not our
purpose to show in detail how this conclusion has
been established ; we propose only to refer to those
facts of glandular structures — of absorbing and excret-
ing structures — which, substantiating the conclusion
above stated, have at the same time a bearing upon
the philosophy of Cell Therapeutics, or the physio-
logy of inflammation.*

The vilh of the intestine are special organs of
absorption, but also, they excrete material no longer
of any use in the operations of life. The lungs are

* "Edinburgh Philosophical Journal," July, 1837. " Human
Physiology," ante pp. 575—585, &c. Also, " The Unity of
Nature," by C. B. Eadcliflfe, M.D. A work which abounds
with striking illustrations.

OP UNITY OP DESIGN

organs of respiration, but it is well known that the
blood in its passage through them absorbs, on the
one hand, from the air, elements which renovate its
arterial character and composition, and on the other,
excretes an exhalation. The skin is an excreting
organ, yet it will admit of the passage of fluid into
the interior of the system, especially when the sup-
ply afforded by the special channels is deficient.
And a mucous membrane exposed to the air will
take on the appearance and function of the skin.
Each secretion appears as if it could be formed by
its own organ alone, yet we may observe when the
excretory function of a particular gland is suspended,
or when it is not performed with sufficient activity,
that other secreting organs, or even the general sur-
face, appear to be able to perform it in some degree.
It seems established by a great mass of observations
that the Urine, or a fluid presenting its essential
characters, may be secreted, or pass off by the sali-
vary and mammary glands, by the mucous membrane
of the intestine, by parts of the outer integument,
and even by serous membranes, the ventricles of the
brain, the pleura and peritoneum ; and such a me-
tastasis has not only taken place in cases in which
the normal excretion was checked or impeded by
disease, but has been induced experimentally — by

AND THE PHYSIOLOGY OF INFLAMMATION. 81

extirpation of the kidneys, or by tying the renal
artery. So, again, if the excretion of Bile be
checked by disease of the liver, its elements are
discharged through other channels ; the urine, the
cutaneous transpiration, and even the sputa derived
from the mucous membrane of the lungs being more
or less deeply tinged with the colouring matter of
bile. The secretion of Milh has been transferred to
different parts of the skin, to the intestinal mucous
membrane, to the bronchial tubes, and even to the
surface of an ulcer. The whole structure retaining
more or less of the primitive community of action.

Geanulations and Pus have the most general
type of organised structure — they are forms of nu-
cleated cell-growth ; we find them possessing the
essential elements of glandular organs. In their ele-
mentary composition, and in the acts to which they
are subservient, there is sufficient to excite an earnest
attention. The sore occasioned by a common bHster
is an excreting surface ; there is a copious discharge
of cells from it, yet the influence of the blistering
fly may be traced, extending by absorption, to the
urinary organs. In other cases the influence of
medicines and poisons may be communicated to
distant organs if the medicine be brought into con-

OP UNITY OP DESIGN

tact with the granuhations of a wound, although from
these granulations there may at the time be a co-
pious discharge of pus. An abscess is both an ex-
creting and an absorbing surface. It may be re-
garded as a kind of new organ developed in the
body. In the formation of an abscess there is puru-
lent accumulation or cell-growth, which forms the
principal part of the swelling ; and there is also at
the same time absorption of the vascular tissue.
Sores give rise to different kinds of pus, and we can
make no doubt that the different^arts of which the
blood is composed, will come away more in one
kind of pus than in another. The poison of small-
pox comes away in the matter of the pustules.
Each pustule acts as a temporary new organ for the
excretion of the abnormal material from the blood.
And when the pustules have performed their task,
they fade away and disappear, as do many forms of
temporary cell-growth during the development of
the germ. There is no natural organ for the ehmi-
nation of small-pox poison from the blood, therefore
the common vascular tissue of the outer integument
takes on the excretory function, and cells of the
most general type eliminate the poison.

