W37 BOUGHT WITH THE INCOME FROM THE SAGE ENDOWMENT FUND THE GIFT OF Mtnvu W. Sage 1891 k.H.lH-.o.l 5-llJS2 Cornell University Library RB 24.W39 Rudiments of pathological liistology ,JLiS£±^2 373 191 I Cornell University J Library The original of tiiis book is in tine Cornell University Library. There are no known copyright restrictions in the United States on the use of the text. http://www.archive.org/details/cu31924012373191 THE SYDENHAM SOCIETY INSTITUTED MDCCCXIAIl LONDON RUDIMENTS PATHOLOGICAL HISTOLOGY. BY CARL WEDL, M.D., Etc. WITH 172 ILLUSTRATIONS ON WOOD. TRANSLATED AND EDITED GEORGE BUSK, F.R.S. LONDON: PRINTED FOR THE SYDENHAM SOCIETY. , MDCCCLV. A. ^^ ^0?, PRINTED BY J. E. ADLA-UD, BAKTHOLOMKW Gt09B. <24vv AUTHOR'S PREFACE. The development of every science is determined within certain laws^ which cannot be transgressed without risk of the inquirer's losing himself in a bottomless abyss. At all times there have been men who have pursued the compre- hensive, rational, inductive method in the study of pathology ; and it is a pity that at certain periods these have been re- placed by mere hypothesis-mongers. The anatomico-chemico- physical method of research at present followed in the culti- vation of pathology has opened out a rich mine of results. The adoption of the pathologico-histological course pursued in this work has only of late been rendered possible with the aid of the microscope and of the advanced state of knowledge in normal histology, — an acquaintance with which is here pre- supposed. But our progress in this direction has not, as yet, been so far successful as to allow of the erection of a complete system ; an incompleteness which is indicated in the title selected for the book — viz., "Rudiments of Pathological Histology." The object of the work embraces a morphology of ano- malous tissues, with due regard to their development, the observations being based chiefly upon original researches. The labours of others, whose names are cited, have been vi AUTHOR'S PREFACE. copiously employed ; and the reason why the literature of the subject has not received more particular notice lies in our allotted space, which, even without that, has been over- stepped. As the work is intended for study, the author has conceived that the object would be best attained if the various subjects were described as much as possible in an objective way, by means of instances accompanied with the requisite illustrations ; thinking, also, that the book would thus be rendered more attractive to the practitioner. The technical execution, moreover, has, throughout, received due attention. The plan followed in the work has been the giving, in the first place, as a methodical foundation, general morphological views and theories of development with respect to exudations, atrophy, hypertrophy, the formation of inorganic and of or- ganic substances, and particularly of new-formed elementary organs and their various combinations. In the Special Part, the subjects treated of are arranged in Families : I. Inorganic formations ; II. Atrophies ; III. Hypertrophies ; IV. Exudations ; V. New-formations ; VI. Parasites. The processes are described as manifested in the various organs ; but in this no strict anatomical or physio- logical order has been observed, those organs being taken first which had been more especially investigated, or which, in their anomalous structural conditions, were found more particularly adapted to afford useful results. In the exten- sive family of " new-formations " the respective pathological structures are arranged in divisions, ideal forms, or categories, not very strictly defined, — the opinion at the same time being held that, although such an arrangement and nomenclature might be requisite for the proper appreciation AUTHOR'S PREFACE. vii of the subjects, they should by no means be taken to repre- sent a logical, systematic classificationj inasmuch as one category passes into another. In all the original measurements" the French scale, as most convenient to every one, has been adopted. With respect to the illustrations, which, in a subject of this kind, are so indispensably necessary, the author would remark that no time nor trouble were spared to render the drawings clear and correct. With the exception of six figures belonging to the parasites, the 203 illustrations are all original, some having been made by the author's brother, but most by himself. The zylography was executed by A. Rosenzweig, who devoted sixteen mouths to the troublesome task. It is obvious that the publication of an illustrated work requires considerable time ; and the delay in the appearance of the present book is thus partly accounted for, and partly, also, because it was preferred that it should appear complete, and not in Parts, These considerations are adverted to by the author in apology for his not having paid more regard to several recent works in the same field. CARL WEDL. Vienna, July, 1853. TRANSLATOR'S PREFACE. The object and scope of the present work are siiflBcieutly shown in the Author's preface and in the table of contents ; it is needless, therefore, to say more than that it does not profess to be a complete system of ' Pathological Histology' ; the time for the completion of such a work not having yet arrived. General Histology, of which, in fact, that of morbid productions is merely a part, though undoubtedly much ad- vanced of late years, is still, as the author says, in many respects far too defective to allow of the production of anything that can be considered a complete and satisfactory system. Observa- tion shows more clearly, day by day, that the doctrine respecting the formation of pathological products, is subordinate to that which embraces the development of all organized tissues — that the mode of development, so far as it proceeds, is the same in both; the difference between the two consisting merely in the varied impulse under which it starts in either case. Whatever, therefore, of truth or error may exist in the received opinions respecting the formation of tissues in general — will apply as well to that of pathological, as of normal products. Among the more important of these views are those which relate to the doctrine or theory of cell- formation. The almost blind obedience at present paid to TRANSLATOR'S PREFACE. ix the doctrines of Schwann and Schleiden, has apparently acted, for some time, as a damper upon original thought on the subject. Attention, however, having of late been di- rected, more particularly by Mr. Huxley,' to the foundation upon which this doctrine is based, and to the many and weighty objections to which it is obnoxious, will, it is to be hoped, awaken a more scrutinizing and independent spirit of inquiry — when, and not till when, we may hope to see General, and with it Pathological, Histology, placed on a firm basis. At present, therefore, the chief value of any work on the subject will consist in the amount of original information in the shape of facts which it may contain ; and, in this respect, credit is eminently due to Dr. Wedl's labours. The extent of original information and of original illustration in his work will always entitle it to a high place. His views also, especially with respect to cancer and new-formations in general, are comprehensive and suggestive ; and his treatment of the subject, though not altogether the most simple, is, upon the whole, as good and perhaps more philo- sophical than most others hitherto propounded. In this edition, it is necessary to remark, that a few of the observations, or rather directions, concerning the means to be employed in histological and microscopical research, and in the preservation and preparation of specimens have been curtailed, as needless, in the presence of special works, at any one's command, on such manipulatory matters. Several of the detailed cases, also, have been omitted, when they appeared superfluous for the strengthening of a ' ' Brit, and For. Med.-Chir. Review,' vol. xii, p. 285. (1853.) X TRANSLATOR'S PREFACE. statement J as well as the entire chapter on the subject of Parasites — one apparently quite out of place in a work de- voted, not to General Pathology, but, simply, to Pathological Histology. The measurements, in the original, are given in parts of the French millimetre, but in the translation (with a few exceptions from inadvertence) they have been reduced to terms of the Paris line ('") (0-088 inch) and inch (")• To render the book more convenient for reference, an Index has been appended, in addition to a copious table of ' contents.' The descriptions of the figures, usually placed at the bottom of the pages, are here given together at the end of the book — ^^an arrangement which it is hoped will be found convenient for reference. G. B. May, 1855. CONTENTS. PART I. CHAPTER I. PAGE 1-89 GENERAL OBSERVATIONS .... The subject, object, and means for the pursuit of Pathological Histology 1-14 CHAPTER II. Pathological chan'Ges connected with the circulation . 15 Congestion ..... ib. Experiments in animals .... ib. Blood-stasis ..... . 17 Dilatation of capillaries .... . ib. Rupture of walls of v^sels .... 18 Influence of nerves upon the contractile power of arteries . 19 Effects of impeded circulation .... 22 Pathological transudation and exudation . 25 Exudations organizable and inorganizable 26 Serous or hydropic exudations .... 27 Fjbrino-serous exudations .... 28 Fibrinous, semifluid, or coagulated.exudations 30 Varieties of fibrinous exudations 31 Organizability of exudations .... ib. Coagulated fibrinous exudations 34 Flocculi ...... ib. "Fibrinous flakes" ..... 35 Albuminous exudations .... 36 Colloid exudations ..... 37 Unorganizable exudations .... 39 Resorption of ditto .... ib. Obsolescence and tuberculization of ditto . 39-40 Fatty degeneration of ditto .... 40 Cretification ...... 41 Gangrene ...... ib. Causes of diversity in exudations 43 xu CONTENTS. Blood-crasis, doctrine of . Increased amoant of fibrin in . Of albumen in Of water Of white corpuscles (leukhcemia) Of fat Of urea Colouring matter of bile Sugar Exudations, effect of, according to situation Capillary apoplexies Contagions nature of some PAGE 43 ib. 44 45 ib. ib. 46 ib. 47 ib. 48 49 CHAPTER III. nutritive material depend PATHOLOGICAL CHANGES OF NORMAL CELLS . . 50 Conditions upon which the quantity and quality of Cells, hypertrophy and atrophy of . Differences between . Cell-contents, pathological metamorphoses of . Fatty degeneration . Pigmented degeneration Dropsical or aqueous degeneration Increased amount of albumen . Colloid in . Diminution of . Cell-membrane Lamellar deposits on Corrugation of . Cell-nucleus, participation in pathological metamorphoses of cell Degeneration of Cells, coalescence of Cytoblastema subject to changes similar to those observed in the cell-contents Pigmented degeneration of Serous or watery degeneration of Development of gas in Elementary organs, death of Ketrograde metamorphosis Partial and total hypertrophy of •57 50 50 51 ib. ib. 52 ib. ib. ib. ib. 53 ib. ib. ib. ib. 54 ib. 55 ib. lb. 56 ib. 57 CHAPTER IV. PATHOLOGICAL NEW-FORMED CELLS . Formative material or plasma Cells the basis of the tissue of all pathological new-formations Forms assumed by newly-developed cells 58-70 . 58 . ib. . 59 CONTENTS. xiii PAGE tfodes of development of new-formed cells . . . . ib. Free and by division 59 Schwann's view of . ib- Nucleus, formation of, in a grannlar protoplasm, H. v Mohl and Nageli on ib. Granular globules of Lebert, vrithout nucleus 62 Division or multiplication of cells ib. Parent and secondary cells ib. Division by constriction 63 Nucleus, division of . ib. Mode of formation of cells in the pathological plasm I identical with that in the normal ib. Fundamental forms of the young cell ib. Discoid 64 Caudate ib. Conical ib. Fusiform 65 Stellate ib. Size of ib. Malformations of . ib. Involution of new-formed cells 66 Shapes of ditto ib. Cancer-cells, what are they ? . ib. No special character belonging to new-formed cells ib. Connexion of new-formed cells . ib. Their secondary arrangement . . 67 Areolar .... ib. Papillary, villous or clavate 69 These two types pervade the entire group of compound vegetations . 70 CHAPTER V. FORMATION OF FIBRES .... 71-74 Fibrin, appearances presented in . . . .71 Coagulation of . . . . . . ih. Mucin, produced in pus, &c., by the addition of acetic acid . . 72 Fibres of connective tissue . . . . . ib. Schwann's description of the process of development of connective (cellular) tissue . . . . . . ib. Elastic fibre, development of . . . . .73 Characters of . 74 CHAPTER VI. FORMATIONS OF THE AREOLAR TISSUES AND OF THE PAPILLARY NEW-FORMATIONS ..... 75-80 Areolated cellular tissue, constitution of . . . .75 Mode of origin of . . . . . . ib. Essentially the same in the pathological and normal condition . ib. xiv CONTENTS. PAQE Fibre cells, diversities in, and mode of formation pf . • 74-75 Fibrous framework of areolar tissue developed from cells by spontaneous multiplication or by the coagulation of a fibrinous or raucous stroma . 78 Fibre cells developed in a spiral . . . ■ .79 Hollow clavate processes or papillse of Rokitansky . . . ib Mode of formation of . . . • • 79-80 CHAPTER VII. FORMATION OF VESSELS .... 81-83 Multiplication of . . . . . .81 Schwann's observations on the multiplication of the capillaries in the germinal membrane of the hen's egg Capillaries, free development of . . . Germinal sacs of Engel .... Size of pathological new-formed capillaries rapidly diminishes Their simple structure .... New-formation of blood in vessels Mode of ramification of vessels in new-formed tissues ib. 82 lb. 83 ib. ib. ib. CHAPTER VIII. FORMATION OF CYSTS .... 84-89 Definition of the term cyst . . . . .84 The cyst consists in an excessive augmentation of volume of the areolae of the areolar tissue and of the papillaiy new-formations . . ib. Favorable conditions for the origination of cysts May take place in any organ . Structure of cysts Membrane Contents . Areolae, constitution of Occlusion and accumulation of transudation in Cysts of the first, second, third, &c., orders, mode of production of Pedunculate cysts ..... Modifications in origination dependent on the special anatomical structure of an organ. C. Bruck's notion with respect to the origin of cysts That of Rokitansky ..... ib. ib. ib. 85 ib. 86 86-87 87 ib. 88 lb. PART II. CHAPTER I. SPECIAL OBSERVATIONS . . . , gj.gn § 1. 1. Famht.— INORGANIC FORMATIONS . . .91 Uric acid ■ ■ . . . ib. CONTENTS. XV PAGE Uric acid, crystals of, various forms of . . . . 92 Genesis of . . 94 In the blood . 95 Urate of ammonia .... . 96 Forms of . . 97 Urate of soda ..... . 98 Hippuric acid ..... . ib. Urea ...... . 99 Phosphate of magnesia .... . 100 Triple phosphate of magnesia and ammonia . 100 Oxalate of lime .... 101 Carbonate of lime 103 Sulphate of lime .... 105 Phosphate of lime .... 106 Easily soluble salts .... 107 Fat . 109 Oleia ...... ib. Fat-globules, various appearances of . ib. Metamorphosis of protein-compounds Into fat . 110 Source of fat . ib. Cholesterin ...... Ill Margarin and margaric acid ib. Colouring matters .... 113 Hiematoidin or xanthose .... 113 Crystalline form of . . . . 11 3-115 Amorphous. ... . . 114 Haematin .... 116 Forms of ..... . ib. Microscopical characters of ... . 117 Urerythrin or red colouring matter of the mine ib. Bile-pigment ...... 118 Black pigment or melanin . . . . ib. Concretions . . . . . 119 Modes of formation of . . . . 11 9-123 Forms of, conditions upon which they depend . 120 Microscopical analysis of an intestinal concretion 121 CHAPTER II. . Family.— ATROPHIES .... 12 3-186 Atrophy, definition of . . . 126 Causes of ..... . ib. Morphological changes attending .... 127 Always attends exudative processes .... ib. Virchow's views respecting . . . . 128 § 1. Atrophy of the Blood ..... ib. Of blood retained within the organism 129 Of blood still circulating ..... 130 XVI VI CONTENTS. J 2. Adipose and Cellular Tissue Fat cells filled with brownish-yellow contents Containing crystals of margarin Serum Thickening of wall of cells Other metamorphoses of . Atrophy of cellnlar (connective) tissue § 3. Cartilage Fatty or pigmented cartilage cells Pigmentation of the intercellular substance Its fibrillation . Cretification Mode in which this atrophy takes place Atrophy of the thyroid cartilage in cystic bronchocele In perichondritis larpnffea In caries of the bones § 4. Osseous Tissue Retrograde metamorphosis of the medulla and of the periosteum Causal influences of atrophy Structural changes in atrophied bone Fatty degeneration of bone § 5. Muscle Textnral changes in atrophied muscle Pigmentation Diminished cohesion Fatty degeneration Local atrophy, various causes of Atrophy of organic muscular fibres § 6. Vessels Fatty degeneration of the elementary tissues of In the capillaries Larger arteries Veins, atrophy of Virchow on partial vesicular dilatation of the smaller vessels His cavernous ectasis Teleangiectasis § 7. Skin and Mucous Membranes . General atrophy of the skin Partial Of mucous membranes' § 8. Lungs. Emphysema, nature and causes of Atelectasis § 9. Teeth Premature involution of . Caries, dry and moist § 10. Liver GONTEI^S. xvii PAGE Fatty liver . . . .162 Yellow atrophy of . . . ib. Nutmeg liver, two kinds of 163 Serous degeneration of 167 §11. Blood-vasculab Glands ib. Spleen ib. Thyroid and thymus 168 Premature atrophy of thymus ib. §12. Kidney 169 §13. Female Sexual Organs ib. Premature atrophy of ovaries and uterus ib. Atrophy of placenta 170 Of umbilical cord 171 (Edema of villi of placenta ib. Dropsy of the amnion 174 Vesicular oedema of the umbilical cord 175 Apoplexies in the placenta and chorion 177 Atrophy of the mammary glands 178 § 14. Nerves 179 Divided nerves . . i 180 Partial atrophy of nerves produced by an increase of the interstitial connective tissue 181 Atrophy of the ganglia ib. § 15. Eye .... 182 Cataract .... ib. Atheromatous deposits in vessels of ciliary processes 185 Cornea, fatty degeneration of ib. CHAPTER III. Family.— HYPERTROPHIES . . . 187-198 Definition, causes, plethora . 187 Of the adipose tissue 188 Epidermis 189 Dark-coloured navi matemi, Ichthyosis 192 Elephantiasis ib. Of connective tissue 193 Bone ib. Striped muscular fibre 194 Organic muscular fibres 196 Blood-vascular, and true glands 198 CHAPTER IV. Familv.-EXUDATIONS .... 199-283 § 1. In Serous Membranes . 199 XVlll ^\ji.y i. riii i. o. page 1. Fibrinous ..... . 199 Pericardium .... . 200 Peritoneum .... . 201 2. Gelatinous ..... . 202 Colloid ... . 203 Cartilaginous il). Cretified . ... . ib. Opacities of serous membranes . 204 2. Skin ...... 206 Variola ..... ib. Pemphigus. .... 209 Prurigo, Eczema 211 Haemorrhoids ..... ib. On ulcers ..... 212 3. Mucous Membranes .... 215 In cholera ..... ib. Croupose exudations .... 217 Morphological changes in the villi, accompanying exudations 218 Polypi of the mucous membrane . . . , 219 Enlargement of solitary and Peyerian glands . 220 Ulceration of mucous membranes 221 4. Vessels .... 223 Vasa vasorum ..... ib. Atheromatous deposits 226 Aneurism ..... 229 Endocarditis ..... 231 Phlebitis ...... ib. 5. Bones . . . . . 233 Periostitis . . • . . ib. Nodes .... 234 Chimmata . . . . 235 Osteoporosis ..... 236 Osteomalacia .... 237 Osteitis . . . . . 240 6. Muscles ...... ib. Collection of pigment within the sarcolemma 241 Suppuration ...... 242 7. Blood-vasoulab Glands ib. Thyroid ... ib. Thymus ..... 245 Spleen ••.... 247 Cells containing blood-corpuscles . . . . ib. Cells containing pigment in ... . 248 Conical deposits in .... _ 249 8. Lungs • • • . . ib. In pneumonia ..... ib. In catarrhal pneumonia .... 252 CONTENTS. XIX In what is termed typhoid pneumonia (Edema of the lungs § 9. LlVEH .... Diffuse and limited exudations in the Yellow atrophy of Rokitansky Lardaceous liver Yellow tuTgescent liver of jaundiced new-born infants Acute oedema of . . . Metastatic inflammatory deposits in § 10. Kidney .... Diffuse exudations in Bright's diseases Fibrinous cylinders Epithelium of tubuli uriniferi in the urine Anatomical changes in the kidney at the commencement of a diffuse exudation Fatty degeneration of the epithelium Radiated colloid bodies Lardaceous kidney Fibrinous deposits in § 11. Sexual okqans Prostate Concentric colloid bodies in . . Uterus .... Change in substance after parturition Placenta, exudations in the § 12. Bkain and Spinal cord Yellow softening of the brain Diffuse exudation in tetanus Fibrinous exudations on the free surface of the arachnoid Albuminous, on the pia mater Red softening of the brain Corpora amylacea § 13. Eye . Cornea Iritis . Choroiditis Colloid bodies in the choroid . CHAPTER V. Family— NEW-FORMATIONS Definition of Comparison of, with hypertrophies Characters of Simple and compound Family categories of § 1. Gbanulb-cells, granular corpuscles, granule-masses Granular cells in the brain and spinal cord page 253 ib. 254 ib. ib. 255 256 ib. lb. 257 ib. ib. ib. 259 262 265 267 ib. 269 ib. ib. 271 272 273 275 ib. 276 277 ib. 278 279 280 ib. 281 282 ib. 284 ib. ib. ib. 286 287 ib. 288 XX CONTENTS. Their occurrence in the blood . In the interstitial tissue of the muscles On the smaller vessels In the air cells . Pathological import of § 2. Pus One kind of, only Pus-corpuscles . Mucin Patty metamorphosis of pus-corpuscles Pus-clots or plugs Formation of pus-corpuscles according to Vogel Leukhsemia Pyaemia Uterine phlebitis Mucus-corpi&cles Pus in the submucous tissue Red and grey hepatization of the lungs In the subcutaneous tissue In the joints Abscess in the liver Pus-corpnscles in the urine' Pathological import of Mucus § 3. Tubercle Histological definition of Morphological elements in Fatty degeneration of Softening of Special conditions presented in — 1. Serous membranes 2. Mucous membranes 3. Submucous tissue 4. Lungs 5. Liver 6. Kidney ; 7. Brain 8. Bone Nature and pathological import of Characters of IV. NEW-FORMATIONS IN THE TYPHOID DEPOSIT V. NEW-FORMATIONS OF CELLULAR (CQNNECTIVE) TISSUE Character of . Point of origin and mode of extension Imperfect nutrition of . Spontaneous involution .... PAGE 290 , 291 ib. 292 , 294 , 295 ib. ib. , 297 , 298 , 299 ib. , 302 . 303 ib. ib. . 304 ib. . 305 . 306 . 307 . ib. . 309 . 311 . ib. . ib . ib. . 314 . 315 . ih. . 318 . 319 . 320 . 325 . 328 . 329 . ib. • ib. . 330 . 332 335 ib. 337 338 339 CONTENTS. Benignanc; or malignancy Consistence of . Special relations of . . . Embryonic forms of, in the transparent mucus of the cervix uteri From the concave surface of the placenta Comparison of mode of evolution with that of the gelatinous con- nective tissue in the embryo shows no difference § 1. On SEROUS MEMBRANES Arachnoid .... New-formed blood-vessels in . Pacchionian glands or arachnoidal villi Pleura .... New-formation of blood in exudation on . New-formed vascular plexus in . Dendritic papillary new-formations on the . Pericardium, granulations and vegetations on . Synovial membranes, dendritic papillaiy growth on the Forms of . Elementary structure . Plica adiposa, or lipoma arborescens Plicce vaseulosce Bursas mucosce, vascular and non-vascular processes In Peritoneum Pedunculate cysts on Elementary examination of the inner surface of a pedunculate cyst § 2. In the Skin, limited to distinct parts of it Acuminate condyloma, or papilloma Elementary examination of Voluminous condyloma Development of the acuminate condyloma Its growth and forms Broad or flattened condylomata (papules muqueuses) Subcutaneous condyloma . Its nature and mode of development . Associated with suppuration Warts, papillary, smooth, subcutaneous Lupus .... Lupous efSorescence L. exfoliativus . L. exulcerans .... Lupous ulceration New-formed cells in . Pathological process followed in lupus Elephantiasis grcecorum E. araium .... Keloid .... Indurated cicatrix of the skin CONTENTS. Cavernous textures, or cavernous blood-tumours of Rokitansky Encysted sebaceous tumours Cutaneous polypi . . • ■ MoUuacum simplex, s. non-contagiosum and pendulum Various names of growths of connective tissue according to diversities in their conformation CoUonema Gelatinous sarcoma Albuminoid fibrous tumour of Miiller Fundamental characters of the various forms of ditto Ihiberculum dolorosum § 3. In the Subcutaneous adipose tissue, and Interstitial tissue OF muscle Embryonic state of development of connective tissue in the pectoral muscle .... Tumour on tendinous sheath of the masseter muscle Tumour in the region of the parotid, analysis of § 4. In Mucous MEMBKANES Acuminate condyloma on the uvula Urethral caruncles Cauliflower-like polypi of the larynx On the gums Teeth and tongue Polypi of the nose, throat, and pharynx Hypertrophy of the membranes of the stomach § 5. In the Uterus and Chorion Polypi Fibroid tumours Embryonic formations in the uterus . Ovula Nabothi . Organized new-formations discharged from the uterus New-formations found in the uterus in puerperal endometritis In the villi of the chorion Mola hydatidosa .... New-formations on the concave surface of the placenta § 6. Thyroid gland .... Cystic bronchocele .... Embryonic new-formed thyroid-gland tissue Development and retrograde metamorphosis of I 7. Liver ...... Granular (cirrhosis) .... Incipient granular liver .... Erosion^ on the surface of . Connective tissue new-formations in syphilis and pemphigus After long-continued intermittent fever § 8. Kidneys ..... Cirrhosis of . PAGE 392 393 395 396 397 ib. 398 ib. ib. 401 402 403 405 407 408 ib. ib. 410 ib. 411 412 ib. 413 ib. 415 416 418 ib. 419 ib. 420 421 ib. ib. 422 423 428 ib. 431 ib. 432 434 435 ib. CONTENTS. xxiii Development of cysts in . page 437 Pedunculated cysts in pelvis of the kidney 440 § 9. Bone ..... 441 Osteosarcoma ..... ib. Tumours in the antrum Highmori . 441-2 On the body of the superior maxilla 442 Oi» its outer aspect .... 443 In the head of the metacarpal bone of the forefinger . . 444 Osteoteleangiectases .... . 445 Diffuse nevf-formations in ... ib. " Usure" of articular cartilages . 446 Osteophytes, wart-like .... . ib. Formation of cysts in osteocystosarcoma 448 § 10. Parotid gland .... 451 Tumours in the region of ... ib. § 11. Mammary gland .... 454 1. Cyato-sarcoma simplex . . ib. 2. C.proliferum .... ib. 3. C.phyllodes . . ib. Intimate structure of papillary grovfths in 456 Nature and origin of . 458 Growth of . 459 § 12. Ovary ..... 460 Cysts in .... . ib. Compound cystic growths .... 461 New-formed organs in cysts 463 § 13. Testis and Prostate .... 464 On the outer side of the tunica albuginea ib. Hydrocele ..... ib. Appendicular structures of, Luschka on 465 Prostate, new-formed lobes of . 466 $ 14. Eye .... 468 Chalazion, synechia .... ib. § 15. Brain .... 469 § 16. Blood ..... ib. After intermittent fevers .... ib. § 17. Structures op an uncertain nature occurring in the sub- cutaneous adipose tissue (probably lymphatic glands) 470 VI. NEW-rORMATIONS OF ADIPOSE TISSUE 471 Lipoma .... ib. Steatoraa ..... 473 Lipoma arborescens .... 474 VII. CHOLESTEATOMA .... ib. Tumours composed of, in the brain . ib. VIII. OF CARTILAGE AND BONE 476 Multifariousness of the cells of cartilage 476-7 XXIV CONTENTS. Fractures of bone Ossification of fibro-cartilage Union of fractured bones Reparation of injuries attended with loss of substance Enchondroma of the femur, case of . In other parts Development of . Ossification of . Excessive new-formation of embryonic cells in cartilage Reparation of cartilage after loss of substance . Formation of cartilage in new-formations of connective tissue Loose articular cartilages Malum coxa senile Osteosclerosis Osteoporosis Synostosis Exostoses and osteophytes Puerperal osteophytes Osteophytes on serous membranes, arachnoid . Texture of ... New-formations of bone connected with the periosteum Osteophytes on the femur after amputation, description of cases of Pathological process in, described Ossification in unusual situations — In the tendon of the biceps brachii In muscles (exercirknochen) Choroid coat of eye . Fibroid tumour of uterus IX. NEW-FORMATIONS OF THE DENTAL TISSUES Dentin, enamel, cement Globular masses and inter-globular spaces Osteodentin .... New-formed enamel imbedded in the substance of a molar tooth New layers of cementum . Malformed tooth, case of . Relations of these new-formations to caries of the teeth X. CANCER .... Definition of . . CeUs of Evolution and involution of Serum of Fusiform or fibre-cells in . Cancer-stroma or framework Degeneration of New-formation of blood and of blood-vessels i Blood-corpuscles contained in the cells of PAGE 477 479 480 481 482 483 487 489 490 491 ib. 492 ibv ib. . 493 ib. 494 495 498 . 499 , 501 , 502 , 504 505 ib. 506 507 509 ib. ib. , 513 , 517 , 519 . 520 . 523 . 525 ib. . 526 . 527 . 528 . ib. . 529 . ib. . 530- ib. CONTENTS. XXV PAGE Development of cysts in . ... 531 New-formations of cartilage and bone in . . . ib. Of adipose tissue and pigment . . . . ib. Gelatiniform cancer . . . . . ib. Areolar, medullary, fibrous, reticular, ichorous, suppurative, blood- vascular, melanotic cancer .... 532 Malignant osteoid, or carcinoma osteoides . . 532-3 Cystic cancer, or cysto-carcinoma .... 533 Epithelial cancer, or epithelioma . . . . ib. Cancroid ... . . ib. Carcinoma fasciculatum . . . . . ib. Classification of the different varieties of cancer . . ib. Seat, origin, and extension of (diffuse or concrete) . . 534 Spontaneous evolution and cicatriform contractions caused by . 535 Ulceration . . . . . ib. Increased size of blood-vessels around . . . 536 Diagnosis of . . . . . . 537 § 1. In THE Skin . . . . . .538 Subcutaneous connective tissue . . . . ib. Medullary and gelatiniform varieties, instances of . . 540 Melanotic form . . . . .541 Variety, Intermediate between medullary and epithelial 543 Epithelial cancer, characters of . . . . ib. § 2. Mucous MEMBRANES .... 550 Epithelial form on the tongue . . . . ib. Cancer of the stomach ..... 551 Scirrhus, medullary, gelatiniform . . . 552-3 Of the intestines ... . 554 Gelatiniform cancer in the rectum .... 555 Epithehal cancer in the rectum . . . 556 Villous cancer . . . . . ib. On the nasal mucous membrane, and that of the bladder . ib. In the gaU-bladder . . .560 § 3. On Serous membranes ..... 560 Gelatiniform on the peritoneum . . . ib. Medullary, melanotic, villous . . 563-4 Hollow clavate bodies of Rokitansky . . . 564 § 4. On Fibrous membranes . . . ib. Fungi dwas matris ... . ib. Villous growths arising from the subserous tissue of the arachnoid, minute structure of . . . . . 565 Cancerous tumours at the base of the brain . . . 569 § 5. On Bone . . . . .571 Gelatiniform cancer arising from the periosteum . . ib. New-formations of bone on inner surface of the ileum, &c. . 572 Medullary form in the cranium .... 573 Fibrous form in ribs, case of . . . .574 XXVI CONTENTS. Medullary and epithelial forms Cancroid (so termed) § 6, In the Lungs Relations between cancer and tubercle Cancer usually secondary in the lungs § 7. In the Liver Medullary most frequent . Fibrous stroma, intimate structure of Blood-cancer in the Fungus melanodes Cystic cancer in Cancerous elements in the portal blood Gelatiniform cancer in the § 8. In the Kidnbt Nodules, structure of Villous cancer in § 9. In the Lymphatic glands Medullary and fibrous forms most usual Villous in a bronchial gland, case of . § 10. Retroperitoneai. cancer . , Connexion with the rerteira § 11. In the Breast Medullary form . Cysto-sarcoma . Ci/sto-carcinoma, and fibrous and reticular cancer Gelatiniform Different forms in combination § 12. Uterus Medullary form frequent in " Cauliflower excrescence" Tumour In uterus, intimate structure of § 13. Ovary and Testis Cystic cancer Blood formed at isolated points in cancer, instance of Medullary form in the testis § 14. Eye .... Melanotic in the orbit, case of Non-melanotic in the same situation . § 15. Brain and Nerves Brain substance of, infiltrated with cancer Neuroma, case of, in the ulnar nerve CONCLUDING OBSERVATIONS WITH RESPECT TO NEW-FORMA TIONS PAGE 575-6 577 ib. 579 ib. 580 ib. 581 583 ib. 584 585 587 586 ib. ib. 587 ib. 588 589 ib. 590 ib. 591 593 594 595 596 ib. ib. 597 599 ib. 600 601 602 ib. 603 ib. ib. 605 607 PART I. CHAPTER I. GBNEEAL OBSERVATIONS'. The abnormal conditions of tissues are the subject of Pathological Histology^ and the elucidation of these conditions constitutes its object. Though chiefly a descriptive science, that is one concerned with the morphological changes in dis- eased structures, and which, as such, might be termed a mor- phology of the latter, it is nevertheless simply impossible to limit its range to mere description, to the exclusion of all reflections on the matters thus described, since even the sifting of the materials afforded in this way can only be undertaken, with any success, according to certain principles dictated by an ordinating intelligence. The task of the science is thus at once obvious; viz., to afford a knowledge of the morphological conditions presented in morbid tissues. The limits within which its province lies are accurately defined, as are also the relations in which it stands towards other allied branches of pathology. The sources whence the latter immediately derives its materials are : 1. Pathological Anatomy, of which pathological histology is a constituent part, precisely as microscopical anatomy or his- tology is an integral part of Physiological Anatomy. 1 2 GENERAL OBSERVATIONS. 2. Pathological Chemistry — a branch of general chemisti^, as applied to the study of pathological products. 3. Experimental Pathology, whose task it is, by the syste- matically arranged concurrence of known conditions, to eluci- date pathological processes — doubtless sources from which the best results, and incontestable proofs of the nature of the morbid processes will flow. This experimental inquiry alone will lend a vivifying breath to the facts derived from pathological anatomy and chemistry ; and in a scientific point of view it becomes the living factor of the dead morbid product. Pathology is a theoretical science of disease, both general and special, based upon physical, chemical, and anatomical facts, whose foundations are of course, at present, laid only upon imperfect fragments, but the erection of which is impos- sible without the strenuous culture of all collateral branches of knowledge. How far we still are from a scientific pathology of this kind will be obvious to every one who is sensible of the deficiencies in our phj'siological knowledge. The obstacles opposed to the investigation of this obscure subject are by no means trifling, and the inquirer must never relax in his struggle to overcome them, striving always to gain a sure footing as he advances. This sure footing consists in acute observation, guided by the judgment. The proper cultivation of these collateral branches of pathology has not been pursued till recent times. Since it has been perceived that pathology can be rationally advanced only upon a physiological basis, we have no longer been con- tented witli the assemblage of symptoms, as constituting a species of disease, any more than a zoologist of the present day is satisfied with the mere outward form of the animal, but is also obliged to take into consideration the internal structure associated therewith. The pathologist must now be acquainted with the morbid textural changes of organs according to the present condition of science, those changes constituting the only positive basis of a rational pathology. Returning to our subject, we may regard it either from a general point of view, or we may treat more specifically of the anomalous conditions of tissues, their origin, progress, and GENERAL OBSERVATIONS. 3 • retrogression. From the former of these modes of treatment arises the General Part of Pathological Histology, in which, together with the methodical doctrine of congestion, inflamma- tion and exudation, will be described in general terms, the pathological changes of normal cells, the development of newly- formed cells, the formation of fibres, of the areolar tissue, and of - the papillary new formations, of cysts, vessels, &c. The Special Part includes the morphological changes of the parti- cular organs, which may be considered and treated from a double point of view. The morbid processes in the various organs may either be arranged in groups, by which means their similarity or diversity is more readily perceived ; or the organs may be taken according to their anatomical and physiological order, with the morbid products belonging to them. Each of these methods has its advantages and disadvantages; but we think it necessary to adhere to the former, which, as has been observed, ensures a more comprehensive survey of the subject, and as by so doing, the analogy and heterogeny of the pro- cesses are rendered more obvious, whilst the repetitions so irksome to the reader are avoided, at the same time that the numerous deficiencies in our knowledge will be less sensibly felt. It is by no means an easy matter to define what constitutes an anomalous condition in a tissue, seeing that the normal texture of an organ is subject to many alterations, within the limits of health. The excessive size or minuteness of an elementary organ (cell), its altered relative position, its changed contents, the various conditions of the nucleus, &c., are points demanding assiduous and strenuous investigation. In order to render the matter clearer, we will here adduce some in- stances. The presence of fat in the contents of the hepatic cells is connected to a certain extent with the conditions of nutrition; and we should be very wrong, where the fat is present in small quantity, and without any other complication, at once in assuming the existence of a fatty degeneration of the cells. The same holds good with the fatty contents of the epithelial cells of the kidney, in which also the presence of fat depends to a certain extent upon the nutritive condition, and by itself alone, in a minor degree, should not be regarded as patho- logical, or in fact as at all sufficient to constitute a " Bright's 4 GENERAL OBSERVATIONS. kidney." The retrograde or atrophic modifications also of the tissues, occurring in old age, have not the same significance, in a pathological point of view, as they would have in younger indi- viduals. A certain amount of atheromatous deposit in the vessels of a person eighty years old would necessarily be referred to the involution proper to the physiological condition at that period of life; whilst the same degree of the affection in the vessels of a youth of twenty would indicate a partial prematui-e retrogression of the organism, and could only under such circumstances be of pathological interest. Hence it is evident that in the expo- sition of the abnormal condition of a tissue, due regard must be paid to all the circumstances, and the more so in propor- tion as the anomalous state is less determinate. To solve the problems of pathological histology it is not suf- ficient to give a precise description of the anatomical condition, that is to say, of the elementary constituents, their connections and relations in various parts of the diseased organ, but an attempt must also be made to develop the origin, progress, and re- trogression of the abnormal tissue, upon anatomical data. It can- not be denied that in the undertaking of this exposition of the elementary organs, a dangerous rock will have to be weathered ; but on the other hand, it must be allowed that the history of the development, progress and retrogression of pathological tissues, is a most important and necessary aid in pathology, and in fact, the only true basis upon "which a rational pathology can be founded. With respect to the means by which pathological observa- tions are to be carried on, and histological researches made, it is, in the first place, requisite that the observer should be fur- nished with optical instruments in which he can have full con- fidence. The mode of investigation must be directed by the nature of the question to be determined, and the best proof that the mode of inquiry adopted is that most fitted to the case, will consist in the clearness with which the anomalous struc- tural conditions are displayed. The clearer the image obtained from the preparation the more satisfactory will be the result of the observation ; care and pains, therefore, must not be spared in the making of a preparation, time and trouble thus bestowed being amply compensated by the additional facility in the carrying out of the observation. Preparations carelessly made GENERAL OBSERVATIONS. 5 are always more or less deceptive ; and the time, however little, thus employed is, in great measure or wholly, lost. The methods followed in pathological histological researches may be described, as it were, as synthetic, and as analytic. The latter commences with the elementary constituents, and proceeds to inquire into their disposition, and relations to other elementary parts, their various chemical properties, their diversities in different parts, &c. In the synthetic method, the secondary arrangements of the elementary parts grouped together, are investigated. For the analysis, the most powerful object-glasses of the compound microscope are employed ; for the synthesis, the lower powers and the simple lens. The course to be pursued in any parti- cular case depends upon the plan of the investigation. The simple lens or microscope, is an indispensably requisite instrument, and every observer should take care to be provided with good lenses of this sort, with which alone many obser- vations in their totality can be undertaken — as for instance, the distribution of the larger blood-vessels, their course and rela- tions to various parts of a tumour : or the areolated tissue of a cystic thyroid gland, &c. It is equally necessary in the preparation of more delicate objects. The powers available should vary from four to fifteen diameters. The lenses should be supported on a firm stand, so arranged as to allow of the object being viewed in various positions and, if need be, by transmitted light. A watch- maker's lens is recommended by some observers. Researches by means of the compound microscope involve a tedious, though absolutely necessary, detailed investigation of the component parts of the diseased tissue already seen to differ by the naked eye. The microscopical examination, therefore, starts from what has been seen by the naked eye, and pre- supposes a strict observation by the latter; and it is evident that pathologico-histological research of this kind, must demand considerable time. The requisite aids, in researches of this nature, are the following : 1. Distilled water, which, though not always, is iu many cases necessary. In common spring water, several accidental impurities frequently occur, such as silicious particles, vege- table and animal remains, and living infusoria, &c., which may 6 GENERAL OBSERVATIONS. interfere with the observation, and in investigations con- cerning concretions, fluids, &c., might give rise to misap- prehensions. 2. Acetic acid, for the display of nuclei, as it usually renders the cell-contents and membrane transparent, whence the nu- clei frequently appear more distinctly as granular bodies. The component cells of the homy tissue are rendered more evident. The fibrils of connective tissue swell to some extent, and are rendered diaphanous, the included nuclei consequently come into view; and the elastic fibres, especially those of smaller size, are also in this way rendered visible. The nuclei of newly formed or of hypertrophied organic muscular fibres, are rendered evident in their natural arrangement by this acid. It is only partially applicable to the nervous tissue. Pigment is unal- tered by it ; mucin is precipitated ; colloid matter remains un- changed. Various applications of it will be found also in micro-chemical analyses. Considerably diluted, it is much used for the boiling of diseased intestinal membranes, sections of tumours and of parenchymatous organs, (for some minutes, until the parts are corrugated). The preparations thus boiled, are to be spread out aud dried in order to be further examined by a method which will be described below. 3. Sulphuric acid is useful as a reagent — for instance, to detect the presence of carbonate of lime in concretions; on its addition to such objects, crystals of sulphate of lime are formed with the evolution of carbonic acid gas. The more solid horny tissue, hair, nails, and the enamel, are disintegrated by it into their elementary parts. When very much diluted (a few drops to the ounce of water) it forms a vehicle for the maceration of vascular parts, which should be immersed for a short time (about half an hour); when the course of the vessels may be traced. Parts also that have been macerated in dilute sulphuric acid and then dried are adapted for the making of sections. 4. Hydrochloric acid is occasionally useful in the investigation of morbid structural changes in the bones and teeth. 5. Nitric add, much diluted, may be employed under the microscope to show the change in colour of the colouring matter of the bile, for giving a yellow colour to organic muscular fibres, the hardening of organs, &c. GENERAL OBSERVATIONS. 7 6. Phosphoric acid is in general of little use^ though, if otherwise applicable, it has the advantage over hydrochloric and nitric acids, inasmuch as it does not give off any vapour which might a£Fect the brass mounting of the object-glass. When the latter acidS are used, it is best to cover the object with a large piece of covering glass, and care should betaken to absorb any excess of acid at the edge of the glass with bibulous paper. 7. Chromic acid, much diluted [or a solution of bichromate of potass], may be employed for the hai-dening of morbid tissues in order that sections may be made. 8. Caustic potass and soda, or the carbonates of those alkalies, are extensively useful for the display of elastic tissue, of the nerve-fibres, or rather of the medullary matter contained in them, for giving transparency to connective tissue and to muscles. These reagents are also frequently employed to loosen the texture of preparations \Wiich had been treated with acids in order to display their elementary constituents, and to afford a clearer image, although for this purpose they must be much diluted. Disintegration of the horny tissue is readily obtained by their means, especially when it has been previously treated with acids, and the alkalies are then added in excess. Pigment is not changed by them unless they are much concentrated and allowed to act for some time. Coagu- lated fibrin and precipitated albumen are rendered hyaline by them. 9. Ammonia is seldom used, at any rate for microscopical purposes. 10. Solutions of common salt, and of sugar (a few grains to the ounce of distilled water, so as to make a solution in which the blood-corpuscles do not contract), is employed in tracing the distribution of the blood-vessels ; plain water depriving the blood-corpuscles of their colouring matter. In the case, also, of very delicate or easily ruptured cells, it is advisable to employ one of these solutions, since they are injured by the imbibition of plain water. 11. Goadhy's fluid, composed of 4 ounces salt, 2 ounces alum, 4 grains of corrosive sublimate, dissolved in two quarts of boiling water, may be employed either as a preservative agent or for the purpose of hardening tissues. 8 GENERAL OBSERVATIONS. 12. Alcohol is very valuable as a preservative agent, and also for the purpose of hardening tissues. Thin sections, also, of preparations made with alcohol and treated with acetic acid or carbonate of potass are very instructive in many respects. 