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CONTENTS. xxTii

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structure and functions of the villi. Reabsorption and retention of the

chyle. Liver; intermediate interchange of matter by means of the

biliary ducts. Fatty liver.—Fatty metamorphosis. Glands; secretion

of sebaceous matter and milk (colostrum). Granule-cells and granule-

globules. Inflammatory globules. Arteries; fatty usure and atheroma

in them. Fatty debris.

LECTURE XVI.—A More Precise Account Of Fatty

Metamorphosis ....... 312

Fatty degeneration of muscles. Fatty metamorphosis of the substance of

the heart. Formation of fat in the muscles in distortions.—Corpus

luteum of the ovary- Fatty metamorphosis of pulmonary epithelium.

Yellow softening of the brain. Arcus senilis.—Optical properties of

fattily degenerated tissues. Renal epithelium in Bright's disease.

Successive stages (cloudy swelling, fatty metamorphosis, fatty detritus

(debris), atrophy). Inflammatory globules. Similarity of the result in

inflammatory and non-inflammatory changes.—Atheromatous process

in arteries. Its relation to ossification. Inflammatory character of the

process; its analogy with endocarditis. Formation of the atheromatous

deposit. Appearance of cholestearine. Arterio-sclerosis. Eudoarteritis.

Calcification and ossification of arteries.—Mixed, activo-passive pro-

cesses.

LECTURE XVII.—Amyloid Degeneration. Inflam-

Mation ......... 367

Amyloid (lardaceous or waxy) degeneration. Different nature of amyloid

substances: concentric and laminated amyloid bodies (brain, prostate),

and amyloid degeneration properly so called. Its course. Commence-

ment of the affection in the minute arteries. Waxy liver. Cartilage.

Dyscrasic (constitutional) character of the disease. Intestines. Kid-

neys: the three forms of Bright's disease (amyloid degeneration, paren-

chymatous, and interstitial nephritis). Lymphatic glands. Functional

disturbances of the affected organs.—Inflammation. The four cardinal

symptoms and their predominance in the different schools: the thermic

and vascular theory; the neuro-pathologists, exudations. Inflammatory

stimuli. Lesion of function. Exudation as a consequence of the activity

of the tissues; mucus and fibrine. Inflammation as a complex irritative
process. Parenchymatous and exudative (secretory) form.

LECTURE XVIII.—Normal And Pathological New-

Formation 395

The theory of continuous development in opposition to the blastema and

exudation theory. Connective tissue and its equivalents as the most

general germ-store of new-formations. Correspondence between em-

bryonic and pathological new formation. Cell-division as the most

general starting-point of new-formations.—Endogenous formation.

Physalides. Brood-cavities.—Different tendencies of new-formations.

Hyperplasia, direct and indirect. Heteroplasia. Pathological formative

cells. Difference in their size and in the time required for their full.de-

velopment.—Description of thedevelopment of bone asamodel-formation.

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Difference between formation and transformation. Fresh and growing,

in opposition to macerated, bone. Nature of medullary tissue..-- Growth

in length of tubular [long] bones; proliferation of cartilage. Formation

of marrow as a transformation of tissue; red and yellow, normal and

inflammatory marrow. Osseous tissue, calcified cartilage, osteoid tissue.

Bone-territories: caries, degenerative ostitis. Granulation of bona

Suppuration of bone. Maturation of pus. Ossification of marrow.—

Growth of long bones in thickness; structure and proliferation of the

periosteum.—Granulations as analogous to the medulla of bones, and as

the starting-point of all heteroplastic development.

LECTURE XIX.—Pathological, And Especially Hete-

Rologous, New Formation ..... 427

Consideration of some forms of pathological formation of bone. Soft oste-

oma of the maxillae. Rickets. Formation of callus after fracture.—

Theory of substitutive new formation in opposition to exudative.

Destructive nature of new-formations. Homology and heterology

(malignity). Ulceration. Mollities ossium. Proliferation and luxuria-

tion. Medulla of bones and pus.—Suppuration. Its two forms: super-

ficial, occurring in epithelium ; and deep, in connective tissue. Eroding

suppuration (skin, mucous membrane): pus- and mucus-corpuscles in

their relations to epithelium. Ulcerative suppuration. Solvent pro-

perties of pus.—Connection of destruction with pathological growth and

proliferation. Correspondence of the first stage in pus, cancer, sarcoma,

&c. Possible duration of the life of pathologically new-formed elements,

and of pathological new-formations considered as wholes (tumours).

Compound nature of the larger tuberous tumours (Geschwulstknoten),

and miliary character of the real foci (Heerde). Conditions of growth

andrecurrence: contagiousness of new-formations and importof the anas-

tomoses of cells. Cellular pathology in opposition to the humoral and

heuristic. General infection of the body. Parasitism and autonomy of

new-formations.

