Imagens das páginas
PDF
ePub

cystic epithelium be derived from the bloodvessels of the gall-bladder, but the correspondence between this epithelium and that of the intestines, the gradual departure of the fat from the free side of the cells, are adverse to the supposition, and in the best examples of fatty liver, the cystic epithelium is free from the infiltration. Portions of the fat separated by the bile from the liver, become reabsorbed and mixed with the general current of the fluids. Thus the gall-bladder has other functions besides that of a mere receptacle, and other substances, as the pigment indicates, pass along with the fat.

Part II.—PATHOLOGICAL MICROLOGY,

TUMOURS, MORBID GROWTHS, EXCRESCENCES, &c. Gelatinous Growth at the Base of the Cranium, at the Clivus Blumenbachii. By Professor H. Luschka.*_The case was that of a man, aged twenty-six, at the base of whose skull, the dura mater, corresponding to the point of union between the bodies of the sphenoid and the occipital bones, was thickened by the presence of some large and small, flattened and lobulated outgrowths, of the colour and consistence of the transparent mucous polypi of the nose, These had obviously projected from the interior of the bones at the sphenooccipital synchondrosis. These structures were seen under the microscope to be very uneven as to their surface, the smaller projections being hemispherical, the larger ones partly pedunculated and partly not so. In the jelly-like basis no traces of fibrillation existed, but a large number of finely granular nuclei, without any arrangements, of the diameter of 0.008 millemetre, and also a number of very peculiar large-sized cells. These latter were for the most part rounded and elongated, their contents being homogeneous or clear, apparently not fluid, but of a slimy consistence. They were doubly contoured, their covering being of variable thickness, and at the thickest part they were the seat of from one to two nuclei, exactly like those prevailing in the basis of the new formation. Besides the above mentioned masses, a mass of the size of a barleycorn was found in the interior of the bone, and communicating with them. This was inclosed in a capsule, and of the colour and forin of the so-called gelatinous nucleus of intervertebral cartilage. Under the microscope this mass was seen to consist of a partly homogeneous, partly fibrous basis, much fat, and large cells of 0.012 to 0.024 millimetre broad, with partly single and partly laminated walls ; many were nucleated, and many so surrounded by a variously thick layer of molecular substance, as quite to obscure the entire cell. Here and there beautiful clear laminated forms were seen; these forms reminding one of the remnants of cartilage between the sacral vertebræ of man. The author was uncertain how far any relation could be traced between these cartilage remains and the gelatinous mass, and proposes a query as to the origin of the mass found in the bone.

After making a number of investigations on the subject, he found that at times the cartilaginous disc between the occiput and the sphenoid does not entirely disappear with the termination of growth-i.e., it is not replaced by bone-tissue; but that the centre of the upper limit of its substance breaks up into a fibrous mass beset by cells. This continues throughout life, or dwindles later on, and there is formed in its place a cavity containing red bone-marrow; or it is occupied by a blastema, changing into bone-tissue, which sometimes grows and leads to the formation of exostoses at the “clivus" of Blumenbach; or, finally, it may form the foundation of soft productions, which, as in the case above described, break forth in the cranial cavity, and grow in various ways.

* Virchow'Archiv, Band xi. Heft 1, p. 8. 1857.

The author comments upon a tendency to the breaking up of the cartilage between the bodies of the cranial vertebræ, and the formation of cavities, as a sequel of typhus.