13. JEther may be advantageously employed in thin trans- verse sections of preparations freed from water, owing to its reaction upon fat ; but the diminished transparency caused by it is an objection to its use. 14. Tincture of iodine is useful, partly for the colouring of objects, partly on account of its reaction upon amylaceous granules, — as, for instance, in fsecal matters, — or upon fungi. The vapour of iodine is apt to obscure the object-glass, although it does not seem to exert any directly injurious effect upon the glass itself. The instruments necessary for the pursuit of Histology, are few and simple. They consist of common needles and straight cataract needles, some Straight and curved fine scissors, hooks, scalpels, razors, fine forceps, slips of glass, pieces of thin glass or talc for the covering of objects, fine glass tubes, a meta- carpal saw with moveable blades having teeth of different degrees of fineness, several files^ probes, and hair-pencils, slices of cork, &c. In order to study the arrangement of the elements of tissues, it is above all things necessary to prepare suitable sections, capable of transmitting the light, and calculated either for lower or higher magnifying powers. The way in which such sections are to be made depends upon the consistence of the tissue. In the case of the more lax and pulpy textures, the most suitable instrument is a pair of fine straight scissors. In order to obtain useful sections of some length and breadth, of parenchymatous organs, such as the liver, spleen, kidneys, or tumours of the skin, &c., the double-bladed knife is to be recommended. The best form of construction of this instrument is that in which the one blade is connected firmly with the handle, and the other is affixed to it by means of two screws, one near the heel and the other at the further extremity, and by which the one blade can be more or less closely approxi- mated to the other, whilst the parallelism between them is maintained, — which is not the case in the double-bladed knife known as Valentin's. GENERAL OBSERVATIONS. 9 There are tissues, however, having only a certain degree of consistence, or of various degrees of consistence, of which it is hardly possible to make very fine, useful sections by means of the double-bladed knife, and which it is necessary should be previously hardened. The means to be employed for this purpose are, for instance, the free evaporation of the aqueous constituents — simple desiccation. With respect to which, it should be remarked that sections made for this purpose should not be more than from one to two lines thick, and that whilst they are drying they should be inclosed in paper; and that thicker portions would be destroyed by putrefaction. It is then easy, after moistening the cut surface with a drop of water to remove any undue brittleness, to procure very fine sections by means of the knife, which are then to be moistened with acetic acid, and will afford a very useful object. What kinds of pathological tissues are especially adapted for this method will be stated in the Special Part. Another and very successful method for many objects is to boil them in diluted acetic acid, in the way already described, in order to procure from them, when dried, fine sections, which are either to be simply moistened with water, or treated with a dilute solution of carbonate of soda, until their elementarj"^ parts are displayed in their natural state of aggregation. Instead of using dilute acetic' acid, it is often advisable — for instance, in parenchymatous organs, such as the spleen, liver, thyroid gland, &c., — to immerse them in hot water and allow it to boil for a very short time (one to two minutes). The parts coagulated by the heat, when dried or half dried, are also suitable to afford sections, which may be treated either with acetic acid alone or with acetic acid followed by soda, of course diluted. As indurating agents, alcohol, dilute chromic and nitric acids, and Goadby's solution, have already been noticed. That they act partly by the abstraction of the watery con- stituents •(alcohol), partly by their coagulating the protein- matter, is clear. In many cases, also, Schleiden's method of preparing sections of vegetable tissues may be usefully employed in the investigation of animal substances, as, for instance, in that of some Entozoa. For this purpose, the clearest and most colourless solution of gum arable, — and very concen- trated, — is prepared, in which the object to be examined is 10 GENERAL OBSERVATIONS. immersed, and allowed to become thoroughly saturated with the mucilage ; it is then affixed upon a little piece of wood and allowed to become perfectly dry, when some of the mucilage should be poured over it and again allowed to dry, which pro- cess is to be repeated a few times. Before it is quite dry, and before the gum has regained its pristine brittleness, suitably thin sections are taken of the object, which are to be again moistened with water when placed upon the glass-slide,. — by which the gum is dissolved out, and the object completely regains its former figure. For hard bodies, as bones and teeth, we of course employ the saw, files, a hone, and two glass plates for polishing.^ Of other instruments, sometimes, but not often required, may be mentioned the compressorium ; but all the objects to be attained by such an instrument, are reached by the prepa- ration of thin sections, or by pressure with the finger or a needle upon the covering glass. For the purpose of estimating measurements, the glass micrometer, on account of its cheapness and greater con- venience, has supplanted the costly and more inconvenient screw micrometer. The diversities in the size of the elementary parts in patho- logical tissues, is frequently so great, as for instance, in the fluid of cancer, that no average dimension can be stated, unless very numerous measurements have been made. Again, how- ever, there are pathological new formations, in which the size of the elementary parts does not difi'er much. The estimation of the dimensions of the latter, in general should not be disregarded, since, on the one hand, this is necessary for a proper understanding of the matter; and on the other, the size certainly stands in a definite relation to different conditions of nutrition, and to a varying productivity of the cells. For ascertaining the permeability of the vessels, injections are important, which may be made with any coloured fluid. For preparations adapted to be viewed with a magnifying power of 50 — 60 diam., a very suitable material is oil of tur- pentine coloured with Prussian blue, or any other colouring ' [For the polishing of thin sections of bone, nothing is better than the use of two pieces of smooth slate, or of what is called "Water of Ayr stone," between which, the thin section is rubbed, moistened with water. Ed.] GENERAL OBSERVATIONS. 11 matter. The colouring matter must be added in sufficient quantity to afford a distinct colour when the fluid is spread out in very thin layers upon a glass plate. This is quite necessary, for otherwise the capillaries will not appear suffi- ciently distinct. Injections made with size, coloured with carmine, have not unfrequently this disadvantage, that the material very readily transudes, — a circumstance usually owing to the too great quantity of ammonia added to the carmine, but which may also sometimes be ascribed to the employment of too great pressure in the injection. It is well known that microscopical vision differs from that with the naked eye, in the circumstance that with the latter we also see the lateral surfaces of an object, which are not in the same plane ; whilst with the compound microscope the image is formed on a mathematical plane, and is correct and true only when the focal distance of the object-glass is adapted to our natural visual distance. The lateral surfaces of an object, or several bodies in various planes, consequently cannot be seen without a change in the focal distance. Moreover, another important circumstance is to be regarded, viz., that in the compound microscope we usually view, objects by transmitted light, and not by reflected, as is usually the case in common vision. Thus, for instance, if we place a transparent cube in a somewhat oblique position, we shall be unable, with the compound microscope, and by transmitted light, to see either the upper or the under surface at one time, without an alteration of the focal distance; nor, likewise, will the four sides be clearly shown, without a change in the focal distance proportionate to their extent. From this theory of microscopical vision, it is obvious that considerable difficulties attend the making of observations with the microscope, and the delineation of microscopic objects. For the thorough study of the morbid changes in the elementary organs and their complex relations — the art of drawing, is indispensable. However much we may strive to represent the forms of an object by description, we shall not succeed, with all our endeavours, to give to another a distinct representation of them', whilst we afl'ord him at once a distinct 12 GENERAL OBSERVATIONS. idea by the mere outlines of the subject. An accurate study of the outline is essential to the determination of the differences of analogous objects, and it might be said that the not retaining this figure upon paper, is a misuse of the faculty of deline- f^tion. It is hence at once apparent, that facility in drawing is indis- pensable for the naturahst in general, but especially for the histo- logist. The latter should even be able to represent microscopic objects on paper, at sight; for in making the outline he acquires an accurate notion of the position of the object ; and by partial changes of the focal distance is enabled to estimate the thick- ness or depth of a body : the accidental, also, will thus be dis- tinguished from the essential, and different modifications in the mode of illumination of the object, together with various media must be tried, &c. And even when the draughtsman may possess the technical apparatus of the microscope, it is very often impracticable to have it at his disposal whenever a microscopic object worth delineation is presented. For a drawing to fulfil every requisite, its execution must be preceded by correct observation, which cannot be made except at a certain expense of time and attention. Schleiden very well says, " Whoever would observe successfully, must observe much, and with strenuous attentioui by which he will soon learn that seeing is a difficult art.'' What is correctly seen should now be figured as truly as possible ; we say as truly as possible, because an absolutely true figure is an impossibility. This brings us to consider the characters of a microscopical drawing. Just as the landscape-artist must study what con- tours or what combination of strokes correspond to the character of an oak or a lime tree, &c., and cannot possibly copy the detail of the branches and leaves (because by doing too much in this direction, the copy of the character will be lost), so also must the delineator of microscopical objects omit a part of the details, in order to retain the general character. It must be left to the subjective judgment to deter- mine how much of the detail should be omitted, and in what way this deficiency is to be covered. Some degree of sub- jectivity therefore creeps into every figure, although the objectivity to be aimed at should never be lost sight of. GENERAL OBSERVATIONS. 13 If the drawing merely represent a view derived from au abstract idea of the object, it forms a schematic figure, or diagram. It represents the subjective abstraction, and is consequently of no objective worth. Nevertheless, figures of this sort are a desideratum in science, and indispensable. Only we cannot avoid remarking, that this schematic representa- tion of all microscopic images, such as we see occasionally given, very much diminishes their objective worth and impedes the studies of the beginner, since, from them, he will hardly be able to recognise the object again in nature. Delineation by means of the camera lucida and of the disc of Sommering is very suitable for the laying down of outlines ; but it requires considerable practice and accuracy in the regu- lation of the illumination, &c. In pathological preparations especially, it is often important, to preserve them, as many may require future investigation and comparison ; and besides, all pathological peculiarities of rare occurrence are worth preservation. The necessity and utility of a collection of pathologico-histological objects are self-evident. The preparation of these objects, however, is a more difficult matter than in the case of objects of physiological histology, inasmuch as the former occur only in the more extensive insti- tutions devoted to pathological anatomy in such abundance as to afford the materials for a large collection. The means by which microscopical preparations are preserved are various, and depend upon the object with which the . pre- paration is connected. They may be enclosed either in the wet or dry state. In rare instances, it is sufficient simply to spread pathological objects upon a glass plate, to dry, and observe them by reflected light and under a low power. This may be done, for instance, with the minute osteophytes of the arachnoid, a small portion of which membrane, with the osteo- phytes seated upon it, may be cut off and spread upon a glass plate, to which, when dry, it will firmly adhere. If it be wished to examine the cut surfaces of diseased bones, or teeth, simply by reflected light, the, objects may be glued upon a slip of glass, with the surface to be observed, uppermost. As an opaque cement for this purpose, a solution of asphaltum in oil of turpentine, and made of the consistence of syrup, or mastic varnish, may be employed. In preparations of this kind it is 14 GENERAL OBSERYATIONS. proper to fix upon the glass slip a piece of black paper or velvet of corresponding size, with gum, so as to form a dark back-ground. To make dry preparations of objects destined to be examined by transmitted light, diflPerent methods may be pursued. Bones, teeth, and injected preparations, may be placed in resinous materials ; and if it be desired to do without any covering-glass, a plan which answers well for bones and teeth, a light-coloured, clear copal- or amber varnish may be employed. [Here follow directions for the putting up of objects in the dry state in Canada balsam, and their preservation in the wet state in cells and otherwise; but as these directions contain nothing but what will be found in several works on the micros- cope, in the hands or within the reach of every one, it has not been thought necessary to insert them. For full information on these subjects, the works of Mr. Cluekett, Dr. Beale, Mr. Hogg, &c., should be consulted. — Ed.J CHAPTER II. PATHOLOGICAL CHANGES IN THE CIRCULATION. CONGESTION. When we are viewing the circulation of the blood, it should not be forgotten that the animal is placed in altogether unusual vital conditions ; and, consequently, that we cannot expect to behold the normal phenomena of the circulation for any long time. An opportunity is therefore afforded, in all experiments upon the circulation, of making pathological observations, even without any other means. For researches of this kind, the Frog — that arch-martyr to science — affords the most convenient subject. [The mode in which the transparent membranes in various parts of the body of this animal, or in the tail of the Tadpole, are to be displayed, is too well known to require any detailed description.] The disturbances which first show themselves in the cir- culation of the blood are manifested by the unequal move- ment of those corpuscles which are suspended in it ; namely, the red and white blood-corpuscles. The latter, rolling along the walls of the vessel, become agglomerated into small masses, and impede the passage of the red blood-corpuscles, many of which make their way between the white granules. The latter generally exhibit a slow, to and fro movement, and are frequently seen to possess a passive quivering motion ; one of them often comes into the midst of the stream, and is carried rapidly forwards for some distance, but again adheres to the wall. In the normal condition of the circulation, the red corpuscles, as is well known, move with such rapidity, that the outlines of the individual corpuscles, under a magnifying power of 120 diameters, are no longer distinguishable. The number of red corpuscles circulating in the capillaries is pro- portionably less than in the larger vessels. A red corpuscle frequently proceeds for a certain distance in the capillary 16 PATHOLOGICAL CHANGES vessel, more rapidly than in a large neighbouring trunk. When the circulation is disturbed, the red corpuscles often pursue each other with greater rapidity, and frequently some time elapses before a single blood-corpuscle passes into an anastomosing capillary-vessel. In these cases, if a larger number of red blood-corpuscles accumulate in a vessel, they become grouped into masses, completely obstruct the lumen of the vessel, and at the same time, cohering together, apply themselves to the walls of the latter; whilst in the normal state of the circulatory movement they are propelled in the main stream, surrounded hy a stratum of serum termed, perhaps incorrectly, by Valentin, the quiescent stratum, because, appa- rently, no motion is perceptible in the clear, colourless fluid constituting it. That the current moves more slowly at the walls than in the middle, depends upon the adhesion and at- trition between the most minute parts. Thiscondition is supposed by Valentin to be conducive to the nutritive phenomena, inas- much as the parent menstruum, which affords the nutritive matters, and absorbs the compounds presented to it, creeps slowly on the porous walls, an4 is thus afforded more time for the performance of its functions. This stratum of serum, sur- rounding the red blood-corpuscles, is displaced when the latter become agglomerated. If only a few corpuscles cohere and become stationary, they may again be propelled by others behind them ; and in this way the circulation may be restored. If the obstruction, however, be caused by a longer column of blood-corpuscles, those behind are repulsed ; and in this way is caused an oscillatory movement. By this retrograde motion, it may also happen that white and red corpuscles, even in considerable numbers, are forced into another vessel, and thus re-enter the circulation. The oscillation, in a larger arterial trunk, may also depend upon the weakened impulse of the heart; for if the transparent heart of a Tadpole of a Tree-Frog, about an inch in length, be taken with the larger vessels attached, instructive observations upon this point may be made even with a magnifying power of 300 diam. By the rapid and regular contractions of the pyramidal apex of the heartj the red blood-corpuscles are not expelled from the lumen of the artery, but are merely propelled for a short distance, returning upon the diastole — which depends probably upon IN THE CIRCULATION. 17 the circumstance that the vessel is open and exposed to the atmospheric pressure. That the blood-corpuscles are propelled by fits and starts in the large emergent arterial-vesselsj at the same time that they observe a continuous, uniform course in the returning trunks, may be seen, for instance, very distinctly in the tail of the embryo lizard. The oscillations become weaker and weaker, ultimately cease altogether, and the stasis is established. The red blood- corpuscles at the same time cohere so intimately as to consti- tute merely a red streak. This stasis is usually manifested earlier in anastomosing branches, and is often fully established in the capillary ramifications of a minute artery, whilst, in a contiguous branch, the circulation is going on in a perfectly normal manner. Stases of this kind may be termed local. Stases may also occur of merely a temporary kind, that is, which disappear again under favorable circumstances. Thus it is possible, by gentle agitation or stroking with a moist pencil, &c., to remove the Ipcal stasis. Wharton Jones ob- served that the circulation in the obstructed vessels was usually restored after a few days, when an artery was simply divided. Dilatation of the capillaries is a phenomenon assumed by some to be constant in the condition of blood-stasis, whilst by others it is altogether doubted, or admitted to exist only to a trifling extent. "With respect to this, however, it should be re- membered that, in making the measurement, a given capillary must be kept in view, since those vessels, as is well known, differ in size. The measurement also should be made with a magni- fying power of not less than 150 diameters ; as otherwise the deli- cate wall of the vessel and the above -described layer o{ plasma would be overlooked, and the occupation of the site of the latter by blood-corpuscles be regarded as a dilatation of the vessel. Still more problematical than the dilatation of the capillaries is their previous contraction. J. Vogel says that he has always no- ticed it, but stating that under the influence of powerful mecha- nical and chemical irritation, the dilatation ensues suddenly, without any perceptible, previous contraction. P. Bidder, in his experiments, was scarcely able to induce any contraction of the capillaries, nor to establish the fact of any dilatation of them, (with which our own observation agrees) ; whilst he proved that a contraction of the arterial and venous trunks immediately 2 18 PATHOLOGICAL CHANGES contiguous to the capillaries took place to the extent of one third of their original diameter, particularly in the mesentery of the Frogj he could not perceive any dilatation of the vessels. Among more recent observers, E. Briicke has observed the contraction of the arteries in the extended membrane of the Frog's foot to which a solution of ammonia had been applied, as formerly noticed by Thomson and Kock. When he ex- amined more closely an artery in this situation in which oscil- lations were manifested, he found that it is considerably con- tracted in the upper portion, so that, not unfrequently, a single branch filled with blood-corpuscles is thicker than the trunk from which it arises in company with several other twigs. In 'fact, if, previously to the experiment, he measured the ar- teries, at the point where they quit the toes to enter the mem- brane, with a glass micrometer, he found it easy to satisfy himself that the internal diameter of those which immediately supplied the portion of the capillary system experimented upon, was reduced during the development of the stasis, to a half or even to one third or a quarter of its original dimensions. This state of contraction and of fluctuation in these vessels, when the stasis was completely established, he often observed to last for a space of four or five hours. The reflections which occurred to E. Briicke with respect to this subject, are briefly as follows : "When an artery is contracted, the rapidity of the current in the branches is diminished, owing to the increased resistance, and a retardation of the stream of blood in the capillaries \akes place in consequence of the contraction ; a local stoppage, or even a change in the direction of the motion in certain vessels may also be produced. Consequently there is no necessity for assuming a hypothetical, primary dilatation of the minute veins and capillaries from a direct or reflex paralysis of the nerves of the vessels, in order to explain the disturbance of the circulation, as was at first stated to be the case by Henle." It should also be remarked, that the dilatation following the contraction of the arterial branch, is attended with^an acceleration of the current, and that individual vessels, in consequence of this acceleration on the one side, and the impediment offered by the column of blood on the other, are exposed to a greater pressure, owing to which a rupture of the distended walls of the vessel may readily take place. IN THE CIRCULATION. 19 Wharton Jones proposed to himself to determine the in- fluence of the nerves upon the contractile power of the arteries, and for this purpose divided the ischiatic nerve of a Frog, when the arteries contracted ; but it appeared to him that the ensu- ing dilatation was more considerable than usual. Even when he divided a nervous twig accompanying the artery, dilatation en- sued very speedily upon a contraction of the vessel, and this was more considerable below than above the point where the section had been made. If both nerve and vessel were divided, contraction of the walls of the vessel took place upon irrita- tion of the natatory membrane, both above and below the wound. Of great pathological interest, also, is the observation by the same author, that a partial, varicose dilatation of an arterial branch was attended with a retardation of the current in the dilated portion, whilst an extensive dilatation of an entire ar- terial trunk was accompanied with an aca^leration of the circu- lation, owing to the diminished resistance. From these experiments upon the irritability of small arteries it is obvious that the contraction thus induced, may cause a disturbance of the circulation, and produce a stasis within its circuit, but that it can merely be regarded as a conditional in- fluence; and that other agencies, as for instance, the elastic contraction of the surrounding organs might, perhaps, among definite influences, be regarded as the proximate cause of the im- peded circulation. With reference to this, we would notice the stasis which is set up in the ciliary vessels immediately after the evacuation of the aqueous humour. If the cornea of a white Rabbit, whose eyes, as is well known, have no pigment, be punctured with a straight cataract needle, the transparent vessels of the iris and the anterior ciliary vessels with their fine branches, visible only under a lens, become apparent after the escape of the aqueous humour. A reddish border is formed around the cornea. It might be supposed that, after the escape of the fluid, the cornea would appear more flattened, and lose much of its tension j but this is by no means the case, the curve of the cornea being scarcely afl'ected. The stasis in the ciliary processes and iris cannot be more closely exa- mined until the parts are removed and dissected after the death of the animal. The vascular ramifications in the ciliary 20 PATHOLOGICAL CHANGES body and the iris are then most beautifully displayed. The question now arises as to the causes which concur to produce this blood-stasis. It is clear that the fluids of the eye exert a considerable pressure, both mutually upon each other, and upon the membranes of the eye. Now if the equilibrium of the fluids which are separated by septa, be destroyed by the removal, at any rate, in great measure of one of them, as of the aqueous hu- mour, a change in the condition of the humor Morgagni contained in the capsule of the lens, and of the vitreous humour must take place. The tension of the membranes of the eye is diminished by the letting out of the aqueous humour, and consequently, owing to their elasticity, they contract, and are reduced to a smaller volume. The muscles of the eye also, attached to the sclerotic, must likewise retract in proportion to the diminution in the curvature of the latter ; and thus is explained the cir- cumstance that the convexity of the cornea remains unaffected, and also that the crystalline lens and vitreous body are forced forward. It is easy to perceive, that under these altered con- ditions and pressure, disturbances of the circulation must ensue, and especially that the ciliary processes, by the advance of the lens, are subjected to a greater degree of pressure, and, therefore, exhibit under the microscope, the most beautiful injection of the vessels. That it is really the evacuation of the aqueous humour, which is the cause of the blood-stasis set up in the ciliary vessels, may be shown by making a puncture through the sclerotic into the vitreous humour, for no stasis is then observed in the ciliary vessels until a portion of the vitreous humour has escaped, whence also the tension of the membranes of the eye becomes lessened, and conditions similar to those which attend the evacuation of the aqueous humour are established. The quantity of vitreous humour that should be allowed to escape must, however, be limited within certain })Ounds, otherwise minute extravasations of blood would appear to occur in the vessels of the ciliary processes. This phenomenon arises in consequence of the determinate degree of elasticity pos- sessed by the membranes of the eye, whose diminution in volume cannot proceed pari passii with the escape of the fluid. In this case, therefore, the pressure on all parts of the vascular system is suddenly diminished, and the same thing must take place as happens under diminished atmospheric pressure — an IN THE CIRCULATION. 21 expansion and rupture of the vessels. Should the quantity of aqueous humour be more considerable, so that in fact, the lens and vitreous humour are not pushed forward so as to elevate the cornea, the diminution of the pressure would likewise be attended with minute extravasations of blood. Phenomena of a precisely analogous kind must also accom- pany the evacuation of fluids from abscesses, cysts, &c. It is VFcll known, for instance, that when abscesses are opened with- out the application of pressure, upon the evacuation of the pus some blood escapes from the cavity itself, derived from ruptures of the vessels in the walls of the abscess ; the ruptures them- selves being caused by the sudden diminution of pressure upon the walls of the cavity. Another influential agent in the production of disturbances in the circulation, is obstruction of any kind to the returning current of blood. A contraction of the organic muscular layer of the minute venous trunks following the application of irri- tants, will effect a retardation of the current of the column of blood advancing from the capillary system ; in like manner, a partial varicose dilatation of a minute venous trunk, is attended with a diminution of the current of blood within the dilated portion, and consequently may produce, secondarily, a retarda- tion of the circulation within a certain circuit. Local interruptions in the circulation may be the effective mechanical cause of numerous phenomena, inasmuch as the rapid increase of pressure upon the vessels of the various con- tiguous organs, puts a stop to the circulation through them, as it were, by a process of constriction. Thus, for instance, the rapid effusion of a serous exudation will necessarily cause a diminution of the local rapidity of the current, and, ultimately, local stases throughout a circuit wider in proportion to the ex- tent of the effusion. In like manner, the coagulum resulting from the rupture of one or of several vessels, being removed from the circulation, may produce an interruption to the latter, in consequence of the unequal pressxire exerted by it upon the svatowaAm^ parenchyma of the organ. ^he phenomena which may arise during life, in consequence of local disturbances of the circulation, and their significance with respect to the whole organism, depend not only upon their extent and the organ in which they are manifested, but also. 23 PATHOLOGICAL CHANGES and essentially, upoa the particular part of the organ affected by them. General interruptions of the circulation are caused by func- tional impediments in the organ which acts as the general, mechanical motive power, viz., the heart. Thus, defects in the valves of that organ necessarily cause extensive derangements in the rhythm of the circulation. These derangements will, in general, be found to be more extensive in proportion as the disturbing cause is nearer to the heart. Thus an aneurism of the aorta affects the circulation more extensively than does one of the radial artery. And, in the same way, obstructions in the returning current of blood from the lungs, as for instance, in emphysema or cedema of those organs, necessarily induce a more general impediment to the circulation. Those obstructing influences, also, which lie beyond the vas- cular system, and are productive of congestion, should not be disregarded ; these are agencies residing in the central nervous system, and which, by their pressure, induce a paralysis of the motor nerves. Thus, for instance, interruptions of the circu- lation in the extremities on one side will be induced by extra- vasations of blood in the corpus striatum of the opposite side, owing to the consequent absence of the necessary periodical assistance to the circulation which is derived from the move- ments of the parts affected, (contraction of the voluntary muscles in locomotion, &c). We have next to consider the effects of the above-described forms of disturbed circulation. It has already been shown that a contraction and dilatation of the lumen of the capil- laries is, at any rate at present, problematical, and that their repletion with blood is due to the admission and accumulation of the red and white corpuscles in the space otherwise occu- pied by the blood-plasma ; these are the conditions, in fact, which constitute hypercemia ; although, on the other hand, the dilatation of a capillary-vessel, up to a certain extent, must, a priori, be admitted. Now, when the blood-corpuscles have accumulated to a certain amount, they become adherent partly to the wall of the vessel, partly together, and ultimately a stagnation of the blood, otherwise in a state of continual change, is brought about. The white corpuscles, which in other circumstances roll along the wall of the vessel, adhere IN THE CIRCULATION. 23 to it, their number not being distinctly shown until the hematin is removed from the red corpuscles by water. Under these circumstances they may be seen agglomerated into masses, though there does not seem to be any reason to suppose that their number is augmented. B. H. Weber's observation, that the white blood-corpuscles, when the circula- tion is interrupted, appear to be more numerous, is undoubtedly correct; but this greater number may equally well depend upon the accumulation of those already existihg in the blood. Nor is there any better reason to surmise that a transfor- mation of red corpuscles into white takes place, than there is to assume a new formation of the latter from the blood-plasma. At the same time, the possibility, or even probability, of the latter notion, which was propounded by Gerlach, cannot be absolutely denied. The supplanted blood-plasma may escape, on the one hand, through the wall of the capillary ; and, on the other, may be propelled towards the venous radicle, through the opposing column of blood. The direction taken by it is determined by special circumstances ; but this much is certain, that so soon as a stoppage of the circulation is set up in any part of an organ, the endosmosis and exosmosis are no longer continued under the usual conditions, when fresh blood is continually supplied, and consequently the nutritive conditions proper to the part of the organ concerned are carried on under other and unfavorable circumstances. The stagnant blood contained in the vessel now undergoes changes, which may be studied on the great scale in aneurismal sacs, as will be more particularly noticed in the Special Part. What changes the walls of the larger vessels undergo in their contraction and subsequent expansion are unknown. That the expansion, when it exceeds a certain amount, may cause such a diminution of the elasticity of the walls of the vessel as to render them incapable of contracting again beyond a certain point, after the cessation of the tension, is very pro- bable, though, at present, the necessary experimental proof of this is wanting. If we assume that the co-efiBcient of the elasticity of a vessel is reduced in consequence of the inter- rupted circulation, it is clear that the less elastic vessel will acquire a larger lumen, proportionate to the degree of tension, to which a vessel having the normal amount of elasticity would 24 PATHOLOGICAL CHANGES respond for the requisite contraction. The subsequent dilata- tion, whether limited to a small portion or occurring through- out a greater extent, will always produce a greater or less disturbance of the circulation, for the reasons above stated. The thin-walled veins — which, moreover, possess only a very thin layer of transverse fibres — will, on that account, the sooner lose their elasticity when subjected to too powerful or too long continued contractions and relaxations, at the same time acquiring varicose dilatations. Upon reviewing all that has been said, it is obvious that under certain morbid conditions of the smaller arterial vessels (with dilatation in a considerable portion of a vessel) those capillaries which are supplied by them experience a more rapid change of blood (conditions which would appear to approach the nearest to what has been understood under the term "congestion"). The more active change of the blood can only result in an augmented nutrition of the organ or of the part of an organ; or, in other words, must cause its hyper- trophy. In the propounding of this theoretical view, it is not intended to imply that the dilatation of a minute arterial trunk, throughout a considerable extent, is the only condition requisite for a more rapid circulation of the blood within a certain region. On the other hand, varicose dilatations of an arterial branch (dilatations limited to a small portion of a vessel), permanent contraction of the lumen of a vessel, whether owing to the contraction of the wall or consequent upon pressure from without, would retard the current, pro- duce oscillation, and ultimately a complete stasis of the blood ; whilst the incomplete interchange, or the entire deprivation of the nutrient blood-plasma, would cause a diminution or complete interruption of the nutrition; or, in other words, would induce an atrophy of the part affected, in all its mani- fold varieties. Hypertrophy and atrophy, as is well known, are often combined — as, for instance, in the sebaceous follicles of the skin — under particular circumstances. If the transverse section of one or two arterial branches be greater than that of the other, it will, of course admit a larger quantity of blood ; but in the same proportion must the calibre of the second branch undergo diminution, if both be supplied by a common trunk, whose size remains unaltered. IN THE CIRCULATION. 25 It is hardly possible to determine the limits within which the increased amount of blood-corpuscles in any particular organ ceases to constitute a physiological condition and passes in the pathological. It is well known that there are certain organs which periodically admit a larger quantity of blood- corpuscles, or, in other words, become congested, — as is the case with the mucous membrane of the stomach during the process of chymification, or in the sexual organs and their appendages, in many animals, during the period of " heat." The same thing occurs in repeated, rapidly succeeding contrac- tions of the miiscles of the extremities, and of the diaphragm, in increased transpiration from the skin in a more elevated temperature, in the more rapid and vigorous contractions of the heart in running &c.; and we cannot regard this hyperamic or congested condition, as it is termed, as morbid, — that term implying a more prolonged and more frequently recurring disturbance of the circulation, resulting in a modification of the nutritive condition of the organ. It is a well known fact that the nutrition of an organ is carried on by the endosmotic action of the smallest blood- vessels, and that the nutrient fluid transudes through those vessels ; and consequently it further follows, that a certain part must exude whilst another enters and is mixed with that portion of the blood which does not exude. Nutrition conse- quently consists in the supply from the blood, of the materials required for the maintenance of an organ, in exchange for those which are no longer applicable to that purpose. Now when a stasis is set up, the latter are no longer conveyed away, and the transudation will take place under other conditions than those which obtain when the circulation is at its normal speed; it becomes a pathological transudation, and the physiological cytoblastema assumes the character of a pathological exudation. Various endeavours have been made to determine the point of time at which this change takes place; and it has generally been admitted, that it does not occur until after a stasis has been established. That this view, however, is a scholastic one, is at once obvious, because there is no reason to suppose that the transudation may not take place during the whole period that the disturbance of the circulation exists, since it must be admitted that it is always going on in the normal condition of 26 PATHOLOGICAL CHANGES the circulation. We cannot trace the act of transudation with our eyes, because the transuding fluid is transparent ; and are consequently only able to observe the exudation when it makes its appearance on the surface of membranes] and it is this appearance alone that can inform us that we have to do with a process of exudation, or an inflammation. If the exudation has undergone no morphological changes recognizable under the microscopej it constitutes nothing more than a hyaline, struc- tureless material, and is therefore not a subject for microscopical observation. It is possible, perhaps, to render it a microsco- pical object, by precipitation by means of heat, or other reagents, or, by evaporation, to render the mineral constituents visible. But in doing this many difficulties stand in the way, which may at once be indicated by an instance. If we examine the kidneys of a person who has suffered from albuminuria, and died within twenty-four hours with symptoms of stupor and dropsy, we shall in many cases be puzzled to specify any patho- logical, anatomical changes, and shall be compelled to allow that these are unsatisfactory. We shall in like manner hesi- tate, when we examine the spinal chord of a tetanic subject, and endeavour to satisfy ourselves of distinct pathologico-histo- logical appearances. These negative results, however, should not deter us, and we must look about for other methods, by means of which we may perhaps be enabled to arrive at a dis- tinct exposition of the pathological changes. In no case should we be justified in wholly denying the existence of a hyaline exudation in the parenchyma of the organ. It is a fact universally recognized, that in all exudations the product is at first a limpid fluid, which does not become viscid and turbid until afterwards. The turbidity of the exudation, moreover, does not reside in itself as such, but is usually due to the development of new elements. Thus in variola we observe the fluid contained in the vesicles which is at first transparent, to become turbid — but this change is caused by newly formed elements, viz., by pus- corpuscles. The time in which exudations are formed, depends in general upon their consistence; the more limpid the exudation, the more rapidly may it be formed. Theoretically there is no reason, as has been shown above, against the supposition that IN THE CIRCULATION. 27 the limpid exudation may be afforded by the still circulating blood before the stasis has become established. We shall be inclined to regard this view as correct, if we consider the cases in M'hich an exudation is observed to take place with extreme rapidity — ^frequently within a few seconds — as in the bites of insects, burns, &c., more especially in those parts of the skin where the epidermis is very thin, or as the effect of various noxious substances upon the mucous mem- brane of the eye, the tongue or the lips. Exudations present great variety in their external form ; and they may be brought into different categories according to their consistence, colour, and chemical and histological conditions. In a physiological point of view, also, they may be arranged in two large groups, one of which would include those exuda- tions which are capable, to a greater or less extent, of under- going development into new elements — or the organizable ; and the other, those effusions which do not exhibit such a capacity for organization — or the unorganizable. In a chemical point of view, according to Lehmann, no classification of them can be made simply from the predominance of one constituent or another, since no definite limits, in that respect, whatever can be drawn; and the absolute deficiency of any given constituent itself cannot be proved even in any particular instance. But the anatomist and physician require a scheme, which, it must be confessed, will not serve as a strictly scien- tific classification, 1. The exudations may be quite limited, exhibiting no histological elements at all, or but very few accidentally mixed with and suspended in them; these exudations will be termed the simple serous or hydropic. They may be ob- tained in considerable purity from the larger visceral cavities, or from cysts; but in the parenchymatous organs, — as, for instance, the lungs, — or in the skin, they are often mixed with several other elements. The fluid is yellowish or greenish- yellow, clear, and transparent ; and, according to several ana- lyses by J. Vogel, contains elements identical with those found in the serum of the blood : that is to say, water, organic matters, including albumen in solution, fat, extractive matter (occasionally, also, small quantities of urea, bilofulvin, and 28 PATHOLOGICAL CHANGES h(smatin), together with various salts (mostly carbonates?), alkaline and earthy phosphates, and metallic chlorides. Serous exudations not unfrequently appear turbid from the admixture of free fat, forming a sort of emulsion with the albumen ; a slight increase in the amount of protein compounds in the fluid will render it mucoid and tenacious. An opalescent film not unfrequently forms on the surface of the fluid, consisting of cholesterin. The frequent instances in which, owing to compression, the return of the blood in the less resistant veins is impeded, — such as takes place, for example, during pregnancy by the distended uterus, or in consequence of the pressure of a tumour, of a cyst filled with exudation, or of the enlarge- ment- of an infiltrated parenchymatous portion of tissue, — justify the conjectural opinion of J. Vogel that the serous effusion is afforded from the veins, and that it takes place whenever a disproportion arises between the porosity of the venous walls and the density of the blood contained in them ; so that either the walls of the veins become more porous or the blood thinner and more .watery than in the normal condition. In either case, there ensues an increased transudation of the blood-serum through the walls of the vessel. Another cause of dropsy is referred by J. Vogel to a change, and more par- ticularly to a thinning, of the blood. In support of this view, he relies upon the more recent experiments of Magendie, which tend to show that after defibrination of the blood, and after the injection of a considerable quantity of water into the vessels (especially in Rabbits), dropsical effusions take place. 3. Another kind of exudation is characterised by the presence oi fibrin, which is contained in the exudation in the liquid state, and coagulates like the fibrin of the blood ; it possesses, also, the same morphological character, exhibiting the aspect of a very delicate, liitricately interlaced, filamentary network. These exudations will be termed fibrino-serous or fibrino-dropsical. In their chemical composition, this fluid, according to Vogel, pre- cisely resembles the blood-plasma, — that is to say, the fluid part of the blood without the corpuscles ; it is blood-serum, the fluid of serous dropsy holding fibrin in solution. Chemical analysis shows the presence in it, of water, organic elements — such as fluid fibrin, albumen, fat, extractive matter, and salts. IN THE CIRCULATION. 