When a tubular structure is severed, the neoplasm first forms an envelope, called a sheath or capsule, which by means of its vessels brings the injured part also into organic connection with the circumjacent structures. Thus, e.g., in the case of the fracture of a bone, when the sheath hardens into the provisional callus. At the same time, both openings of the medullary cavity are closed by a similar callus, formed from the lining membrane of the bone. Meanwhile the terminal surfaces of the bone are so far involved in the inflammation of the circumjacent parts that they themselves pass into a state of inflammation, and can give rise to a neoplasm, which, as a whole, is slowly converted from a firm jelly into true cartilage, and then gradually ossified; although, according to Virchow, osseous or marrow cells can also arise directly from it, as, according to the same authority, all three, cartilage, bone, and marrow cells, may be directly converted into one another. Whilst this process is effecting the renovation proper, the expedients of the intermediate stages, the provisional callus, as well as the gelatine contained in the circumjacent parts, are softened and reabsorbed, the medullary cavity also restored, the dense substance of the callus becoming first cellular, then thinner and thinner, and finally disappearing. The bone recomposed in this way exhibits an uninterrupted connection with the old ends, and exactly the same formation in substance and vessels. An excavation of the radius and ulna of a dog six lines in length was completely filled with bony substance after forty days. If the inner layer of a piece of bone perishes, the regeneration begins from the outer one, and conversely, if the whole bone perishes, the membrane inside the bone and periosteum replaces it, after being first freed from bone. Should these also perish, the piece in question is enclosed by a new piece, which is formed partly of the ends of the bone which have remained sound, partly of the surrounding soft parts.
In canals which are formed of mucous membrane, as the intestinal canal, or excretory ducts of glands, this neoplasm likewise forms a capsule or sheath, on the inner side of which the particular canal is re-formed, whilst the dead edges of the old piece are thrown off and carried away by the newly formed canal. In the case of displacement of the intestines or strangulated hernia, pieces of the intestine several inches, nay, even a foot in length, are often removed through the anus, and the digestive canals are restored. Is it possible that the rejection of a strangulated piece of intestine is regulated by another principle than that which governs the rejection of the claw of an injured crab, or the casting off of a spider’s leg?
If the external surface of any structure is destroyed, it is replaced in the same way, and the process is, on the whole, a higher one than in the case of union of severed parts, because the catalytic action of the homogeneous adjoining tissue can exert far less influence. The neoplasm appears here in the form of granulations, i.e., it is richer in vessels, and exhibits a number of reddish prominences. In this way new skin is formed on a part laid bare, which, at first, owing to the absence of a substratum of fat, lies closely on the muscles, but later on resembles the rest of the skin. Suppuration only occurs spontaneously, when the injury has been of such a kind that the parts of the tissue are to a great extent rendered incapable of continuing the vital functions (mortified), so that it is necessary to separate, i.e., to reject, these mortified tissues from the organism, and to replace them by new formations (e.g., in contusions, gunshot wounds, &c.) When this task is accomplished, the suppuration ceases as spontaneously as it occurred; when there are no parts to be thrown off, the healing takes place “per primam intentionem,” without any suppuration. It is true suppuration occurs only too frequently here also, just as in the former case the suppuration often continues beyond the requisite extent, sometimes even to exhaustion, but it is not then a suppuration which is spontaneously set agoing by the organism, but one produced and relatively maintained by injurious external influences, namely, through the germs of parasitic organisms floating in the air, which may make the slightest wound become malignant and fatal. The disinfection, by dressings of carbolic acid, &c., of the air thus reaching the wound obviates these injurious external influences, and thus experimentally proves the correctness of the above assertions.
Mucous membrane can change into epithelium if it is necessitated by abnormal circumstances to form an external surface (e.g., in the case of prolapsed and everted rectum or uterus). In amputations the organism produces a stump which encloses all the hitherto existing canals (medullary cavity of the bone and vessels), and serves for the present use of the limb. The bone is well rounded off; the two bones of the fore-arm or leg, by growing together at the lower end, obtain the firm connection which is usually given by the wrist or ankle-joint; the vessels and the afflux of blood are limited to this now diminished need, and the stump forms a strong fibrous skin, which quickly scales. The fibrous structure of the stump also partially extends to the adjoining muscular fibres, nerves, and now useless vessels.
Let us now turn to some other remarkable phenomena of the vis medicatrix in man and mammals.
