Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol 1: A-Dea
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit25759/65/
53 
ADHESION. 
more readily as the tissue may be more cellular 
and vascular. That these organs are very vas¬ 
cular is evident from the rapidity with which 
they bleed upon the slightest contact ; that they 
contain nerves is shewn by the pain which 
is produced in them by the slighest touch : 
does not their prompt destruction by slight 
causes seem to indicate the existence of absor¬ 
bents ? 
No one has made more interesting researches 
into the nature of these bodies than Sir Everard 
Home.* He carefully observed the changes 
which occurred in an ulcer of the leg. By using 
a lens which enlarged objects eight times, he 
saw that granulations were formed in the fol¬ 
lowing manner : hrst, is seen a mass of capil¬ 
lary vessels differently arranged ; secondly, 
small sinuosities containing pus. The ulcer ob¬ 
served during ten minutes, offered, in the first 
place, an extremely thin and transparent pel¬ 
licle, under which were disengaged globules of 
gas, then canals having a horizontal direction, 
and containing blood. The tunics of these 
vessels were so delicate that they were ruptured 
by the simple motion of the leg. These canals 
anastomose with each other, taking different 
directions ; those which are developed the first 
were the next day changed into true vessels. 
Soon these new vessels have enough of solidity 
to admit of our passing a needle under them 
and raising without rupturing them. The forma¬ 
tion of all these parts is due, according to 
Home, to the coagulation of pus, and the de¬ 
velopment of carbonic acid gas ; “ for if the 
puriform matter be wiped off, these phenomena 
are not produced.” When, on the contrary, he 
employed substances, calculated to coagulate 
the pus, the formation of those vessels was 
accelerated. He concludes from his experiments 
that bloodvessels are developed, almost as it 
were under the eye of the observer ; that they 
are not a prolongation of pre-existing vessels ; 
that they are formed independently of the action 
of the subjacent solid parts. So far, therefore, 
although the processes may differ, yet the 
general points of union between the two modes 
is singularly similar. 
While suppuration is proceeding, another 
operation is in progress under the layer of gra¬ 
nulations. A stratum of cellular tissue, at first 
simple and not very resistent, afterwards fibro- 
cellular, and lastly fibrous, is organised iusensi- 
bly to serve as the base of the succeeding me¬ 
dium of union. 
When granular surfaces are brought into con¬ 
tact, and the tendency to secrete pus has ceased, 
they enter into adhesion. This tendency is 
marked by a diminution of activity in the gra¬ 
nulations; the membrane ceases to secrete pus, 
and the granulations become firmer and con¬ 
tracted : before union can be effected, the sup¬ 
purating surface must, therefore, change its 
nature—must be destroyed. A state like that in 
simple union by the first intention is produced ; 
the secretion becomes plastic, and somewhat 
analogous to that which accompanies that mode 
of union. 
* Home on Ulcers. 
When these new tissues or media of union 
are developed between surfaces naturally free, 
the structure of the two portions of the organ 
between which they are seated becomes changed. 
In serous or mucous membranes, as well as in 
those surfaces which are immediate modifica¬ 
tions of these two systems, this may be ob¬ 
served. When, for example, the pleura costalis 
becomes adherent to the pleura pulmonalis, the 
point of union is no longer a serous membrane ; 
the free surface having disappeared, an un¬ 
interrupted continuity is established between 
the subserous cellular tissue of the pleura cos¬ 
talis, and the interlobular cellular tissue of the 
lung. This conversion is frequent in the peri¬ 
toneum ; in the tunica vaginalis a similar effect 
is produced by the common operation for hy¬ 
drocele ; in synovial membranes a similar effect 
occurs in what is termed false ankylosis. 
Having described the general laws by which 
the phenomena of adhesion are governed, I 
shall now point out, generally, the modifica¬ 
tions which are impressed upon it in different 
tissues. 
It is upon serous membranes that we may 
with most advantage study the process of ad¬ 
hesion, not only because it is more rapidly 
developed there, but because it much more 
frequently occurs there than in other tissues. 
If we examine the surfaces of two such mem¬ 
branes which have been recently united, com¬ 
mencing at a certain distance from the point of 
adhesion, we see the layer of coagulable matter 
effused between the two surfaces become thinner 
as we approach the point of contact. If the 
adhesion be sufficiently recent to admit of our 
separating the surfaces, we see the intermediate 
layer tearing, but remaining adherent to the 
inflamed surfaces. If the inflammation be 
more advanced, and the pseudo-membrane be 
more dense and organised, we find that the 
very thin layer of new deposition by which the 
union has place is more resistent than the 
thicker layer of organisable matter by which it 
is surrounded ; and at a later period we may 
discover vascular filaments attaching the ad¬ 
herent portion of the new tissue to that upon 
which it has been developed. These filaments 
are as much more evident as the adhesion is 
more immediate : of this we may very easily 
assure ourselves by cutting transversely two 
portions of digestive tube which have become 
to a certain extent adherent by their external 
tunic. The adhesion may be already very 
solid at the points where contact is so imme¬ 
diate that we can scarcely distinguish the in¬ 
terposed matter. Very delicate red capillaries 
creep through this matter, whilst perhaps at the 
distance of some lines, and even at the centre of 
an already organised point, the contact having 
been less immediate, a plastic layer of one, 
two, or more lines in thickness, may be seen 
uniting the surfaces, but not presenting either 
the solidity or the organisation of the exces¬ 
sively thin layer which adjoins it. 
When these adhesions have existed for a cer¬ 
tain time, the serous structure completely dis¬ 
appears. This destruction of serous membranes 
at the adherent point is very evident around
        

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