29 This correspondence of the fluid with the blood-plasma, in rare cases, extends also to the quantity of the individual elements, though it usually contains more water than the latter, and less of the organic elements, and, in particular, less albumen and fibrin; it is only in very rare instances that it presents a greater abundance of these elements than is contained in the blood- plasma. According to the same author, it may with great probability be assumed, that in these fibrinous effusions, the fluid part of the blood escapes through the walls of the capil- lary vessels ; whilst, as we have seen above, in the serous form, the fluid part of the blood probably transudes through the walls of the veins. The agreement of all experiments on this subject indicates that the endosmotic product of the veins is thinner and poorer in organic elements than that aflbrded by the capillaries. It is not to be wondered at, that, in our complete ignorance of the endosmotic conditions of the vessels, we are unable to arrive at any positive conclusion with respect to this point. The subtle questions thence arising can be satisfac- torily answered, in some measure, only by experiment. Expe- riments upon the endosmotic properties of thicker and thinner vessels, filled with various fluids, at different temperatures, must be instituted; and in addition to this a varying pressure by means of a column of fluid should be applied, — nearly that of the column of blood ; and the vessels of individuals of various ages must be compared, as should also healthy and diseased vessels, &c. For the solution of the question, as to the influ- ence of the rapidity of the current upon the endosmotic condi- tions, a determinate quantity of fluid might be propelled through a porous vessel in a given time, and under a deter- minate pressure. It should also be ascertained how the rapidity of the current, modified by the curvatures of the tube, and by tlie various modes of division of the lateral branches, &c., affects the endosmotic conditions. The importance of experiments of this kind, both physiologically with respect to nutrition, as also pathologically, for the establishment of the physical theorems concerned in exudation, imperfect nutrition, &c., is so great, that we have been thus induced to dwell upon it. To return now, to our modified, dropsical effusion, or fibrino- serous exudation. This exudation, if the aqueous constituent 30 PATHOLOGICAL CHANGES does not fall below a certain minimum, will remain unor- ganizable ; but when the proportion of the watery element is so far diminished that the exudation ceases to be a thin fluid, it is then rendered capable of becoming organized, unless other impeding circumstances intervene, with which it must be con- fessed we are but very imperfectly acquainted. It appears that the fibrin plays an important part in the organizability , although there are other secondary requirements for this, which we shall endeavour in some measure to elucidate in the course of the work. Lehmann doubts the correctness of VogePs opinion, that it is only exudations containing ^6rm that are plastic, that is, which are capable of developing cells and tissues. He believes that in the organization of the exudation, the fibrin continues to be formed out of the albu- men of the transuded plasma, but that it is rapidly again metamorphosed, because the fibrin in general is to be regarded as an intermediate link, as a transitionary stage in the meta- morphoses of the nitrogenous substances. Prom these brief observations it is obvious that the organizable exudations cannot be distinguished from the unorganizable, but that the two forms pass into one another. The fibrinous exudation is characterised by its containing a greater abundance of fibrin. Now, as the latter occurs in exudation in both the semifluid and coagulated states, we might in an anatomical sense, distiiiguish a semifluid or gelatinous, and a coagulated fibrinous exudation ; and at the same time, it is at once apparent, that the latter must be secreted in the fluid condition. The distinguishing characteristic of the fluid Jibrin, as is well known, is its spontaneous coagulability, when removed from the vital influence. " With respect to the causes of this coagulation," says Schlossberger, " the most various hypotheses have been propounded since the time of Hippo- crates, without our having arrived at any satisfactory explana- tion of them. We have gradually become acquainted with a variety of substances, some of which hasten and others retard the coagulation; but with all these experiments we have not advanced a step towards the proper solution of the question, as to why the Jibrin, which is naturally in solution, should be spontaneously coagulable. Under certain circumstances, the coagulation is very much retarded, in the blood, in exudations, IN THE CIRCULATION. 31 and in other fibrinous fluids ; but we are still very much in the dark with respect to this, frequently remarkable, modifica- tion of the most important property of dissolved ^6rm, and it must be left to futurity to determine, whether, in these cases the fibrin has itself undergone modifications, or whether this retarded coagulation is the consequence of foreign admixture, of various degrees of dilution, or of other external influences." Fibrin, whilst in a state of solution, cannot be made the subject of histological observation, but when, in combination with other elements, in the form of fluid, fibrinous exudation, its organization has commenced, its state of aggregation changes ; it becomes in certain parts more consistent j the viscous consistence becomes gelatinous ; the uniform yellowish colour is replaced in parts by a whitish speckled hue ; the transparency is diminished in those portions, which, by reflected light, appear as white points and filaments; and in these situations, under more powerful magnifying powers, we may observe newly developed elements which are wanting in the transparent parts. The newly developed elements, in the different forms of exudation, present very great variety, and it has even been attempted to denominate exudations from their predominant elementary constituents. Thus we speak of purulent, ichorous, cancerous, tuberculous exudations, &c. Properly speaking, these denominations are illogical, because the fluid fibrinous exudation, is in fact nothing else than a formative material, a blastema, an amorphous substance from which the various kinds of elements are not till afterwards developed; we cannot, therefore, name the exudation from something which does not really exist in it so long as it is an exudation; but when new elementary parts have been deve- loped, it has ceased to be a simple exudation, and has become metamorphosed into a new formation. Nor, again, in strict terms, can we speak of a hemorrhagic exudation, for an exuda- tion cannot take place from a ruptured vessel; under this term, therefore, can merely be understood an exudation asso- ciated with an accidental hemorrhage. A question connected with this subject, and which, on account of its importance, has been raised by many persons, is this : whether any given exudation possess a determinate organizability, that is, say, for instance, whether an exudation. 32 PATHOLOGICAL CHANGES by virtue of its innate properties, may in its organic meta- morphosis, merely reach an imperfect cell-formation; whilst a second, destined to undergo a higher organic expansion, is transformed into cells of various degrees of development ; and a third merely attains to the production of homologous ele- mentary constituents. The affirmative answer to this question would imply an independent specialty in each exudation, and the matter would of necessity have to be regarded in the same light as the case of the impregnated ovum. Just as in that case, from an apparently homogeneous substance, so many kinds of tissue arise whose development is continued according to a deter- minate type in each animal, so also would the structureless fluid exudation possess an innate tendency to assume only a definite form of organization; and thus, one exudation would be capable of being transformed only into pus, a second into tubercular matter, and a third into cancerous matter, &c. J. Vogel is of opinion that the question whether a given cytoblastema pos- sesses merely the general property of becoming developed, or whether it has a tendency to become developed into a particu- lar tissue, cannot at present be definitively answered ; but there are very strong grounds for believing that the nature of the tissue subsequently produced does not depend upon the consti- tution of the blastema, but upon subsequent external influences. He was never able to detect any morphological or chemical dif- ference between the cytoblastema of tubercle, scirrhus, pus, con- nective tissue, &c. And experiments on the subject of inflamma- tion prove distinctly that an exudation {blastema) of the same morphological and chemical properties, and derived from the same source, may, under different conditions, give rise to tissues of the most diverse kinds. The answer to this highly important but difficult question can only be arrived at by the way of ob- servation and experiment.. Let us seek the aid of the former, and consider various exudative processes in their origin, course and result. In variola, for instance, the exudation is a local deposit, confined to circumscribed parts in the cerium and on its surface ; the epidermis is elevated by the exudation collected beneath it, into the form of a hemispherical vesicle ; pus-cor- puscles then arise in the fluid, which multiply to a certain extent ; the aqueous part of the pus is removed, and the vesicle dries up, and so on. IN THE CIRCULATION. 33 This process, therefore, which is repeated so many times in the same individual, and takes place in so many with unvarying uniformity, presents in the form of development of its exuda- tion such a stability that it is impossible to escape the conclu- sion that the exudation poured out in variola possesses a ten- dency to become developed into pus. It is evident that this development may be interrupted by various circumstances. Again, if we examine the exudation which is poured out into the corium in scarlatina or in rubeola, we shall also notice constant peculiarities in the mode of deposition, in the conse- quent detachment of the cuticle, and in the non- development of the exudation into elementary organs. But although we derive little assistance from chemistry or the microscope in the case either of these or of other exudations in which the investigation is more readily made, still we should not absolutely deny the specific nature of an exudation ; as the negative results at which only we have at present arrived, may simply be owing to the coarseness of our methods of research. It is even very possible that our balances are not, at present, delicate enough to estimate such minute quantitative diflPerences between the elements in va- rious exudations, with respect to the proportion of the protein- compounds to the aqueous medium, salts, &c. Our knowledge, also, of the products of the decomposition of the protein-com- pounds is still very defective, although they promise to afford some conclusive evidence as to the capability for organization of the exudation. The micro-chemical investigation, also, of this subject, still requires great attention. The specific organizability of an exudation also depends with- out doubt, upon the situation in which it is deposited. If it take place, for instance, between the ends of a fractured bone, osseous substance is again developed from it, whilst incised wounds in the connective tissue are united by an exudation which becomes organized into connective tissue. Newly formed cancerous deposits are modified in the type of their conforma- tion, at any rate to a great extent, according to their situation, as will be afterwards more particularly shown. Lastly, as regards the organizability of the exudation, an unknown quantity must be considered — the vital factor. Experiments as to the possibility of limiting or of promoting the capacity for organization of an exudation under the vital 3 34 PATHOLOGICAL CHANGES influence, and of determining the necessary conditions under which the one or the other may take place, are every day per- formed by the practising physician. "When he employs caustic to destroy the newly-formed connective tissue on the surface of an ulcer, or the pus-corpuscles, or newly developed connec- tive tissue elements on the surface of a mucous membrane, his aim is to prevent the multiplication of the newly formed ele- ments. When he unites the edges of a wound by sutures, and endeavours to obtain its closure by rest, proper position, and temperature, &c., his object is to provide against the newly formed connective tissue elements being impeded in their de- velopment by any external circumstances. But the cardinal question lies in this — whether as an experimenter he is in a condition, by a certain change of the external influences, so to alter the organizability of the exudation, that its tendency to become developed into a determinate tissue shall be perverted. When all the circumstances pro and contra are duly weighed, it would seem to us rather to be the case, that he is not able to induce a transformation of the kind in question by a change in the external conditions, and consequently, that he must be content with the power of limiting or destroying the or- ganization of an exudation, or of obviating all those circum- stances which may impede its development or removal in one way or another. This opinion is merely broached hypo- thetically, as we are unable at present to adduce any positive proofs in its favour. The forms of the coagulated fibrinous exudation, are extra- ordinarily various, and divers transitionary stages may be ob- served, in the same individual. The colour is white, whitish- yellow, greyish, yellow, yellowish-red, yellowish-brown, or brownish-red ; the consistence soft and doughy, elastic or tough, dense, or even as hard as cartilage.^ The form assumed by the fibrin in coagulating, depends in great measure upon the cir- cumstance, whether it coagulate tumultuously in entire masses, or more slowly in smaller particles; just as salts in solution may crystallize in various forms, according to the concentration, temperature, quiescence, surface, &c., of the menstruum which holds the mineral substances in a state of solution. It assumes, therefore, the aspect of fiocculi, little masses, fine filaments, plates, more or less consistent coils, and flakes. The trans- IN THE CIRCULATION. 35 parency is of course lost upon the coagulation taking place, being the more completely destroyed the more closely the fi- brinous coagula are aggregated, and the less the amount of protein compounds still remaining in solution between the already coagulated fibrinous material. The elementary form of the latter we will now proceed to consider more attentively. There are certain structureless hyaline plates having no de- fined fundamental form, of various dimensions, to which, as occurring in the blood, Nasse first assigned the name of "fi- brinous flakes.'^ The possibility of confounding these with old epidermis- cells accidentally present, was shown by C. Bruch, but such a mistake can only arise when the characters of the old epidermis-cells as plicated, flattened corpuscles, containing delicate molecules, of a definite size, and often retaining a manifest nucleus, are disregarded. We consider the existence of flake-like bodies in blood withdrawn from the circulation as placed beyond all dispute, only doubting whether they he fibrin, regarding it as more probable that they are of a colloid nature, since they are not farther altered by acetic acid. The filamen- tary form, affords the only certain morphological character of coagulated fibrin. The filaments constitute a delicate interlacement, and may be seen hanging separately, and never aggregated into bundles, at the edge of the preparation ; they resemble a fine elastic network of filaments with numerous free interstices filled with a hyaline fluid. If the coagulated fibrin be treated with alkalies, it is rendered transparent and gelatinous, and is then deprived of its coagulability. Schlossberger proposes the question, whether under these circumstances it is not changed into albumen, in- duced by the remarkable discovery of Liebig, that albumen may be produced from the fibrin of the blood. If well washed fibrin be covered with water and left to itself in a close vessel in a warm situation, putrefaction soon commences, and at the end of about three weeks almost all the fibrin is resolved into albumen, as can be demonstrated in the filtered fluid. In acetic acid, also, coagulated fibrin becomes gelatinous and swells up. The molecular form of coagulated fibrin is now described but by few chemists as more than a particular state of aggregation (molecular fibrin) ; and both this and the flaky form have been declared by Lehmann not to be any form of coagulated fibrin. 36 PATHOLOGICAL CHANGES The organizability of the coagiilated fibrinous exudation is in general trifling, and may occasionally be wholly wanting. The newly developed elements are limited to a few, and often imperfectly developed forms ; as for instance, pus-corpuscles, large granular cells, groups of roundish nuclei imbedded in a molecular substance, or solitary and elongated, which are not apparent until the fibrinous mass has been rendered transparent by acetic acid, &c. ; as will be afterwards more pai-ticularly adverted to. Various authors have classified the fibrinous exudations in different categories, according to their consistence, their effects, and the elementary parts contained in them. Thus Rokitansky distinguishes a simple or plastic, fibrinous exudation, corres- ponding to what is termed by us, the fluid fibrinous exudation, and a croupose corresponding to our coagulated fibrinous exu- dation. The latter, according to him, has either a great ten- dency to liquefy into pus, or is dissolved more rapidly without any well marked formation of piis, and exerts a corrosive, solvent influence upon the substrata. It consists, as he states, besides an amorphous matTix, of nuclear and cell-formations. His third form of croupose exudation is characterised by the solidity of the product, and its tendency to become rapidly disintegrated, when the tissues are resolved into a fetid, ichorous, pulp, or into a viscid, tenacious, spongy, soft slough. J. Engel distinguishes a soft, solid, and a gelatinous exudation — fibrin ; and Henle describes three principal forms of fibrinous coagula — the flocculent, gelatinous and fibrous. The albuminous exudation is characterised by its containing a considerable proportion of albumen. It is yellowish, yellowish- red from the admixture of blood-corpuscles, transparent or milky from elements suspended in it, sometimes a thin fluids some- times viscous, stringy and tenacious. It does not coagulate spontaneously, but only after the addition of the same reagents as are usually employed for the coagulation of albumen, viz. — heat (between 55° and 75°), nitric acid, corrosive sublimate, &c. and it is not till then that it exhibits under the microscope a very fine molecular substance, whilst in the fluid condition it of course presents no elementary forms. To ascertain the organizability of this exudation, is the more difficult because it occurs so frequently complicated \Yith the fibrinous, and because IN THE CIRCULATION. 37 it is well known, that chemistry as yet possesses no certain means of distinguishing coagulated fibrin from coagulated albu- men. Consequently we are not in a condition, in case we have to do with a protein-compound coagulated during life, to say with certainty which of the two bodies above mentioned it may be. With respect to the origin of this exudation, C. Schmidt has ascertained the most important fact, that the albuminous admixture contained in a transudation is derived from the capillary system, through which the transudation has taken place, a statement which he has also supported by several careful parallel and simultaneous examinations of normal and morbid transudations. Schmidt assumes for each group of capillaries a determined and constant quantity of albuminous contents in the transudation. He found that transudations into the pleura were the richest in albumen (=3'85g), those into the peritoneum containing considerably less (=1'135), whilst still less was contained in those of the arachnoid (0'6 at most O'Sj), but the smallest quantity existed in effusion into the subcutaneous cellular tissue (=0-36§). He found the same proportions to obtain in an individual who had suffered under ' Bright's disease ;' and satisfied himself by farther researches into the normal transudation of the cerebral capil- laries and into hydrocephalic effusions, that not only where the transudation is excessive do the albuminous contents in the transudation always remain pretty much the same, but also when, after the removal of the older transudation, a new effusion is poured out from the same capillaries. Exudations containing colloid, we have thought, with Forster, should be described as of a distinct kind, although hitherto no certain re-agents are known for their discrimination. It is well known that there are certain exudations, which are de- posited, especially in cysts, and the dilated areolar spaces of the neighbouring parts — for instance, in the enlarged thyroid gland, appearing as transparent, glutinous, yellowish masses not unlike liquid glue, which under the influence of hot water, coagulate into a sort of jelly, although at the same time retaining their transparency. Treated with water, they exhibit the same appearance as glue which has solidified in small portions upon a piece of glass, and which has been broken into small bits, and moistened with water. The colloid sub- 38 PATHOLOGICAL CHANGES stance is also met with in a more compact form. There occur, for instance, not unfrequently, on the walls of the large cysts of the thyroid gland, and on the pleura, little greyish-white masses, closely resembling the flakes ahove noticed, and which are not affected by acetic acid or very dilute alkalies. A frequent form, also met with, associated with the above, are, sometimes smaller, sometimes larger, flattened, smooth, or concentrically laminated bodies. Their more particular de- scription must be reserved for the Special Part, since they are met with in many organs in very marked and characteristic forms. It will be sufficient here to remark, that they are to be regarded as a form of solidified colloid, and might be designated laminated colloid corpuscles. They have been described and figured by Kolhker and Virchow, under the name of corpuscula amylacea. H assail has termed the bodies which are found very frequently in the prostate, prostatic con- cretions or calculi. They have also been described by Henle under the name of corpora Hassalliana. This exudation pos- sesses a low grade of organizability, inasmuch as the flattened cells which multiply by division, are usually soon impeded in their development by the colloid medium; and thus arise various kinds of formations, which will be afterwards described more particularly. It may even happen that elementary parts belonging to the parenchyma of an organ, or others, which may be regarded as of new formation, are enclosed in the colloid deposit, whence arise tissues of which a variety of explanations have been given. The forms of exudation above enumerated are to be looked upon, as it were, in the light of fundamental types; and the combinations and variations of which they are capable are innumerable, and are met with not only in various exudative processes in different organs and individuals, but, upon careful examination, may be noticed in the course of one process in the same organ. Our present doctrine with respect to exu- dation is but a very poor crutch, upon which we must hobble for a time, in order in some degree to obtain a measure of the ground we have to survey. Above aU is it requisite to submit to an exact examination the exudations of animals in the most recent possible condition ; for in the human subject, owing to the time which necessarily elapses before they can be examined, IN THE CIRCULATION. 39 they have undergone numerous changes ; and those exudations which we obtain from the surface of the living human body, are in many respects insufficient for the purpose in view. Another, more disadvantageous, circumstance opposed to an accurate chemical investigation, is the fact that the exudations are often mixed with other structural elements ; and we are consequently frequently puzzled to say what should be referred to the exudation, and what to the original struc- tural tissue of the organ. The unorganizable exudations, under favorable circumstances, undergo a retrograde process, which has been termed retro- grade metamorphosis, or involution. But the organizable effusions may also, under particular circumstances, be impeded in their development from the very first, and may present the phenomena of involution without their having undergone any, or a very imperfect organization. For the resorption of an exudation to take place, its elements must be in the fluid condition; consequently, the solid con- stituents remain, if incapable of becoming fluid. This fluidity is caused by a new exudation termed 'solvent,' by J. Engel. The changes undergone by the protein compounds in this process are unknown to us. The structural parts which more especially participate in this act are the minute venous trunks, and the lymphatics, which in many situations are still problematical. The possibility of a resorption must depend upon the excited circulation around the liquefied exudation, in consequence of which the equilibrium between the plus and minus of the fluid constituents in the contiguous parts of the tissue is restored. The practitioner endeavours to establish this possibility by local or general excitants of the circulation, or even by simply attempting to remove the obstacles to a free circulation. In this way the resorption may ensue either partially or entirely. If a portion of the exudation incapable of being absorbed be left, this remainder of the solid and partly fluid organic substance is metamorphosed in various ways. Sometimes it constitutes a flaky or stringy, sometimes a finely molecular substance, which when it forms thicker layers assumes a brownish-yellow colour. This kind of retrogression of the exudation has been termed obsolescence, shrivelling [Verschrump- 40 PATHOLOGICAL CHANGES fang), and tuberculization. The deposition of pigment takes place in exudations which have undergone involution, in the form of aggregations of orange-yellow, reddish-brown, or brownish-black molecules, which sometimes seem to be united by a connective substance, in such a manner as to appear like black specks under the microscope. The pigment is most probably derived from the colouring matter of the blood, which, upon the disintegration of the blood-corpuscles, transudes through the walls of the vessels in the fluid state, and subse- quently assumes the solid form. It may also without doubt be formed from the defunct blood-corpuscles, both within the uninjured vessels, in the case of stagnation, as well as without them, in the extravasated blood-corpuscles,^ the colouring matter held in solution in the red corpuscles being precipi- tated in their interior. The special proofs of this proposition cannot be given here. The protein-bodies in the exudations, when removed from the direct vital influence, frequently present an accumulation of fat, which is termed a fatty metamorphosis or degeneration. In fatty exudations of this nature, we perceive a large number of fat-globules of various dimensions, floating on the surface of the preparation when moistened with water. The size of these globules diminishes down to that of a barely-perceptible molecule, but which, when properly focussed, exhibits a brilliant appearance. The fat-globules are frequently aggregated into larger or smaller granular masses, or occupy a considerable space. The exudation, in consequence of this, loses its transpa- rency, and presents, by reflected light, a whitish-yellow or dirty- grey aspect. The fatty degeneration often extends uniformly throughout, but is more frequently observed in many places in the retrograding exudation in considerable quantity, and is by no means always connected with a loosening of the tissue, as has been sometimes asserted. That this deposit really is of a fatty nature, is demonstrated by the use of ether. Treatment of the preparation with acetic or hydrochloric acid prevents any confounding of the finely divided fatty matter with carbonate or phosphate of lime, or with urate of ammonia. Fatty degeneration may also occur in an organizable exuda- 1 \yide a Case recorded by J. Vogel, ' Pathol. Anatomy ' (English translation), p. 194, and observations on Pigment generally, ibid., p. 189-196. — Ed.] IN THE CIRCULATION. 41 tion, in the course of its organic development ; the contents of the newly formed elementary constituents undergoing the same metamorphosis, and their further development being stopped. We shall afterwards return to this most important subject in greater detail. The question as to the mode in which this transformation of the protein compounds into fat takes placCj is one of the greatest interest ; but it is to be regretted, that at present we are unacquainted either with the mode of transformation, or with its products in general. If numerous inorganic constituents exist in an exudation undergoing involution, they are precipitated in the organic basis, giving it a greater degree of hardness and fragility. The principal mineral constituents occurring under these cir- cumstances are carbonate and phosphate of lime j and the process of their deposition, consequently, has been termed cretification, a term which is to be preferred to that of ossifica- tion, which is sometimes applied, since a new formation of osseous substance in exudations of this kind does not take place. Cretification is characterised by amorphous opaque masses, deposited for the most part in groups in the organic matrix, and which are best brought into view in thin sections. The carbonate of lime, in particular, often assumes the form of considerable sized, grouped granules. In the microscopic analysis of these deposits, it is always requisite to employ acids as reagents, — of which the most useful are the acetic, hydro- chloric, and sulphuric. The inorganic constituents, again, may exist in such abundance, as almost to displace the organic; — of which the small quantity of coal on heated platinum-foil affords satisfactory evidence. Retrograding exudations of this kind, with a preponderance of mineral constituents, pass into concretions and calculi ; in which it not unfrequently happens, when forming in the intestinal canal, urinary bladder, &c., that other accidental products may be inclosed. The highest degree of retrograde metamorphosis is the putre- faction of the exudation, or its gangrene, which is brought about by means of the products of the decomposition of the protein compounds. The characteristic of a gangrenous exudation consists in the circumstance that, in consequence of the putre- factive decomposition, the subjacent tissues, in a comparatively 42 PATHOLOGICAL CHANGES short time, and for a considerable extent, also die ; a similar process of decomposition being set up in them. A peculiar mawkish odour is given off under these circumstances. The texture of the tissue is broken up, it becomes discoloured, dirty reddish-brown, or of a dirty gray colour, and is transformed into a softish pultaceous mass. The dry gangrene, which is caused by a sudden and permanent interruption of the circu- lation, and is, therefore, unconnected with a rapidly decom- posing exudation, does not belong to the same category. But since, in consequence of the peculiar putrefaction of the dead portion, a process similar to the moist gangrene is excited in the sound tissues, it may be mentioned in this place. The histological characters of the gangrenous exudation are limited to its disintegration into a fine mole- cular substance and fat-drops. The surrounding tissues are transformed into an amorphous mass ; a change which is more marked in proportion to their less powers of resistance to che- mical decomposition. The stronger elastic fibres, therefore, especially, may be very readily observed, when the fibrils of connective tissue have already undergone decomposition. Ac- cording to Vogel, the transverse striiB of the muscular fibres disappear, the latter being rendered pale throughout, transpa- rent, and gelatinous. Black or reddish-brown corpuscles of indeterminate form occur very frequently, termed, by the same author, "melanotic gremules.'^ The gangrene of the exudation is a necessary consequence of a diminution, to the lowest possible degree, of the vitality of the organ affected. The blood, stagnating in the vessels, is speedily decomposed, the corpuscles are dissolved, the delicate vessels perish, and the infiltrated tissue is more or less destroyed by the products of decomposition of the protein compounds, with which we are unacquainted. This decomposition proceeds the more rapidly in proportion to the degree of diminution of the vital energy of the whole organism. Dry gangrene is caused, as it were, by a cutting off of the arteries implicated from the rest of the organism by coagula which are formed in them, and, according to Rokitansky, may be compared with the rotting of organic substances, — that is to say, with the decay consequent upon the total deficiency or insufiicient supply of moisture, with separation of carbon. IN THE CIRCULATION. 43 Various attempts have been made to determine the causes of the diversity presented by exudations, in their external habit and chemical relations ; and, as the exudations are a product of the blood, endeavours have necessarily been made to ascer- tain the pathological changes in the latter. From these inquiries has arisen the doctrine of blood-erases. The blood, as a nutritive fluid, must, as regards its condition, depend upon all those agencies which aiFect its preparation in a direct or indirect manner. These agencies may undergo various modifications, without any transgression of the limits of health. It is, consequently, in many cases, difficult to de- termine whether we have to do with blood simply modified within the limits of health by special circumstances, or in a pathological state. The simple physical changes of the blood in themselves are not sufficient to enable us to decide upon the morbid condition, because a multitude of circumstances may induce them. For instance, it depends upon circum- stances with which we are unacquainted in all their bearings, whether the /?6rm in the vessels coagulate more or less rapidly, and whether it assume one or another form in coagulating. In considering the subject of erases, therefore, we can only decide upon chemical grounds, and regard the physical phe- nomena of the blood, in the living as well as in the dead subject, simply as the starting-point of our inquiries. The pathological changes of the blood may be divided into two categories. The quantitative proportion of the normal con- stituents of the blood may be so far changed, that an essential preponderance of the one or the other element will be apparent ; or constituents may be superadded which do not exist either at all or only occasionally in the normal blood. To the former category belong : I. An increase of fibrin (Simon's hyperinosis), which has been observed especially after inflammation, with a simultaneous diminution of the red, and an increase of the white corpuscles of the blood (?). It has been stated by many, without sufficient reason, to be a primary lesion of the blood, whilst it may just as well be regarded as the effect of the inflammation. The existence of such a crasis, therefore, remains problematical, until by experiments in animals it shall have been shown, that by the introduction of determinate conditions an increase of 44 PATHOLOGICAL CHANGES the quantity of ^6rm in the hlood may be produced^ before the setting in of an inflammatory action. Lehmann's observation, also, is of importance, viz. : that non-febrile inflammations do not cause any augmentation of the quantity of fibrin in the blood, any more than does simple fever without inflammation. The explanation of the increase of fibrin after inflammation, and the question as to whether it may arise from the trans- formation of another protein compound into fibrin, of a kind admitting of chemical demonstration, have likewise not yet been afl'orded or answered. The fibrinous exudations proceed- ing from this problematical crasis might also be the product of a merely local cause of inflammation. A diminution of the fibrin in the blood, as a constant phenomenon in any disease, has not been proved with certainty ; and in cases where such a diminution has been met with, it has always been incon- siderable.^ 2. Increase of albumen (Simon's hypinosis, albuminosis), with diminution of the fibrin and increase of the red corpuscles, it is just as difficult to establish as a crasis, especially when the blood from a dead subject is subjected to chemical analysis. Chemical determinations of recent blood are therefore indis- pensably requisite, as by this means alone can it be ascertained whether the increase of albumen in the blood be primary or secondary. The albuminous nature of an exudation — for in- stance in morbus Brightii — does not necessarily lead to the conclusion that it has proceeded from an albuminous crasis of ' Lehmann (' Phys. Chemistry,' English translation, vol. li, p. 243), states it as an aphorism, that the quantity of water in the blood is always proportional to its quantity of fibrin, though it is impossible to refer the augmentation of the_^Jn"n in inflammation in a direct manner to the diminution of the albumen, that is to say, to explain the augmentation of the fibrin by a too early metamorphosis of the albumen into that substance, as some have attempted to do. If this be the case, it is directly opposed to Henle's notion, that the increased amount of fibrin in the blood is due to the circumstance that where exudations have taken place — these effusions contain a less proportion of fihrin than is contained in the blood serum, which would thus be robbed by the effusion of proportionally less, fibrin than water. But Lehmann's aphorism would appear to accord with the fact long recognized, that the amount of fibrin in the blood is augmented in many affections, which may be regarded as diseases of debility, or dependent upon a diminution of vitaUty in the blood ; at any rate the proneness to the deposition of fibrin and its rapid orga- nization in such affections has been long remarked, especially by Mr. Dalrymple (' Med.-Chir. Trans.,' 2d ser., vol. v, 1835 ; vol. ix, 1844). IN THE CIRCULATION. 45 the blood, unless, by chemical means, the latter has been pre- viously shown to exist. We must here remark how necessary for the proper un- derstanding of the increase of fibrin or albumen in the blood, is a physiological knowledge of the development and retrogression of the blood-corpuscles — a knowledge which it is much to be regretted has not as yet been sufficiently cultivated. If, for instance, it can be proved that the red corpuscles are developed from the fluid albumen, and serve as an intermediate agent in the change of the albumen into fibrin, a rational theory with respect to the increase and diminution of these substances might be established. The former, in that case, might be regarded as an excess of development ; and the latter as indicating a defect in that respect, induced by the abnormal phases of development of the red corpuscles. 3. Increase of the aqueous contents of the blood {hydrdemia), as an idiopathic lesion, cannot be disputed ; it frequently appears as a secondary condition, and is to be regarded as indicative of impeded sanguification, such as arises in certain diseases of the lungs, heart, liver, kidneys, and after great losses of blood. 4. An increase in the quantity of white corpuscles {leukamid), according to Virchow, occurs as in a defective development of the elements of the blood under various conditions, particu- larly after inflammations, venesections, in pregnant women, simultaneously with an increase of fibrin, in typhus, cholera, pyiemia, and also in chronic enlargement of the spleen, and in general hypertrophy of the lymphatic glands. Under these circumstances the increase of the white corpuscles is very evident in fibrinous coagula taken from the large vessels, and in the chambers of the heart.^ 5. An increased amount of fat in the blood (piomemia) renders the serum milky, and may also be recognized micro- scopically by the floating fat-globules. It occurs in old people ' The main difficulty, at present to be overcome, with regard to the affection de- scribed under different names by Virchow, and afterwards by Dr. Bennett, consists in the determination of the true nature of the " white corpuscles" observed in such unusual number in the blood. Morphologically they resemble the white blood- corpuscles — but they equally resemble pus-globules, and the endoplasts of epithethial and mucus-cells or corpuscles ; but it has by no means been shown, as yet, in what respect these various elements agree with or differ from each other in their essential nature. 46 PATHOLOGICAL CHANGES and in drunkards. In old horses, it sometimes happens also that such a quantity of plates of cholesterin exists in the blood in the heart as to cover the entire field of view. A certain degree of pionamia probably also occurs after chylification. In hybernating animals a considerable amount of fat in the blood belongs to the physiological condition. 6. A diminished quantity of red corpuscles is stated to occur in chlorosis. A less deep red coloration of them may also be caused by a more scanty development of the colouring matter, or by a more watery medium, by which the latter is extracted. 7. The distinct presence of urea in the blood {uramia) has been demonstrated by Christison and several other chemists, especially in Bright's disease, whilst in the normal condition of the blood, it would appear to occur only occasionally. In the blood of cholera patients, Eeiny and Marchand found urea, though only when ischuria existed; Garrod also believes that he has found it in the blood of persons affected with gout. In serous exudations the presence of urea has been often demon- strated ; but Lehmann has been able to detect it only where these coexisted with some lesion of the kidneys.^ Urea, moreover, appears to him to exist in all the serous fluids, in Bright's disease. Schlossberger found it on one occasion even in the watery effusion in the cerebral ventricles.^ In cases of uremia, urea has also been found in matters ejected by vomit- ing, and in the saliva. The notion that the urea met with in cases of urcemia has been absorbed from the kidneys or urinary bladder, has been controverted by the presence of that principle in the blood of animals from which the kidneys have been removed. By simple ligature of the nerves of the kidneys in a Dog, Marchand produced all the phenomena of urcemia, and was able to prove, with the greatest certainty, the presence of urea, not only in the blood, but also in the matters vomited. 8. Increase of the colouring matter of the bile in the blood, [' According to Bostock, whose statement it appears is confirmed by Dr. Garrod, urea has been found in the fluid of hydrocephalus, but whether coincident with any affection of the liidneys does not appear. (' Pathol. Anat.,' by Drs. Jones and Sieveliing, p. 236).— Ed.] ' [In cases of advanced albuminuria (Bright's disease), urea has been detected repeatedly in the serous effusions so often, in such cases, found in all the visceral cavities ; and in the aqueous humour of the eye. — Ed.] IN THE CIRCULATION. 47 which gives the exudations a light or deeper yellow colour. The bile-pigment is wanting in the blood, or its presence cannot be proved in inflammations, whilst cholic acid or its cognate acids are found in it ; but the reverse is more fre- quently the case, bile-pigment being found in ^the blood, and no cholic acid (Lehmann). 9. Increase of sugar in the blood, occurs in diabetes mellitus. Although in this disease a peculiar change in the constitution of the blood might have been expected (Lehmann), such a thing has by no means been observed; for besides the in- creased amouut of sugar it presents almost exactly the same composition as normal blood, except that it contains rather more water, and, in particular, less fibrin, whilst the blood-cells and solid constituents of the serum are but slightly diminished (Gorup-Besanez). The serum of diabetic blood is occasionally milky (Thomson). From this brief sketch of the doctrine of crasis, it is obvious, that idiopathic or primary blood-erases as such, have not yet been demonstrated, and their causal relation to the different kinds of exudations must still remain doubtful : whilst, on the other hand, it cannot be denied that the blood-erases which in many cases are manifestly secondary to preceding local affections, influence subsequent exudations according to their own peculiar nature. To obtain an idea of the effects induced by exudations in the living organism, we must pay close attention to the situation in which they are deposited, and carefully trace their extent, for upon these two points principally, depend the symptoms produced by them. This is easy enough when the exudation is deposited on the surface of membranes ; but numerous difiiculties often intervene, when we wish to subject a fluid exudation in parenchymatous organs, which has not become at all organized, to a more strict examination. The latter object is more readily attained when characteristic new formations have arisen from the exudation, which will serve as guides in the inquiry. If, for instance, pus or granular cor- puscles are present, they will afford indications of the nature of the previous exudative process ; coagulated exudations even, or such as have undergone fatty degeneration, may be ascer- tained by careful observation and constant comparison with other contiguous tissues. 48 PATHOLOGICAL CHANGES It is e^ily understood that every exudation, being a plus of transuded nutritive material, must produce a tumefaction of the organ infiltrated 'with itj but it may happen that at the time we proceed to the dissection the more fluid constituents of the exudation have become absorbed, and the swelling no longer exist; a subsidence, also, of the swollen organ neces- sarily ensues in consequence of the stagnation which takes place after death, and of the gradual evaporation of the fluids. The cornea or external integument will serve as striking instances of this. When the exudation has reached a certain volume, it will mechanically impede the circulation, in consequence of the pressure exerted by it upon the neighbouring parts of the organ, and this impediment will be the more marked in proportion to the rapidity of the efi'usion, and the extent to which it has taken place. Owing to this rapidly-pro- duced and unequally-distributed pressure, the rupture of a smaller or larger vessel may readily ensue, and thus a hemorr- hage be produced. At the periphery of an exudation, also, isolated extravasations of blood are frequently met with; but the hemorrhages, owing to the pressure and counter-pressure, soon reach their limit, — that is to say, the bleeding is stayed. These minute punctiform extravasations are usually termed capillary apoplexies, although the anatomical proof of such being their nature is wanting. It is just as likely that they may be derived from the minute venous or arterial trunks. The disturbance in the circulation around the exudation will now produce a new exudative process, and thus its advance may be explained in a mechanical way, until a term is put to it by external circumstances, and the special anatomical rela- tions of the organ. The nutritive conditions of the latter must necessarily be altered by the increased transudation; more plasma will be afforded to the organ or parts of the organ involved than it can employ. This overplus, which cannot be applied to the formation of homologous elements, remains, as has been stated above, as an unorganizable material, or becomes the matrix of new heterologous elements, which, like parasites, by their independent increase, give the nutritive process another direction. The nutritive conditions of the organ will remain disturbed only until the unorganized exudation is absorbed, IN THE CIRCULATION. 