A Case of Neuroma within the Spinal Membranes. By Dr. Ludwig Benjamin.* -It was that of a man, aged sixty, who had suffered pain in the lower limbs for seven years, preceding paralysis of the bladder. The spinal arachnoid was thickened and injected, and at the lower part was the seat, here and there, of bony plates. A tumour was found almost of the size of an olive, having several nerve-branches surrounding it, but only outwardly adherent, and some passing directly into the mass without reappearing from it, and not at all connected with the cord itself. The tumour was of a brownish-white colour, and enclosed by a firm thin covering of elastic and areolar tissue, being a projection of the neurilemma from the nerves as they entered. On section, the growth was seen to be in some places resisting, granular, and of an ochreous colour; in other places it was soft and medulla-like, and filled with cysts varying in size up to that of a bean. The softest parts were seen by the microscope to contain pus-cells, united by a hyaline amorphous substance, in which acetic acid revealed from one to two small nuclei. The harder portions possessed a stroma coursing in various directions, partly of elastic and partly of nerve-like fibres, with numerous large, round, hard granular cells. Some ellip. tical caudate forms existed, as also corpora amylacea and granular fat. The cysts were of various sizes, chiefly small and thin, very fine arachnoid-like membrane, and contained clear, yellow amorphous gelatinous fluid. Some of the cysts communicated with their neighbours, and so formed a system of cavities. Many large vessels existed in the tumour, and the darker-coloured parts showed granules and rounded conglomerates of crystallized pigment, evidently arising from extravasation. On tracing the roots of the nerves before their entrance into the growth, where they appeared to be quite healthy, they were found to contain coloured pigment, with cells like the above-described, and fat; and on reaching the tumour the cells were seen in numbers to exist between their fibres, whose final course was not clear; the fine fibrils, how. ever, of the stroma appeared to be united with them. The peculiar interest lay in the fact that the tumour was a true neuroma, in the alteration of the nerve substance itself, and in the presence of the cysts.

Growth of Connective l'issue from the Semilunar Valve of the Pulmonary Artery and Pedunculated Epithelial cells. By H. Luschka.t.-The author remarks upon the comparative prevalence of connective-tissue outgrowths at the origin of the crescentic aortic valve-flaps on the inner side, which are villous to the naked eye. He observes, however, that these formations are but very rarely met with on the pulmonary artery valve-flaps. In the case mentioned, no trace of any heart disease existed. The specimen was removed from the body of a woman, aged forty. Near the corpus Arantii of each flap on the free borders, a short pedunculated body, of the size of a small pea, existed, whose upper surface was very cleft and occupied by fine branching whitish threads. Microscopical examination showed that these terminated in a number of rounded laminæ, each of which possessed a darker portion, an axis, and a clearer peripheric border-like segment. Each axis appeared to be composed of fine elastic so-called nucleus-fibres, whose origin from cells was obvious in places; and on the addition of acetic acid, a small quantity of structureless connective tissue was seen between these fibres. This formed the chief part of the broad border-like material, and exhibited a very delicate whitish granular appearance. Embedded in this stroma were numerous connective-tissue corpuscles variously branched, some of which were very like bone corpuscles.

Virchow's Archiv, Band xi. Heft 1, p. 87. + Ibid., Band ii. Heft 6, p. 567.

Many projections of these cells formed a network, and most of them held a well-seen nucleus with a nucleolus. Occasional projections of these cells were elongated into peduncles stretching out beyond the level of the surface of the leaf-like formations, and ended in a structure corresponding to an epithelial cell, being a cell-like nucleus-holding body, generally of a roundish shape. The author had formerly described, among the ordinary epithelium of the crescentic folds, cells elongated, thread-like, and projecting more or less far. The abovedescribed called to the author's mind the ciliated conical epithelial cells which he found lining the canal of the spinal cord of the horse, and which were supplied with these pedicles.

SECRETING GLANDS. The Lachrymal Glands, Hypertrophy of. By Mr. Savory,* Surgeon to the Royal General Dispensary.—The lachrymal gland was found after death to be developed into a tumour, three inches long, and two inches in breadth and depth, filling the orbit, and imbedding the globe of the eye, which was greatly sunken and flaccid. The mass of the tumour was uniform in structure throughout, soft, somewhat elastic, easily torn with the needle, the separated parts readily breaking up, mingling with water on section, and yielding a thick white opaque fluid by scraping. The microscope showed scarcely anything else but nuclei and clusters of lachrymal gland-cells, which were very easily broken up by manipulation. They were remarkably uniform in size and shape, and scarcely a trace of areolar tissue could be found amongst them. The tumour was removed after death from the body of a man, aged seventy-eight, who had suffered from it between two and three years, but without any constitutional taint or general ill-health. It was so large that shortly before death the contents of the orbit protruded in a mass like a small egg, the entire globe of the eye being concealed by it, excepting a small part of the cornea.