A complete regeneration of the crystalline lens has often been observed in mammals from whom it had been removed, and even in human beings couched for cataract an imperfect regeneration of the lens sometimes takes place. If after such an operation the upper lip of the wound of the cornea protrudes and cleaves to the outer edge of the lower lip with its inner edge, both lips afterwards become soft and swollen, and, when the swelling is lost, both are found to be in the same plane. In this way the disturbing effect is obviated, which such an unevenness of the cornea would necessarily produce in respect of vision. When an osseous fracture cannot heal, the organism seeks to help itself in some other way. The fractured ends close and round themselves off, and are either kept together by a fibrous cord into which the callus-sheath has been converted, or by a cylindrical ligament, or united by a so-called false joint, the one end forming a cavity which receives the other spherical end. Both ends are enclosed by a fibrous capsule, and, like other places exposed to friction, receive the requisite lubrication by means of a newly formed synovial sac. A similar process takes place in limbs which have not been set; the abandoned socket is filled up, and at the place where the head of the joint now lies there is formed a new one with the other appurtenances of the joint,
Very remarkable is the formation of excretory passages answering a purpose, when certain secretions in the interior of a structure have no natural vent, and unless such were formed would destroy the organ. This is especially the case in all normal secretions, when the natural drains are stopped up; fistulæ are then formed by the nearest, or rather the most suitable path, making a way outwards (e.g., lachrymal, salivary, bilious, urinary, fæcal fistulæ). They perfectly resemble the normal excretory ducts of the glands, in that the cellular tissue is converted at the walls of the passage into a mucous membrane insentient to the particular matter carried off. They cannot possibly be healed over so long as the natural outlet is not restored, but then they heal of themselves quickly and easily. One cannot see any material reason why this secretion, which is certainly obliged to establish an excretory channel through dissolving and liquefying the cellular tissues, effects this considerable destruction only in the one direction of the channel, whilst on all other sides the attacks are proportionately too evanescent for the purpose; why the direction in which this violent chemical decomposition is manifested is precisely the most appropriate for the new drain, and why this drain shows not merely signs of destruction, but rather of organic reconstruction. Sometimes such channels, especially in the case of pus-fistulæ, extend through several other organs before they can reach the outside, e.g., from the liver to the stomach or the intestine, or through the diaphragm into the lungs. This process is perhaps most remarkable in internal mortification. The excretory canals (or drains) then arise, if merely the inner layer of a bone perishes, in the vicarious external layer; but if this also perishes, in the new environing bony substance from the very commencement of its formation, and moreover, without suppuration being perceived. Th
ey are round or oval canals, lined with a smooth membrane, passing from the membrane inside the bone to the periosteum, open externally by a smooth edge, and are subsequently prolonged by means of a fistula to the outer surface. They cannot in any way be permanently healed over as long as dead pieces of bone lie within the newly formed bone, but close spontaneously when these have been removed.
Connected to a certain extent with the foregoing is the killing and shrivelling of the embryo, the evacuation of the remains by newly made paths, or the encysting of these remains when child-bearing is impossible.
Further worthy of note is the elaboration of a particular secretion by quite other organs than those properly concerned with this secretion, when the latter are incapable of performing their functions. The secretions, which play so great a part in the economy of the organism, are, as is well known, never present in the blood as such, but always only in their elements, and only during and after separation from the blood obtain their proper chemical composition (wherefore, also, the secretory courses are longer the higher the nature of the secretion). We must therefore usually look upon the organs of secretion as the cause of the special chemical nature of the secretions. So much the more must it surprise us that, under certain circumstances, when this or that organ cannot perform its function, but yet the retention of those matters in the blood which heretofore were separated out of it by means of secretion might become dangerous to the organism, that under such circumstances other organs also are able to perform this act of secretion in an approximately similar way, and thus to secure the continued existence of the organism. The material expedients, which the unconscious will makes use of for this end, can only be looked for in a temporary change of the secreting membranes of the vicarious secretory organs, whereby they are accommodated to their vicarious secretions, just as we observe such an influence of the will on the secretory organs in terror, anger, &c.
Let us look at a few examples. Urine acts as such fatally in the blood; in the blood there are only its elements, but these, too, require to be excreted if the organism is not to be destroyed. In guinea-pigs whose renal arteries had been ligatured, peritoneum, pericardium, pleura, cavities of the brain, stomach, and intestines secreted a brown fluid redolent of urine; the tears also smelt of urine, and the testes contained a fluid very similar to urine. With dogs there ensued vomiting of urine; in rabbits, fluid discharge of the bowels. In men, whose sweat has possessed a decided odour of urine, post-mortem examination usually brings to light causes of suppressed urinal secretion. With persons in whom the ordinary passages have been completely obstructed, daily vomiting of urine has often been observed for years. In the case of a girl with such a constitution, evacuation took place through the breasts till her fourteenth year. In other cases of suppressed urination, urinal discharge showed itself through the skin of the armpits. Also in degeneration of the kidneys, when the latter could no longer secrete urine, or when there was a want of connection with the bladder, normal micturition is said to have been observed for years, whence some would infer a vicarious capability of the bladder itself for the secretion of urine.—A great number of observations proves the secretion of lacteal moisture through the kidneys, the skin of the navel, the groin, thighs, back, ulcers, and peritoneum, on inflammation of the peritoneum which had arisen in consequence of suppressed lacteal secretion. In that mode of formation of jaundice where the action of the liver (as subsequently shown by dissection) has been arrested, the secretion of bile must take place in the minutest blood-vessels, since all the organs, even fibrous tissue, cartilage, bones, and hairs, are penetrated by the coloured constituents of bile.