49 and the organized is either removed from the organisnij or undergoes one or other of the processes of involution already described. A matter which has given rise to various theories is the disturbed sensibility — the pain, vpliich is excited during and after the act of exudation. The physiological process attending sensation is unknown, and we cannot consequently give any satisfactory explanation why sudden or slowly-produced dis- turbances of the circulation in the sheaths of the nerves should produce a momentary or a more lasting painful sensation. The effects of the exudation cannot, however, he limited to tlie region concerned, but must extend beyond it, and involve the entire organism to a more or less injurious extent, the more influential is the organ affected. A local and a general effect, therefore, must so far be distinguished. The distinction between a direct and an indirect influence of the exudation appears to us sufficiently marked. The latter effect is one brought about by intermediate organs, chiefly vessels and nerves. To the veins and lymphatics especially has an important function been assigned, and it has been sup- posed that an exudation capable of being absorbed is conveyed from one place to another. Whence has arisen the doctrine of metastasis. Of this, however, the anatomical proof is wanting, and we have been obliged to substitute a secondary blood-crasis, produced by the unorganized or organized exu- dation. But this has been done without the due precision, and a name given to the blood-crasis to which, perhaps, it had no claim at all. Thus we often speak of pycemia, but in this case the presence of pus in the circulating blood of the arteries and veins has never been demonstrated, and the existence of pus in some of the veins contiguous to a collection of matter, or in the lymphatics, is obviously insufficient to establish a crasis of the kind. Lastly, we have to consider the effect produced by the con- tagious nature of many exudations. It is to be regretted that neither chemical nor histological researches have afforded any grounds from which we might come to a conclusion as to the specific nature of these exudations, whilst experiments in the inoculation of them have presented the most incontestable proof of contagiousness. 4 CHAPTER III. PATHOLOGIGAX CHANGES 01 THE NOEMAIj CELLS. It is well known that the tissue of the animal organism consists of minute separable parts of definite form and orga- nization, distinctly visible only with the aid of a magnifying power of at least 300 diam., which will be termed elementary organs. The cells are elementary organs, consisting essentially of a " cell-membrane " and " contents." They constitute the true parenchyma, and require for their maintenance the recep- tion of fluid nutritive materials, which are either conveyed to them immediately by the capillary vessels distributed in the parenchyma, or which reach them mediately through other permeable parts in a more or less fluid condition. The quantity and quality of the nutritive material supplied by the circulating blood to the cells depends, in each individual, disregarding the possible variations of the constituents of the blood : 1. Upon the rapidity of the circulation, which is modi- fied in very various ways by the disposition of the capillary ramification, whether the branches are given off under obtuse or acute angles — whether they run in a straight course or are convoluted — whether they form coils, soon divide into nume- rous twigs, &c. 2. Upon a possibly varying porosity of the walls of the different capillary vessels, of unequal diameters in different tissues. But if the transuded blastema is modified by interruptions to the circulation, the nutrition of the cells is also changed. A more rapid multiplication of the cells may take place by division, or, in other words, the organ may become hypertro- phied; or the cell is not supplied with plasma fitted for its nutrition, and undergoes involution; that is to say, the cell- contents in particular undergo such a change, that the cell gradually loses its vital properties and perishes. We would term this process in the cell, involution or atrophy, and shall advert to it in the Special Part of this work, as occurring in NORMAL CELLS 51 many organs, convinced that the type of this retrograde meta- morphosis remains everywhere the same. Schwann has shown that the differences which exist between the independent cells are partly of a chemical nature, and in part referable to a difference in the growth of the cell-mem- brane, whence a morphological change of the cell may be pro- duced. With respect to this he has remarked, that the cell- membrane in various kinds of cells is chemically different. The membrane of the blood-corpuscles is dissolved by acetic acid j that of the cells of cartilage not. Just as the cell-membrane of homologous cells at different ages presents chemical dif- ferences, so also do their contents, which undergo a transfor- mation in the same cell. Young cells have hyaline contents ; and a granular deposit is gradually formed, usually, in the first place, around the nucleus. Other cells, at a certain period, form fat ; others pigment, in their contents. It would lead us too far from our purpose were we to further discuss the mani- fold and as yet too little studied metamorphoses of the cell- contents, though at the same time it appeared requisite that we should indicate the necessary connection between their normal and pathological metamorphosis. We shall commence at once with the pathological metamor- phosis of the cell-contents, which is brought about by deficiency of the nutritive material afforded to them. The most common form of metamorphosis or degeneration is the fatty. Smaller and larger granules make their appearance in the contents, which are strongly refractive, presenting a dark border and a brilliant central portion, and remaining unaltered when touched with acetic acid or soda. These fat-drops are sometimes so large as nearly to fill the entire cell. Care must be taken not at once to diagnosticate a fatty degeneration of the cell-contents from the presence of a few minute fat-drops in that part of an organ where the cells produce fat in the normal condition. The latter may be so abundant, that in a thin section nothing will be seen but a mass of fat-drops. The degeneration at the commencement is not uniform throughout the cell, the fat- drops accumulating usually in one part, and being grouped in such a way around the nucleus, that the latter is partially or entirely concealed by them. The fatty degeneration of the cell-contents, by the reception 53 PATHOLOGICAL CHANGES of colouring matter, may pass into the pigmented, although the latter may arise independently. The first modification of the pigmented degeneration, in all its stages, is easily followed with a little attention, since the colours from deep yellow gradually passing to brownish-black are presented in the cells whose contents have undergone fatty degeneration. It may be assumed, with considerable probability, that the pigmented involution originates, for the most part, from the dissolved, colouring matter of the blood, which penetrates the cell-wall, and undergoes various changes of colour within the cell, although, perhaps, the pigment may also arise in a kind of carbonizing process of the protein substance contained in the cell. The colours are deep yellow, orange, brownish-yellow, brownish-red, and black, with innumerable shades of all these hues. The molecules of pigment may either be still separable, or they may be so united together, that nothing but an opaque mass can be distinguished. In general, the pigmented form of involution of the contents appears to be develo{)ed more slowly than the fatty ; under particular circumstances, however, the development takes place more rapidly. If the blood contain an undue amount of water, the cell becomes distended by imbibition, rupture readily ensues, and the diluted contents escape. Such a change of the cell-contents is termed dropsical or aqueous. Its formation must take place with comparative rapidity. There are, doubtless, several other metamorphoses of the cell- contents, but which are observed with more difficulty. If, in consequence of a disturbance in the circulation, a larger quan- tity of albumen transude, the richer nutritive material will also influence the form of the cell- contents. In speaking of the adipose tissue, we shall become acquainted with metamorphoses of this kind, which are probably due to the reception of albumen. It is no less probable, we think, that a fluid colloid-substance may penetrate the cell wall, and induce modifications in the contents. By the abstraction of the watery portion, as may happen where the supply of blood is deficient or wholly wanting, the quantum of the cell-contents is diminished, the materials can no longer remain in a state of solution, and crystals form in the interior of the cell. OF THE NORMAL CELLS. 53 It has been long a well known fact that the lamellar de- posits are formed on the inner surface of the cell-membrane, successively from without to within, and are to be regarded as a solid continuous substance precipitated from the cell-contents. Now, these lamellar deposits on the cell-membrane also occur in pathologically metamorphosed cells, as we shall show in the course of the work, in cartilage and fat-cells. This view ap- pears to us much more likely than to suppose that these con- centric layers, formed on the cell-membrane, represent a thickening of that part. The cell-membi'ane varies in thickness in cells of different ages ; in young cells it is obviously thinner and less resistant. It is, therefore, conceivable that the thin-walled cells are more easily ruptured by the imbibition of water than those with older and thicker membranes, which are capable of enduring a more powerful distension. In numerous cases a very rapid disappearance of the cell- membranes takes place, caused by the chemical properties of many exudations, and in consequence of which a solution of them is effected. By the abstraction of a considerable proportion of the fluid contents, the cell-membrane becomes wrinkled, as may sometimes be observed in the shrunken fat-cells in lipoma. With respect to the question, as to whether the nucleus participates in the pathological metamorphoses of the cell- contents, — whether, for instance, it undergoes fatty degene- ration, it must be confessed that we have never been able fully to satisfy ourselves that this is really the case. The difficulty attending the ascertainment of this point will be apparent to any one who considers that both the fatty and the pigmented degeneration frequently commences at the immediate neigh- bourhood of the nucleus, in consequence of which the latter is often concealed from observation, without its being justifiable to assert that it has become degenerated in the one way or the other. On the other hand, we have so frequently an oppor- tunity of demonstrating the existence of the nucleus in cells thus metamorphosed, that well-founded doubt will arise whether it has become degenerated in those cases where it escapes our observation. The possibility, however, of its undergoing de- generation cannot from this be denied, a priori ; and we think, therefore, that no decisive opinion should be expressed upon 54 PATHOLOGICAL CHANGES the subject. The nuclei in cells of one and the same kind are of yarious size and figure ; their contents also themselves vary. The nuclei of younger cells are larger, vesicular, often quite transparent, or enclosing a fine molecular substance; whilst those of the older cells diminish in size, the smooth surface being replaced by a sinuous one, and at the same time they often become elongated. Several granules are perceptible in the interior. But this general typical form may, it is true, un- dergo various modifications. The common chemical character of most nuclei, consisting in their not being rendered transpa- rent by acetic acid, whilst that reagent renders the majority of cell-membranes hyaline, is very valuable in those cases where we desire to satisfy ourselves by chemical reagents of the nature of the nucleus. It not unfrequently happens, for instance, that, of the parenchyma of an organ, nothing remains but the nuclei, surrounded by a group of molecules, united by a connective substance. In the decomposition of an organ, the nuclei offer considerable resistance, and are even still to be met with when not a single perfect cell can be discerned. What pathological changes the nuclei undergo in the invo- lution of the cell cannot be stated. A coalescence also may take place between several cells con- tiguous to each other ; that is, the walls become invisible, and a larger or smaller cavity is formed, containing nuclei imbedded in a molecular substance. Even these may disappear; and nothing remain but a hyaline space, enclosing a few granules. This retrograde process appears to take place in consequence of the reception of a fluid matter, chiefly of an albuminous nature, or containing colloid. We shall say more concerning it in speaking of cartilage. Schwann has shown that the intercellular substance, or the cytoblastema external to the cells, is subject to the same changes as those which occur in the cell-contents. Usually, its quantity diminishes in proportion to the growth of the cells. With respect to the physiological relation of the cyto- blastema to the cells, it may be twofold. In the first place it must contain the nutritive matter for the latter ; and secondly, it must, at any rate to some extent, retain what remains of this nutritive material after the cells have taken up what is requisite for their growth. In animals the cytoblastema OF THE NORMAL CELLS. 55 receives the new nutritive materials from the blood-vessels. This theory of Schwann's also finds its full application in the pathological metamorphoses of the blastema deposited in the normal condition among the cells. The most frequent change is fatty degeneration. Larger or smaller fat-globules accu- mulate in this interstitial substance, so that the cells appear to be 'bordered by a circle of fat- drops. The latter may also be aggregated into larger groups, when the space occupied by the intercellular substance is more considerable, as, for instance, in cartilage- tissue, which in consequence loses its normal transparency and consistence. Pigmented metamorphosis takes place when colouring matter is deposited in the intercellular substance. In lower degrees this change is indicated by opaque, brownish-yellow, brown- red, or blackish specks of small size, in which the pigment- molecules may be still sometimes distinguished, and sometimes only dark- coloured diffuse spots are visible. The greater the extent and intensity of this colouring by pigment, the more completely must the intercellular substance disappear. We shall have an opportunity of referring to these observations more particularly in speaking of cartilage and bones. If the transudation destined for the restitution of the inter- cellular substance contain chiefly watery elements, or, in other words, if a dropsical efFusion be poured out, the intercellular substance undergoes a dropsical or watery degeneration, which proceeds, pari passu, with the degeneration of the cell-contents above described, and causes the cells to be more readily sepa- rable, or even wholly isolated. In many tissues the intercellular substance undergoes a peculiar metamorphosis, which may be termed "cleavage." It consists in a breaking up of the apparently homogeneous substance, and appears to take place not so much in conse- quence of a deficiency of nutritive fluid (a kind of desiccation), but rather by the intervention of a nutritive material, which, owing to its peculiar chemical properties, causes a separation of the individual layers of the intercellular substance. We shall meet with this process in the most marked way in carti- lage and bone. Lastly, a development of gaseous fluids may cause a disruption of the mutual cohesion between the cells. Relying upon these observations, we may be allowed to 56 PATHOLOGICAL CHANGES propound a theory of involution, which appears to us a scien- tific postulate for the necessary comprehension of the various phenomena. If we desire to resolve the life of the organism, as it were, into its elements, we must endeavour to acquire a more inti- mate acquaintance with the vital properties of its elementary organs — the cells. We must endeavour to ascertain Kbw the first appearance of the cells in the homogeneous blastema is evidenced — how their multiplication by division proceeds — what metamorphoses they undergo — what are the conditions pre- sented in the cells in their further existence — whether they remain stationary in their external habit or not — what stage of development they reach — whether motile phenomena occur in them, — or, in other words, we must strive to comprehend the cells as something living, in their nutrition, propagation, and movement. This vital and physiological survey must also be carried on in a pathologico-histological point of view, so that we must not be content to confine our regards merely to what is presented in the dead subject. ■ Just as the organism, as an individual whole, requires for its maintenance, nutrition, propagation, and motion, which are carried on only under certain external conditions, — ^just as when it reaches a certain point of development it remains stationary, and, as a whole, undergoes no further development of its vital properties, but begins gradually to retrograde, seeing that the sum of the vital phenomena is reduced to a smaller quantity, which, after a gradual diminution, falls to a minimum, and ultimately disappears, — which event we term the death of the organism, — so is it on the small scale with the elementary organs. The involution of the organism, however, does not proceed in a uniform and equal manner throughout ; individual organs undergo involution earlier than, and in a difi'erent way to, others. Thus, if the ovary, in the female, ceases to perform its function — which is the development of the unimpregnated ovum — at an early period, the proper parenchyma of the mammary glands will exhibit a difi'erent mode of proceeding in its retrograde metamorphosis. In these processes the affected organs necessarily receive less material applicable to their nutrition, or in their reception of it they must be impeded by corresponding external unfavorable OF THE NORMAL CELLS. 57 conditions. Now if the absorption of the fluid nutritive ma- terial, and the giving off of the non-assimilable parts, do not proceed according to the determinate mode appropriate to the cell, unorganizable elements will be left, and undergo the same metamorphoses which we have enumerated as forms of involution of the separate parts of the cells. The defective assimilation of the cells removes them, as it were, from the dor main of vitality, and they remain like dead particles, incapable of again entering upon their proper formative processes, en- closed within the sphere of the living organism. The possibility of the occurrence of a defective nutrition in the cell involves that of the opposite condition or of an exces- sive nutrition; or in other words the. possible occurrence of atrophy in the cell in the one case, implies in another that of its hypertrophy ; which latter condition is produced by a rela- tively excessive quantity of the nutritive material afforded to it. But this condition presupposes an exalted degree of assi- milative power, without which the nutritive matter would re- main an indigesta moles. In this hypertrophy the new molecules may be conceived to be deposited in two ways : they are either arranged uniformly around the whole periphery of the cell, or the deposition takes place in one part or another of it, unequally. There would thus arise a partial and a total hypertrophy of the cell, which latter may produce numerous modifications of form. The exalted vitality of the cell, however, is not limited simply to an exaltation of the assimilative power, but also ex- tends to the augmentation of the propagative faculty, in con- sequence of which a larger number of cells is formed by the process of division, when an increased supply of nutritive ma- terial is afforded. The result of the hypertrophy of the cells is an increased volume of an organ. This frequently happens, also, — that the nutritive material is not all applied to the purposes of assimilation, and consequently, some of it remains between the elementary structures as an in- applicable portion, and undergoes the same metamorphoses, as those which we have described as occurring in the involution of exudations. It has already been stated that hypertrophy of one part of an organ may co-exist with atrophy of another. CHAPTER IV. PATHOLOGICAL, NBW-POBMED CELLS. However incomprehensible it may seem, a priori, that from a fundamental substancBj the formative material or plasma, with whose more intimate chemical properties, it must be con- fessed, we are as yet unacquainted, parts apparently chemically dissimilar to it should be produced and, moreover, of great di- versity of form, still we can scarcely doubt that, at any rate, a partial explanation of the phenomenon may hereafter be ex- pected ; modern chemistry having aiForded such available results in the elementary analysis of organic bodies. As everywhere else, so in this~case, we are not in a condition to assign the cause of the specific formation of the blastema — its essential nature. We are consequently obliged to substi- tute a name for this unknown quantity, though it should be clearly understood that it is merely a name, unconnected with any distinct idea. We speak of a specific plastic force, know- ing, however, that in that expression nothing more is meant than the keystone of our conceptions with respect to the special organic formations of the plasma. It has been explained above, that the pathological plasma or exudation arises from an increased transudation of the liquor sanguinis under disturbed conditions of the circulation ; and with respect to this, chemical research has as yet afforded the most unsatisfactory results. With regard to the concen- tration of the formative fluid, Schwann has established the law that a concentrated solution is required for the first formation of a cell, as well as for the growth of one already formed. In ordinary crystallization also, the solution must be more than saturated for the crystallization to commence j when this has taken place, the fluid may serve, probably, for the growth of the crystals, though no longer for the commencement of crystallization. The basis of the tissue of all pathological new formations. PATHOLOGICAL, NEW-FORMED CELLS. 59 is constituted by the cells. We have, therefore, in the first place, to trace their mode of formation, to explain their various forms, and the metamorphoses the latter undergo. The forms assumed by the newly developed cells are very numerous, varying according to age, their different kinds, and a variety of malformations. Regarding the question in a genetic point of view, we shall commence with the form of development. Two modes of cell development may be distinguished, a free development originating in the amorphous plasma, and one by division. Schwann has endeavoured to show, that in the for- mation of the elementary parts, the way in which the molecules are conjoined does not diflfer according to the physiological nature of these elementary parts, but that they are arranged everywhere according to the same laws, so that whether it be a muscular fibre, a nerve-tube, an ovum, or a blood-corpuscle of determinate form or of one subject to only trifling modifi- cations, that is to be developed, a nucleus arises, a cell is formed around this body, and it is only in consequence of the changes undergone by one or by several of such cells, that the subsequent forms of the elementary parts are produced, or in a few words, that a common principle of development governs all the elements of the organism. The matter, however, does not seem to be so simple as this, and it is still very questionable, whether this last assertion be universally applicable, or whether divers modes of formation may not exist. In order to show, how even in Botany, where the conditions to a great extent are patent, and, consequently, more readily embraced, this question is still very far from having received a satisfactory solution — we will adduce the following remarks. With respect to the way in which the nucleus is formed in the granular protoplasm. Hugo von Mohl states that opinions differ very widely. The first observer who recognized the import of the nucleus and its development, was Schleiden. According to him, rather large globules are first formed in the protoplasm (the future nucleoli), around which the other granules become aggregated, coalesce to a greater or less extent, and uniting form the nucleus. Whilst, according to Nageli, a considerable mass does not at once unite to form the nucleus, but that body is said to make its appearance as a very minute corpuscle, seeing that the very commencement of 60 PATHOLOGICAL, the formation of the nucleus may be distinguished, although at first it be little larger than the globules of the protoplasm. He also assumes that t\\e , nucleolus is first formed, around which a layer of protoplasm is afterwards deposited, which itself is again invested by a gelatinous membrane, not coloured by iodine. W. Hofmeister expresses himself decidedly in opposition to both- these statements. Prom his researches it would appear that the formation of the nucleus is not preceded by the development of the nucleolus, and that free corpuscles are never met with floating about in the cell-juice, but the nucleus arises under the form of a spherical drop of mucous fluid, which subsequently becomes invested with a membrane. In many cases the nucleus does not at first present a trace of a nucleolus, and it is not till afterwards that one or several are formed in it, whilst in other cases, from the very beginning, one or several granides of a more solid substance swim about in the fluid of the nucleus, but which are not of necessity all developed: directly into nucleoli, inasmuch as only one of them may in- crease in size, and become invested with a membrane, whilst the others are dissolved. Mohl appears to regard the latter view as the more correct, except as regards the existence of the membrane around the nucleus and nucleolus, of which he has been unable to satisfy himself; he looks upon Nageli^s view as decidedly erroneous. With respect to free cell-formation, Mohl furthermore expresses himself in the following terms : " Although it is the rule, to which in the normal development of the cells of all the higher plants there is no exception, that in the nitrogenous substances, which give rise to the formation of a free cell, cell-nuclei make their appearance, this is by no means a necessary condition, but it seems that every spherical mass formed entirely or partially of protein-compounds may assume the functions of a cell-nucleus, and become invested with a membrane composed of cellulose, and thus give rise to the formation of a cell." From our own observations with respect to the elementary forms which first make their appearance in the pathological plasma, we feel compelled to adhere to MohFs view. It is certain that eyen in our protoplasm there is a primary formation of nuclei ; but under what conditions this takes place it is by no means easy to ascertain. It is too arbitrary an assumption NEW-FORMED CELLS. 61 at once to. explain the groups of molecules which occasionally are the first to appear in the plasma, as being nucleoli, seeing that these pretended corpuscles are often absent, and there are many elementary organs, whose nuclei present no nucleoli. Bruch and Virchow go so far, in fact, as to assert that in pathological cells the nucleolus never exists before the nucleus ; that it is, on the contrary, more probably a secondary forma- tion in the nucleus, which, according to Virchow, indicates a certain age of the latter, and according to Bruch a tendency to endogenous new formation in the nuclei. This assertion, in our opinion, is expressed too generally, seeing that in the in- dependent multiplication of the large nuclei in medullary cancer we decidedly witness a division of the nucleolus preceding that of the nucleus. A further question arises with respect to the vesicular nature of the nucleus, whether the frequently very obvious dark border at the periphery of the nucleus is to be regarded as a membrane investing it, or merely as representing a greater density in that portion of the substance. But the solution of this ques- tion has not yet been attained to. The primitive formation of the nucleus, in the more manifest instances, appears to us to ensue upon the precipitation of a compact, frequently very transparent substance from the fluid blastema; which precipitate becomes aggregated into masses of tolerably uniform size, in which, the nucleus is not formed till afterwards. Very delicate, hyaline corpuscles, in particular, frequently occur (for instance, in the gelatinous masses of the cervix uteri), of pretty uniform dimensions, and which maj be very readily overlooked. In consequence of their mutual pres- sure, they are compressed, and assume a polygonal figure; being arranged usually in series, or placed in groups together. In some a nucleus is apparent, without any granular appear- ance around it. These delicate elements cannot be equivalent to cells, and must be taken to represent coagulated corpuscles of uniform size. They are also frequently granular. Valentin termed these bodies, " exudation corpuscles," which name, as is at once obvious, has been unsuitably selected, inasmuch as they do not belong to the exudation as such. We should rather prefer the name of primitive corpuscles. It appears to us that the formation of the nucleus, and of the cell-wall 62 PATHOLOGICAL, ■ ensues as a secondary process in them. We are very far from regarding this as the normal mode of formation of the nucleus, though doubtful at the same time of the universal correctness of Schwann's view, that the more or less thick, sometimes homogeneous, sometimes granular layer deposited around the nucleus, is never formed until the nucleus has attained a certain stage of development. The peripheral portion of the layer surrounding the nucleus, appears to become consolidated, and gradually transformed into a membrane, which is not distinct until the substance enclosed by it has become diluted and liquefied. It is, in fact, indubitable, that in many pathological, newly formed, elementary structures, no development whatever of a cell-membrane takes place; the molecules consequently are merely held together by a connective substance. This is the case, for instance, in the pus- and granular corpuscles. The existence of newly formed pathological elements of this kind {e.g. Lebert's granular globules), which, though possess- ing a cell membrane and molecular contents, present no vestige of a nucleus, affords room for a double mode of inter- pretation. They have either not reached to the formation of a nucleus, or if such have once existed, it has been removed by solution. The second mode of development of the cell is that by divi- sion, a process which has also been termed multiplication. It consists in the introduction of a morphological metamorphosis of such a kind that septa are developed, by which the space occupied by the contents of the cell is divided into two or several distinct cavities. This process, as in plants, is preceded by the formation of as many cell-nuclei as there are sub-divi- sions oiihe parent cell; the cells contained in the latter have been termed daughter- or (secondary) cells. Cases, however, are met with, in which a separation of the cell-contents by ■septa, takes place into two or three divisions, but in which separation the nucleus takes no part ; for instance, in those newly formed elements, which are met with on the inner sur- face of many cysts. In other cases, again, it very frequently happens (in the cells of medullary cancer) that 3-8 nuclei and more collect in one cell, and often, in fact, more to one side of it, without there being the slightest indication of a division of the cell-contents. In this case, therefore, there can be no NEW-FORMED CELLS. 63 question of secondary cells. The latter, in general occur but very rarely. Division may also be effected in another way ; for instance, by a gradual constriction taking place from the periphery to- wards the centre, by which the cell is parted into two or more divisions. A fine groove is formed at the periphery of the cell which penetrates more and more deeply, until the portions which are ultimately united only by a slender bridge are com- pletely separated. The division of the nucleus takes place either before the formation of a cell-membrane or after it. Multiplication pro- ceeds in the following manner : the large nucleolus begins to elongate, presents two lateral grooves, and assumes an hour- ■ glass shape. The two portions are separated by constriction, and two nucleoli make their appearance, which are at first closely approximated, and gradually more and more distant. With the divergence of the nucleoli, the nucleus also increases in length, exhibiting at the same time shallow lateral grooves which penetrate more and more deeply, until from a single nucleus two are produced, each furnished with the preformed nucleolus. The grooves proceeding on the periphery of the nucleus, are continued usually in two, often in three places, or, it may be, in four. The figure of the nucleus is thus rendered hour-glass shaped, or of a trefoil form. After a cell-membrane has been developed, the same process goes on within it; but it cannot, under these circumstances, be traced with the same precision. Upon reviewing these primary modes of origin of the patho- logical, newly formed cells, and comparing them with those which arise in the normal plasma, we shall arrive at the con- clusion that the mode of formation of the cell in the patholo- gical plasma, is identical with that in the normal ; a conclusion expressed years ago by J. Vogel, Giinsberg, and several others. We shall now proceed to trace the further development of the newly formed cells, and to describe the various forms which they assume, remarking also upon the interruptions to which they are subject in their development, and pointing out the modes of involution which they undergo. The fun- damental form of the young cell is that of a sphere, or of an ellipsoid. They are seen very abundantly in those elementary 64 PATHOLOGICAL, organs, which undergo no further development, as, for instance in the pus-corpuscles, which are sometimes furnished with a cell-membrane, in the " pyoid- globules,'^ as they are termed, &c. These bodies, consequently, may be said to retain the fundamental form of the young cell. By a gradual flattening on two opposite sides, the sphe- rical form passes into the discoid, whose principal character resides in the diminution of the altitudinal diameter. Nu- merous varieties of this form exist, of wliich the principal are, the round, oval, and polyhedral. If the flattening take place, on two or several not corresponding places, we have the irre- gularly polygonal, elongated, flat form. The cause of the flat- tening may depend upon a dilution of the cell-contents, as Schwann has before remarked. If, as he expresses it, the contents of a spherical cell are altered in such a way that a fluid is produced in them of less density than the surrounding fluid, the cell loses some of its contents by exosmosis, must consequently collapse, and may thus be flattened into a tabular form, much like the blood-corpuscles, in whose cage, however, the acetabular depression has still to be accounted for. From the sphere or the ellipsoid is developed the caudate form, by a filamentary appendage being formed on one side of the round or oval cell, besides which, the latter appears to be attenuated at the point of insertion of the filamentary prolon- gation. The filament diminishes in thickness from that point to its acuminate extremity. Two modes of proceeding may be conceived as productive of this form. The cell is either elongated as a whole, by the apposition of new molecules, especially towards one side, or the cell-membrane is ruptured at a minute point, and a portion of the semifluid contents escape, and are immediately consolidated into a filament. The latter process, it must be confessed, has only once been ob- served in the young spherical cells of the cellular tissue in the Tadpole, in which, after rupture of the cell-membrane a portion of the contents was protruded in the form of a conical appen- dage, which in the course of a few seconds, was extended into a slender acuminate filament at least six times as long as the cell. The conical form may be regarded as marking a transition NEW-FORMED CELLS. 65 to the caudate, in which a less diminution of the transverse diameter of the cell takes placBj in consequence of attenuation. If two processes are formed at opposite points of the cell, so that the latter, in fact, appears to be drawn out in two directions, the fusiform figure is produced, modifications of which arise from the more oval or more elongated shape of the central or main portion. Not unfrequently a bifurcate splitting of one or other of the filamentary appendages is ob- served. If, again, three or several processes project from the periphery of the cell, the stellate form, as it is termed, is pro- duced, which aiFords numerous varieties, dependent upon the dimensions and figure of the body, and the thictness, length, and points of insertion, of the processes. The cells furnished with processes, like the ganglion-cells, may be distinguished into unipolar, bipolar, and multipolar, according as they are furnished with one, two, or several processes. The size of the newly formed cells is subject to much diver- sity ; whilst, on the one hand, it may not attain to the dimensions of the normal cell, on the other, it may far exceed them. In one and the same cancerous tumour, elements of the most widely difi'erent size are not unfrequently met with. The inordinate size is caused by an excessive nutritive and proga- gative faculty in the cell, which, moreover, may be limited to only some of the groups of cells. The pathological newly formed elementary bodies often appear malformed, sometimes in consequence of an unequally distributed superfluity of development, sometimes owing to the development being interrupted; in which latter case the condition is attended with all the phenomena which we have described as belonging to the involution of the normal cell. The malformations consist in the unsymmetrical develop- ment of the parts of the cell. The nucleolus may attain the comparatively enormous size of a pus-corpuscle, and the nuclei may be considerably distended, whence a coalescence of several nuclei appears to take place ; or, on the contrary, they may be- come smaller, and undergo solution; the cell-membrane may be unusually thickened or attenuated. In consequence of these changes, the outhne of the cell is altered in many ways, presenting irregular, boss-like enlargements, wrinkles, &c. 5 66 PATHOLOGICAL, The involution of the newly formed cells may take place in every stage of their development, whence it is obvious that, a mass of elementary organs of this kind may cease to be any further developed, — stopping short at the formation of the nucleus or cell-membrane, — the ceU contents, in consequence of the depressed vitality, degenerating ; or, in other words, that the newly foimed elementary organ will perish. The most fre- quent form of involution is the fatty degeneration of the cell- contents, occasionally passing into the pigmented. The newly formed cells may, besides this, become softened, shrunken, and cretified, or the subject of dropsical degeneration. In taking a general survey of the shapes of the pathological, newly formed cells, we shall be unable to discover, even in those which are fully developed, any fundamental type peculiar only to new-formed cells ; for the malformations which occa- sionally occur, whether they are referable to an excessive size of the nucleus, or of the nucleolus, or to the irregularity and more considerable dimensions of the external outline, may also be wanting, without the newly formed cell losing any of its character. We sometimes hear of cancer-cells, and should, therefore, be justified in demanding such information respecting them as will place us in a condition to distinguish a cancer-cell from any other. But the supposed characters are referable to malformations, which, it is true, are not very rare among this class of cells, but they are just as often wanting, although the cancer-cell, nevertheless, would not on that account cease to be a cancer-cell. This proposition may be regarded as established, that pathological, newly formed cells have no special characters peculiar to them. It would certainly be very convenient if we could at any time at once recognize a cancerous, tubercular, or pus-corpuscle (an appellation likewise conducive to misunderstanding, as we shall afterwards see in the Special Part) as such, in the same way, for instance, as we can distin- guish the itch-mite from the acarus folliculorum ; but, alas ! it is not so ordered for our convenience. In continuing the general consideration of the subject, we come to the connexion of the new-formed cells. This may be so las, that a very moderate pressure on the surface of a section of the new-formed tissue affords a mass of cells NEW-FORMED CELLS. 67 which may be very readily isolated in water. - In other instances, again, the connection may be so intimate, that pressure on the cut surface will not afiford, as in the former case, a juice rendered turbid by the admixture of cells, but a transparent, limpid fluid containing scarcely any morphological elements. The reason of this difference, independently of a certain degree of laxity of tissue due to maceration &c., must depend upon the chemical diversity of the intercellular fluid, by which the elements are united sometimes more closely, some- times more loosely. The cohesion of the new-formed cells also depends upon the mode in which they are mutually conjoined, and the latter again upon their form. Flattened, new-formed epithelial cells, for instance, from the inner surface of a cyst, exist only in a single layer, and are easily raised from the surface in entire plates by means of a scalpel ; but they are themselves tolerably firmly united to each other by a viscid, intercellular fluid soluble ia water. Laminated flat cells are conjoined, loosely wedged together by their oblique lateral surfaces, and may readily be obtained in lamellar groups. Acuminated, elongated cells often occur closely wedged together. New-formed connective-tissue cells, as, for instance, in a fibroid growth, can be brought into view only after careful separation under water. The disposition of the new elementary structures also depends upon the situation in which they occur ; in a large space, and on a free surface, it will not be the same as in a more confined locality. The secondary arrangement of the elementary organs, or the relative disposition of the groups formed by them, to each other, is by no means accidental, but takes place according to a deter- minate type, connected with the character of the new-formed tissue. The type necessarily alters, according as connective tissue, organic muscular fibre, bone or dentine, constitute the new formation. The most extensively distributed type is the areolar, of which, on account of the frequency of its occurrence, as well, also, as on account of its relations to other formations, we will treat more thoroughly. The areolar (better than alveolar, because area signifies a free space, alveolus a depression or space entirely closed on one 68 PATHOLOGICAL, side) tissue has, in our opinion been hitherto too little regarded in its various forms by German histologists ; English writers having given it the proper appellation. Todd and Bowman were the first to give a good figure and a corresponding description of this tissue. Among the Germans, it is well known that Henle had previously proposed the adopted name of " connective tissue" instead of " cellular tissue," because the idea of a cell involves that of a closed space, but the spaces of the " cellular tissue" are not closed ; if the latter term, there- fore, be employed, it is requisite that the idea of the cell should be abstracted from it, and, instead, that of spaces communi- cating by connecting passages with others, alone comprehended under it. The areola are formed by the fibrous fasciculi taking an arched course, and, consequently, decussating with others. The fasciculi, moreover, subdivide into secondary and tertiary branches, whence is produced a fine network of delicate fibrous bundles. This system of subdividing fasciculi is bounded by thicker bundles, constituting, as it were, the fundamental frame-work, or stroma. Nor should the fan-shaped expansion of a cylindrical bundle be overlooked, because it is precisely by this that the walls of the areola are chiefly bounded. The latter, consequently, represent incompletely closed spaces bor- dered by the fan- shaped expansions and bifurcations of the fibrous fasciculi. The areolar passages are constituted of much-branched, sometimes tubular, sometimes fissure-like spaces, connecting the areola. It is through them that fluids may be forced from one areola to another. The size and form both of the areola, as of the areolar passages, are very various. The chief difierences in figure are shown in the rounded and fissure-like areola, and also in the simple and compound, which latter are subdivided into several secondary sinuses by projecting ridges, as may always be observed in the larger areola. When a fine section of an areolar tissue is made, the areola must necessarily be cut across in all directions; consequently, a tolerably extensive section is required to enable us to judge of their form. In these spaces, the new-formed elementary organs are deposited, filling them more or less completely. It is probable NEW-FORMED CELLS. 