Lectures on nutrition, hypertrophy, and atrophy : delivered in the Theatre of the Royal College of Surgeons, May 1847 / by James Paget ; reported by William S. Kirkes.

  • Paget, James, Sir, 1814-1899.
Date:
1847
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Licence: Public Domain Mark

Credit: Lectures on nutrition, hypertrophy, and atrophy : delivered in the Theatre of the Royal College of Surgeons, May 1847 / by James Paget ; reported by William S. Kirkes. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    and that then, development ceases, and growth goes on alone till the full stature, and the full proportion of each part to the rest, are gained. But this is only generally true ; for we cannot say that all development ceases at a determinate period, since some organs may go on to be developed when many others are complete. Neither can we assign the period of terminated growth; since, not only is the period, even stated generally, very various in different persons, but, some parts, unless placed in unfavoura- ble conditions of disease, continue growing to the latest period of life. M. Bizot and Dr. Clendinning have proved, of the heart and arteries, that their average size regu- larly increases, though with a decreasing ratio of increase, from childhood to old age, provided only the old age be a lusty one.* And this is a real growth ; for the heart not only enlarges with advancing years, but its weight augments, and the thickness of its walls increases; so that we may believe it acquires power in the same proportion as it acquires bulk—the more readily, since the increased power is necessary for the increas- ing difficulties put in the way of the circula- tion by the increasing rigidity of the parts. It may be that the same is true of some other parts. This certainly is true—that any part, after it has attained its ordinary dimensions, according to the time of life, may grow larger if it be more exercised : in other words, every part has, throughout life, the power of growing, according to its par- ticular needs, in correspondence with the degree in which its function is discharged. Now, when such growth as this is the result of the natural, though almost exces- sive, exercise of a part—as of the limbs, for example, during hard work—we regard it only as an indication of health, and its result is admitted to be a desirable accession of strength. But, when such growth in one part is the consequence of disease in ano- ther, it is commonly described as a disease,— it bears thealarming name of Hypertrophy,— and it comes to be a subject of considera- tion in Morbid Anatomy. But in both these cases the process of growth is the same, and is according to the same rules ; and the tendency of the process of genuine hypertrophy in disease, like that of healthy growth in active exercise, is al- ways conservative. I say genuine hyper- trophy, meaning, under that term, to in- clude only the cases in which the enlargement of a part is effected with development, or with increase of its natural tissue. To in- clude nearly all enlargements, as some do, under the name of hypertrophy, leads only to confusion. * See the Croonian Lectures delivered by Dr. Clendinninsr in 1838; reported in the London Medical Gazettk for 1837-8, vol, xxii. p. 450. The rule, then, concerning hypertrophy is, that so long as all conditions remain the same, after the attainment of the average size, each part of the body merely assimi- lates, retaining its state, or, at most, growing at a certain determinate slow rate ; but when the conditions alter, so that a part is, or needs to be, more than usually exerted, then it manifests a power of renewing or accelerating its growth. As we may say, each healthy part has a reserve-power of growth and development, which is put forth in the time of emergency. The converse is equally true : that, when a part is less than usually exercised, it suffers atrophy ; so that the whole rule may be that each part nourishes itself according to the amount of function which it has to discharge. We may constantly see this in many more examples than I need refer to. The simplest case that can be cited is that of the epider- mis. In its original formation, even before it has come into relation with the external world, it is formed on the several parts of the body—take, for example, the back and the palm of the hand—in different quantity and kind adapted to the several degrees in which the cutis it has to protect will be exposed to pressure, friction, and the influence of other external forces. Not only is its original quantity and construction on these parts different, but its rate of growth is so ; for, though the back of the hand loses compara- tively little by friction or otherwise, yet its epidermis does not grow thick ; and though the palm loses more, yet its epidermis does not grow thin. So, then, both in original construction, and in rate of nutrition, the epidermis is thus adapted to the amount of function it has to discharge—that is, to the amount of protection it has to afford. But suppose now, that, by some new handicraft, the amount of exercise of the epidermis is increased; its rate of waste is increased in the same proportion, yet it does not grow thin—nay, it grows thicker, till it is com- pletely adapted to protect the cutis from the greater sources of injury to which it is now exposed: it puts forth its reserve-power, which is enough not only to repair all amount of waste within certain limits, but, further than this, to increase the quantity of the tissue to the amount required for the discharge of its increased functions. What we can see in this case of the cuticle, we may be sure of for other tissues. For example, in a muscle: or in this heart, by disease of the valves, an obstacle is put in the way of the circulating blood : it is held back at the heart: and the heart, or one of its cavities, acts with additional force to drive it on. But, as we know, the more of action in a muscle, the more consumption of the tissue ; so that we might now expect a diminution of the heart. On the contrary,