A common issue is established as a drain to the
blood. But there can be no drain except in con-

AND THE PHYSIOLOGY OF INFLAMMATION. 83

junction with cell-growth. A sore having been
made, and granulations established, the peas are
inserted to prevent them heahng. These foreign
bodies, in contact with the granulations, fulfil the
conditions we have supposed in tubercular consump-
tion, in necrosis of bone, carbuncles, diseased joints,
&c. ; they are hindrances to the process of repair ;
they alter the destination of the young and growing
cells, so that instead of becoming fixed in the granu-
lations and proceeding to a fibrous transformation,
they are checked, become deciduous, and fall away
as cells, at the same time carrying out from the
system the materials they have taken for their own
growth from the blood. Such an operation as this
upon any great scale must impoverish the blood.
But in a smaller degree, and under particular cir-
cumstances— those, for example, in which an issue
is required — the circulating fluid, by such an action,
may be relieved of excrementitious matter, as it is
by the several natural actions of the same kind.
The granulations of the issue becoming a preter-
natural excretory organ.

Errors in diet, unwholesome habits, &c., vitiate the
quahties of blood ; and sedentary occupations long
continued are known to be favourable to inactivity
in the functions of the natural excretory organs.

OF UNITY OP DESIGN, &C.

Under such cn-cumstances new cell-growth or
granulations established for repair or cure of a
local injury may fall into the condition of an
issue. Cell-growth is diverted from one form or
quality to another by the condition of the blood ; and
granulations, instead of metamorphosing into fibrous
texture, continue to discharge deciduous excreting
cells. Abscess, ulceration, and suppuration persist
to the exclusion of the local reparation, as long as the
abnormal state of blood remains. To cure the sore
or wound, the condition of the olood must be altered,
by arousing into activity all the natural excreting
organs, and when this has been accompHshed the
excreting acts of the new growth cease and the sore
heals.

The process of Inflammation we conceive to be
in Harmony with the Unity op Design traceable
throughout Nature in all that relates to the structure
and functions of Living Beings ; and we have briefly
submitted an outline of its Therapeutical uses in
accordance with the doctrines of Cell-growth.

PINIS.

ESSAYS PUBLISHED BY DR. ADDISON.

EXPERIMENTAL RESEARCHES WITH THE MICROSCOPE, IN
PHYSIOLOGY AND PATHOLOGY. In One Volume 8vo., Plates, 12s.

First Series. — On the Blood, Inflammation, &c. 1843.
Second Series. — On Nuteition, Seoeetion, &c. 1844.
Third Series, — On Nuteition, Secretion, &c. 1845.

CONTENTS.

First Series. — 1. Human blood corpuscles, red and colourless — Molecules
and Fibrine. 2. Pus corpuscles — Inflaromation, Tubercles, &c. Pages 76.
Plates.

Second Series. — Fibrous tissue forming from the colourless elements of blood
— Fibrous appearance in mucus — Colourless blood corpuscles, action of
weak acids and alkalies on — Nutrition, walls of capillaries— Blood from a
pimple, appearance of (wood-cut)— Yellow-coloured cells found in the
substance of the lungs — Congestion and inflammation. Pages 76. Plates.

Third Series. — On the moving molecules in the interior of the cells of blood,
mucus, saliva, and pus — On the change of pus to mucus, by the rupture
of pus cells — On the fibrous tissue developed in saliva by acetic acid, &c.
— On the coagulation of the blood — On the nature of the fluid element of
blood, the natm-e of capillary vessels — Appendix, with Experiments on
the circulation in the Frog. Pages 114. Plates.

" We are indebted to Dr. Addison for the discovery of an immense number of
'colourless cells,' observable in the clear colourless fluid at the top of coagvilatLng
blood. In some blood taken in pleuritis, I found the number of such cells or
globules prodigious." — Dr. Martin Barry, Philosophical Transactions.

" The microscopic observations of Dr. Addison have established the important
fact that a great accumulation of colourless cells takes place in the vessels of
inflamed parts. He has noticed it in blood drawn from an inflamed pimple, the
base of a boil, the skin in scarlatina, &c." — Report on the Origin and Function
of Cells, by Dr. Carpenter.

London: John CHrEOHiLL, New Burlington Street.

ON THE CONTAINING TEXTURE OF THE BLOOD.
(London Medical Gazette, June and July, 1860.)

CONTENTS.

On the development and growth of vascular tissue — Diiferences between it
and parenchymatous substances — On absorption by cells, &c.

LONDON :

G. J. PALMKR, SAVOY STREET, STRAND.

London, New Burlington Street,
February, 1856.

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