69 that the older formations of this kind are placed more towards the wall of the areola, and the more recent in the central part of it J but since, as we shall afterwards see, the grouped cell- formation proceeds in a serpentine line, the position just remarked has only an approximate probability. This much, perhaps, is certain, that the fusiform cells are usually met with on the wall of the areola. It is self-apparent, that all areolar tissue in which new-formed elements are deposited, should not be regarded as newly developed, inasmuch as exudations may be poured out in the normal tissue, as, for instance, in cedema of the skin. But, on the other hand, a new formation of areolar tissue must be assumed to exist when it is present in large quantity, or when it occurs in an organ which, in the normal condition, contains no areolar tissue of the kind. A type, closely connected with the foregoing, is the papillary, villous, or clavate, which becomes the dendritic vegetation of Rokitansky, when the hollow clavate processes, as they are termed by him, are developed, by their throwing out of pro- trusions and processes into sacculi of a secondary and tertiary order. The shape of the papillae, villi, club-shaped processes, or vegetations, is sometimes tapering, sometimes conical, cylin- drical, or tuberculous, and verrucose, with every variety of intermediate form. In size, they vary from a diameter of 0'039" and more, to one requiring a magnifying power of 50 to 100 diameters, for its distinct definition. The long diameter may considerably exceed the above, but in the case of those of the verrucose shape, it may be less than the transverse. These structures are affixed upon the parent surface sometimes by a slender peduncle, sometimes by a broader basis, placed in groups or isolated, and forming umbellate figures or botryoidal eleva- tions. The arrangement of the elements composing them is as follows : On the surface, a membrana propria is occasionally demonstrable, or a simple layer of epithelial-like cells ; in the interior, sometimes, a hyaline fluid, a more or less fatty or pigmented substance, or solitary cells of various characters, together with blood-vessels, or blood simply enclosed in a space. These new formations occur either upon free surfaces, serous membranes, — as the arachnoid, pleura, peritoneum, — on syno- vial membranes, or within the areolar tissue. Rokitansky has 70 PATHOLOGICAL NEW-FORMED CELLS. pointed out their frequent occurrence in the stroma of cancer, and in cysts. Both these types constitute the basis of the secondary arrangements of the pathological new-formed elementary organs. We shall show, that the areolar and papillary types of tissues, extend through the entire group of compound vege- tations (neophytes). CHAPTER V. FORMATION OE FIBRES. A portion of the fibrin of the blood, prepared for micros- copical examination, procured from the dead subject, and freed from albumen and other constituents of the serum, exhibits the appearance of a fine, intricately interlaced network of fila- ments. The filaments are short, and of pretty nearly uniform thickness, presenting angular curves, and are never arranged in parallel bundles. Larger and smaller interstices are left in this filamentary network, which are occupied sometimes by blood-corpuscles, sometimes by a transparent fluid. As regards the process followed in this formation, it maybe supposed that when the fluid fibrin is removed from the circulation, its state of aggregation becomes altered, more or less rapidly, according to circumstances ; passing into the solid state from the surface, inwards, in which proceeding the molecules rapidly coalesce, and form short, interlaced filaments, without their having previously entered into any stage of development. This coagulation cannot go on simultaneously in all the layers of the fluid fibrin, since it is not possible that the ex- ternal circumstances should act with equal intensity throughout; at most, the difference of time, when the influence is very in- tense, may be inappreciably minute. It may also, perhaps, be assumed, that in the case of thin layers, a portion of the fibrin may remain fluid even after a certain lapse of time, whilst in another portion it has already become solidified, since the pro- cess must ultimately remain the same on the large as on the small scale. Now this fluid fibrin may be lodged in hollow spaces formed by the interlaced filaments, whence it is at once obvious that the spaces must be larger in proportion as the quantity of fluid fibrin is greater. It must also be allowed that the fluid fibrin may ooze through the porous network and, having assumed a viscous consistence, be retained in the 72 FORMATION OF sinuses formed in the completely coagulated fibrin. When this mode of grouping of the filaments of fibrin is compared with the areolar tissue, a striking similarity will be apparent. If we take, for example, blopd in the fresh condition, pus, or the sputa from diseased lungs, and treat these substances with acetic acid, we shall remark an immediate turbidity to be produced, depending principally upon fine straight filaments, which in many places form a delicate interlacement, and which were not perceptible before the addition of the acetic acid. This form of coagulation differs from that above described, in this respect, that the filaments are longer, straight, rarely con- stitute a fine network, and are occasionally arranged several together and parallel to each other, though they never occur in delicate undulating bundles. These fibres differ from those oi fibrin and of connective tissue, in the circumstance that they remain unaltered by acetic acid ; they belong to the principle termed mucin. l^hus we find two elements, fibrin and mucin, which are di- rectly produced by a change in the state of aggregation from the fluid to the solid condition, without their having previously entered any other stage of formation. They are met with in the most various morbid products. Quite distinct, in an anatomical, chemical, and genetic point of view, are the fibres which belong to the cellular or connective tissue, and which cannot be confounded with the filaments of coagulated fibrin. They are characterized mainly by the deli- cate wavy course of the bundles formed by the united fibrils, and, when treated with acetic acid, by their exhibiting at cer- tain intervals, numerous, oblong nuclei, after the bundles have been rendered so pale as to be almost indistinguishable. The origin of the connective tissue fibres is to be sought in gelatinous new-formations of cellular tissue, and it may be satisfactorily shown that the mode of origin from the fibre-cell is precisely the same as in the normal condition. We venture, therefore, to quote Schwann's description of the process of development of the cellular tissue. " In the structureless, gelatinous, cytoblastema of the cel- lular tissue minute spherical cells are first formed, probably around a pre-existing nucleus. The cells containing a charac- teristic (?) nucleus, become pointed in two opposite directions FIBRES. 73 and these points are drawn out into filaments, which occasion- ally give off branches, and ultimately break up into bundles of excessively fine fibres, which at first cannot he distinctly recog- nized when isolated. The further development now consists in a continuation towards the body of the cell of this breaking up of the main filaments into a bundle of finer fibres, so that subsequently a fibrous fasciculus proceeds immediately from the body of the cell, in which itself, at a later period, the same process of subdivision commences. Ultimately, the body of the cell is entirely broken up into fibres, and the nucleus rests merely on a fibrous fasciculus. At the same time the fibres are developed in such a way as to become separately, distinctly discernible and smooth, assuming an undulating course, and, in short, putting on the aspect of the common fibres of cellu- lar tissue. Since the fibrillation proceeds from both sides to- wards the cell-nucleus, the fibres remain connected for the longest time close to that body, until at last this portion also becomes fibrous. The nucleus then remains for some time longer, lying upon the fibrous fasciculus, and is ultimately ab- sorbed, so that in place of the original single cell, we have a bundle of fibres." From analogy, the same author considers it probable that the fibre-cells are hollow. Some support for this supposition may be inferred, in a pathological point of view, from the frequency with which fibre-cells, whose contents have undergone fatty degeneration, may be noticed. The con- nective tissue fibres, the main foundation of all tissues, play a very important part in all compound new formations. The development of the elastic fibres has not been traced so far as to allow it to be stated with certainty, whether even in the normal state, they always originate in a fibre-cell. It is quite certain that fibres of this sort occur in a pathological new formation often in very great numbers, and of considerable thickness, the contiguous fibres also being interwoven into a close and fine lattice work, which presents the same morpho- logical conditions as coagulated fibrin. The thicker, elastic fibres of course cannot be confounded with anything else, exhi- biting on one side a strongly marked shadow, on account of their cylindrical figure, together with the well-known serpen- tine, frequently spirally contorted, tendril-like course; but the very delicate fibres when, not in connexion with cells or with 74 FORMATION OF FIBRES. thicker elastic fibreSj may, when very closely packed, give rise to mistakes. The unchangeableness of the elastic tissue in acetic acid and dilute solutions of carbonated alkalies must also not be lost sight of. CHAPTER IV. rOUMATION OF THE AHEOLAS TISSUE, AND OE THE PAPILLARY NEW-EORMATION. The areolar cellular tissue is constituted, as has been said above, of inarching fibrous bundles, which by their ramifica- tion and decussation inclose spaces communicating with each other. In the latter exist the cells of the cellular tissue, rounded elementary organs, furnished with one or several pro- cesses. The fibrous framework and the elementary parts lodged in it are, consequently, the two things whose develop- mental relation we have to pursue. Let us reflect upon the possible eventualities of the formation, and endeavour to re- concile them with unprejudiced experiments. First, as to the question — is the fibrous framework produced before, simultaneously with, or after the formation of the cells ? "With respect to the mode of origin, let us inquire, — may it be assumed with certainty, that the fibres of the young patho- logically new-formed tissue, also, always originate from fibre- cells; or do they arise, in some degree, by the intervention of coagulated fibrin or mucin ? If we compare our observations with respect to the origination of the embryonic cellular tissue with the formative process (with respect to the former question) in the gelatinous new- formed cellular tissue, and in gelatini- form cancer, we shall find, that the progress, or the series of successively developed elementary organs, in pathological cases, remains essentially the same as in the normal condition. The modifications which are found to occur, present no essential differences. The first morphological elements that make their appearance in the hyaline, pathological blastema are solitary, spherical, and granular cells, — sometimes with, sometimes without, any de- monstrable nucleus ; and isolated fibre-cells, — usually furnished with two, diametrically opposite processes, containing one, two, or more nuclei, and occasionally without any, and which are 76 FORMATION OF THE AREOLAR TISSUE capable of spontaneous division, so that from a single fibre-cell two are produced, a circumstance of considerable importance as regards our subject, and which has not, as yet, so far as we know, been noticed. A third process is often perceptible on the body of the fibre-cell, which runs either in the same or in a different direction to the other two processes. In addition to this, a third fibre-cell will present a fourth process given off from its body (e. g., in the young cellular tissue- formation on the concave surface of the ■placenta), whence a figure is produced repre- senting two fibre-cells whose bodies have coalesced. In the body of a cell of this kind, furnished, as it were, with four pointed protrusions, there may be observed sometimes one, sometimes two nuclei. These undoubtedly represent quadripolar fibre-cells undergoing division. Now, the elementary parts just described, may be seen before any trace of a fibrous bundle is perceptible. We can, conse- quently, answer the first question by stating, that the formation of the cells precedes that of the fibrous frame-work. Before going further, it is necessary to consider those modifications in which the spherical elementary organs (gelatiniform cancer) occur, not solitary, but at once in groups, in places in the blastema, where few or even no solitary fibre-cells whatever, and still fewer fibrous bundles are to be met with. This grouping of the elementary parts sometimes takes place in the form of a cross, sometimes 'in that of a serpentine line. Hence, it is probable that the cause of this grouped disposition resides in an augmented multiplication of the cells by division. For an answer to the second question, it is necessary that we should recur to what has been said with respect to the formation of the fibres, and also, to some extent, discuss it more fully. From the supposition thrown out' by Schwann, it has been thought that the fibre- cell is hollow; and we have con- ceived that this supposition might be strengthened by the fact of the frequent occurrence of fatty degeneration in the cell-contents. The statement first made by him, also, will be remembered, according to which, the fibrillation of the process of the fibre-cell proceeds from its point towards the body of the cell. The matter may be put thus : let that part of a glove which corresponds with the hand be regarded as the body of the cell, the fingers of the glove as a fibrous AND OF THE PAPILLARY NEW-FORMATION. It bundle. Now, if the membrane at the point of the angle between two fingers continue to grow towards the hand, the glove will ultimately be subdivided into five fibres. In the case of the fibre-cells of the cellular tissuCj however, the additional difficulty occurs, that the fibrillation proceeds, from two opposite sides, towards the cell-body ; and, ultimately, each fibre on the one side must correspond with another on the opposite side. But this can be as little explained as can the union of the corresponding primitive fibres in the reproduction of nerves. This attempted exposition of Schwann's may be assisted by the assumption that the contents of the fibre-cell are fluid, and gradually pass from the fluid into the solid condition, from the point of the process towards the body of the cell, during which the precipitated molecules arrange themselves in longi- tudinal rows, become fibres, and meet in the transverse plane of the cell-body. In consequence of the spontaneous multipli- cation of the fibre-cells, which indubitably takes place, entire chains and series of such cells are formed, all of which, passing in the way just described, into connective tissue fibrils, are metamorphosed into a more or less considerable fasciculus. At the same time, it is conceivable, or even actually demonstrable, that the multiplication of the fibre- cells, like the modified cir- cular and spiral grouping of the spherical elements (gelatiniform cancer) above noticed, may also take place in a spiral form, in consequence of which a fibrous fasciculus is produced, enclosing a hyaline fluid blastema, or which is hollow ; in fact, Rokitansky has shown the existence of such hollow connective tissue bundles in the stroma of cancer. Nor should it be overlooked, that the fibre-cells are arranged, not simply in longitudinal rows, but that they also present lateral branches of similar series of cells, so that dendritic ramifications of chains of fibre-cells are produced. Now, let us suppose that three fibre-cells, a, b, c, occur in the hyaline blastema in various positions, from them as many chains of fibre-cells, a', b' , c', will be produced, which must decus- sate at three points. And if we suppose similar chains of cells to be placed above and below a', b', c', we shall manifestly have decussations in numerous directions, and some of the series of cells disposed parallel to each other. It is also instructive to observe, that the spherical cells of the areolar tissue, which 78 FORMATION OF THE AREOLAE TISSUE are, nevertheless, also multiplied by division and disposed in groups, must be encompassed by the chains of fibre-cells trans- formed into fibrous bundles. A second possible mode of origin of a tissue, closely approach- ing the areolar, is exhibited when the blastema is highly coagulable, and the fibrin or mucin contained in it assumes the form which we have already more particularly discussed [vide, formation of fibres), viz., a fibrous framework with intercom- municating spaces, in which an organizable fluid is lodged, which afterwards gives origin to spherical fibre-cells. It appears to us probable, that this fibrinous or mucinous frame- work, containing elementary organs imbedded in it, occurs in many, rapidly developed forms of cancer. The second question, therefore, may be thus answered : that, in the great majority of cases, the fibrous framework of the areolar tissue is developed from the fibre-cells by spontaneous multiplication ; and that, in other cases, a chiefly fibrinous or mucinous framework aflurds the sole or an accessory fundamen- tal stroma. Now, with respect to the process of development of the papillary new formation, or of the hollow clavate growths, and of the dendritic vegetation of Rokitansky, we have only to apply what has been above adduced on the subject of the mode of formation of the areolar tissue, and shall find that the formative process in question is also readily explained in the same way. In many pathological blastemata, the multiplication of the new- formed elementary organs by division is very extensive; whilst, as these elements are usually developed only in a deter- minate direction, the absence of many-sidedness of the organization is recompensed by an extension in the single direction. This is the case, for instance, in the fibre-cells, which, in inany morbid structures, exhibit an enormous pro- ductive faculty, so that the lateral branches above noticed again give off lateral twigs ; and in this way an arborescent system of fibre-cells Is produced. Now, this formation projects inter- nally, on the one side, into the more spacious areolae and areolar passages ; whilst, on the other, less obstacle is afibrded to its comparatively greater development on the free surfaces of organs, the mucous and serous membranes. When the productive faculty of the fibre- cells ceases, it is conceivable that those AND OF THE PAPILLARY NEW-FORMATION. 79 last produced, at the extremities of the whole chain of fibre- cells will incline towards each other, and that in this way would be produced an arched bundle of fibres, such as we have often an opportunity of noticing at the clavate extremities of the dendritic vegetations, — for instance, on serous mem- branes. In the areol<£, particularly of the stroma of cancer, the projecting fibrous bundles frequently acquire an epithelial investment. Now, if we consider the development of the fibre-cells in a spiral, it is obvious, as stated above, that a hollow fibrous bundle is produced after the completion of the fibres, which, after the fibre-cells have ceased to multiply, is closed in the way above described, by the mutual approximation of the latter. The pi-ocess of formation of Rokitansky's " hollow tubes," may be explained in this way. The papillary new formation, and the dendritic vegetation arising from it, do not, however, always attain to the stage of fibre-formation, often remaining, apparently, in the primarystate of nuclear formation, or the contents of the growth may even at once break up into an opaque molecular substance. The nuclei occasionally appear simply as lighter-coloured, minute, symmetrically distributed spots at the apex of the papillary new-formation, imbedded in a fine molecular substance, or disposed along the whole length of the growth {vide Gelatini- form Cancer). We have termed the nuclear formation merely apparent, since it is possible that the nuclei may belong to very delicate cells. Eokitansky has traced the development of these papillae or clavate processes, in the so-termed false mem- branes or serous membranes, and describes them as conical and clavate processes, opaque at the free extremity, and usually transparent and empty at the base, growing from determinate spots which look like nodular points of the mesh-work. It is obvious that the earliest rudiment of the papilla is essentially the same, as that which may be observed in the young villi of the chorion in the first months of pregnancy, when they consist merely of a molecular substance. The same author has, moreover, observed, the farther development of the clavate processes in gelatiniform cancer. In this case he describes, besides the older stroma, consisting of slender, hyaline trabe- cule, occasionally broken up into delicate, undulating, curled 80 FORMATION OF THE AREOLAR TISSUE. fibrils and pervaded by oblong nuclei, a second, of younger growth, constituted of stronger opaque trabecuke, occasionally perforated by very minute openings, the former of which were composed of nucleated cells, together with elementary granules. Thus, from the papillary processes a new system of cells per- vading the fibrous stroma would be formed. To explain the mode of construction of the papillary new-formation, it might be supposed that below the siirface of a free membrane, or in a hollow tube of the cancerous stroma, composed of connective tissue, a blastema was deposited in certain, circumscribed places, in consequence of which an exalted productivity would be established, and new molecules be deposited among the older, which new molecules gradually accumulating, would produce a saccular protrusion. To render the matter plain, let us take four atoms, a, b, c, d, corresponding to a spot of the subjacent organ, and it will be allowed that these atoms must be separated from each other, if new atoms a' , b', c' , d', come to be intercalated. Eight molecules, however, cannot be lodged in the same space, consequently if opposed by any obstacle towards the interior, they must be deposited towards the exterior. The projecting blastema now undergoes a sort of organization, the new elements continue to multiply in it, and form catenated rows with lateral branches; in short, the same process goes on as that which we have described in speaking of the fibre-cells. Upon comparison of the dendritic ramifications of these new formations with certain crystalline forms (sal ammo- niac, for instance), there will be observed, in the latter case also, at certain intervals, points at which branches and twigs are given off; and, therefore, a perfectly analogous type of formation will be seen to exist between organic and inorganic substances. CHAPTER VII. I'ORMATION OP THE VESSELS. In the case of pathological new-formed cells, we distinguished a development of them from pre-existing cells, that is to say, a multiplication, and a free development from an amorphous blastema, without any pre-existing cells ; and in the same way, in the case of the formation of vessels, we meet with a simple multiplication from already existing vessels, and a primitive origination in exudations undergoing organization ; and we shall satisfactorily find that the formative type in the physio- logical condition is essentially the same as in the pathological. Schwann has observed the multiplication of the capillaries, both in the germinal membrane of the Hen's egg, and iu the tail of the Tadpole, and found that these vessels are not regu- larly cylindrical, but of very various diameter. " Usually they are widest where branches are given off, sometimes even wider than the common capillaries. The branches as they proceed from these dilated portions very rapidly diminish in size, enlarging again as they approach another wider part. All degrees of this attenuation may be observed, from vessels in which it is scarcely perceptible, up to some in which the narrowest part is scarcely tliicker than a fibre of cellular tissue. Besides this, branches are sometimes given off from these wider portions which likewise become rapidly attenuated to the fineness of cellular tissue-fibres, and afterwards cease, before reaching another dilated part — caecal branches." KoUiker has confirmed Schwann's researches on this subject, and also shown that the young capillary vessels are connected with nucleated, many-branched fibre-cells. The contents of the latter, as well as of the young capillary vessels, according to Kolliker, appear to consist of fatty globules. These globules are afiixed iu groups on the inner surface of the irregular young vessel. Opportunities are frequently afforded of noticing appearances 6 82 FORMATION OF in a pathological point of view, entirely analogous to the phy-^ siological process, in the so-termed false membranes developed on the inner surface of serous membranes. We have only to add the general observation, that the continued development of the fibre-cells in a spiral, finds its application in the capillaries, and that in this way the occurrence of sacculi may be explained. The free development of the capillariesin an exudation, or their primitive appearance, also undoubtedly takes place in the same way as that already described by Schwann, as being followed in their development in the germinal membrane of the incubated egg (at the end of 36 hours). That is to say, stellate cells are formed, — ^primary cells of capillary vessels, — placed at certain dis- tances apart. " The elongations of various cells meet, the dissepi- ments are absorbed, and thus is produced a network of canals of very unequal dimensions, since the elongations of the primary cells are far slenderer than the bodies of the cells. But these elongations or connecting canals of the cell-bodies, continue to enlarge until they all attain to a uniform size, equal to that of the cell-bodies, which contract in the progress of growth ; in this way a plexus of canals of uniform diameter is formed. The blood-plasma constitutes the contents both of the primary as well as of the coalesced or secondary capillary-cells, and the blood-corpuscles are young cells formed in the interior of the capillary vessels." In pathological instances, a certain excess, and occasionally a deficiency in the formation of capillary-cells, cannot be denied to exist, in these cases, therefore, various forms are met with. In formations of this kind, we frequently find sacculated aneu- rismal dilatations, termed by Bruch sacciform vascular new- formations, referring them, as we think correctly, to the " germinal sacs" of J. Engel. We also conceive that the supposed enlargements of the capillaries in an inflamed part of the human cerebrum, containing blood- and lymph-corpus- cles, observed by K. E. Hasse, and KoUiker, belong to the same category, and are to be regarded, not as dilatations of the capillaries previously existing in the tissue, but as new- formed vessels of the kind now in question. The diameter of the pathological, new-formed capillaries, is in general more considerable, and increases or diminishes with THE VESSELS. 83 greater rapidity, than that of the vessels of normal tissue. The structure, also, in the vessels of larger calibre, to which, judging from the normal, a more complex kind of construction would seem to belong, is usually one of the simplest kind, consisting, in fact, merely of fibre-cells, disposed in the longi- tudinal direction of the vessel, and furnished with oblong nuclei ; more rarely a transverse layer of fibre-cells is super- added ; but more frequently a thinner or thicker layer of un- dulating connective-tissue fibrils. It is obvious that the blood, which is newly formed in vessels, spontaneously developed in the exudation, cannot enter the circulation, until, by the multiplication of the new-formed capillaries, the communication between them, and the normally existing vessels is definitively established. The new-formed blood, properly speaking, can be continually urged backwards and forwards, only on the supposition that the fibre-cells of the vessel, and those immediately contiguous to it, are con- tractile. The blood-vessels in new-formed tissues usually ramify in the same manner as those of connective tissue ; the vessels may be noticed running in wavy, more or less abrupt curves, in many places forming vascular coils, and breaking up into oc- casionally very delicate, much interlaced capillaries ; and not unfrequently we may observe parallel vessels, as is well known to be the case, in the connective tissue. The number of blood- vessels is very unequal in diiferent new formations, and even in the same, in different parts of it, and depends much upon the basis or organ upon which the new formation is situated. CHAPTER VIII. I'OKMATION OP CYSTS. Observers have latterly arrived at the conviction that the idea "comprised in the term " cyst," must be restricted, in order to avoid the throwing together of things which have manifestly no mutual relations. For instance, at the present day, we no longer term a membrane of connective tissue, such as is formed in cancer and sarcoma, a cyst, but regard it as an hypertrophied capsule composed of connective tissue; nor should the cavities which arise in medullary cancer, in consequence of softening of the substance, be described as cysts. According to our notion, the cyst consists in an excessive augmentation of volume of the areola of the areolar tissue and of the papillary new formations composed of connective tissue ; which augmentation is limited to smaller or larger portions of the tissue. Cysts, therefore, would stand in intimate relation to the last-named formations, from which, in fact, they would originate. Favorable conditions, therefore, for the origination of cysts would be afforded in all those organs, which, in their normal anatomical condition, include partially or completely closed saccular spaces, and which besides that, in their pathological states, are especially prone to the production of new forma- tions constituted of the areolar tissue, and of papillary excres- cences (e. g., thyroid gland, kidney, mammary gland, ovary, &c.) The formation of cysts, therefore, may take place in any organ, only it will occur the more rarely in proportion to the rareness with which new formations of areolar tissue are pro- duced in the organ. We regard cysts, consequently, not as anything substantive or primary, but as of a secondary nature. Before proceeding to the mode of formation of cysts, it is necessary to consider their intimate structure. In the perfect cyst-wall there are two layers which demand attention : — 1. The external tunic, composed of connective FORMATION OF CYSTS. 85 tissue, and constituted of intricately interlaced, more or less lax, connective tissue-fibrils. Towards the part by which it is attached to the parent tissue, consequently towards its basal portion it is always more dense, a circumstance especially ap- parent in pedunculated cysts. This membrane also contains blood-vessels, often in a high degree of development, and forming a more or less complete capillary system. 2. On the inner surface of this tunic a single layer of flattened, more rarely conical cells is apparent, which is termed the epi- thelial layer of the cyst. It is not found to cover the whole internal surface of the cyst, being absent from those parts at which ridge-like processes of the external connective tissue layer- project into the interior. Blood-vessels proceeding from the outer layer also run in these projecting ridges, and often give rise to hemorrhages into the cavity. Papillary, and also dendritic new formations may often be noticed upon these pro- jections, which may attain such dimensions as more or less completely to occupy the cavity of the cyst ; they lodge in their interior, vessels derived from the connective tissue tunic, and frequently present an epithelial layer on their exterior. These hypertropliied ridges of connective tissue and papillary new formations, may themselves again be metamorphosed into cysts, when we have a larger cyst enclosing several smaller ones. The contents of the cyst are usually fluid, albuminous, or of a colloid nature. If its organizability is promoted by a greater development of the vascular system, and by an exalted formative nisus in the parent tissue, new organs even, may be produced upon, or in the layer composed of connective tissue, of the cyst- wall — which new productions, however, though con- tained in the cavity, did not originate on the inner surface of the cyst. It is in this way that may be explained the possi- bility of the occurrence, in the contents of cysts, of hairs, se- baceous and sudoriparous glands, teeth, portions of bone, or as has been above noticed, of papillary, dendritic new formations. The immature cell-wall is not lined with the epithelial layer, and consequently represents merely a tunic composed of con- nective tissue, enclosing a more or less thin fluid, often in the coagulated state. This defect occurs sometimes in young immature cysts, scarcely visible to the naked eye, and which are to be sought for in the papillary new formations, some- 86 FORMATION OF times in the walls of larger cysts, apparently in process of involution. An important difference in the structure of cysts, consists in the circumstance that their cavity is sometimes completely closed, and sometimes communicates with the contiguous areo- lar spaces by fissure-like passages. An apparently peculiar modification of the cyst-wall is ob- served when new cysts are developed in the immediately con- tiguous areolar tissue in which the cysts are situated ; or their wall itself may be in part replaced by a formation of cysts, situated more in the outer wall of the connective tissue tunic. Into the interior of many of these adventitious cysts several smaller ones project, and others again into these, so that an entire system of cysts, one within another, is formed, lying upon the wall of the large cyst. We have indicated the areolar tissue and the papillary new formation, as affording the foundation of cysts; with refer- ence to which it appears necessary again to remark that the former tissue is constituted of thick bundles of connective tissue, enclosing a complete system of other fasciculi branched in a dendritic manner. The areola enclosed by the stronger external fasciculi, might be termed areola of the first order. From these fasciculi, branches are given off, which subdivide the areola of the first order, into several compartments, areoloe of the second order ; these again are subdivided into areola of the third order by other branches, and so on. This mode of subdivision is found to obtain wherever connective tissue exists ; in the so-termed parenchymatous organs it forms the fundamental framework. In pathological instances, we fre- quently observe an asymmetrical hypertrophy of the fasciculi, and in these cases it is that the formation of cysts so readily takes place. Now if we suppose that, from a vessel whose branches run along the subdivisions of the fasciculi of connective tissue, an exudation, or perhaps, more properly speaking, a somewhat augmented transudation takes place, the possibility arises of the introduction of a new formation of fibre-cells, and of a multi- plication of the blood-vessels, in consequence of which, an inter- nal occlusion of the cavity of the areola is brought about. This being the case, should a further repetition of the transudation CYSTS. 87 occur, and the latter not be capable of organization it will ac- cumulate in the areola, whilst the growth of the new forma- tion advances outwardly from the cyst-wall. In this way may be developed epithelial cells, various forms of immature elements of cellular tissue, especially fibre-cells, and from these the pa- pillary new formation with dendritic branching, and, when the formative impulse is greater, hairs, teeth, &c. Now should the same process go on in a whole system of areola contained one within another, a similar system of cysts will also be con- stituted, cysts of the first, second, and third orders, &c. The same process, on the other hand, of partial or complete occlu- sion, may be limited to an areola of the first order, whilst in those of the succeeding orders, from the pressure of the transuded fluid, the fibrous framework undergoes a partial or complete fusion ; in consequence of which, a more or less sacculated cyst, furnished with projecting ridges of connective tissue, will be produced. If the papillary new formation, in consequence of a dropsical degeneration of its contents, particularly in its clavate extremi- ties, present a more or less circumscribed dilatation, the form of a pedunculated cyst is produced, which either depends free into one of the visceral cavities, or, when the cysts are more numerous, they may fill a distended areola. Concretions may be deposited in it; the peduncle may become so slender, as ultimately to be ruptured, and the cyst deprived of its stem, or the concretion, will be found detached in a visceral cavity, as is frequently the case in the cavity of the abdomen, and in the articulations. We have now to consider the modification observed in the origination of a cyst, dependent upon the special anato- mical structure of an organ, the mode, however, remaining essentially the same. If we regard, for instance, a group of acini of the mammary gland, it is well known that each group has a single excretory duct, and that it is enclosed in a tunic of connective tissue, which is subdivided into as many com- partments as there are acini. Now, should an increased transudation take place in the connective-tissue tunic, in consequence of which a new formation of fibre-cells, blood- vessels, and papillary excrescences is there set up, the proper glandular parenchyma must of necessity be subjected to a pro- 88 FORMATION OF cess of absorption, and a cavity is formed partly filled with variously shaped excrescences, and which is necessarily in connexion with the corresponding excretory duct of the group of acini. It is probable that this is the nature of the process in cysto-sarcoma of the mammary gland. In the case of the villi of the placenta, or of the minute, normal, clavate extremities of the choroid plexuses in the brain, pedunculated cysts may be formed by the hypertrophy of the cellular tissue of which they are composed, and a hydropic degeneration of the inter- cellular fluid. This is not the place to ehter upon the individual peculiari- ties of the, anatomical structure of cysts, and the mode of formation deduced therefrom. This belongs to the Special Part of the work. We have deemed it necessary here to propound a theory of the formation of cysts, regarded from a general point of view, and think that it recommends itself by the simplicity and congruity of the explanation it affords of these complex pathological structures. It corresponds, to some extent, with C. Bruch's notion, who says, that all cysts, with- out exception, owe their origin simply to an accumulation and deposition of the contents of whatever kind in the parenchyma of the organs and tissues ; and, consequently, that not only does no cyst proceed from a parent-cell, but, also, that no cyst, which does not correspond to a pre-existing areola, can, as such, be an independent structure. According to him, the contents would be the primary, and the wall the secondary element in the formation of the cyst. C. Bruch's theory of cysts, and our own, are thus opposed to that of Rokitansky, who regards the cyst, from its organization and (secretory) function, as a definite hollow structure, whose essential rudiment is a determinate substantive element. The elementary granule grows by intersusception, into a nucleus, and this, in the same way, into a structureless vesicle, which may attain to a diameter of from ^ to T^"""- To the cyst, in its primitive condition as a structureless vesicle, there is superadded, on the exterior, a more or less distinct fibrous layer, which coalesces with the wall of the cyst. Thus, the cyst, in the secondary condition, is constituted of a wall of a definite tissue, lined on the inside with epithelium, and is forthwith capable of attaining to even a monstrous growth. In order to explain the nature of com- CYSTS. 89 pound cysts, Rokitansky was obliged to adopt the supposition of an endogenous multiplication of the vesicles ; asserting, that new cysts are developed in the fluid, or in the parenchymatous contents of a cyst, by the enlargement of the nucleolus into a structureless vesicle. The development of these vesicles, how- ever, is not carried beyond the primitive condition, the necessary element to be superadded to the structureless vesicle, required for its fixation and continued development, being absent. It is obvious that Rokitansky requires several hypotheses for the establishment of his theory of cysts, whilst that here advo- cated by us, is based simply upon the anatomical structure of the normal, or of the pathologically modified, areolar tissue, and of the papillary new formations of connective tissue. PART II. SPECIAL OBSERVATIONS. CHAPTER I. § 1. 1. FAMILY — INORGANIC POEMATIONS. The constituents of the animal organism exist either in a state of solution or in the fluid form, or in the solid state. The vital conditions of the animal body, however, may be so altered that one or other of its constituents removed from vital connexion with the organism, will necessarily undergo changes within it similar to those to which it would be liable were it wholly eliminated from the body, and exposed to external influences. Mineral substances, which usually occur in the state of solution, will, under these circumstances, pass from the fluid to the solid form, and may be precipitated in a more or less perfectly crystalline condition or in an amorphous state, intermixed with organic and other accidental constituents. In this condition they form white deposits, which, when accumu- lated in any situation in considerable quantity, and at the same time rendered coherent by an organic connecting medium, be- come concretions. We shall now proceed, at once, to consider the special substances. 1. Uric Acid. This acid, in the crystallized condition, affords one of the best examples of the multiplicity of form which may be pro- 92 INORGANIC FORMATIONS. Fig. 1. duced by various modifications of circumstances. E. Schmidt and C. Schmidt have lately made the crystalline forms of uric acid the subject of accurate investigation; and the latter especially, by rigorous and precise goniometrical measurements, has determined the axial relations of this crystalline acid. The fundamental form is best observed when a uric acid- salt, as of potass, soda, or ammonia, is brought i.nto contact with acetic acid. The uric, being a very weak acid, is imme- diately set free, and appears in the crystalline condition in the form of rhombic tables (fig. 1 a), whose acute angle, according to C. Schmidt = 45°. The angles, however, often appear to be rounded, and in this way are produced tables ap- proaching the oval form ; these are imperfect crystal- line figures. The angles at the obtuse or at the acute corners of the rhombic tables are often truncated, when a hexabedral figure results. An octangular table will be formed when both the obtuse and the acute angles are thus truncated, which are thus usually rendered more or less inapparent, and the oval form above noticed arises. It not unfrequently happens that two or more ' tables are superimposed one upon another, so as, when viewed on the side, to form a rectangular line of steps. It very often happens that the fundamental table upon which the others are heaped is bounded by sharp contour lines, whilst the super- imposed layers are more or less fissured and jagged j they may also be deposited only on the one or other half of the table. The term rhombic table is employed as a useful expression of the idea of flatness, but it is at once obvious that each of these tables must have a certain elevation, and might therefore more properly be described as a much depressed rliombic prism. That this is the case is more distinctly obvious in fig. 1 h, with the shaded lateral planes. Before going further, we are here compelled to remark .upon a circumstance which is seen URIC ACIU. 93 with especial distinctness in transparent crystals viewed in the microscope by transmitted light. If the position of the crystal be such that the transmitted rays of light strike its surface at a right angle, or in other words, if its position be perfectly horizontal, we shall, in the microscope and by transmitted light, perceive only the rhombic figure. But immediately the position of the rhombic prism is rendered slightly oblique, it becomes possible for us to see the lateral planes ; and we shall, in fact, perceive not only the lateral planes of one side, as by reflected light, but by changing the focus, those of the opposite side also, by means of the transmitted light. This circumstance alters, to some extent, the external aspect of the crystal, when delineated by transmitted light ; and it is often a nice matter, especially in the complex crystalline forms, to arrive at a correct judgment. The study of crystals in various positions is there- fore indispensable. What has been said with respect to the altered forms of the rhombic table in the series a, of fig. 1, is equally applicable to the series b (the rhombic ^prism with shaded lateral planes). In this form also the angles appear to be horizontally trun- cated, or more or less rounded off', so that at last a barrel- shaped figure is produced (yid. the second crystal in the series c). The edges frequently lose their sharpness, and become faintly toothed, or undulating. When laminated, as they not unfrequently are, [vid. the first crystal in the series d, fig. 1,) they represent a much elongated, cylindrical body, with crystals projecting on the surface. In the same series, d, are two other crystalline groups, the one consisting of minute radiating crystals, the other of larger crystals heaped together. A more rare form has been described by Scheerer ; this is a hexagonal pyramid, produced by the acumination of a vertical prism, which forms its base. The dimensions of uric acid crystals differ very considerably, depending, like their form, upon the degree of concentration of the fluid, the temperature, the surface of contact with any solid body, &c. All these varieties, also, may be shown on the small scale by a modification in the mode of preparation. For in- stance, whether the crystallized uric acid be combined with potass, soda, or ammonia, on three separate object-glasses, and a drop of dilute acetic or muriatic acid be added to each, or the solu- 94 INORGANIC FORMATIONS. tion be previously heated^ &c. It is consequently to be ex- pected that, in the urine of diseased persons, very various forms of uric acid will be precipitated, according to the various changes iu the conditions. The great mutability of form as- sumed by uric acid, may also be employed very usefully to es- tablish its presence chemically, for if doubtful or indistinct forms of this acid are treated with potass or soda, upon the addition of acetic acid to the solution, characteristic crystals of uric acid will at once be obtained. If those crystals be selected, which constitute the lateritious sediment in the urine of febrile patients, in rheumatism, gout, &c., they invariably exhibit a yellow or yellowish-red colour, derived from the colouring matter of the urine, and not belonging to the crystals in the pure state. With respect to the genesis of the crystals of uric acid, C. Schmidt states that, if the acid be dissolved in the smallest possible quantity of soda or potass, and a drop of the solution be placed under the microscope with some acetic acid, the fol- lowing phenomenon will be observed : at the moment the two fluids touch each other a sudden precipitation takes place of globules about 0-007 — 0"006 mm. in diameter, which exhibit the Brownian molecular movement ; this is seen particularly well when the acid is so applied that the two drops are ap- proximated as closely as possible without actual contact. The acetic acid, slowly evaporating, decomposes the uric acid salt, gradually from the periphery to the centre of the drop, and an abundant precipitate is formed, of white, spherical molecules of uric acid, which are readily distinguishable from the globules of carbonic acid evolved at the same time from the superfluous carbonate of the alkali employed, by the sharp contours (strong refractive power) of the latter, as viewed by transmitted light, and their greater delicacy as seen by direct light. The mole- cules in question, as the molecular movement becomes weaker, gradually coalesce into spherical masses, which assuming an oval shape and becoming more and more transparent, ultimately assume the form of hexagonal tables, or of short vertical prisms, having tables of that form for their bases. By slow precipita- tion, caused, in this way, by the vapour of the acetic acid, the original globules increase in size; a few only unite to form such an embryo, as it were, of a hexagonal prism ; or even URIC ACID. 95 single globules may, not unfrequently, be seen to assume an oval form, like that of the blood-corpuscle of the Frog, from which the six angles continue to project more and more until the perfect form is produced. Very remarkable also, is another experiment instituted by C. Schmidt, with respect to the formation of the crystals of uric acid. He placed a drop of a concentrated solution of uric acid, heated to 100°, under the microscope, and whilst still hot, if he then touched its border with any cold object, such as a wire, or glass rod, or, best, with the latter dipped in ether, rhombic prisms were formed at the point of contact; these increase in size, and up to a certain moment present a per- fectly regular form ; suddenly they seem to be covered with a veil, become fissured and clouded, breaking up into innumer- able rectangular, distinct crystals, each of which, continuing to enlarge, forms a regular rectangular parallelopidon, C. Schmidt properly regards this phenomenon as of the highest interest, as it is witnessed in the process of formation of very various crystals, and proves that their formation is governed by a law, in obedience to which the crystal must intrinsically pass through a morphotic process, apparently in no way conducive to its further development, prior to the commencement of the actual completion of the later permanent form. In this formative process, therefore, we may perceive the indication of an analogy between the modes of formation of inorganic and of organic bodies. Lehmannhas never been able to detect ready formed crystals of uric acid in perfectly fresh urine, notwithstanding the frequency with which he has met with it in urine which has stood for an hour or longer. According to him, in the majority of instances the uric acid is formed from the urate of soda, after exposure of the urine to the atmosphere, and in fact, in consequence of a process termed by Scheerer " [acidj urinous fermentation." Lehmann has seen free uric acid passed with the urine directly from the bladder only in cases of the so-termed calculous dia- thesis, or when vesical gravel already existed. Strahl and Lieberkiihn have detected uric acid in the blood, both in the healthy and diseased condition, and particularly after extirpation of the kidneys. Garrod has always found uric acid [in the form of urate of soda] in the blood of persons 96 INORGANIC FORMATIONS. labouring under gout ; and in patients subject to chronic gout, with tophaceous deposits, the uric acid is always present in the blood, and deficient in the urine, both absolutely, and relatively to the other organic matters ; and the chalk-like deposits appear to depend on an action in and around the joints, &c., vicari- ous with the " uric-acid- secreting,'' function of the kidneys.