Liver, Cyst within, containing Ciliated Epithelirim. By Dr. N. Friedrich.tThe case was that of a man, aged twenty-eight, who died of pulmonary and laryngeal phthisis. The liver was dwindled, anæmic, the centre of the lobule being of a dark brown colour, owing to brownish-yellow pigment-granules in the centre of almost each hepatic cell. The intervening stroma was very thickened, containing most varied cell-forms with large projections and sharp contour. A white-looking projection from the surface near the suspensory ligament was seen, which, when cut into, was seen to consist of a cyst larger than a hazel nut, whose walls were formed of thick greyish-white membrane, connected with the hepatio substance by a spongy mass of areolar tissue. The contents of the oyst were a very tenacious yellowish-grey, almost gelatinous mass, which could be removed entire from the cyst wall.

The microscope showed the walls of the cyst to contain a network of elastic tissue and areolar tissue-corpuscles ; also many bloodvessels, and a delicate, rather varioose system of canals, to be looked on as lymphatic vessels. The inner surface of the sac showed large numbers of roundish cells rather smaller than pus oorpuscles, with nuelei; and towards the interior of the cyst these elements presented transitions into perfect ciliated cells, just like those found on the bronchial mucous membrane. These ciliated cells also contained yellow and yellow brown pigments, but no fatty degeneration of them was soen.

The contents of the oyst, when acted on by acetic acid, coagulated in a striped direotion, and contained bodies which, by the presence of cilia, single, and still in situ, as well as by their conical form, were recognised

* Medical Times and Gazette, Feb. 21, 1857.
+ Virchow's Archiv, Band xi. Heft 5, p. 466.

as allied ciliated epithelium; they also contained oval and irregular, slightly angular bodies, which appeared to be the nuclei of epithelium, gradually removed from the inner surface of the sac, and mixed with the fluid, around which the cell-membrane, after diffusion of the contents, had collapsed so closely, that only a simple band with cilia remained, until at last the cilia also became destroyed, through each membrane being uplifted from the nucleus, on addition of water. The author here alludes to similar changes which he had seen in the bronchial epithelium of an old woman affected by chronic bronchitis. But besides the above elements in the cyst contents, a number, not large, of large round bodies existed, varying as high as 0.1 millimetre in diameter, with granular contents, clearing on the addition of acetic acid, and also a granular detritus, owing probably to the destruction of these latter cells.

The above-described cyst is considered by the observer to be most probably a dilated gall-duct, its walls agreeing thereto, as also from the fact that a branch of the vena portæ lay directly in contact. It might be a question whether it was congenital, or whether after birth it had originated owing to some local cause, and if so, the change in the character of the epithelium would be remarkable. As regards the congenital supposition, it is worthy of notice, that according to Leydig, * in some animals partly only during fætal life, in part during the entire life, the gall-ducts possess ciliated epithelium, so it might be that in the fætal life of higher animals similar epithelium might be found in the gall. ducts. Friedrich found, in the gall-bladder, and the large gall-ducts, of the three-and-a-half months' embryo of the ox, cylindrical epithelial cells, which had on their upper portion partly conical appendices and partly broad ridges, which latter had the appearance of being united cilia, or being about to diside itself into such. In other fætuses he failed to find them, but he did so in a human fætus of three or four months.

Virchow appends an observation to this paper, in which he says that Luschka had communicated to him a case lately, in which he had found papillary growths covered with ciliated epithelium in an ovarian cyst. A case had also been communicated by Virchow to the Obstetric Society, in which ciliated epithelium and nerve-tissue &c., were found in the ovary. Virchow says he has moreover observed similar striped ridges on the epithelium of the gall-duot and bladder in the adult man.