A very remarkable phenomenon is the constancy of the temperature of warm-blooded animals under the most varied changes of external circumstances. We are far from being acquainted with all the circumstances whereby this constancy is rendered possible; but this much is certain, that the most efficient, perhaps the only, factors independent of the animal itself, are the regulation of the quantity of food, the excretions, and respiration. Now, since the constant temperature of a class of animals is manifestly that most favourable for its chemical processes, we must recognise an act of nature’s sanative power in every act of the organism which accommodates the conditions to changing circumstances. The observation that the quantity of cutaneous as of pulmonary respiration (of carbonic acid and water) varies in brief intervals without perceptible cause, but in longer intervals of several hours remains pretty constant, is manifestly connected with this.
Noteworthy is the mechanical and chemical capacity of resistance on the part of living tissues, which immediately ceases with death. It is best observed in the stomach and intestines. The gelatinous Medusæ digest animals provided with spiny cuirasses without being injured; the stomachs of birds comminute pieces of glass and bend iron nails without being wounded (for stomach-wounds notoriously heal very slowly, and would accordingly not easily escape observation). The intestinal canal of Plaice and Blennies is often entirely stopped up with sharp mussel-shells, and after death is cut through with a little shaking. As a greater mechanical solidity of the living tissue is not to be thought of, these phenomena are only explicable by reflex movements, in consequence of which the part threatened on occasion of a movement of the sharp object gives way, and the other parts bring the sharp object into a less dangerous position. Just as wonderful is the resistance which the stomach opposes to the chemical attacks of a particularly pungent gastric juice. There are examples where the degenerated gastric juice began immediately after death to destroy the stomach, and also decomposed a fresh animal’s stomach, without any injury occurring during life. The like takes place in other acrid secretions and their secretory organs.
After these examples, let us proceed once more to the refutation of some objections to the vis medicatrix as a purposive manifestation of unconscious volition and ideation. Although I think that I have proved by many reasons the utter insufficiency of materialistic attempts at explanation, still it seems important once more briefly to indicate the unsatisfactory character of the two chief materialistic arguments. They run thus: (1.) The existing assimilates the freshly added material by catalysis and cell-growths; and (2.) the constitution of every secretion is dependent on the constitution of the nutritive fluid and the secreting membrane.
The first statement is refuted by the fact that new formations take place in the body at different times, which receive no assistance from similar tissues, because they either altogether, or at this particular part of the organism, appear for the first time, e.g., at the different stages of embryonic development, birth, puberty, and pregnancy. But besides the fresh formations and secretions, several secretions are periodical, whether normally or morbidly, and then also the recurrence of the secretion cannot arise from the contact of the secretion, since this is non-existent. In the same way the regeneration of solid structures is not directly dependent on the seat of development. Thus, e.g., we have seen that the neoplasm for the required renovation of the bony mass has also in great part exuded from the other neighbouring tissues. In the same way mucous membrane is formed in fistulæ, and skin on granulations without contact with similar tissues. As little, then, as one can fail to acknowledge, on the one hand, that this principle of assimilation by catalytic action offers a remarkable expedient for husbanding energy in the economy of the organism, so little, on the other side, can the facts be ignored, which show that the unconscious will can produce a state of things in the organism wherein products may be formed according to chemical laws, which are not caused by adjoining similar tissues, but which are most accurately adjusted to the present life-stage or momentary need of the organism.
As concerns the second point, the dependence of the secretion on the secreting membranes, this principle is likewise in general correct; only one must not forget that the difference of the secretions of one and the same organ at different times, the fresh introduction of secretions at certain vital stages, the intermittence and recurrence of others, as well
as the doctrine of vicarious secretions, still leaves open the question with regard to the inconstant character of the secreting membranes; that thus the phenomenon is correctly explained so far as its proximate efficient cause is concerned, but that this efficient cause, on its side, only admits one ultimate explanation, namely, an ideal one. With such provisional explanation the man of science has done his nearest duty, and nobody will impugn it, if he only grants that the question is just as open as before, if only he does not assert that he has achieved everything by this proximate explanation, for then he immediately comes into collision with the facts.
Philosophy of the Unconscious Page 19