^ In "Bright's disease/' or in the albuminuria atter scarlet fever, he met with uric acid in the blood, when the function of the kidneys was much interrupted, often even in as great quantity as in gout ; in other cases the amount was less in those dis- eases, although always exceeding that which exists in the nor- mal blood. In acute rheumatism, on the other hand, accord- ing to him, the blood never contains more uric acid than it does in a state of health. Lehmann has confirmed these ex- periments of Garrod, from his own researches. The chemical theory with respect to the origin of uric acid, and its application to the increased secretion of that principle in many diseases, does not belong to our subject. 2. Urate oi? Ammonia. The morphological properties of this salt afford no decisive characters by which it can be recognized. Under the micro- scope it appears, when formed by the decomposition of a hot solution of urate of soda by an ammoniacal salt, as a very fine pulverulent substance, agglomerated into groups, and causing a considerable turbidity of the fluid. It may not unfrequently be observed in the form of pig- ment — like black specks in the medullary substance of the kidney, especially in children in the first years of life. To the ' [The discovery of the presence of uric acid in the perfectly healthy human blood appears to he due to Dr. Garrod, for Strahl and Lieherkiihn, failed equally in de- tecting it, in the blood of men and of birds, though they appear on one occasion to have found it in the blood of a Dog. Willi this exception, they never observed uric acid in the blood, unless after extirpation of the kidneys. Dr. Garrod's observa- tions, in which the above discovery is announced, are contained in the ' Med.-Chir. Trans.,' 2d ser., vol. xiii, p. 88 (1848), and in a recent communication (Ibid., vol. xix, p. 49, 1854), he gives another mode of ascertaining the presence of uric acid in the blood, which he says, may be readily employed by every medical practi- tioner, and which has the advantage of requiring for its performance, the abstraction of only a very small amount of blood. — Ed.] URATE OF AMMONIA. 97 Fig. 2. naked eye, the urate of ammonia in that situation appears in the form of orange yellow streaks, radiating from the renal papillae ; when the substance of the kidney is squeezed, it ap- pears as a very fine powder, coloured, without doubt, by the colouring matter of the urine and suspended in the expressed fluid. If a vertical section of the kidney in which the salt is depo- sited be examined by transmitted light, and under a low power, the urate of ammonia will be seen in the form of divergent, jagged, broad, black streaks, among the radiating tubuli (fig. 2, a), from which lateral branches and twigs are given off at acute angles. If a stronger magnifying power be applied, it will be seen that the black substance is composed of tolerably large molecules with a polygonal contour, and aggregated into little opaque masses disposed in rows. The dark substance rapidly disappears under the influence of potass or soda, and is unchanged on the addition of acetic acid, and it is not until after the application of heat that minute, ill-formed, rhombic and hexagonal tables (uric acid) are formed. The murexid test shows, at the same time, the cliaracteristic reaction of uric acid. Urate of ammonia is deposited in many kinds of morbid urine, when left at rest, also in the form of globules (fig. 3, a) which ar- range themselves together in various ways, and exhibit some resemblance to the spores oi fungi, with which, how- ever, on closer examination they can never be confounded, inasmuch as the spores present a nucleus, and are not altered after the addition of potass or soda. According to C. Schmidt, the deposit formed by this salt undergoes no change after long standing in the cold or warmth, 7 Fig. 3. 1 ^Ji^ll 98 INORGANIC FORMATIONS. nor has lie ever chanced to perceive isolated crystals, or, at most, only a crystalline form of the smallest molecules or ag- glomerated spherical masses. Lehmann states that he has occasionally noticed extremely fine points projecting from the spherical mass. The latter author has rarely found urate of ammonia forming a sediment even in alkaline urine. In alkaline urine, even passed by persons suffering from injury to the spine and consequent paralysis of the bladder, he has but very rarely observed such crystalline masses of urate of ammonia. In al- kaline urine, passed under other circumstances, such a product, according to him, is never found at all. 3. Urate of Soda. The crystalline forms of this salt are usually fine needles, whose figure cannot be more precisely given ; they occur grouped together in a radiating manner, and are occasionally very slender and short (fig. 3, b). The salt, however, also crystallizes, though more rarely, in hexagonal prisms, and thick, six-sided tables, which might be confounded with crystals of uric acid. The reaction with dilute hydrochloric acid, in which the former are dissolved and the latter remain unchanged, will determine their true nature. It is well known that the occurrence of urate of soda in the sediment in acute febrile affections, was regarded as a rare phenomenon. But it has been fully demonstrated by Heintz and especially by Lehmann,^ that this sediment consists of urate of soda mixed with very small quantities of urate of lime and urate of ammonia. In the " chalk-stones " of gout, yel- lowish-white concretions, the fascicular needles of urate of soda, occur in very great number. Garrod asserts that the blood in gout contains uric acid in combination with soda, and that this salt may be thence obtained in the crystalline state. 4. HippURic Acid (Uro-benzoic Acid). According to C. Schmidt, this acid belongs to the rhombic system. In form and aspect, the crystals are very like those of the triple phosphate of ammonia and magnesia, when the ' Lehmann, ' Phys. Chem.' (English translation), p. 214, who adveris also to the simple method of ascertaining that the sediment consists of urate of soda, afforded by the circumstance, that it dissolves at a temperature of 50°. UREA. 99 latter, obtained from dilute solutions, by spontaneous evapora- tion, are formed slowly and regularly j on the other hand, they may be confounded with the hexagonal tables of uric acid, or even with the crystals of urea, which latter are distinguished from those of hippuric acid by their sparing solubility in water. Hippuric acid has been known by Liebig to exist in the normal human urine ; although, before it was found there, Lehmann had ascertained its presence in diabetic urine, in which, according to him, it may be demonstrated far more readily than in other kinds of urine abounding in extractive matter. In morbid urine he has almost invariably met with it, and especially, in large quantity, in the acid urine of fever. Pettenkofer found a very extraordinary amount of hippuric acid in the urine of a young girl affected with chorea. It has not, as yet, been found elsewhere than the urine.^ 5. Urea. The crystals of urea assume the form of vertical prisms of various sizes, and either pointed or flattened. The angles are occasionally truncated ; frequently, also, several thin plates are superimposed one upon the other. A well-known reagent for urea is nitric acid ; the morphological relations of nitrate of urea, therefore, are of especial interest, to enable us to obtain a crystallographical proof of the presence of that principle. The rhombic octohedrons and hexagonal tables of, nitrate of urea may be confounded with the nitrates of potass and soda ; and although the latter salt, by its ready solubility in water, is easily distinguished from the nitrate of urea, the distinction from the nitrate of potass still remains to be made. Under these circumstances, therefore, we are deprived of the aid to be derived from the form merely of the crystals. Oxalate of urea is readily thrown down in the crystallized state, from urine evaporated to about one half, or from the alcoholic extract of the concentrated residuum of urine, by oxalic acid, in the form of fascicular needles and plates. It may be confounded with the acid oxalates of the alkalies and alkaline earths ; and, according to C. Schmidt, is recognized, ' It has been discovered in the blood of oxen, by Verdeil and Dollfuss. (Lehm., ' Phys. Chem.' (Eng. trans.), vol. i, p. 197.) 100 INOIIGANIC FORMATIONS. by incineration on a narrow strip of platinum foil or of flattened platinum wire, whicli is then immersed in acid and viewed under a low magnifying power ; if nothing remain, it is oxalate of urea ; if globules of carbonic acid are evolved, it was an oxalate of one of the earthy or alkaline bases. 6. Phosphate of Magnesia, May be obtained in the crystalline form, when dilute solutions of phosphate of soda and sulphate of magnesia are brought together and allowed to evaporate gradually. The crystals thus obtained, according to C. Schmidt, are hexagonal, vertical prisms, with inclined terminal faces. They are of trifling interest to us, since the phosphate of magnesia, very probably on account of its great solubility, has never been observed in urinary sediments ; and is said to occur only occasionally, together with phosphate and carbonate of lime, in the arteries, membranes of the brain, and of the uterus and ovary, in an uncrystallized condition. 7. Phosphate of Magnesia and Ammonia (triple phosphate). This salt, on account of its frequent occurrence in patholo- gical secretions and excretions, is of the highest importance. The crystalline forms are extremely numerous, depending upon the conditions under which the crystallization takes place. The imperfect forms usually appear foliated, and the borders of the four opposite conjoined plates are sometimes smooth, sometimes irregularly toothed. At the commencement of the crystallization, — that is, at the moment when a solution of phosphate of magnesia is brought into contact with an ammoniacal salt(of course under the microscope), — C. Schmidt observed the formation of regular tetrahedrons with angles of exactly 60°. These crystals become flattened, and the border more and more thickened ; the original tetrahedrons being metamorphosed into three-sided prisms with straight or inclined terminal faces. According to him, this metamorphosis presents the only instance of dimorphism at the first origin of the crystal, other conditions being equal ; it is a morphological OXALATE OF LIME 101 Fig. 4. transitionary period, or stage, whilst all other known examples of a double crystalline form proceed simultaneously, and the development of one form or the other is determined by various external circumstances, such as differences in temperature during the formation, or subsequently influencing the already formed individual. The fundamental figure is the rhombic vertical prism. The usual combinations are exhibited in fig. 4, and arise in consequence of a symmetrical or unsymmetri- cal flattening of the correspond- ing edges or angles; the common sarcophagus - lid forms of the triple phosphate are shown in the middle series (fig. 4), from left to right in the first and second ; these are hemihedral forms, which may be further metamorphosed by the truncation of the angles. More rare, remarkable crystalline forms of triple phosphate have been described and figured by E. Schmidt ; they bear some resemblance to the quadrat-octohedrons of oxalate of lime. Dilute acetic acid must, therefore, be employed to distinguish them, in which the crystals of triple phosphate are very readily soluble. It is well known that this salt is to be regarded as the accompaniment of the process of decomposition in the animal organism. In the motions passed in typhus fever, on the surface of which it forms a crystalline pellicle, it was for a long time regarded as a diagnostic character by Schonlein and his followers, until it was shown to exist in very many other situations, where, in the process of putrefaction, phosphatic salts came in contact with compounds of magnesia and ammonia. 8. Oxalate op Lime, Crystallizes principally in the form of an obtuse square octo- hedron (fig. 5 a), which is seen in various sizes down to an 102 INORGANIC FOEMATIONS. almost imperceptible minuteness. This form is usually com- pared with that of a folded envelope ; ^'°- 5- and the acutely-pointed, white stri(B, crossing at a right angle, are caused by the planes of the pyramids on both sides, and which, by transmitted light, are illuminated only from one direction. The larger crystals of this kind, whose basal plane is a square, and in which all the sides of the square are equal, and all the angles right angles, is more rarely met with; as are also those octohedral forms, whose basal plane is a rectangle (that is to say, having the angles equal, but only the opposite sides equal to each other), fig. 5, b. In fig. 5, c, are represented two crystals of oxalate of lime, probably a combination of the square octahedron with the quadratic prism ; one is seen from the front, and the other on the side. The imperfect forms of this salt are biscuit- shaped (fig. 5, d), and of various dimensions.^ The crystals of oxalate of lime are insoluble in water, alcohol, ether, acetic acid, and much diluted hydrochloric acid ; whilst they are dissolved by concentrated hydrochloric and nitric acid. The oxalate of lime constitutes a frequent sediment in the urine, though for a long time overlooked, until Dr. Golding Bird remarked its crystalline forms. Lehmann, in his numerous researches, has found true sediments of oxalate of lime to be far more rare than they would seem to be according to English observers. In the amorphous state it occurs in mulberry calculi, characterised by their nodulated surface and dark colour ; and it iff found not only in the urinary bladder, in the form of calculus, but, relatively speaking, more frequently in the kidneys themselves, constituting nodular, dirty grey, con- sistent earthy concretions. They are usually situated in the pelvis of the kidney between the mamillary processes, the pro- jections of the latter corresponding to the depressions in the former. In the pelvis of the kidney of an individual dead of ' [These " dumb-bell crystals " have been supposed, by Dr. Golding Bird, to be formed of oxalurate of lime. — Ed.] CARBONATE OF LIME. 103 Bright's degeneration of the gland, with pulmonary tuberculosis, and general dropsy, in his fiftieth year, C. Schmidt, found an oval concretion of oxalate of lime ; fragments of the whitish or grey oxalate layers presented an irregular aspect, and were ap- parently amorphous ; whilst the larger prominences on the sur- face of the calculus were perfect half-octohedrons with rounded edges and angles. In the atrophied kidneys of old people, dirty yellow conglomerates are occasionally met with as much as ^ m.m. in size. In the cortical substance they present a rounded or oval form, and in the medullary are elongated ; the surface is nodular and uneven, and they disappear on the ad- dition of concentrated hydrochloric acid, without the evolution of air-bubbles. In many minute rounded concretions, acute, crystalline projections, having the form of half-octohedrons, may be distinguished under a strong magnifying power. These con- cretions also, therefore probatly contain oxalate of lime. The dark colour of the oxalate concretions depends, without doubt, upon pigment, which, according to C. Schmidt's correct opinion, is precipitated from the hematin ; the mechanical irri- tation caused by the acute eminences of the calculus giving rise to hypercemia and extravasations of blood. The blood- corpuscles undergo a gradual decomposition, the nitrogen, hydrogen, and oxygen escaping, in consequence of which the proportion of carbon in the pigment becomes more and more considerable. He considers that, in this instance, as in that of the occurrence of other black and brown pigments in patho- logical cases, there is obviously set up a slow process of decom- position of the hematin. 9. Caebonate of Lime. As a pathological deposit, this salt never occurs in the crystal- line, but always in the amorphous condition, assuming either the nodulated form or that of white opaque masses, which may be broken up into a fine powder. At the same time it is usually combined with a larger or smaller quantity of phosphate of lime. The nodules form rounded botryoidal eminences (fig. 6, a) rising from a common homogeneous mass, and retaining a certain degree of transparency. In the instance here repre- sented, they were obtained from the inner aspect of the posterior 104 INORGANIC FORMATIONS. capsule of a cataractous crystalline lens of an old Horse, and were loosely imbedded in the form of larger or smaller particles in the atrophied sub- stance of the lens. Under a stronger magnifying power, it was possible, in this case, also to observe the minute deposits of which the masses in the aggregate were made up (fig. 6, b) ; these were sometimes isolated, sometimes grouped granules, from / about the diameter of a blood globule, down to indistinguishable molecules. The °2 ^. ®^^ €? external contour of each granule is" more o W8 © rarely circular, usually reniform or having several protuberances, owing to its being constituted by the coalescence of several granules, and sur- rounded by a dark border. The central part of the granule is transparent, and, in its mode of refracting light, bears some resemblance to that of a fat-globule. If several of these layers are superimposed one upon another, it is obvious that they must darken a considerable part of the field of view. In larger masses of crystals, a concentric lamination or streaks radiating from the centre, may be perceived. The origin of the granular deposit is most probably to be sought in the rounding off of the edges and angles of the crystallizing carbonate of lime. So far as is known, the latter in a composite crystalline form (six-sided prism with six-sided pyramids), occurs in man, and the mammalia, only in the labyrinth, forming the so-termed " otolithes." It is always requisite, in conglomerates of this kind, to notice . the reaction of an acid, under the microscope, in order to ascer- tain whether the particle submitted to examination disappear with the evolution of air-bubbles or not. The effect of dilute acetic acid upon the crystals of carbonate of lime is interesting, the latter constantly diminishing with the evolution of bubbles of carbonic acid, though still retaining the characteristic crystalline form, until they gradually melt away equally on all the surfaces, and are reduced to a mere point, the outlines of which are at last no longer distinguishable. If the acid be added to amorphous carbonate of lime, the development of carbonic acid is at first very vehement ; the air-bubbles may be SULPHATE OF LTME. 105 seen making their way through, the fissures of the concretion, and in their passage, on account of their elasticity, assuming the form of the cavity traversed by them ; but they always retain their peculiar, dark, abruptly defined borders. So soon as the gaseous carbonic acid, has quitted the periphery of the con- glomerate, and come into contact with the surrounding, mainly watery fluid, it expands uniformly on all sides, and assumes a spherical shape. The gas-bubbles, thus formed, rise to the surface of the fluid covered by the glass, and are enlarged by the addition of others. The morphological conditions of these gaseous bubbles are identical with those of air-bubbles ; they present a dark border, abruptly defined on the exterior, which, owing to the imperfect achromatism of our instruments, is surrounded by a slightly coloured luminous haze, and in the centre, in a certain position of the focus, may perhaps exhibit a well-defined white ring. Towards the interior of this, hollow spherule the dark border is not sharply defined, but gradually fades off into the brightly illuminated central spot, and there presents a greenish red colour.' If dilute sulphuric acid be employed as the re- agent, the formation of crystals of sulphate of lime will at once be observed, to whose forms we will advert more fully below. Carbonate of lime occurs only very rarely in urinary sediments and calculi, at any rate in man ; in herbivorous animals, de- posits of this salt are in general more abundant. It will very frequently be observed in old exudation-membranes, fibrous tumours, &c., imbedded in the organic substance. 10. Sulphate of Lime. Chemists make no mention of the presence of this salt in urinary sediments, and the various kinds of concretions j con- sequently, in the crystalline form, it is of interest to us only with respect to the circumstance, as above noticed, that it always appears in the reaction of sulphuric acid upon carbonate of lime. In this case, radiating bundles of minute acicular crystals are immediately formed, resting upon the main mass, and which are ' [ThU chromatic defect, at any rate, cannot be said to exist in our object- glasses. — Ed.] 106 INORGANIC FORMATIONS. so small, that no precise determination of the form of the crystals can be arrived at. Those crystals which are subse- quently formed more slowly, are of larger size (fig. 7), and may be recognized as consisting of numerous, ob- lique, six-sided columns with occasionally truncated angles and edges. Twin -crystals, also, may frequently be no- ticed. 11. Phosphate of Lime, Occurs in all pathological deposits only in the amorphous condition, as a coherent, finely granular, opaque substance; but the opinion occasionally expressed, that it is never ob- tained in the crystalline condition is erroneous. With respect to this point, C. Schmidt relates the following experiment : " On bringing together soluble phosphates and calcareous salts, as, for instance, phosphate of soda with chloride of calcium, a gelatiniform, perfectly amorphous precipitate of phosphate of lime is thrown down. This precipitate, after some days, be- comes more and more transparent, not unlike thick mucilage of gum or dextrin, and op"alescent; in direct sunlight the varying reflexion of the luminous rays renders visible, innume- rable, delicate, flickering crystals into which the amorphous precipitate has become transformed, apparently without any change of its chemical constitution. Examination by the assisted eye confirms the correctness of the observation ; the microscope showing innumerable, excessively slender and de- licate rhombic tables." Phosphate of lime is a frequent ingredient in urinary sedi- ments, and, owing to its amorphous condition, presents no posi- tive morphological character. We are compelled, therefore, to distinguish it by the use of acetic acid, or still better of hydro- chloric acid, in which it is more soluble than in the former ; the non-evolution of gaseous bubbles distinguishes it under these reagents from carbonate of lime, and the non-appearance of EASILY SOLUBLE SALTS. 107 crystals of uric acid, from any urate. In order to display it when in connexion with organic substances, more distinctly, a solution of potass or soda should be employed, in which it remains as an insoluble residue, whilst the organic matter is rendered hyaline. In cases where deposition of carbonate and phosphate of lime has taken place, it is a nice question to determine whether it is situated in the cells of the parenchyma or in the inter- cellular substance. C. Schmidt has broached the proposition that the phosphate of lime stands in very intimate relation to the process of cell-formation in the plant ; he has never found so-termed " cretifications'^ of phosphate of lime in the vegetable cell, whilst the oxalate, sulphate, and carbonate of lime are frequently deposited therein in the crystalline form. We leave the universality of application and the correctness of this proposition undetermined, as at present we are not in possession of sufficient means by which to recognize phq^phate of lime ; and for the same reason we regard the opinion ex- pressed by Lehmann, that phosphate of lime is deposited in many, pathologically degenerated cells in the animal body, as at present without due confirmation. Notwithstanding this, however, we consider it as highly probable that the two salts in combination are deposited in the form of crumbly masses, in the cartilage and bone-cells of atrophied, cartilaginous and osseous tissue, under particular circumstances which will be discussed hereafter. 12. Easily soluble Salts. Under this head we include the hydrochlorates, sulphates and phosphates, which are met with, contained in solution in pathological fluids. It is to be regretted that micro- chemical analysis and morphology can at present contribute nothing towards the scientific determination and separation of these compounds, for the crystalline forms obtained by the spontaneous evaporation of the solution are too indetermi- nate for the purpose. Nevertheless, in adverting to their forms, we would merely indicate the possibility of ascertaining the presence of these salts in general. The imperfect crystal- line forms presented by those having as their bases soda, am- monia, potass and magnesia, are of such a kind that from a 108 INORGANIC FORMATIONS. straight main line branches are given off at an angle of about 45°, or at a right angle, (figs. 8 & 9), upon which, again, secondary Fig. 8. Fig. 9. branches are disclosed at similar angles. The edges and angles in the larger crystals are so much round- ed off, and in the smaller ones so minute, that a go- niometrical estimation of them is impossible. Occasionally, minute cubical crystals may be distinguished, identical with those of common salt or hydrochlorate of ammonia. All of these exhibit a great ten- dency to dissolution, and their dimensions are less iu proportion to the rapidity of the crystallization. J. Vogel considers it probable, that in certain cases, preci- pitations of these soluble salts may occur, even in the living body, in consequence of the concentration of the fluid. After the internal employmeat of sulphate of magnesia as a purgative, he has observed microscopic crystals of that salt in the liquid motions. Even in concretions, precipitates of soluble salts are some- times met with, together with phosphate and sulphate of lime. P. Boudet's statement that a large quantity of salts readily soluble in water (chloride of sodium, sulphate, and phosphate of soda), occurs in such concretions, is so far supported that Schlossberger has found in a phlebolite, a considerable amount of a soluble salt — phosphate of magnesia; and Landerer in the vesical calculus of an Arab stallion, has demonstrated the presence of even 16 per cent, of the same salt. 109 13. Pat. Of the compounds of the fatty acids with organic bases, the one of most interest, as respects our subject, is olein, the principal constituent of the fat in many pathological structures. Its chief morphological character consists in the circumstance, that, when made into an emulsion, it is subdivided into microscopical fat-globules, which may be made the subject of observation. The suspended fat-globules present a dark, externally well-defined, comparatively broad border, in which the white ring above-described as existing in the air-bubble, is never seen. The outer contour of the dark border forms a clear, usually reddish or greenish circle, which is, of course, the more intense the less perfect is the achromatism of the instrument; it is never absent.^ Towards the centre of the floating globule, the contour of the dark border is rather less sharply defined, as it passes gradually into the illuminated central part. The opalescent brilliancy, as it may be termed, is often coloured, — yellowish, yellowish-red, according as there is more or less colouring- matter mixed with the suspended fat. The size of the globules depends upon the minuteness of the subdivision of the fat. If fluid fat be carefully tritprated with vegetable mucilage, the fat-globules are rendered so much the smaller. Ultimately, they appear, only in a certain focal distance, as brilliant molecules, on account of the strongly refractive property of fluid fat; and when their diameter is below 0005mm, they are found to exhibit an active molecular motion. If water be added, the fat-globules rise to the surface, and, consequently, at a certain focal distance, a mass of fat- globules may be perceived; whilst, unless adherent to other solid particles, they will not be seen at a greater depth. The fat-globules present a different appearance when they are compressed, as may be efi'ected by the abstraction of the fluid in which they float (as by it^ evaporation) . Under these circumstances, they run together, assume very irregular shapes, and, at the same time, lose their sharply-defined contour. Similar changes take place when the surrounding fluid is treated with acids, — as, for instance, with acetic acid. ' rWhen the object-glass is perfectly achromatic, it is needless to observe that these oil-globules have no coloured border. — Ed.] 110 INORGANIC FORMATIONS. When fat, in the form of globules, is lodged among the tissues, it is most easily brought into view, if the latter are rendered transparent by a dilute solution of potass or soda. The question, as to whether the fluid fat is simply deposited in the intercellular fluid, or also within the elementary organs themselves, has already been decided in the General Part, since we have established the fact, that an accumulation of fat-globules takes place in the contents of cells undergoing involution; stating, at the same time, the morphological and micro-chemical reasons which have induced us to arrive at such a conclusion. With respect, then, to the ascertaining of the mode in which the pathological deposition of this fat is brought about, we protest, in limine, against the notion that a protein-compound can be directly metamorphosed into fat; and we, therefore, employ the expressions of " fatty metamorphosis" and " fatty degeneration," only as importing a change of kind in the cell- contents and in the intercellular substance. It must be regarded as a positive fact in organic chemistry, that the fatty matters are conveyed to the animal organism, not only in the vegetable and animal alimentary substances, but also that fat may be formed within the animal body out of hydro-carbons (as starch, sugar). An abundant source of fat is thus afforded to the organism. Fat exists also in the nutritive fluid, the blood, in the chyle, and in the lymph. That fat plays a certain part in the processes of nutrition and propagation of the cells is obvious from the experiments of Tiedemann, Gmelin, and Magendie, who fed animals exclusively upon protein compounds, — as albumen, fibrin, and gelatin, — that is to say, upon substances containing no fat ; in conse- quence of which, they observed the death of the animal by hunger. A pathological proof of the importance of fat in the formation of cells, is afforded in those forms of cancer which abound in cells, and which, at the same time, contain an abundance of fat; all plastic exudations also contain more fat than the aplastic ; the latter — as, for instance, serous fluids, — may occasionally contain a considerable amount of cholesterin, but very little true fat (Lehmann). At the same time, the fatty contents of an exudation cannot be regarded as affording a measure of the subsequent cell-formation. This being the case, we shall not be surprised, in the FAT. Ill instance of a very profuse cell-formation, at meeting with fat, not only in the intercellular fluid, but also enclosed in the cells themselves. It is also probable that, in anomalous conditions of the general process of nutrition, fat may be deposited in the tissues. We have already said that the blood, particularly in old persons, may contain an undue amount of fat ; and that a nutritive fluid of this kind imperfectly suflBces for the restitution of the cells, whence an atrophy of the latter ensues; and, in this case, they manifestly contain fat in their interior. A second compound of a fatty acid with an organic base is margarin, which, as is well known, exists in the human fat-cell in combination with olein or elain ; it crystallizes in fine soft needles, forming stellate groups. A definite morphologicfll distinction between the crystals of margarin and of its fatty acid, — margaric acid, — cannot be laid down, since the indi- vidual crystals are so minute as to render their determination impossible. The distinction indicated by C. Schmidt, that the crystalline needles of margarin are shorter, and not so distinctly formed, as those of margaric acid, is one only of degree, and, therefore, insuflicient ; nor are we at present well enough acquainted with the crystalline relations of perfectly pure margarin. According to J. Vogel, the crystals of margaric acid may be chemically distinguished from those of margarin, by the circumstance, that the former are at once dissolved by boiling in weak spirit, and the latter only upon the application of strong alcohol. Margarin and margaric acid undoubtedly crystallize under certain conditions {lipoma) during life, and may easily be obtained artificially, simply by the cooling of the fluids which contain the margarin in the state of solution. They are found, therefore, very distinct, in fat-cells artificially cooled, whilst they are not met with in the same cells in the recent condition. Margaric acid occurs, not only free and crystallized, but also in combination with alkalies, forming margarates. Margarate of lime has been found in conctetions. Cholesterin is characterised by the form of its crystals ; which are thin rhombic plates, whose angles were found by C. Schmidt to be invariably in the proportion of 79° 30' to 100° 30', whence no mistake in their determination can arise. It is self-evident 112 INORGANIC FORMATIONS. Fig. 10. that in an inclined position of the crystal, when it is not lying horizontally, the acute angle may appear to be diminished, and the obtuse rendered larger, as may be noticed in several of the plates represented in fig. 10 {vide also the figures of choles- terin plates in cholesteatoma). The crystals are of very vari- ous dimensions though always retaining the same proportional angles ; and they are very trans- parent, so that when present only in a single layer they may readily be overlooked. Many exhibit a truncation of one of the acute angles (fig. 10, in the centre crystal at +), and the angles between the side thus formed, and those of the fun- damental figure, according to C. Schmidt's measurements, are pretty nearly equal to each other. That this truncation of the acute angle, does not repre- sent any accidentally injured form, the possibility of which must be admitted, is obvious from the frequent occurrence of plates of this shape, but mainly, from the constant, well-defined propor- tions of the angles formed between the truncated side, and those belonging to the fundamental form. The plates of cholesterin are frequently superimposed one upon another, in such a way that the corresponding sides are applied one above the other. Smaller plates, also, being fre- quently intercalated (fig. 10, «). In the majority of crystals, however, the direction of the sides of the superimposed plates is irregular (fig. 10, b), in consequence of which the angles and sides appear broken, fissured, and jagged. But even in these irregular, fragmentary aggregations, usually two remaining un- injured sides of the rhombic plate with one of the angles above- mentioned, may be discerned, so that even from these incom- plete forms, the diagnosis of cholesterin may be satisfactorily made. The laminated tables of cholesterin, viewed under the microscope, by reflected light, afford a very beautiful play of COLOURING MATTERS. 113 colours, evidently dependent upon the interference of the luminous rays. Occasionally they are imbued with a deep or brownish-yellow colouring matter. Cholesterin is insoluble in water, acids, and alkalies, which last property may be made use of to render more distinct, plates of this substancewheu imbedded in the tissues (by means of potass or soda), and soluble in alcohol and in ether, from which it crystallizes again. It may be regarded as an indifferent non- saponifiable fat, which, from the nature of the products of its oxidation, according to Redtenbacher, approaches nearest to the non-nitrogenous constituents of the bile. Lehmann is of opinion that it should not 'properly be associated with the fats, regarding it as being probably a product of decomposition. Its import, looking at its wide destribution in the organism, is still enigmatical. Pathologically, cholesterin is often accumulated in large quantity. Becquerel and Rodier have found an increased quantity of it in the blood of old persons, and in most acute diseases very soon after the invasion of the fever, especially in inflammation and jaundice. According to Lehmann, cholesterin is an integral constituent of pus. In gall-stones, the so-termed cholesteatoma, hydatids, follicular tumours, ovarian cysts, in the atheromatous deposits in the walls of the arteries, in cancerous tissues undergoinginvolution,&c.,we often meetwith an astonish- ing quantity of cholesterin. 14. Colouring matters. We shall here especially notice the principle termed he- matoidin {xanthose), which is formed from the hematin by a mode of transformation not as yet investigated. The crys- talline form of hematoidin is the oblique rhombic prism [fre- quently almost perfect rhombohedra] . As in most of the crystals this prism is much depressed and almost always laid upon the broad side, the two lateral planes are usually invisible, the shaded terminal planes of the rhombic prism alone being apparent. In this way may be explained the two dark streaks along the crystal which come into view under transmitted light. The larger crystals (fig. 11, a) are more rare than the smaller 114 INORGANIC FORMATIONS. {b), the size of which may be so far reduced that they are scarcely any longer distinguishable even ''■*^'"' under the highest magnifying power, as elongated angular crystals. A more rare form is presented in the hexagonal prism (a +), a form analogous to the six-sided prism of the crystals of uric acid. The crystals of hematoidin are transparent, and of a yellowish-red colour passing into a ruby red, whence, when imbedded in the tissues, they are the more easily recognized. «=a CH Under the inflftence of a solution of potass or soda, the crystals break up, and become, g as it were, cleft into lamince, but without ^^ undergoing solution even after the lapse of c^y vO some time (half an hour) ; at the same time ■^ they may be observed to become paler. The changes of colour produced by sulphuric acid are very interesting ; the solution, which results from the application of this reagent, becoming brownish-red, steel-green, blue, light-red, and yellow. This fact was noticed by Virchow, who was also the first accurately to describe the crystals of hematoidin. In acetic acid, alcohol, and ether, they remain un- altered. On some occasions Lehmann observed the smaller lighter coloured crystals to be dissolved by alcohol containing sulphuric acid or ammonia, and that they were again pre- cipitated when the solution was neutralized. But this was not always the case. Hematoidin also occurs in the amorphous condition aggregated into reddish-brown granules or amorphous masses, nxixed with crystals,as for instance in the apoplectic cysts, as they are termed, in the brain, the large cells of medullary cancer &c. ; and pre- senting the same changes of colour when acted upon by sulphuric acid as are witnessed in its crystals. To a certain extent it has been proved that hematoidin is closely allied to hematin (hematosin, colouring matter of the blood), which when prepared artificially appears as a brownish-red powder. As regards the chemical properties of the latter sub- stance, its ready solubility in weak alkaline solutions, is especially to be noticed, since by this it is distinguished, on the one hand COLOURING MATTERS. 115 from hematoidin, and on the other from the fully formed, orange- coloured, reddish-brown pigment ; both the latter remaining undissolved in alkaline solutions. Otherwise, however, there are so many intermediate stages between hematin, hematoidin, and fully formed pigment, in the chemical reactions above no- ticed, that it might at once be said — that hematoidin and pig- ment represent merely the products of decomposition of hematin. The crystals of hematoidin are met with most beautifully displayed in sanguineous extravasations in the brain, in ence- phalic collections of blood, and in the so-termed apoplectic cysts, in which latter these crystals, together with the amor- phous, reddish-brown hematoidin, imbedded in a fibrous sub- stance, form the principal constituent. They occur, moreover, though in less abundance, in extravasations of blood in the lungs, spleen, and Graafian follicles, and in aneurismal dilata- tions of the arteries, filled with coagula. Chemists have hitherto been unable to establish a theory of the formation of hematoidin, since the chemical composition of hematin itself is not as yet accurately determined, and that of hematoidin is still unknown. The fact, however, observed by Kolliker, that the latter principle originates within the blood- corpuscles in some fishes, places it beyond all doubt that the crystals are formed from the hematin} ' [It would appear that several distinct kinds of crystals occur in connexion with the blood, either within or without the organism. 1 . The hcanatoidin crystals of Virchow. Brilliant, transparent crystals, having the form of regular oblique rhombic prisms, and of a red colour, varying in tint and depth, according to the state of aggregation of the ciystals. They are of a com- paratively stable nature, and are insoluble in water, alcohol, ether, and acetic acid. And they occur either free, or enclosed in flaky particles, or in cells, exclusively in extravasated blood, which has been retained for a longer or shorter time in the organism. These crystals seem to have been first noticed by Sir E. Home, and more recently by Scherer, Zwicky, and Rokitansky, but were first accurately described and placed in then- true light by Virchow, who regards them as composed mainly of a new colouring matter, which he termed hcematoidin, and conceived to stand between hcematin and Mlofulvin, combined with a small amount of protein. And this view of the nature of hcematoidin appears to be confirmed by the circmnstance, that Zenker and Funke have transformed crystals of bilofulvin into htematoidin. 2. The "black crystals" observed by Mackenzie, GuiUot, and Virchow, in mela- notic deposits. These are flat, rhombic tables, with very acute angles, and resist nearly all reagents. They are probably similar in chemical composition to the above, plus some carbon. 3. The third kind of blood-ciystals are the "globulin crystals" of Kolliker. 116 INORGANIC FORMATIONS. Fig. 12. Nor can there be any doubt, also, that hematin may occur as an amorphous, dark substance, precipitated, partly within, partly without the blood-vessels. It assumes the shape of usually rounded, occasionally irre- gularly angular, brownish-black corpuscles which in the aggre- gate represent an opaque black mass (fig. 12, a & 6) and differ in size, which in the larger specimens exceeds that of the largest blood-corpuscles by somewhat more than a fourth. In the larger particles the border often appears wholly or partially facetted ; the surface frequently seems to be smooth. In the corpuscles several smaller molecules may often be dis- tinguished. The smaller form of hematin is constituted of scattered brownish-black granules (fig. 12, c, the dark granules scattered among the lighter coloured blood-corpuscles). Precipitated hematin of this kind is met with most abun- dantly and most frequently within the vessels of the mucous membrane aud submucous tissue of the duodenum and upper part of the small intestine, less so in the lower portion, and They would seem to be of a totally different nature to the hamatoidin crystals, inas- much, as they are extremely perishable, and very soluble in acetic acid, dilute solu- tions of potass and soda, and in nitric acid. The crystals assume divers forms, such as prismatic, tetrahedrons, octahedrons, and hexagonal tables, the shape varying apparently in different animals. These crystals seem to have been noticed at about the same time (1849), by Kolliker and Reichert. By the former, in the interior of the blood-corpuscles of the splenic vein in the Dog, and of several Fish, as well as of Python bivittatm, and although he had noticed their formation externally to the body, still he thought there was reason to believe that most of them were produced during life, from a sort of decomposition of the blood-corpuscles in the spleen. Reichert noticed the occurrence of similar crystals in the membranes of the ovum of the Guinea Pig, and indicated their composition out of an albuminous substance, &c. But the proper interpretation of their nature and constitution was reserved for Funke who had independently noticed them in the splenic vein of a Horse, and subse- quently in the blood of Fishes. He made the important observation, that they are formed only externally to the body, and that they may be produced at any time by a certain mode of procedure ; and throws out the supposition, that they are formed from the albuminous contents of the blood-cells combined vrith hcematin. It has since been shown by Kunde, and others, that the " globulin crystals " may be pro- COLOURING MATTERS. 117 most rarely in the large intestine^ in persons dead of cholera. The same forms frequently occurj in pretty considerable number, in the capillary system of the vena portts, (vid. sup. on the new formation of connective tissue in the liver), in the slate- coloured liver observed in connexion with intermittent fever, as well as in the larger branches of the vena port» fluid protein-compounds of the blood, even within the vessels; a point which will be further discussed in speaking of pus-corpuscles. The colouring-matter escapes from a great number of the red corpuscles, and is precipitated in the form of brownish-black particles (fig. 12, a, b), or may constitute the hematin-crystals, which have not yet been chemically investigated, or contribute to the colouring of epithelium, flocculent corpuscles, the inter- cellular substance, &c. ; it may even be transformed into black pigment, the dark streaks formed by which indicate the remains of the dead blood. Atrophy of the blood still in circulation, consists in the diminution of its elementary parts, and the increase of the fatty and aqueous contents. Precise quantitative determina- tions are still wanting on this subject, although the question, as to how far an increase of urea, of the saline contents, extractive matters, &c., in the blood, may contribute towards the involution of that fluid tissue, is, nevertheless, of the highest importance. The solution of this question must commence with the analysis of the blood in old age. § 2. Fatty and cellular Tissue. Our attention is here directed principally to the fat-cells. For the proper study of the atrophic conditions of these elementary organs, it is necessary to examine single layers of them, taken by means of the scissors j for if several are super- imposed one upon the other, the observation is much obstructed. Much emaciated, or dropsical, subjects should especially be selected. FAT AND CELLULAR TISSUE. 