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.

  • James Paget
Date:
1847
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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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    nutrition in parts. Let me, however, aa preparatory to the consideration of these, first engage your attention on the healthy formative process, or process of nutritive assimilation. The formative process manifests itself in three modes, which, though they bear dif- ferent names, and are sometimes described as if they were wholly different things, yet probably are only three expressions of one law operating in different conditions. The three, enumerating them in the order of their time, are development, growth, and assimilation. By development, we mean the process by which a tissue or organ is first formed ; or by which one, being already imperfectly formed, is so changed in shape or composi- tion as to be fitted for a higher function ; or, finally, is advanced to the state in which it exists in the most perfect condition of the species. We must carefully distinguish develop- ment from mere increase : it is the acquiring, not of greater bulk, but of new forms and structures, which, by greater powers, are adapted to higher conditions of existence. For example, when, in the child, cartilage is changed to bone, there is not, necessarily, an increase of size ; or, if there be, there is something more; there is that change of texture by which it is developed into bone. So, when, from the simple cavity of the embryonic digestive system, the sto- mach, intestines, liver, pancreas, and other organs are produced, these are developed ; there is increase, but, at the same time, something more than mere increase of quan- tity. And the distinction between develop- ment and increase, or growth, is shewn in this,—that, sometimes, even in instances in which they usually concur, the one pro- ceeds without the other. I might quote many instances of this. I will choose two or three which illustrate some other striking facts. These brains of two adult idiots [exhibiting specimens] are equally diminu- tive, and of nearly equal size ; but in cne, so far as we can see, there is a due proportion of the several parts ;—it is only too small. In the other, the p;rts are not well-propor- tioned ; the posterior parts of the cerebrum do not half cover the cerebellum ; indeed, no posterior cerebral lobes appear to be formed. Herein we recognize something more than a checked growth; for this trun- cation of the cerebrum is due to an arrest of its development, at the time when its hind- lobes—the parts last produced, and pecu- liarly characteristic of the human brain— were only just beginning to be formed. Our explanation of this most interesting speci- men must be, that, when the brain had at- tained that degree of development which, according to Professor Retzius,* is proper to the human foetus, about the beginning of the fifth month, and corresponds with the completed development of the brain of lower mammalia,—then its developement ceased. But though in form it is like the foetal brain in the fifth month, yet, in all its dimensions, it is larger; so that when iU development had ceased, its growth must have continued ; and this was not checked till the brain had attained the size of the mature foetus. In this brain, therefore, we find at once defective development and de- fective growth ; but in that [pointing to the example first described] the development proceeded, and the growth alone was checked.f Again, for an example in which develop- ment was checked and growth proceeded even beyond its normal limits—this heart, [exhibiting the specimen] from a child of three years old, presents only a single cavity ; no partition has been developed between its auricles or its ventricles ; it is, in respect of its development, like the heart of a foetus in the second month ; but though its development was checked thus early, its growth continued, and it has more than the average bulk of the heart at three years old.X So has this heart,§ in which deve- lopment was arrested at a later period, when the septum of the ventricles was in- completely formed: in the eleven years the patient lived after birth, the development made no further progress, but the growth passed its ordinary bounds. I will not multiply examples more than by referring to those two striking specimens in the physiological Museum—the skeletons of O'Byrne the giant, and of Madlle. Cracami the dwarf : compare these with the model- skeletons which stand beside them, and, allowing for the age of the dwarf, you will not find in it a defect, nor in the giant's skeleton an excess, of development; the one has not less than all the characteristic human forms, the other has no more ; but the one is defective, the other is excessive, in * Arch. d'Annt. et de Physiol., Janv. 1846. t The two brains, together with casis of them, which were exhibited, are contained in the Mu- seum of St. Bartholomew's Hospital, and are des-ribed in the Physiological Catalogue, Series 23, No. 40 and No. 70. The one in which the posterior cerebral lobes are deficient, weighed in its recent state 13 oz. 2 drachms avoirdupois; the individual from whom it was taken was 22 years of age, and had been an idiot from birth. The other brain (No. 70) was from a female, aged 21, who also was idiotic from birth. ± The above specimen is contained in the Mu- seum of St. Bartholomew's Hospital, Physiolo- gical Division, Scries 23, No. 33. The pulmo- nary artery is contracted and has no valves ; the mitral velves arc also absent; the ductus arte- riosus is open. . „ _ § Exhibited from the Museum of the College of Surgeons ; Malformations, No. 127.