The lesions produced by the action of injurious conditions are usually so distinctive in situation and character that by the examination of the body after death the cause of death can be ascertained. The lesions of diseases may be very obvious to the naked eye, or in other cases only the most careful microscopic examination can detect even the presence of alterations. In the case of poisons the capacity of the cell for adaptation to unusual conditions is of great importance. It is probable that certain changes take place within the cells, owing to which the function can be continued in spite of the unusual conditions which the presence of the poison brings about. It is in this way that the habitual use of such poisons as morphine, alcohol and tobacco, to speak only of those best known, is tolerated. The cell life can become so accustomed to the presence of poisons that the cell activities may suffer in their absence.

Repair of the injuries which the body receives is effected in a variety of ways. We do not know how intracellular repair takes place, but most probably the cells get rid of the injured areas either by ejecting them, or chemical changes are produced in the altered cell substance breaking up and recombining the molecules. When single cells are destroyed, the loss is made good by new formation of cells, the cell loss stimulating the formative activity of the cells in the vicinity. The body maintains a cell and tissue equilibrium, and a loss is in most cases repaired. The blood fluid lost in a hæmorrhage is quickly restored by a withdrawal of the fluid from the tissues into the blood, but the cells lost are restored by new formation of cells in the blood-forming organs. The blood cells are all formed in bone marrow and in the lymph nodes, and not from the cells which circulate in the blood, and the stimulus to new cell formation which the loss of blood brings about affects this remote tissue.

In general, repair takes place most easily in tissues of a simple character, and where there is the least differentiation of cell structure for the purposes of function. A high degree of function in which the cell produces material of a complex character necessitates a complex chemical apparatus to carry this out, and a complicated mechanism is formed less easily than a simple one. In certain tissues the cells have become so highly differentiated that all formative activity is lost. Such is the case in the nerve cells of the brain and spinal cord, a loss in which tissue is never repaired by the formation of new cells; and in the muscles the same is true. The least differentiation is seen in those cells which serve the purpose of mechanical protection only, as the cells of the skin, and in these the formative activity is very great. Not only must the usual loss be supplied, but we are all conscious of slight injuries of the surface which are quickly repaired.

Repair, other things being equal, takes place more easily in the young than in the old. New formation of cells goes on with great rapidity in intra-uterine life, the child, beginning its existence as a single cell one two hundred and fiftieth of an inch in diameter, attains in nine months a weight of seven pounds. The only similar rapidity of cell formation is seen in certain tumors; although the body may add a greater amount of weight and in a shorter time, by deposit of fat, this in but slight measure represents a new formation of tissue, but is merely a storage of food material in cells. The remarkable repair and even the new formation of entire parts of the body in the tadpole will not take place in the completely developed frog.

Repair will also take place the more readily the less complicated is the architectural structure of the part affected. When a series of tissues variously and closely related to one another enter into the structure of an organ, there may be new formation of cells; but when the loss involves more than this, the complicated architectural structure will not be completely replaced. A brick which has been knocked out of a building can be easily replaced, but the renewal of an area of the wall is more difficult. In the kidney, for example, the destruction of single cells is quickly made good by new cell formation, but the loss of an area of tissue is never restored. In the liver, on the other hand, which is of much simpler construction, large areas of tissue can be newly formed. For the formation of new cells in a part there must be a sufficient amount of formative material; then the circulation of the blood becomes more active, more blood being brought to the part by dilatation of the vessels supplying it.

Repair after a loss can be perfect or imperfect. The tissue lost can be restored so perfectly that no trace of an injury remains; but when the loss has been extensive, and in a tissue of complex structure, complete restoration does not take place and a less perfect tissue is formed which is called a scar. Examination of the skin in almost anyone will show some such scars which have resulted from wounds. They are also found in the internal organs of the body as the result of injuries which have healed. The scar represents a very imperfect repair. In the skin, for example, the scar tissue never contains such complicated apparatus as hair and sweat glands; the white area is composed of an imperfectly vascularized fibrous tissue which is covered with a modified epidermis. The scar is less resistant than the normal tissue, injury takes place more easily in it and heals with more difficulty.

Loss brought about by the injuries of disease can be compensated for, even when the healing is imperfect, by increased function of similar tissue in the body. There always seems to be in the body under the usual conditions a reserve force, no tissue being worked to its full capacity. Meltzer has compared the reserve force of the body to the factor of safety in mechanical construction. A bridge is constructed to sustain the weight of the usual traffic, but is in addition given strength to meet unusual and unforeseen demands. The stomach provides secretion to meet the usual demands of digestion, but can take care of an unusual amount of food. The work of the heart may be doubled by severe exertions, and it meets this demand by increased force and rapidity of contraction; and the same is true of the muscles attached to the skeleton. The constant exercise of this reserve force breaks down the adjustment. If the weight of the traffic over the bridge be constantly all that it can carry, there quickly comes a time when some slight and unforeseen increase of weight brings disaster. The conditions in the body are rather better than in the case of the bridge, because with the increased demand for activity the heart, for example, becomes larger and stronger, and reserve force rises with the load to be carried, but the ratio of reserve force is diminished.

New York, Henry Holt And Company.
London, Williams and Norgate, originally published 1913

Tags: Disorders and Diseases