131 Schwann was the first to notice the nuclei of the fat-cells, still very distinct in the subcutaneous cellular tissue of a rachitic child one year old. Kolliker has more precisely defined the morphological changes of the atrophied fat-cells, which he distinguishes into serous fat-cells j those deprived wholly of fat and filled merely with serum ; and, lastly, those containing crystals. In a morphological point of view we distinguish the following metamorphoses of atrophied fat-ceUs. la place of the ovoid figure which they possess in the normal state, and instead of their being so-filled with fluid, transparent fat, that not even a trace of a nucleus can be discerned, we notice a collapsing and flatten- ing of the oval cell. The olein and margarin, either remain enclosed in it, and become decomposed, or are replaced by a serous fluid by endosmosis, in consequence of which the re- maining fluid fat is suspended in the serum, and ultimately, gradually disappears altogether from the cell. In the former case we remark granular dark brownish yellow contents (fig. 14, a) ; the cell appears more or less tuberculated, and the contour line has lost its oval form owing to the numerous sinuosities. When treated with carbonate of soda, the coloured substance is not removed, even after a prolonged action, nor, owing to the dark colour, is it possible to discern groups of crystals in it. In similar cells, however, of lighter hue {vid. the cell under a) needles may be per- ceived radiating towards the periphery. These crystals, which are more probably margaric acid than margarin, also appear in stellate groups i^'id. lipoma). The colour cannot well be at- tributed merely to the accumulation of crystals, but must be due to the metamorphosis of the colouring matter proper to the fat as such. It is highly interesting to observe that (fig. 14, h) a coloured fat-cell contained a granular substance, and, consequently, in a state of atrophy may occur in con- nexion with one in perfectly normal condition. This circum- FiG. 14. 132 ATROPHIES. stance afiForda a striking proof of the independence of the cells, in their involution. The second case, in which the fluid fat is either partially or wholly replaced by a serous fluid, is manifested by a flattening, owing to the circumstance that the fat no longer distends the cell wall, but appears in the form of spherical, sharply defined, strongly refractive globules, of a light or deep yellow colour verging into a yellowish red (fig. 14, c, the sharply defined circles within the cells). The cell membrane retains its rounded figure, and often presents a double contour line. The most important circumstance,however,is the appearance of the oval, pale-coloured nucleus furnished with a nucleolus (fig. 14, c, the delicate, oval bodies contained in the cells). The nucleus is sometimes single, sometimes double, and it is brought into view more dis- tinctly on the application of acetic acid. It is at once obvious that the nucleus is not formed merely after the disappearance of the fat, but that its existence in the normal fat cell must be supposed. The fat-globules in this form of atrophied cell may ultimately disappear altogether, a finely granular material often presenting itself instead. With regard to the cell-membrane, it is to be remarked that it apparently becomes thicker, and that several concentric layers are visible on its inner aspect (fig. 14, d). In this case two things are conceivable ; the apparent thickening, and the con- centric lamination, are either caused simply by a folding of the cell membrane, or, if that be denied, we are compelled to assume a deposition of solid layers on the inner surface of the membrane. A somewhat difierent atrophic form^ is presented when the fat is subdivided into a multitude of globules (fig. 15, a a), which are frequently grouped around a lighter coloured, ill defined space (serum). In many of these cases the cell membranes are no longer visible, and the cells are also placed at cer- tain distances apart. No ves- FiG. 15. FAT AND CELLULAR TISSUE. 133 tige of the nucleus can be perceived. These forms were occa- sionally met with in an oedematous mesentery, which had become swollen into a gelatinous, watery pulp; and in the case, from which the figure was taken, in the tunic of a gelatinous sarcoma seated in the subcutaneous cellular tissue. For the purpose of comparison, the normal fat-cells which oc- curred in association with the above, have been added (fig. 15, b), and, to complete the picture, the elastic filaments with their en- largements and divisions (c, c), and jagged margin, have also been given. KoUiker describes other metamorphoses of the fat-cells besides those above noticed, such as cells sometimes rounded, some- times fusiform or stellate, and furnished with 3-5 irregular pro- cesses often of some length, which are said to be developed out of adipose cells deprived of their oily contents. We cannot coincide in this opinion, because, in the first place, the metamor- phosed cells so described and figured, differ in no respect from young cells of connective tissue ; secondly, because, according to our experience in pathological histology, no instance exists of a pathologically modified cell which has assumed entirely the habit of another kind of cell, either normal or newly-formed, or, as in the present case, of an entire series of them; and, thirdly, because it is not a rare occurrence for new formations of cellular tissue to take place together with serous collections; with respect to which we would simply indicate the case of cysts. The fat, which is removed from the adipose cells in cases of emaciation, must enter the intercellular fluid, whence it is taken up by the lymphatics ; the collapsed groups of fat-cells are re- duced to a smaller volume, until their contents are by degrees entirely removed, nothing but the delicate cell-membrane re- maining, which, in many cases, undoubtedly undergoes a com- plete solution. Not long since we were enabled to trace, for a considerable distance, a large number of lymphatics in an oedematous adipose tissue (in the muscular tissue), whose character was placed beyond doubt by their course, their sac- cular sinuosities, and finely molecular contents. The fat-cells presented the characters proper to them in a state of atrophy. We do not conceive that these vessels were of new-formation, because they were also met with in the normal adipose tissue, 134 ATROPHIES. and were only more manifest than usual in consequence of the oedematous condition of the part. In the cellular (connective) tissue, we distinguish the pheno- mena of atrophy into those occurring in the areolar framework, and those whose seat is in the areolae (in the elementaiy organs contained in them) and in the intercellular fluid. In the areolue the retrograde nutrition is indicated hy deposits of various kinds, among which we would place fat in the first place. This material is usually deposited in the form of larger or smaller fat-globules, which are unaffected by acetic acid, are rendered more distinct by alkalies, and when expressed, float on the surface of the fluid in oily drops. They occur not only in the inter-cellular fluid but also, as a form of degeneration, in the elementary organs, which (young connective tissue-cells of rounded or fusiform shape) present an accumulation of fat-globules in their contents. Cholesterin, in the form of minute, superimposed, transparent plates with jagged edges, is frequently met with in the areolae of atrophied connective tissue, especially in old persons. Pigment occurs as an orange-yellow, reddish-brown, brownish-yellow, brownish-red, and black, gra- nular, aggregated deposit. Of the inorganic salts, the principal here met with belong to the calcareous group — carbonate and phosphate of lime — they assume the form of amorphous masses, sometimes granular, sometimes nodular, which dissolve in acetic and hydrochloric acids, sometimes with, sometimes without, the evolution of air bubbles. A very frequent form is the col- lection of a hydropic (serous) fluid, by which the areolae and areolar passages are distended, and the cells subjected to a gradual fusion. The thin fluid, at the same time, owing to the communications between the areolae is easily forced from one into another by pressure or the dependent position, an ex- periment which may be easily performed, especially in an oede- matous extremity. The areolar framework, undergoes essentially the same mor- phological changes, inasmuch as similar deposits take place between the separate fibres and bundles of which it is composed. The blood-vessels, running in the framework, collapse, together with the latter, and the volume of the connective tissue is diminished, since, according to the notion of the older physio- logists, the exhalation {halitus vitalis) of a gaseous fluid from CARTILAGINOUS TISSUE. 135 the blood ceases, and in this way the so-termed turgor vitalis subsides. Fig. 16. ^ 3. Cartilaginous tissue. This tissue is especially adapted for the study of atrophied tissues, since fine sections in various directions may be readily prepared from it; the textural changes are very manifest and easily traced. The contents of the cartilage-cells are metamorphosed. They frequently contain unusually large fat-globules, (fig. 16, the strongly defined, light co- loured, circular and oval bodies in the cells), which often occupy the entire cell, in consequence of which, the granular nucleus of the latter gradually disappears. It cannot be denied that distinct fat-globules occur in cartilage which, to the naked eye, presents a perfectly normal aspect, and in which the cells thus containing oil cannot properly be described as in a state of atrophy, un- less at the same time some change in the intercellular sub- stance has previously taken place. An accumulation of pigmentary molecules, usually of a brownish- yellow hue, begins to take place around the nucleus far more probably than in the nucleus, and gradually extends throughout the cavity of the cell, so that ultimately the entire cell is filled with it, a sharply dcr fined fat-globule being at the same time included in it (fig. 16, a). According to our present experience, the nucleus in the atro- phied cartilage-cell undergoes no determinate pathological change, it simply disappears, as stated above. An apparent thickening of the cell-wall, similar to the one above described, as occurring in atrophied fat-cells, may be witnessed in many cartilage- cells, the appearance in this case also admitting of a different interpretation. But .here the circumstance is superadded that a cartilage-cell with thickened walls might represent one in what is termed the process of ossification. The membrane, especially of the secondary cells. 136 ATROPHIES. Fig. 17. 'A^ K, not unfrequently undergoes a sort of solution, nothing re- maining but a parent-cell with several fat-globules. With respect to the intercellular substance, several metamor- phoses are to be noticed. The normally structureless, trans- parent substance between the cells (fig. 16) becomes granular, and a brownish-yellow molecular material accumulates in thicker or thinner layers around the individual cells, so that the latter are partially or entirely concealed, nothing but the fat-globules being apparent (fig. 17, the dark intercellular substance c). In con- sequence of this, the cartilage loses its opaline aspect and its proper transparency in thin sections ; it be- comes yellowish, brownish - yellow, even to the naked eye, and loses much of its elasticity. When sections of cartilage in this condition are treated with alkalies, no appearance of change will be perceived either in the coloured cells or in the coloured inter-cellular sub- stance, any more than is noticed after the application of acetic acid. A deposition of fat assuming the form of scattered largish fat-globules, like those in the cells, is never observable, whilst smaller fat-drops perhaps make their appearance, which' become grouped into granular masses. The metamorphosis of the structureless intercellular sub- stance, for instance, of the articular cartilages, into a liga- mentous or fibrous texture, is one of considerable interest. Cartilages in this con- dition are of a dirty yel- low colour, brownish-yel- low, and occasionally present a homogeneous aspect; they are much more lax in their con- sistence, and so soft that they can be said rather to be scraped than cut by the knife. The intercellular substance (fig. 18, a) is split into fibrils, sometimes very delicate and undulating, and sometimes Fig. 18, CARTILAGINOUS TISSUE. 137 of more considerable size. They decussate frequently and in various directions, often projecting at the border of the preparation as ligamentous threads. They enclose the carti- lage-cells more or less infiltrated with fat, which in the case above noticed (investing cartilage of the osteoporous upper extremity of the iibia) were beset with several brilliant mole- cules, and furnished with oval nuclei. The latter, as well as the molecules, were rendered more manifest by the action of acetic acid, whilst the fibrous substance disappeared. In a fibrous intercellular substance of this kind. Dr. Redfern noticed a series of elongated nuclei, brought into view by acetic acid, whose longer diameter corresponded with the direction of the fibres. The intervertebral cartilages of aged individuals are usually of a dusky colour, and dry ; and the fibrous intercellular sub- stance contains pigment. The intervertebral cartilages of an imbecile woman, more than 70 years old, afflicted with cyphosis, were atrophied to an extreme degree, of a dirty brown colour, and contained crumbly calcareous masses, without a trace of osseous texture. Some of the cartilage-cells, concealed in the opaque intercellular substance, were liberated in the dissection, and presented a brownish-yellow colour. The calcareous par- ticles were deposited in considerable quantity in the centre of the cartilage. The retrograde formations of cartilage, above enumerated, are induced by disturbances of the circulation in those vessels by which the nutritive fluid is conveyed to the affected tissue, and the cartilages, according to the diversities of their struc- ture in various parts of the body, and the special morbid process affecting their nutrition, necessarily undergo dif- ferent modifications of retrograde formation. Exudations in the mucous membrane and submucous tissue of the air-passages as in tuberculosis, chronic catarrh, reiterated pneumonia, &c., will injuriously affect, from the inner side, the nutrition of the cartilage, whilst towards the perichondrium, on the outer aspect (fig. 17, the right border, b), the nutrition is less interfered with, the circulation in the nutritive vessels in the perichon- drium suffering no interruption. The proposition broached above, that hypertrophy of one portion of tissue may frequently be noticed conjoined with 138 ATROPHIES. atrophy of another, receives confirmation in the present instance also. The nutrition of a group of cartilage-cells may cease, in consequence of the deposition of fat, or the precipitation of molecular, pigmentary matter, in their contents; and theit multiplication will also cease, owing to the cessation of the nutrition, whilst, in a contiguous group of cells, conditions of precisely an opposite nature will be observed; an increased supply of nutritive fluid being afforded to the latter, in consequence of which, a more active production of cells will take place. It very frequently happens, also, that a considerable quantity of cartilage-cells may be observed crowded into the same space ; which is due, in part, to the increased volume of the cells, which may amount to more than double the usual bulk, so that the intercellular substance is supplanted to a greater or less extent. Let us consider, for instance, the conditions presented in the cystic thyroid gland, in which, owing to the partial increase in the bulk of, and special new-formations in the gland, the vessels of the perichondrium of the larynx are also involved in the disturbance of the circulation ; and the nutritive conditions of the subjacent cartilaginous tissue are so altered, that an anomalous state of the texture is obvious, even to the naked eye. The cartilages become dry, yellow, dirty brownish-yellow, and occasionally softened, so as frequently to present a soft, pulpy consistence, especially towards the middle of their transverse diameter. If the softened part be examined microscopically, it will exhibit the appearance shown in fig. 19. Some of the cells are seen to contain oil- globules, the granular nucleus is still visible in most of them; the walls in many are thickened (a) ; the intercellular substance en- closing, sometimes a finely granu- lar material, grouped especially around the cells, sometimes elon- gated corpuscles {b b), which can scarcely be regarded in any way as nuclei, inasmuch as they correspond, both in their re- fractive power and in their chemical properties, with fat- FiG. 19. CARTILAGINOUS TISSUE. 139 Fie. 20. globules. In the very soft parts, lastly, nothing remains but a grumous material, where the cartilaginous substance has become almost entirely broken up, and an amorphous matter, sometimes containing pigment, sometimes fatty, with scattered calcareous particles, constitutes the principal element. If the drier, brownish-yellow portions of the laryngeal cartilages in this state of atrophy be selected for examina- tion, we shall observe the appearances represented in fig. 30, exhibiting a group of the various kinds of pathological, morphological meta- morphoses of the cells. They cannot all, however, be described under the term atrophy. It has already been stated, that cartilage-cells, with appa- rently thickened walls (fig. 30 a, c), may also be noticed at the commence- ment of the process of ossification. Thus, the cells b b represent imper- fect forms of development into se- condary cells; and, in the same way, between b b, and near c, may be ob- served a granular mass, which must, perhaps, be explained as of new forma- tion, and not as resulting from the re- trograde metamorphosis of a cartilage-cell. d, will bfe noticed an accumulation of a coloured granular material, particularly towards one side, the secondary cells con- taining fat-globules of considerable size. The other cells are in a state of fatty and pigmented degeneration. In what is termed by Albers perichondritis lai^ngea, when the exudation passes into a puriform new-formation, a suppurating sac of various dimensions, as Dittrich has correctly described it, is developed, most usually formed of a thick, whitish-grey, or slate-coloured fibrous tissue, which appears sometimes to be wholly of new-formation, sometimes to be intimately coalescent with the surrounding textures. Within this capsule is con- tained a thick, purulent, or ichorous, fluid. In that situation, not a vestige of the perichondrium is any longer to be discerned ; the affected cartilage is bathed by pus and ichor, sometimes throughout its whole extent, sometimes in a circumscribed In the parent-cell. 140 ATROPHIES. space, and often floats about in a detached state in the fluid. It is manifest that, in this case also, the cessation of nutrition, and the death or necrosis of the aflected cartilaginous tissue, are consequent upon the development of pus- corpuscles in the perichondrium. A process of a precisely analogous kind takes place in caries of the bones towards the investing articular cartilage, which is raised, as it were, by the suppuration proceeding from the bone. This separation of the articular cartilage is manifested, especially at its borders, which are gradually detached; and by means of the forceps, larger or smaller fragments, or even the entire cartilage may be elevated, to which a thin layer of bone remains attached. The substance of the cartilage appears somewhat softened, and its transparency is diminished by the considerable quantity of fat which may be shown to exist in the cells ; and the light, blueish-grey colour of the surface is replaced by a yellowish tinge. A new-formation of pus- corpuscles around the vessels by which the nutrition of the cartilage is carried on, is equally conducive to the atrophy of the latter; thus, also, the new-formations of connective tissue which frequently occur simultaneously with that of pus in the cancelli of the articular ends of the bones, and even appear in the form of substantive neophytes, are greatly conducive to the retrograde development of the articular cartilage. Sarcoma and cancer, when seated in the bones near the articular cartilage, will induce the atrophy of the latter. The growths and suppurations of connective tissue, which are of such frequent occurrence, may cause a solution of the osseous tissue in circumscribed portions, whence irregular, ulcer-like losses of substance arise. • § 4. Osseous tissue. Atrophy of the bones depends upon a partial or complete abo- lition of nutrition throughout the bone, or in separate portions. It is in general induced by the involution of those tissues by the aid of which the nutrition is carried on. The various kinds of the latter are also followed by various forms of atrophy in the bone. We have, therefore, to consider (1) : the retrograde development of the tissues subservient to the OSSEOUS TISSUE. 141 nutrition of the bone, and to discuss the causes by which this is induced ; and (2) : thence to develope the divers forms of atrophy of the bone, considered organically. The forms of retrograde development of the tissues subser- vient to the nutrition of the bone, have reference, in the first place, to the medullary substance and the periosteum. The fat- cells of the former have been described by Hasse (in rheu- matism), and by KoUiker (in the hypersemiated medulla of the articular ends of bones), as containing serum, and as being deficient in fatty matter ; and they resemble the forms figured above (fig. 14 c, and fig. 15 aa). But there are also those dark brownish-yellow metamorphoses of the fat-cells represented in fig. 14 a. The vessels of the medulla, under these circumstances, may be either anaemic or hypercemic ; in the latter case, owing to the interruption of the circulation, they will convey no fresh supply of blood, and the stagnant blood acts directly as an impediment to nutrition. This stagnant blood, whether in- cluded in the vessels or partially extravasated, now undergoes those retrograde metamorphoses of which we have spoken more particularly in referring to the atrophy of that fluid. In this way is produced the dirty, dark red, greasy medulla. In the anaemic condition of the vessels of the medulla, their walls col- lapse, and the elementary organs of which they are composed gradually shrink, nothing being left, for the most part, but the accompanying connective- tissue fibres, which are beset with a brownish-yellow pigment. As a form of atrophy occurring in the medulla, we must describe that in which calcareous granules are found in the cancelli ; it is met with especially in old indi- viduals, and is due to the deposition of amorphous, calcareous salts, no longer capable of entering into an organic union with the osseous tissue. The periosteum, composed of connective tissue with vessels ramifying in it, communicating with those proceeding to the surface of the bone from the medullary canal, exhibits its atro- phied condition by its shrinking, or by the softening of its sub- stance, together with the loss of its silvery lustre and the diminution of its cohesion to the bone. If we inquire into the causal influences that induce the above-described forms of retrograde development of the tissues subservient to the nutrition of the bone, we shall find that they 142 ATROPHIES. may be subdivided into general and special. The former are to be sought in the general disturbances of nutrition and motion. In old age an atrophic condition of the blood, as the general nutritive fluid, is established, and induces the form de- scribed as senile atrophy of the bones. This insufficiently nutritive condition of the blood, however, occurs not only at the normal period of involution in old age, but also in those premature atrophic states of the blood which accompany tuber- culosis, syphilis, gout, rickets, &c. These diseases, consequently, are often attended with atrophy of the osseous tissue, though undoubtedly of a modified kind. General disturbances of the motile faculty, such, for instance, as occur in paralysis, second- arily induce a retardation of the circulation, in consequence of the diminished contractility of the motile organs ; which re- tardation, in the paralysed parts, may lead to atrophy of the bone. The special causal influences consist in local, pathological formations, injuriously afiecting the nutrition of the bone in a circumscribed extent, or which may entirely cut it off; forma- tions of this kind are aneurisms, abscesses, sarcomatous tumours, osteophytes, &c. {vid. new formations of the osseous tissue). The various forms of osseous atrophy developed from causes of this kind, concern the bone-corpuscles and the inter corpuscular substance. With respect to their external aspect, the former undergo no further metamorphosis, the contents alone are sub- ject to various modifications, for the bone-corpuscles often appear throughout of a dark, black colour, which cannot be ascribed merely to the air contained in them, since the dark hue cannot, like that dependent upon the presence of air, be removed by careful expression in Canada balsam. The re- markably light colour of the bone corpuscles, recalling their appearance in young, developing bones, occurs principally in bones undergoing absorption. The intercorpuscular substance in necrosed portions of bone frequently presents a dark, brown- • ish-yellow colour (fig. 21). A portion of the tibia whose nutrition had been cut off by an exudation (necrotic) has been selected for representation; and in the transverse section of which the speckled aspect of the bone is very well shown. At a a, are seen Haversian canals, laid open perpendicularly to their long axis, around which the elongated, opaque bone- OSSEOUS TISSUE. 143 corpuscles are disposed in concentric layers. The radiating stri These pultaceous deposits are, not unfrequently, replaced by others of a tougher and cartilaginous nature, and of a structure- less, transparent substance, which are not changed by acetic acid, and, by the reception of earthy salts, become converted into ossific plates. The latter, also, are at first lined on the inner surface by the longitudinal fibrous layer, which is gradually necrosed, and detached from the edges of the plates, which, when thus exposed, project into the canal of the vessel. When polished, and closely examined, these plates never present the characteristic corpuscles of bone, nor any system of medullary canaliculi; for the irregular spaces filled with calcareous salts (fig. 51, b), cannot, in any way, be regarded as incomplete bone- corpuscles and canaliculi. It follows, therefore, that this kind of deposition should not be termed ossification of the artery, but cretification. When the examination is continued, from these plates towards the lighter-coloured spots, scattered groups of globular bodies will be perceived (fig. 51, c), which are rendered very distinct by the interstices between them. These globular masses resemble, in all respects, those first accurately described by J. Czermdk in the dentine, and termed by him " globular masses," and " interglobular spaces." We think 228 EXUDATIONS. that they should be described as protein-masses (colloid ?) impregnated with calcareous salts. The pathological metamorphosis of the annular fibrous layer consists, chiefly, in the deposition of fatty molecules between the more consistent layers. If portions of the latter are raised, proceeding from within to without, by means of the forceps, the fatty molecules will be seen lying, partly in longitudinal rows, partly in sacciform dilatations, in the fibrous network of the membrane in question, towards whose outer layers the fatty contents and the yellow colour due to them increase, but ceasing towards the cellular coat. By this fatty infiltration, the annular fibrous layer is rendered thicker, though its con- sistence and elasticity are diminished. We agree with Engel, in the opinion that this accumulation of fatty molecules should not be regarded as a fatty degeneration like that of the muscles, looking upon it rather as a usually unorganizable exudation, assuming the form of minutely divided fat, and connected, in its origin, with a hypersemic condition of the cellular, and, perhaps, of the annular fibrous tunics.-^ In rare cases, new formations are produced on the inner- most layers of the annular fibrous tunic. In a softened mass, situated beneath the inner coat of the aorta, which was elevated by it, Virchow observed immature cell-formations, free, smooth nuclei, and minute cells, some uni- some multi-nuclear, with homogeneous contents. In this case, besides the semi- cartilaginous, thickening layers, as they are termed, the aorta presented cretified and fatty plaques ; whence it is apparent, that, even together with the so-termed atheromatous deposit, a process of cell-formation may co-exist. The same observer has also shown, experimentally, the possibility of suppuration beneath the inner coat. It is thus obvious, that an exudation, or increased transuda- tion, may take place in the annular fibrous layer ; and that, in ' [Some excellent observations on the subject of fatty degeneration of the arteries, in which nearly all the facts noticed in the text and others of equal importance are given, will be found in a paper by Mr. Gulliver, in the ' Med.-Chir. Transactions,' 2d ser., vol. viii, p. 86, 1843. The true nature of atheromatous deposits is there pointed out, so far as I am aware, for the first time, at any rate in a satisfactory and de- tailed manner. Although the fact of the presence of fatty matters had been pre- viously indicated in thein , by Bizot, Cruveilhier, and Gluge. — Ed.] VESSELS. 329 many cases, this product is even organizable. Now, whence this exudation is derived, whether from the blood-vessels of the annular fibrous coat itself, or from those of the cellular coat, depends, as has been already stated, upon the existence, which, it is true, has yet to be established, of blood-vessels in the annular fibrous coat. If we assume the existence of these vessels, it becomes the more easy to explain the occurrence of a new-formation of elementary organs beneath the inner coat of the artery. In speaking of the atrophies of the vessels, we have already shown that their elasticity and contractility are affected by the fat which accumulates in the walls, as a consequence of the insufficient supply of nutriment ; and, therefore, that from the greater afflux of blood, and the hindrance to its return, an ex- pansion takes place at the points more copiously infiltrated with fat, from which, owing to its diminished contractility the vessel is unable to regain its pristine calibre. The same mode of dilatation may also be conceived to occur in inflamed vessels, except that in this case it would reach a greater extent, in pro- portion to the weakness of the wall of the vessel, induced by the exudation deposited in it. Now the stream of blood must be delayed in the dilated portions of the vessel, or may even be partially arrested in some of the hollows, or perhaps entirely stopped, when a coagulum is formed, by which the canal of the vessel is ob- literated, and which undergoes several morphological changes. On one occasion, we examined an old coagulum, contained in a very large aneurismal sac of the aorta. It was compact, leathery, and tough, and consisted of several fibrinous layers, marked with yellow and rusty-brown streaks, so that the cut surface was not unlike agate. The outer surface, applied to the wall of the artery, had a rough, velvety aspect, was for the most part of a reddish-brown colour, and in some places of a dirty yellow. The coagulum was softer towards the centre, which was occupied by a more lax, yellowish, fibrinous sub- stance. From the denser portions, sections could be made, presenting between the dirty, reddish-brown streaks, scattered granular corpuscles, of various dimensions, for the most part of a rounded figure, but occasionally furnished with processes. The reddish-brown fibrinous coagulum was rendered pale by 230 EXUDATIONS. acetic acid, though still retaining a light yellow colour. The granular masses were not afifected by that acid. The softer portion towards the centre contained numerous white blood- corpuscles, and a large quantity of a molecular substance. In the aneurismal mesenteric artery of a Horse, the coagulum, which contained several strongyli (a circumstance of frequent occurrence in old horses), was soft and spongy, and in many places distinctly puriform. In the latter portions were nu- merous granular corpuscles, some rounded, some elongated, many of which, of a lighter colour, presented a vesicular nucleus. Together with these, were numerous, solitary and agglomerated fat-globules ; and white blood-corpuscles existed everywhere, in such large numbers as almost to exceed the red in amount. To the inner wall of the aneurismal sac adhered a yellowish, spongy, lacerable substance, containing, chiefly, nuclei, which, in form and size resembled those of the lymphatic glands, thymus, &c. Those parts of the inner surface of the sac, which were covered with this substance, had lost their smoothness. In the gelatiniform deposit, | — 1'" thick, on the inner surface of the descending aorta, of a Man who had died of periostitis of the bodies of the dorsal vertebrae, we, in like manner, found a large quantity of variously shaped nuclei and numerous fat- globules. Besides these elements, the exudation contained flattened cells, with rounded nuclei, in a state of fatty degene- ration, and which perfectly corresponded with the epithelial cells usually occurring in that situation. In the somewhat deeper layers of the exudation, lastly, elastic, fibrous networks were visible, manifestly referrible to the longitudinal fibrous layer. The tunica media contained a large quantity of fat-globules, and the cellular coat was much injected. The question, whether this nucleated substance on the inner surface of the artery, should be regarded as a deposition from the circulating blood, or, as formed from the exudation which was originally poured out beneath the longitudinal fibrous layer, we think must be decided in favour of the latter supposition, since these nucleated formations are intimately connected with the wall of the vessel, and cannot be removed like particles merely adherent to the smooth tunica intima. Luschka's observations on the subject of endocarditis, should also, here, be noticed. Having proved that the endocardium is VESSELS. 231 constituted essentially of the same elements as the coats of the vesselsj he proceeds to demonstrate more precisely the patho- logico-anatomical changes in that disease. In the first step of the hyperemia, the vessels of the cellular and elastic layers of the endocardium appear to be filled with blood, although the latter still retains its normal brilliancy and smoothness. In the stage of efi'usion, the blood-vessels are more or less concealed by the exudation, whence is produced a dirty-red, sometimes uniform, sometimes spotted colour. So long as the exudation is confined to the cellular and elastic layers, he found that the endocardium retained its smoothness and glistening aspect; but when the non- vascular layers and epithelium were infiltrated, as is always the case in acute endocarditis, the smoothness and brilliancy were lost, and various degrees of opacity and changes of colour became ap- parent. He very truly remarks, that the exuded matter adhering to the free surface of the endocardium, was not parted from the deeper strata of the exudation by any structural layer, but was directly continuous with them. When the exudation deposited beneath the longitudinal fibrous layer and the epithelium was organized, its growth advanced into the cavity of the heart, the endocardium being destroyed. Con- sequently, the same changes are here observable, as have been shown to take place in the arteries. When we speak of inflammation of the veins [phlebitis), the expre^ion can be understood as applying only to that of their walls; consequently, when the signs of inflammation are wanting in the latter, all criterion fails by which the pro- duct accumulated in the vein can be characterised as an inflammatory product. Thus, we not unfrequently meet with pus in a vein whose walls exhibit no indication whatever of inflammation. The phenomena attending phlebitis are analogous to those which accompany inflammation of the arteries. The hyperemia is confined chiefly to the cellular coat, which is not unfre- quently, also, the seat of sanguineous suffusions of greater or less extent. According to Rokitansky, the injection, in the veins, involves the annular fibrous coat. That coat appears vascular, but more frequently the injection of its tissue and the conse- quent redness have already disappeared, besides which the 333 EXUDATIONS. surface presents minute red points from extravasations in the proper substance of the tissue. The injection could in like manner be traced into the innermost layer, but this never exhibited any red injection. When exudation has taten place, both the outer and middle layers are thickened and infiltrated with a fluid which is sometimes thinner, sometimes thicker, sometimes transparent and at others turbid, The innermost layer either retains its smoothness, although rendered grey and opaque by the subjacent exudation and speckled with blood- red or brown-red spots of extravasation, or the surface is roughened by the spongy-filamentous exudation adherent to it. In the latter case the tunica intima is wanting, and the exuda- tion, usually metamorphosed into a nucleated substance, rests immediately upon the middle coat of the vessel. Rokitansky has occasionally found the layers of which the inner membrane is constituted, (together with the valves), detached from the annular fibrous layer, or even thrown off in the form of a tube. In consequence of this infiltration, the coats of the vein are softened in their texture, and their elasticity and contractility so far diminished that they cannot afford the same resistance to the circulating blood, whence a dilatation of the relaxed venous walls the more readily ensues. This can take place only at the expense of the thickness of the latter ; but since the veins, independently of that, have very thin walls, they are easily ruptured, when extravasations of blood take place in the parenchyma of the organ. * If the calibre of the vessel remain dilated, a retardation of the current of blood will occur in those situations, or even a complete stagnation will be established in isolated parts, the blood coagulating into a plug by which the venous canal is ob- structed. This plug afterwards undergoes various metamor- phoses ; among which, the excessive formation of white blood corpuscles is especially to be noticed, which, as is well-known, do not differ morphologically from pus-corpuscles. The question now remains to be determined, whether the pus contained in a vein is produced by metamorphosis from the stagnant blood, or from an exudation which has been poured out upon the inner surface of the vessel. We know that the inner coat of the vessel is certainly non-vascular, con- sequently an exudation from the outer and middle coats only. BONE. 233 can be regarded as possible. But with respect to tbisj a capacity for transudation must be assumed to exist in the inner layer, in accordance with which we must suppose that the ex- udation is deposited on the inner surface of the vein in the fluid state ; in which case, however, it would be removed by the current of blood. We fully agree with Luschka in assuming that the same thing obtains in the vessels as his observations have proved to take place in inflammation of the endocardium. He is satisfied, that is to say, that neither is it demonstrable by observation nor reconcilable with theory, that an exudation can in any way remain, or undergo metamorphoses, on the free surface of the endocardium. Consequently it must be admitted that the metamorphosing exudation is collected beneath the inner layer of the vessels, which undergoes a necrosis similar to that which we have described, as attacking the corresponding tunic in arteritis. We are, therefore, necessarily opposed to the view which would assume that the exudation may take place on the internal free surface of the vein, and consequently within its canal, and that the metamorphosis of the plastic forms of exudation is there effected. The fact that the pus, in these cases, may be formed from the stagnant blood, and more especially from its serum, perhaps no longer admits of doubt, since the metamorphosis of the co- agulated blood into a puriform fluid may be traced from the centre of the plug towards its periphery. § 5. Bone. When the exudation is aff'orded by the vessels of the peri- osteum, that membrane will be found in a hypersemiated con- dition. Its thickness is increased and its consistence diminished, the tense connective-tissue-fibrils being separated from each other by the exudation. The gelatinous eff'usion is often denser, assuming a lardaceous consistence, so that the proper tissue of the periosteum is entirely lost in it. The exudative process is sometimes limited to a small, circumscribed portion of the membrane, and is sometimes more extensively diffused. The surrounding connective tissue is usually found in an infiltrated condition, standing as it does in such close connexion with the periosteum. 234 EXUDATIONS. From the free communication between the vessels of the periosteum' and those proceeding from the surface of the bone, it is easy to understand that the exudation, in periostitis, may readily involve the superficial layers of the bone, of which oc- currence their dull aspect will afford an indication. The con- sistence of the affected bone is, by this, somewhat diminished, and changes of colour occur, which, as Lobstein has remarked, are perceptible in the dry bone. Under these circumstances parts of the bone may be observed which have lost their natural colour and appearance, and in which may be noticed dark spots alternating with white. This change of colour, which is especially remarkable in the long bones, depends, on the one side, upon the hyperemia of the medullary canals, and on the other, upon the deposition of the exudation, by which a rarefac- tion of the osseous lamellae is brought about. At the same time, the nutrition of the affected portion of bone ceases, in consequence of which a superficial scale becomes necrosed, and is thrown off. The exudation deposited in the periosteum is very prone to become organized, when it assumes a delicate villous aspect; its consistence is increased, and ultimately a new osseous substance is formed, which is in organic connexion with the subjacent bone. The elementary organs developed under these circum- stances, upon examination, will be found to consist only of such as bear the closest resemblance to young connective-tissue- elements ; they consist mainly of fusiform cells with an oval nucleus. We shall return to this subject more particularly when we come to the " formation of bone." The exudation in the periosteum, when less organizable, may be transformed into a lardaceous membrane of considerable thickness, or become developed into a strong layer of connective tissue intimately united with that in immediate contiguity with the membrane.' ■ [Scorbutic nodes, as they are termed, consist of a fibrinous deposit or exudation between the periosteum and bone, sometimes conjoined with a similar effusion in the superjacent connective tissue. This scorbutic effusion, though deeply coloured with blood, cannot, any more than the effusions among the muscles and into the tissue of the gums, &c., be regarded merely as coagulated blood, inasmuch as it is solid or semi-solid from the first, and rapidly assumes an imperfect kind of organi- zation, that is to say. It will be found when recent and soft to contain an abundance BONE. 235 Pus is not unfrequently formed from the thin fluid exudation in the periosteum, and collects between that membrane and the bone, causing its partial separation. The bone is thus exposed, and its superficial layers being deprived of their nutriment^ be- come spongy, and the process termed exfoliation takes place. A special kind of exudation is seen in what are termed ffum- mata. Lobstein describes it under the name of " gummose periostitis "siadcomT^&res the contents of these nodular swellings, as respects their consistence, with a semi-fluid mucilage of gum arable, and of the colour of currant-jelly. The seat of these gummata he places in the tissue of the periosteum itself, or, more often, between that membrane and the bone. With respect to the more intimate constituents of this exudation, so far as we are aware, nothing has been ascer- tained.' The exudation, as is well known, may also originate from the interior of the bone, the latter in this case undergoing various morphological changes, dependent upon the nature of the ex- udation, and its mode of distribution. The exudation is seated chiefly in the spongy part of the bone, of which satisfactory evidence is afi"orded especially in the long bones ; the compact substance is not involved until afterwards. The exudations may undergo various modifications in one and the same bone, since they may be limited to separate portions. Out of several, we will here adduce an instructive instance of inflammation of the tibia. In the superior and inferior ex- tremities of this bone, an isolated collection of sanious fluid was found in the middle of the spongy substance. The sanies contained principally pus-corpuscles in a state of fatty degenera- of fusiform nuclear bodies, and when older and more solid, to be richly furnished with new-formed capillaries, or vascular channels. On this subject, vid. Mr. Dalrymple's Observations on the Organization of Lymph in Cachexia, ' Med.-Chir. Trans.' 