LECTURE XX.—Form And Nature Of Pathological

New-formations 462

Nomenclature and classification of pathological new-formations. Consist-

ence as a principle of division. Comparison with individual parts of the

body. Histological division. Apparent heterology of tubercle, colloid,

&c.—Difference of form and nature: Colloid, Epithelioma, Papillary

tumour, Tubercle.—Papillary tumours: simple (condylomata, papillo-

mata) and specific (villous cancer and cauliflower-tumour).—Tubercle:

infiltration and granulation. Inflammatory origin of tubercle. Its

production from connective tissue. Miliary granules, and solitary masses.

The cheesy metamorphosis.—Colloids myxoma. Collonema. Mucous

or gelatinous cancer.—Physiological types of heterologous new-forma-

tions: lymphoid nature of tubercle, hsematoid of pus, epithelioid of

cancer, cancroid, pearly and dermoid tumours, and connective-tissue-

like of sarcoma. Infectiousness according to the amount of juice.—

Comparison between pathological new-formations in animals and vege-

tables. Conclusion.

LECTURE I.

FEBRUARY 10, 1858.
CELLS AND THE CELLULAR THEORY.

Introduction and object.—Importance of anatomical discoveries in the history of medicine.—Slight influence of the cell-theory upon pathology.—Cells as the ultimate active elements of the living body.—Their nature more accurately defined.—Vegetable cells; membrane, contents, nucleus.—Animal cells; capsulated (cartilage) and simple.—Nuclei of.—Nucleoli of.—Theory of the formation of cells out of free cytoblasteraa.—Constancy of nucleus and its importance in the maintenance of the living cell.—Diversity of cell-contents and their importance as regards the functions of parts.—Cells as vital unities.—The body as a social organization.—Cellular, in contradistinction to humoral and solidistic, pathology.

Explanation of some of the preparations.—Young shoots of plants.—Growth of plants.—Growth of cartilage.—Young ova.—Young cells in sputa.

Gentlemen,—Whilst bidding you heartily welcome to benches which must have long since ceased to be familiar to you, I must begin by reminding you, that it is not my want of modesty which has summoned you hither, but that I have only yielded to the repeatedly manifested wishes of many among you. Nor should I have ventured either to offer you lectures after the same fashion in which I am accustomed to deliver them in my regular courses. On the contrary, I will make the attempt to lay before you in a more succinct manner the development which I myself, and, I think, medical science also, have passed through in the course of the last fifteen years. In my announcement of these lectures, I described the subject of them in such a way as to couple histology with pathology; and for this reason, that I thought I must take it for granted that many busily occupied physicians were not quite familiar with the most recent histological changes, and did not enjoy sufficiently frequent opportunities of examining microscopical objects for themselves. Inasmuch as, however, it is upon such examinations that the most important conclusions are grounded which we now draw, you will pardon me if, disregarding those among you who have a perfect acquaintance with the subject, I behave just as if you all were not completely familiar with the requisite preliminary knowledge.

The present reform in medicine, of which you have all been witnesses, essentially had its rise in new anatomical observations, and the exposition also, which I have to make to you, will therefore principally be based upon anatomical demonstrations. But for me it would not be sufficient to take, as has been the custom during the last ten years, pathological anatomy alone as the groundwork of my views; we must add thereto those facts of general anatomy also, to which the actual state of medical science is due. The history of medicine teaches us, if we will only take a somewhat comprehensive survey of it, that at all times permanent advances have been marked by anatomical innovations, and that every more important epoch has been directly ushered in by a series of important discoveries concerning the structure of the body. So it was in those old times, when the observations of the Alexandrian school, based for the first time upon the anatomy of man, prepared the way for the system of Galen; so it was, too, in the Middle Ages, when Vesalius laid the foundations of anatomy, and therewith began the real reformation of medicine; so, lastly, was it at the commencement of this century, when Bichat developed the principles of general anatomy. What IMPORT OF THE CELL-THEORY. 3

Schwann, however, has done for histology, has as yet been but in a very slight degree built up and developed for pathology, and it may be said that nothing has penetrated less deeply into the minds of all than the cell-theory in its intimate connection with pathology.

If we consider the extraordinary influence which Bichat in his time exercised upon the state of medical opinion, it is indeed astonishing that such a relatively long period should have elapsed since Schwann made his great discoveries, without the real importance of the new facts having been duly appreciated. This has certainly been essentially due to the great incompleteness of our knowledge with regard to the intimate structure of our tissues which has continued to exist until quite recently, and, as we are sorry to be obliged to confess, still even now prevails with regard to many points of histology to such a degree, that we scarcely know in favour of what view to decide.

Especial difficulty has been found in answering the question, from what parts of the body action really proceeds—what parts are active, what passive; and yet it is already quite possible to come to a definitive conclusion upon this point, even in the case of parts the structure of which is still disputed. The chief point in this application of histology to pathology is to obtain a recognition of the fact, that the cell is really the ultimate morphological element in which there is any manifestation of life, and that we must not transfer the seat of real action to any point beyond the cell. Before you, I shall have no particular reason to justify myself, if in this respect I make quite a special reservation in favour of life. In the course of these lectures you will be able to convince yourselves that it is almost impossible for any one to entertain more mechanical ideas in particular instances than I am wont to do, when called upon to interpret the individual processes of life. But I think that we must

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