NERVOUS SYSTEM. Neroes in Degenerated Tissues. By F. Marfels.t-The author, for the pur. pose of observing the condition of nerves in degenerated parts, examined four cases, to ascertain the condition of the vagus nerve in pulmonary consumption and marasmus. He found that the fatty degeneration did not affect the nerves immediately, but that the development of cells preceded it. These cells are nucleus-holding, of the size of small colourless blood-corpuscles, which lie in the midst of the fibres, chiefly unaccompanied by any granular deposit. Potash, æther, and iodine effect no change in them. On one occasion, in examining portions of the ischiatic nerve, he found these cells situated inside the axis cylinders, thus establishing a correspondence with the discovery in some of the lower animals of the partly-granulated and non-nucleated, and partlytransparent, clear, and nucleated cells in nerves. The author failed to observe nuclei in the sheath of the primitive nerve-fibres in man; on the contrary, however, he found them in animals where he thinks he saw the sheaths occupied by fibres. On two occasions he observed the escape of nerve contents from the sheath, when at the same time the above-mentioned cells existed. I * Lehrbuch der Histologie. 1857. + Virchow's Archiv, Band xi. Heft 2, p. 200,

# We are compelled for want of space to postpone the remainder of the Report.

HALF-YEARLY REPORT ON FORENSIC MEDICINE,

TOXICOLOGY, AND HYGIENE.

By BENJAMIN W. RICHARDSON, M.D., L.R.C.P. Physician to the Royal Infirmary for Diseases of the Chest, and Lecturer on Physiology and

Hygiene at the Grosvenor-place Medical School.

I. ToxicoLOGY. THE celebrated toxicological cause of the past six months has been the Glasgow poisoning case. This instance of arsenical poisoning has been so fully dis. cussed elsewhere, we may say everywhere, that we do not feel bound to more than mention it. We pass, therefore, to the reports of cases and papers given in foreign literature, the number of which is so great that we have difficulty in the space allowed to select those of most scientific interest.

Poisoning by Arseniuretted Hydrogen.—Poisoning by the inhalation of ar. seniuretted hydrogen gas, although of comparatively rare occurrence, has occasionally resulted from accidents in chemical manipulation. In the case of Gehlen, , German chemist, the inhalation of a small quantity of this gas proved fatal on the ninth day. Another instance has been published by Dr. O'Reilly, of Dublin. A gentleman, for the sake of experiment, wished to respire one hundred and fifty cubic inches of hydrogen gas. Unfortunately the sulphuric acid he used in its preparation was largely contaminated with arsenic. His death took place on the sixth day. It was supposed that a quantity of arsenic equal to about twelve grains of arsenious acid was inhaled. Dr. Mouat has lately published a most interesting case of the same kind of poisoning, which, however, arrived at a favourable termination.

During the summer of 1851, whilst Professor Robertson, of Calcutta, was exhibiting to his class the application of Marsh's test, a pupil incautiously opened a window in front of the Professor, who at the time was standing with his back to an open door; the current of air produced had the effect of directing the gas, which was at that time being abundantly and rapidly generated, directly towards the lecturer. He soon became aware of a sense of burning and constriction in his throat, and was compelled abruptly to leave his classroom. Dr. Mouat visited him next morning, about sixteen hours after the accident, and found him labouring under the following symptoms :-Intense acrid burning sensation from the pharynx to the lower extremity of the alimentary canal, excessive irritability of the stomach, vomiting, first of the previously-taken food, then of bile, ultimately of dark coffee-ground-looking matter, consisting of broken-down blood corpuscles and desquamated epithelium of the stomach and lower portion of the æsophagus, obstinate constipation of the bowels. There was severe deep-seated pain in the lumbar region; he had voided between three and four pints of bloody urine, which on being analysed exhibited minute traces of arsenic. Symptoms of great constitutional disturbance were present; considerable fever; full, hard, frequent, incompressible pulse; dry, hot, unperspiring skin, intense restlessness, anxiety, and general uneasiness; a pale, anxious countenance, and considerable prostration of the vital powers. On the third day the bowels not having been opened, and a good deal of tenderness in the left iliac region, with a sense of weight and dragging in the fundament being present, the administration of a dose of castor oil and laudanum produced a copious clay-coloured evacuation, with a tubular membranous-looking slough, somewhat ragged in appearance, and about four inches in length. This consisted of a portion of the lining membrane of the rectum, with a large amount of fibrinous exudation. For four days, under the exhibition of castor oil, small patches of fibrinous exudation continued to be

« AnteriorContinuar »