2d ser., vol. v, p. 212, and vol.ix, p. 70. — Ed.] ' [In syphilitic gummata, such for instance as are frequently observed on the frontal and breast bones, the contents are a glairy fluid, containing but fevr morpho- logical elements. The latter qonsist chiefly of irregular molecules and colourless granule-cells, and granular masses, often consisting apparently of oily spherules surrounding a transparent mass, but notwithstanding the apparently complete separation of the periosteum from the bone, by this heterogeneous product, it rarely happens, if the case be properly treated, and the opening of the tumour be avoided, that any exfoliation takes place. — Ed.] 236 EXUDATIONS. tion, and larger rounded nuclei belonging to flattened granulai' elements about twice or thrice the size of the pus-corpuscles. The collection in the upper part of the bone penetrated the tibia obliquely inwards and downwards, opening on its inner aspect with an oblique orifice (cloaca) ; superiorly, where the cavity was widest, it enclosed a bony sequestrum. The gelatinous deposit upon the medullary substance in the middle portion of the bone was interesting. It con- sisted of numerous, immature connective-tissue-elements with comparatively large, oval and elongated nuclei, containing 1 — 2 — 3 nucleoli, which had frequently escaped. These elements were for the most part lodged in a hyaline matrix. Numerous connective-tissue-fibrils could be detected in the denser portions of this substance, which were manifestly of new forma- tion, since, in the normal condition, connective tissue is never found so abundant in the medulla. The absence of fat-cells also, in this situation, was very remarkable. Besides this metamorphosis of the exudation into pus and connective tissue, its transformation into bone is to be noticed, whence in one case the circumference of the bone is increased (excentric new-formation of osseous lamellae), or in another, its peripheral limits remain the same, and its density merely is augmented (concentric new-formation of osseous lamelke). In the latter case, the new lamellar systems are deposited at the expense of the medullary canals and cancelli of the bone (scle- rosis), whilst in the former an absorption of the osseous sub- stance appears to proceed simultaneously with a partial new- formation, whence an enlargement of the medullary canals and cells is produced (osteoporosis). This rarefaction of the osseous tissue, is most striking in the more compact parts, as, for in- stance, in the cortical lamella of the long bones. The medullary substance existing in the more porous parts, is manifestly reddened, and the thin, arched processes of bone enclosing it, show the lamellar structure as distinctly as it is, otherwise, seen only in young bones in a state of development. To prove that in osteoporosis, together with a marked rare- faction of the tissue, a new-formation of osseous substance from the exudation deposited in the medullary canals and cancelli, may also take place, the case of an osteoporosis of the cranium in an old mad woman, may serve as an instance. The increase BONE. 237 of volume was very considerable, especially in the frontal and occipital bones, whose thickness amounted to as much as 1'56". The outer surface presented bluish-black spots, cor- responding to the dilated, injected canals of Breschet ; and on the inner surface projected verrucose and acicular osteophytes. The substance of the bone was spongy, so that it crumbled in the polishing of thin sections removed with the saw. Minute fragments, not so far disintegrated, when polished, exhi- bited a streaked, intercorpuscular substance, the appearance being caused by the decussation of the osseous lamellae at various angles ; their connexion was more lax than it usually is in the normal condition. The diversity of form of the ex- cessively numerous bone-corpuscles, was also very remarkable. These had sometimes the form of elongated fissures, were sometimes rounded, sometimes irregularly distorted; their jagged prolongations on all sides, were well marked, and their size very variable. In several places the substance of the bone was rendered so opaque by dirty, brownish-yellow spots, that the corpuscles were no longer visible where the change was most advanced. The cancelli contained principally a dirty .brownish-yellow, molecular substance. Thus, in this case, we have a confirmation of a phenomenon, to which we shall have repeatedly to recur in speaking of new formations ; viz. that, in exudations, one part may be in a state of involution, whilst another is metamorphosed into new-for- mations, which, on their side, again may also undergo a retro- grade transformation. As an exudative process, also, in which the osseous substance is, to a great extent, fused, or melted away, we have here to consider the disease known under the name of osteomalacia. In a well-marked case of this kind, in which, except those of the head, all the bones were afifected, we noticed the follow- ing condition : the bodies of the vertebra were so soft as to be readily cut with a knife, the medulla full of blood and very fluid, contained but little fatj the separate fat-cells were far apart, and among them was a large quantity of white blood- corpuscles, and numerous groups of brownish-red pigment- molecules, derived partly from necrosed blood, partly, perhaps, from the infiltration of the finely-divided fat, with the colouring matter of the blood. The osseous substance contained light- .238 EXUDATIONS. coloured^ transparent bone-corpuscles^ and the intercorpuscular substance showed a great tendency to separate into lamell(B, whence it presented a finely striated aspect. The medulla in the ribs was in the same condition as that in the bodies of the vertebra, except that the collections of pigment were wanting. The marrow in the femur was very remarkably aflfected. It was of a light-yellow colour, of a gelatinous consistence, and could be drawn out into threads. The fat-cells were evidently rarefied, many of them were minute, sometimes of a rounded, sometimes of an elongated form, whilst some were of unusual dimensions. In many of the smaller fat-cells, still more minute fatty molecules were collected, enclosing an oval nucleus. The fat in the form of globules within the cell, and grouped around the nucleus, appeared to be suspended in a gelatinous and albuminous fiuid. Oval nuclei were visible among the isolated fat-cells, which, from their size and form, appeared to belong to cells which had been destroyed. The osseous tissue of the femur, in a transverse section, taken from the middle of the bone, was reduced to a cortical substance, scarcely 0'22"' in thickness, from which jagged, slender, osseous spicules projected towards the medulla, constituting a delicate network. The compact osseous tissue of the femur could be split into lamellae, some of which presented no appearance whatever of bony structure, being simply structureless plates, whilst some were hyaline, and in many places exhibited opaque bone-corpUscles, according as the part was more or less ad- vanced in its degeneration. The medullary canals had disap- peared ; and the polished section of bone was quite flexible. A very remarkable circumstance was presented in one of the ribs, a transverse section of which, made at a distance of four or five inches from the cartilage, displayed a glistening, greyish- white substance, about 1-77'" in diameter, and with ill-de- fined outlines. This body proved distinctly, in several places, to be fibro-cartilage. The oval cells of various dimensions were lodged in great numbers, and isolated, among the decus- sating, rigid, fibrous bundles. This cartilaginous mass must doubtless be regarded as of new-formation, and as having been developed out of the exudation deposited in the substance of the rib. The condition of the intervertebral cartilages was also interesting. In many places,. in the midst of the normal cartUa- BONE. 239 ginous parenchyma, were contained cells covered with calcareous particles. Just as in this situation the removal of the earthy salts had not gone on, notwithstanding the advance it had made in the contiguous hones, so also had it produced no change in the forms of ossification of the cells of the thyroid cartilage and of the intercellular substance. The exudation in the interior of the bone often leads to a fusion of the osseous substance, as may be witnessed, for instance, in syphilitic or tubercular caries. In these cases, we find, not only the portions of bone immediately around the ulcer, in a state of infiltration, but frequently, also, the closely contiguous bone in the same condition. We have selected as a good instance, a horizontal section of a hypertrophied occipital bone, taken from an individual affected with syphilitic ulceration on the parietal bone. Fig. 53, A, a a, represents the external. Fig. 52. condensed portion of the bone, with the medullary canals ap- pearing as streaks and points. This part is of a white colour, whilst the adjacent substance is of a dirty, light-yellow hue, and (by reflected light) the expanded cancelli are seen as lighter coloured spaces. These cancelli are filled with fat, as shown in fig. B, which represents one of the cancelli of an elongated form, and in great measure filled with fat. The light-coloured bone-corpuscles surrounding it differ from the more opaque ones (C) filled with calcareous salts, which are taken from the external dense portion (a a) of the bone. 240 EXUDATIONS. The further changes effected in the bone depend upon ex- ternal circumstances and the nature of the exudation with which it is infiltrated. From the great difficulties opposed to the accurate analysis of this exudation^ we must at present be satisfied with conclusions drawn from analogy, bearing in view the products arising from it. Fibrinous exudations, in par- ticular, appear to be connected with a rapid fusion of the osseous tissue, as is seen in many, rapidly spreading, ulcerations of a syphilitic or scrofulous character; whilst thin, fluid exudations abounding in albumen, simply cause an erosion and sponginess of the bone, as in [other forms] of caries. These exudations, among which, probably that described in the case of osteomalacia should be reckoned, may, under particular modifications, afterwards become connected with a fusion of the osseous substance. In order to study the changes exhibited in bone, in osteitis, Virchow properly recommends the examination of recent bones, the principal part of the alterations being lost, or at any rate rendered far less distinct, in dried and polished sec- tions. He breaks off minute plates of bone from the inflamed part, and either places them at once entire under the microscope, or rapidly removes their earthy constituents by concentrated hydrochloric acid. In this way he has succeeded in detecting a fatty metamorphosis of the bone-corpuscles, in- dicated by the collection in the interior of the corpuscle of one or two, or of entire groups of fatty molecules. In some, especially well-marked cases, he says that he has distinguished similar fatty granules in the canaliculi ; but in this situation they were isolated, wide apart, and far smaller. In many instances the bone-corpuscles presented the aspect of thickened cartilage-ceUs furnished with pore-canals. § 6. Muscle. Under this head we include the infiltration of the primitive fasciculi, which, thence, in the aggregate, present an altered aspect visible even to the naked eye. In this affection there is no increase of the muscular substance. When speaking of hypertrophies of the tissues, we were obliged to notice several pathological changes of the muscles, MUSCLE. 241 connected in part with the involution of the hypertrophied primi- tive fasciculi, and in part referable to an exudation in them. Thus we spoke of succulent portions of hypertrophied muscular tissue, in which it is infiltrated with a gelatinous material. This morphological change is also seen in exudative processes in muscles not in the hypertrophied condition. Examination of the elementary tissues, in this case also, shows that the transverse striation is rendered less distinct, the primitive fasciculus being filled with a transparent homogeneous sub- stance ; at the same time, also, irregular swellings are produced apparently by an accumulation of the viscous fluid contents within the sarcolemma. The fasciculi adhere more closely together, and, in the aggregate, appear of a paler colour. In the muscular parenchyma, in this state of gelatinous metamor- phosis opaque spots may be noticed, enclosing primitive fasciculi transformed into a fine molecular substance. Their consistence is thus so far reduced, that in some places the limits of the individual fasciculi can no longer be distinguished. The sarcolemma is so much softened by the exudation, as to be dissolved leaving nothing but a fine molecular substance, in which not a single primitive fasciculus can be discerned. Virchow has described the latter condition in precisely the same way, terming it inflammatory softening, and referring the fatty degeneration also, to it, in accordance with his notions of inflammation. We have treated of this change under the head of atrophy of muscle, since fatty degeneration also occurs without any indication of increased transudation (as for instance, in advanced age). On the other hand, however, it must be allowed, that a similar morphological change of the primitive fasciculi, attended with the appearance of rows of fat-globules also occurs in inflammation. This form of in- volution is induced, not by a diminished (as in atrophy), but by an increased transudation (exudation). Another morphological change is produced in inflamed muscle, by the accumulation of pigment within the sarcolemma, as we have shown to be the case also in hypertrophied and atrophied muscle. In this condition, pigment-molecules are seen on the surface of the fasciculus, grouped parallel with its longitudinal axis; they lie at pretty regular distances, and are most probablv disposed around the nucleus of the sar- 16 242 EXUDATIONS. colemma, and consequently represent a pigmented degeneration of the elements of that membrane. The exudation in the interstitial connective tissue of the muscle, when organizable, undergoes transformation; new connective-tissue is formed, and the nutritive material being diverted in this direction, the connective-tissue elements rapidly increase, at the expense of the elementary organs of the muscle. We have termed this wasting of the muscle, " atrophy by growth of cellular tissue." Suppuration constitutes the second, frequent transformation of the exudation. It never occurs in the primitive /ascicM/i, but in the interstitial tissue. When the suppuration is rapid, the former undergo a process of solution. § 7. Blood-vasculak Glanhs. In the thyroid gland we usually meet with exudations con- taining colloid, constituting the so-termed struma lymphatica (Rokitansky's first type of bronchocele). They are deposited in considerable quantity in the lobes of the gland, so that the latter is seen to enclose more or less extensive cavities filled with the colloid substance. The primary seat of the deposit is in the glandular vesicles. The form assumed by the colloid substance, either whilst still within the vesicles, or external to them, after their rupture, is very variable, affording as it were a cast of the cavity in which it was deposited. We meet with discoid, reniform, or more elongated, hyaline corpuscles, which, when lying exactly behind a granular cell, might cause it to be confounded with a large nucleated cell. No cell-wall, however, is ever perceptible. The outline of these transparent, floating colloid masses disappears, almost entirely, on the addition of water. The very variable form, also, and the size of these bodies are equally opposed to their being any kind of ceU, even of a pathological origin. These exudations are afforded by the fine capillary plexus which encompasses the gland-vesicles, and gradually induce a dissolution of the delicate epithelium, on the inner surface of the vesicle, and ultimately that of their connective-tissue tunic, so that two or several of such infiltrated gland-vesicles coalesce, and constitute cavities recognizable even by the naked BLOOD- VASCULAR GLANDS. 243 eye. The more extensively the exudation is diflfused, the more is the bulk of the organ increased, and in the same proportion is its proper texture destroyed. In fig. 53, we have represented three lobules of the thyroid, ^'°- ^^■ containing colloid mat- ter. The cavities, which are filled with a very viscous fluid resembling thick mucilage of gum- arabic, were of ex- tremely various dimen- sions ; the smallest had a mean diameter of about 0-022'", and were usually more or less opaque ; the larger reached the diameter of 0044 — 0-35'". But few blood-vessels could be seen even in the basal portions of the lobules, whilst, under other circumstances the normal thyroid is well supplied with them. The larger cysts are usually deprived of epithelium, and are surrounded by a fine plexus of straight, delicate connective- tissue filaments, which are particularly well seen in thin sec- tions of a boiled and dried thyroid gland. The above- described structure was found to obtain throughout the diseased gland. In the second type the enlargement of the organ is not universal, but limited to certain portions of the gland. Thence arise the well-known nodular elevations, which may reach a considerable size. In this form of bronchocele, which has been termed struma cystica, the same process as that above described, essentially takes place. The colloid exudation is poured out in separate groups of lobules. An important cir- cumstance should here be noticed, that a new-formation of cellular tissue takes place around the infiltrated lobules, by which they are enclosed, as in a sort of capsule. The enclosed colloid exudation undergoes changes of form, which we will now submit to more particular consideration. In proceeding to the examination, it is necessary to slit open a thickened sac of the diseased thyroid gland, and to take particles from the soft, hyaline spots on the inner surface. Forms will then be perceived, which have been explained in 244 EXUDATIONS. various ways. Rokitansky has described and figured them correctly. They may be brought under various categories : 1. Flattened, transparent, colourless corpuscles of various dimensions, without any cell-membrane or nucleus. Their shape is usually round, oval, or occasionally presenting different kinds of indentations and sinuosities, and they consist of a homogeneous substance; 2. The peripheral outline is more distinct, and the substance begins to become differentiated ; a narrower or wider border being apparent at the periphery of the corpuscle, surrounding it like a ring, within which the substance presents a homogeneous, hyaline aspect ; 3. The latter now begins to undergo a further metamorphosis ; groups of granules make their appearance, which sometimes occupy the whole of the space surrounded by the annular border ; 4. Instead of the molecular substance, isolated, flattened, gra- nular bodies, solitary or multiple, are seen in the central hyaline mass ; 5. Several annular layers are formed, disposed con- centrically around a, usually, granular mass. All these bodies may also become detached from the wall of the cyst, in whose fluid they are frequently found floating. For representations of their forms we must refer to the thymus, and prostate, and to the choroid coat of the eye. Nor shall we here enter into a more precise exposition concerning them ; merely noticing, that we cannot coincide in the view expressed by Rokitansky, according to whom they are adherent, vesicular nuclei, whose wall has coalesced with the contents, chiefly after the transformation of the latter into the so-termed colloid, in consequence of which, all farther development and growth, appear to cease. In order to explain the concentric, annular layers, he assumes an endogenous- formation of nuclei, in which, within the enlarged nucleus, a second is produced, in the latter a third, and so on. We simply regard the bodies in ques- tion as, at first, homogeneous, the external, solidified substance afterwards assuming the form of an annular layer, whilst the enclosed fluid matter sometimes breaks up into a molecular substance, and is sometimes transformed into vesicular and nucleated structures. The subject will be discussed more particularly, as has been said, hereafter. Another form of metamorphosis of the colloid exudation is that of cretification. It is developed on the walls of the THYMUS GLAND. 245 sacculi of the thyroid gland, and appears in the form of bony plates, usually spotted with yellow, in all respects analogous to the plates met with in the thickened 'pleura and in atheromatous vessels. In polished fragments, jagged, irregular cavities may be noticed, especially towards the bordering, cellular tissue, which it demands some closeness of observation not to confound with bone-corpuscles, and which resemble in every particular those microscopic forms in the cretified pleura depicted in fig. 43. Isolated groups of spherical deposits (carbonate of lime) are imbedded in the more transparent parts. Like Forster, we have never been able to observe a true ossification. If the examination of the thickened cyst-wall be carried farther, a layer of polygonal, epithelial cells will be noticed on the smooth parts of the inner surface; at other points, a spongy, connective tissue-substance is apparent, projecting from the wall of the cyst into the cavity, and concerning which more will be said when we speak of " new-formations." We will now mention the following, as forms of the highest interest, which were met with in a colloid exudation in the thymus gland of a new-born child affected with pemphigus. In sections across the lobes, the central portion of the paren- chyma appeared to be softened, whence was produced an irregular cavity filled with a reddish-yellow fluid. This fluid contained principally nuclei, usually beset with a few brilliant molecules, and which after treatment with acetic acid, afforded no indication from which it could be supposed that they were any form of disintegrated pus-corpuscles. But a remarkable opacity resulted upon the addition of that acid, and streaky masses were apparent in the opaque portions (mucin). The paren- chyma of the gland was swollen, and rendered opaque, by a molecular infiltration. But besides this, there were, also, imbedded corpuscles, remarkable by the multiplicity of their forms. These were : 1. (fig. 54, a a) discoid bodies of a light grey-green colour, consisting of concentric peripheral layers; and enclosing a central substance, sometimes finely molecular, sometimes containing minute nuclei. 2. The central substance contained elements, in part simply granular, in part furnished with a vesicular wmcZcms (6). 3. The granular, round corpuscles were accumulated in such abundance in the central transparent substance as to occupy it almost entirely (c), 246 EXUDATIONS. Fig. 54. the solidified, peripheral colloid substance, forming closely ap- proximated layers, surrounding the brownish-yellow globules. 4. The corpuscles often enclosed several smaller ones of divers forms. Thus, in {d), we have groups of larger and smaller, nucleiform bodies, perfectly hyaline spaces, and cell-like cor- puscles ; and in (e), the layers embrace a multitude of isolated, encysted bodies, and in the lower part surround a hyaline substance containing no [morphological] elements. In (fj the central, enclosed bodies are of various forms, each separate group being surrounded by concentric layers. With respect to the origin of the forms above enumerated, several possibilities may be imagined. Either the elements are first formed and afterwards enclosed by the fluid, gradually solidifying colloid substance, or the peripheral layers are formed by the solidification of the colloid exudation deposited in the interstitial tissue, — as may be observed, for instance, in a drop of solution of gelatin, — the central substance remaining, at any rate for a time, in the fluid condition, surrounded by the solidified outer layers, and the various kinds of elements not being precipitated, till afterwards, from the fluid blastema. But again, the solidification of the peripheral layers may, also, take place simultaneously with the new- formation of the elements. It must be allowed, however, that we have no sufficient grounds upon which, conclusively. SPLEEN. 247 to decide in favour of one or the other mode of formation, and believe, therefore, that both the above possibilities must be admitted. Exudations in the spleen are either diffused throughout its entire substance, or are sometimes confined to isolated, peri- pheral, well-defined spots. The fluid albuminous exudation, deposited in the parenchyma, in tumefied spleens so afi'ected, may be precipitated by means of hot water ; in the boiled and dried organ, therefore, fine sections may be readily prepared, exhibiting a laminated deposit of a finely granular substance (precipitated albumen) lying in the parenchyma. These exudations are usually accompanied with hemorrhages from the small vessels, and, for instance, in the pulpy spleen (in typhus), may be recognized by the large accumulation of red-brown pigment, which is deposited in the parenchyma, and remains unchanged in the alkaline carbonates. Minute hematoidin-cxysXals, also, are of not unfrequent occurrence. An exudation, mainly of a colloid nature, appears to occur in that form of induration known under the name of " larda- ceous spleen" (Speckmilz). In minute, well-washed portions of the organ in this condition, especially in many places, numerous amorphous transparent masses will be seen, deposited in flakes, resembling the colloid masses in diseased thyroid glands, and which are not further changed upon the addition of acetic acid. Together with these, a dirty brownish-yellow pigment, in the free condition, is always present.^ The genesis of the so-termed " blood-corpuscle-containing ' [According to H. Meckel (quoted by Dr. Parkes, ' Brit, and For. Med.-Chir. Review,' vol. xix, p. 416), the spleen in lardaceous affection is never free from dis- ease, although in some cases nothing may be apparent to the unassisted eye. The arterial capillaries are lardaceous, and sometimes have little lateral bulgings, especially where in connection with the Malpighian corpuscles. These bodies con- tain, at first, normal splenic corpuscles ; at a later stage, some irregular, granular, gelatiniform lymph-corpuscles appear among them ; then minute masses of lardace- ous substance appear. Virchow states that the sago-hke grains in " waxy spleens" are composed mainly of particles affording the reaction of cellulose when treated ■mVa. iodine and sulphuric acid. He distinguishes two kinds of the affection, in one of which the cellulose-particles are contained within the Malpighian corpuscles, and in the other in the inter-corpuscular substance — a distinction, however, without much real difference, since there seems to be little or no difference, except mprphglpgical, between the corpuscles and the surrounding pulp. — En.] 248 EXUDATIONS. cells" of the enlarged spleen is probably connected with this form of coagulable exudation. Many doubts have been enter- tained with respect to these structures, and in particular has their cell-nature been contested by several observers. They are discoid -bodies which have been observed in the pulp of the spleen, enclosing from one to twenty blood-corpuscles, but in which neither a cell-membrane , nor a nucleus can be perceived. In general they are rare; and they arise, as we consider, in islands of coagulated exudation, which, during the process of solidification, have enclosed the blood-corpuscles escaped into the parenchyma. This process may be com- pared with the well-known experiment, in which, after the admixture of almond- or olive-oil and blood, groups of blood-corpuscles appear, encysted, as it were, by a spherical, vesicular capsule. The cell-nature of the blood-corpuscle-con- tainiiig bodies, has been shown by Kolliker and Ecker in the spleen of animals, inasmuch as they could perceive a cell- membrane and a nucleus in them. In man, however, these cells cannot be said to have been demonstrated, although the pigment-cells, not unfrequently met with in the human spleen, correspond with those which have been observed in several animals, associated with the cells containing blood- corpuscles, and with respect to which, it is supposed that the pigment in them originates from pre-existing blood- corpuscles. As it is certain that pigment is formed from disintegrated blood-corpuscles, so, also, has it been satisfactorily shown, especially by the more precise observations of Virchow, that the colouring matter, quitting the blood-corpuscles, enters the neighbouring parts (fibrinous coagula, cells, fibres, &c.) by imbibition, and undergoes further transformation in them ; the existence of blood-corpuscles, consequently, in the cells, is not necessarily requisite for the formation of pigment in them. Moreover, lastly, it should be remarked, that Remak, upon weighty grounds, calls in question the existence of the blood- corpuscle-containing cells, in the spleen, even in animals. Cells containing pigment occur very extensively in the greyish- black spleen, especially after intermittent fever, as has been shown by H. Meckel and Heschl ; the former has also met with brownish or blackish pigment, either aggregated into masses or in cells, in the blood of persons suffering under intermittent fever. LUNGS. 249 An excessive amount of white blood-corpuscles (resembling pus-corpuscles) is found in cases of the affection first described by Virchow, under the term leukhamia, in the vessels of the much-enlarged spleen. In the peripheral, conical deposits of a light-red or yellowish- red colour, arranged by Rokitansky under the secondary in- flammations, a considerable quantity of free fat, in the form of larger or smaller globules, which are sometimes, also, col- lected into extensive plaques, is found in the dirty, light- yellow, speckled spots. Besides which, brownish-yellow, granular agglomerations are also visible. The trabecules of the spleen are covered with the same fatty granular substance, so that, even when compressed, they will be found to have lost their normal transparency. In the yellowish streaks presented in these conical masses, the fatty infiltration of the trabecule is so considerable, that, by transmitted light, they appear even to the naked eye as opaque strim. Abundant crystals of hematoidin are lodged in the yellowish-red spots. § 8. Lungs. In the lungs, the exudation appears to follow the course of both vascular systems — viz., that of the bronchial — and of the pulmonary arteries. In the latter case, true pneumonia is esta- blished, in which the air-cells are, likewise, always the seat of the exudation. In the former a bronchial exudation is de- veloped, giving rise to consecutive blood-stases in the system of the pulmonary artery. Since the injections of Adriani, and of Rossignol have shown that the bronchial arteries and veins may be filled from the pulmonary veins, and the latter again from the bronchial arteries, the intercommunication of the two systems is demonstrated, and disturbances of the circulation in the one system explain those which are wit- nessed in the other. Thus, also, in an anatomical point of view, an exudation in the ramifications of the bronchia, a so- termed " bronchial catarrh," in which the exudation more or less obstructs the canal of the bronchiee, might induce a conse- cutive pneumonia, and the reverse. An exudation in the interstitial pulmonary tissue, in which the walls of the air-cells are said to be mostly involved, and 250 EXUDATIONS. occasionally even in the form of croupose pneumonia, as stated by Rokitansky, cannot, according to Engel, with whom we agree, be shown to exist ; he says : " There is no pneumonia in which the interstices of the air-cells serve as a seat for the deposition of the exudation, without a simultaneous implication of the air-cells, or in which, in fact, the latter are not chiefly the seat of the effusion. The structure of the pulmonary parenchyma renders the possibility of the formation of an exudation exclusively in the interstices between the air-cells, in general, doubtful." The course of the exudative process in the lungs, is some- times observed to be limited to abruptly defined portions, and manifestly follows the terminal ramifications of the minute pulmonary arteries. A single arterial ramuscule enters each pulmonary lobule, where it ramifies in the groups of air-cells, which are disposed exactly like the acini of a lobate gland, and in which the cells are in all respects analogous to the terminal vesicles of the acinose glands. Since, therefore, the ramification of the pulmonary artery corresponds with the grouping of the lobules, so also does the exudation proceed in the same manner. This is most distinctly seen in exudations in the pulmonary parenchyma which have undergone such a degree of transfor- mation, as to be distinguishable, by their colour and consistence, from the uninfiltrated pulmonary tissue. In sections of por- tions of the lungs thus partially affected, the latter present the aspect of consistent opacities usually of a dirty-yellow or greyish colour, whose peripheral limits are sharply defined by a scalloped border. But the exudation is often diffused throughout a greater extent of the pulmonary parenchyma, so much so, in fact, as, at last, occasionally to involve an entire lobe. In these cases also, without doubt, the infiltration of the air-cells advances according to the acinose arrangement of the latter, only more rapidly and more extensively. The examination of the surface of a pulmonary lobe in a state of nearly complete infiltration, shows that the line of demarcation is sharply defined in those situations where the diseased tissue, rendered more distinct by the metamorphosed exudation, abuts upon that still in the normal condition. The morphological changes, exhibited in the infiltrated pul- monary tissue, depend upon the nature of the exudation, and LUNGS. 251 other concomitant circumstances. In exudations, mainly of the fibrinous character, or in croupose pneumonia, the infil- trated tissue undergoes various metamorphoses simultaneously with the transformation of the exudation, which, as is well known, have been described as so many difi'erent stages of pneumonia; for instance, by Rokitansky, as those of inflam- matory congestion, hepati^zation, and purulent infiltration. The fibrinous exudation appears originally as a viscid fluid, tinged with blood, filling the hypersemiated air-cells. The entrance of air, however, is still perhaps maintained, so long as the corres- ponding bronchial twig is unobstructed, though this period is but brief, the latter being obstructed by subsequent exudations, and thus by degrees entire lobes are deprived of their normal contents — the air, — and, when compressed, afibrd no frothy liquid, and sink in water. At the same time, it must not be supposed that the exudation is poured out simply in the interior of the air-cells, and on the free surface of the bronchial mucous membrane, without its also involving the interstitial tissue. In a theoretical point of view, it is not conceivable, that the exudation, which is afl'orded by the very close capillary plexus of the air-cells, should be deposited only within the cell, and should not also penetrate the thin wall in an outward direction. Equally erroneous would be the supposition, that the exudation is poured out only on the surface of the bronchial mucous mem- brane, and that the parenchyma of the membrane is not at the same time pervaded by it. Consequently there is no pneumonia without infiltration of the corresponding interstitial tissue, just as in bronchitis the infiltration of the tissue of the mucous mem- brane is always comprehended. The exudation, which at the commencement ot pneumonia is thin and fluid, being of about the same density as the blood- serum, gradually becomes more and more viscid, as we have established to be the general rxile, and new elements begin, at once, to be developed in it. These reiterated exudations are accompanied by minute ex- travasations of blood, arising from the rupture of the delicate- walled vessels, and which may be recognized in the viscid sputa, by the presence of a large quantity of red blood-corpuscles. Not unfrequently also, upon close examination, entire lobules will be observed, infiltrated with blood, presenting in miniature 253 EXUDATIONS. the same conditions as are witnessed in larger portions of lung in a state of hemorrhagic infarction. The above-noticed new elements, whose more particular description will be subsequently given under the head of new- formations, are formed in the air-cells and corresponding minute bronchix, whence they are removed by expectoration. They increase rapidly, so that both the air-cells, and bronchial branches, are wholly filled by them, and groups of the former, especially on the surface of a section, are seen in the form of granules. Thence ensues the condition termed " hepatization of the lung." The organic metamorphosis of the exudation induces a textural change in the parenchyma. The air-cells become distended, whence results a tumefaction of the portion of lung, which, owing to the absence of air, loses its compressi- bility, and at the same time has its density increased. The distended and infiltrated air-cells, appear on the surface of a section, as is well-known, in the form of very minute granules ; but it would be wrong to attempt to explain all granular bodies of this kind as single distended air-cells, since it is easy, by the dissection of a somewhat larger granule, to show that it consists of a collection of infiltrated air-cells ; in fact, it may, in general, be said that those granules whose diameter is about 0'44"', certainly cannot be single air-cells. Even still smaller granules are occasionally met with, consisting of an aggregation of cells. With the transformation of the exudation into pus-corpuscles, and a certain degree of anismia, the pulmonary texture under- goes the change known under the name of " grey hepatization." In consequence of this alteration, the tissue of the lungs is considerably softened, so that the walls of the air-cells, and even the interstitial tissue, are the seat of softening and fatty degeneration. A manifest solution of the tissues takes place in pulmonary abscesses. An exudation of a less plastic nature, in which the product undergoes little or no metamorphosis, is exhibited in that form of pneumonia described by Rokitansky as catarrhal pneumonia. A portion of the lung infiltrated in this way, does not present the granular aspect on the surface of a section, neither does it attain to the same degree of consistence as that of a hepa- tized lung. This disease is very frequently developed in chil- LUNGS. 253 dren as a secondary aflfection after a bronchial catarrh, when the affected portion of pulmonary tissue becomes the seat of a serous infiltration. There is no such thing as a typhoid pneumonia, distinguished by any specific characters, whence even Engel considered it improper to assume the existence of such an affection. What is usually understood under the term, is either a hypostasisj or an albuminous or even fibrinous exudation into the pulmonary tissue, which presents an appearance differing from ordinary pneumonia, merely from the peculiar colour of the blood con- tained in or escaped from the vessels. Nor are there any other results, as such, independently of those proper to pneu- monia in general, peculiar to the typhoid form in particular. Serous exudations are often poured out very rapidly into the air passages, partially expelling the air. This is the case in acute cedema of the lungs ; in the chronic form of oedema reiterated exudations ensue secondarily from the involution of the pulmonary tissue. To these also may be added, the thin- fluid exudations poured out in the course oi pneumonia. The changes which the portion of lung infiltrated with exu- dation subsequently undergoes, depend upon the plasticity of the latter ; the most common is a collection of pigment in the form of reddish-brown or blackish-brown, irregular corpuscles, which originate partly from extravasations of blood, and, con- sequently, immediately from necrosed blood-corpuscles, partly from transuded hematin. Occasionally, also, blackish -brown, minute crystals of hamatoidin are formed. Free fat occurs in the walls and among the elastic pulmonary fibres ; the smaller arterial twigs, also, are covered with a large quantity of similar fat-globules, or may even, in parts, be more deeply infiltrated, nothing being visible but a flocculent material, containing fat, indistinct aggregations of nuclei and remains of elastic fibres, and in which the air-cells are in great measure no longer distinguishable. Calcareous particles, also, are not unfrequently met with in the pulmonary tissue undergoing involution, in consequence of the exudation. 354 EXUDATIONS. § 9. Liver. In this organ also the exudations may be distinguished into the diffuse and the limited; the former extending over a con- siderable portion of the orgauj or the whole of a lobe, whilst the latter are confined to isolated groups of lobules. The condition termed by Rokitansky "yellow hepatic atrophy" must be regarded as a diffuse hepatitis, in which the parenchyma of the organ is softened, in consequence of the albuminous exudation. The colour of the hepatic substance, whether dirty-yellow, reddish-yellow, or reddish-brown, depends upon the greater or less admixture of blood and bile. The most remarkable histological character of the affection is seen in the merely rudimentary condition, or entire dissolution of the hepatic cells. For in the softened parts, merely rounded nuclei are observable, sometimes quite free, sometimes surrounded by a group of dark-yellow, brownish-yellow, or reddish-brown pigment-molecules. Parenchymatous cells in a better state of preservation, and retaining their polygonal outline, are ex- tremely rare, and exist, in any considerable quantity, only where the softening is less far advanced. Ultimately the nuclei of the hepatic cells also disappear, nothing being visible but a fine molecular substance, with aggregated and solitary, larger or smaller fat-globules. The capsule of Glisson does not yield so soon to the active process of solution, and conse- quently appears more distinct, in the form of streaks, although the connective-tissue fibrils of which it is constituted are like- wise obscured by an interposed molecular substance. If a portion of a liver, in this state of softening, be treated with boiling water, the latter is quickly rendered turbid by the broken down and detached portions of the hepatic sub- stance J which again is rendered so opaque that even after careful disintegration of it, nothing can be perceived but amorphous, molecular particles possessing but very little trans- parency. In a child six weeks oldj which died, after a fortnight's illness, of diarrhoea and general wasting without jaundice. Dr. Bednar found about half of the liver destroyed, and presenting the appearance of a reddish-brown pultaceous mass; the capsule being corrugated and readily detached. Closer exami- LIVER. 255 nation showed, in all essential respects, the results stated above. In softened livers of this kind, also, may be observed, groups of ruby.red, or dark, brownish-red hematoidin-crystals, and, besides these, occasionally may be noticed, numerous black molecular masses, and brownish-black particles of hematin, readily soluble in carbonated alkalies {vid. hematin, fig. 12). Clotted, reddish-brown masses in the parenchyma indicate previous extravasations of blood. Another form of diffuse exudation in the hepatic parenchyma, is seen in what is termed the lardaceous liver, in which the parenchyma is infiltrated with an exudation, mainly of a colloid nature. In a well- marked instance of this kind, the substance of the liver exhi- bited the following characters : it was of a dirty, yellowish- brown colour, and presented on section a smooth, faintly-glisten- ing surface, the blade of the knife not being greased j in some places the forms of the lobules were distinctly defined, and on pressure a reddish fluid was afforded in considerable quantity. Thin sections showed that the parenchyma, in in- distinctly circumscribed spots, contained a flocculent material, consisting of minute, hyaline, amorphous flakes. This material was unchanged by acetic acid, and was also deposited in the well-developed areola of the hypertrophied " capsule of Glisson." The disposition of this matter was still more manifest in thin sections of the boiled and dried liver, which had been treated with acetic acid. The hepatic cells were small, their molecular contents almost wholly removed, and the nuclei, even after the addition of acetic acid, were not distinctly evident. The real condition of things in lardaceous livers of this kind, which are at the same time fatty, is not so evident, the fat-globules, both within, and, perhaps also, without the hepatic cells, impeding the observation. The transparent, amorphous masses, which we have described as of a colloid nature, are, as has been stated, lodged in the hepatic parenchyma, without inducing any solution of the cells, such as is produced by the exudation in the so-termed " yellow atrophy." In the latter, a collapse of the substance, and a diminution in the bulk of the whole organ, is produced by the destruction of the proper constituents of the parenchyma, viz. the hepatic cells, whilst in the "lardaceous" liver, owing to the 256 EXUDATIONS. uninjurious effect of the exudation, a considerable increase of volume is observed.^ As a diffuse exudation also, we regard the yellow, turgescent livers of jaundiced new-born infants. The cut surface is smoother than usual, and the denser structure contains a viscid fluid; the hepatic cells throughout, present a gold- yellow colour, from the molecules of bile-pigment contained in them. The acute oedema of the liver also, is, of course, to be referred to the same category. The circumscribed exudations take place in groups of hepatic lobules, which are infiltrated with a consistent, yellowish, or yellowish-green exudation. The most remarkable example of this affection is seen in the so-termed metastatic inflammatory foci of the liver, which are occasionally formed after previous lesions with inflammatory deposits, in other organs. The infiltrated lobules, sharply defined by their yellowish, or yellow- ish-green colour, often present no decided pus-corpuscles, as might be thought from the purulent aspect, but merely rounded bodies, which, from their size, form and reaction with acetic acid, can only be regarded as the remains oi nuclei of the hepatic cells, and which frequently exhibit pigment-molecules still adherent to them. The better preserved hepatic cells, are comparatively more opaque, and more rarefied than those in the non-infiltrated parts of the organ. Fibrinous exudations, limited in the same way, in their earlier stages, appear in the form of somewhat more consistent, dark-red, circumscribed spots in the hepatic substance. It may now be asked, from what system of vessels are the last-named exudations in the liver afforded ; whether they pro- ceed from the capillary system of the hepatic artery, or of the portal vein ? Although we are still ignorant with respect to the venous termination of the capillaries of the former system, and are consequently insufBciently acquainted with the extent of that system, still we know that a limited portion towards the periphery of the lobules is occupied by it, whilst the portal capillary system is distributed in the proper substance of the lobule. Consequently, in exudations pervading the entire thickness of the lobule, it is more probable that the effusion ' [On the subject of lardaceous liver, vid. Meckel, ' Die Speck-oder Cholestrin- krankheit'(Ann. desCharite Krankeuhauses zu Berlin),4ter Jahrg.,H.2,p.264. — Ed.] KIDNEY. 257 proceeds from the portal capillaries. This supposition is also strengthiened by the circumstance that coagulation of the blood in the branches of the vena porta is attended with these cir- cumscribed inflammatory deposits. § 10. Kidney, With B. Reinhardt, we regard the pathological change occur- ring in this organ in morbus Brightii, as a diffuse exudation in the renal substance. In this affection the exudation is not merely deposited between the tubuli uriniferi, but also pene- trates the delicate membrana propria of the latter, and makes its appearance on their inner surface. The connexion of the epithelium lining the inner surface of the tubuli with the membrana propria is loosened, and it is detached in continuous portions. Being propelled towards the pelvis of the kidney by repeated transudations, it reaches the bladder through the ureter, and is passed with the urine. When the epithelium is thrown off from a tubulus, and the exudative process in the latter continues, the cylindrical bodies which are well known under the name of fibrinous Cylinders are formed. These are solid (fig. 55, a), translucent, well-defined, elongated particles, of various dimensions, containing a thicker or thinner layer of a delicate granular substance, and in places often perfectly transparent. Occasionally, few oval nuclei are seen upon them, as in the wider portion at a. Whether the bodies here represented, which were procured from the urine of a puerperal female affected with albuminuria and convulsions, deserve the name of fibrinous cylinders, is, perhaps, very problematical, since the coagulation of fibrin into molecules, or a molecular form of fibrin has not been demonstrated. But the confounding of these so-termed fibrinous cylinders with the epithelium of the tubuli uriniferi (or epithelium of Bellini) is a still more extravagant supposition. The latter (a + ) presents an entire 17 Fig. 55. 258 EXUDATIONS. chain of equidistant, oval nuclei, retained in connexion by an interstitial, molecular substance. Besides the cells thus agglu- tinated together, we also find, in the urine, distinct, isolated epithelial cells of various forms. Thus Virchow has remarked the three-toothed, clamp-like forms which occur after an abun- dant desquamation of the epithelium in scarlatina and erysipelas. They belong to the transitional epithelium, which in the lining of the pelvis of the kidney even in the normal condition, pre- sents the most various shapes. In the case above adverted to, the solitary, smooth epithelial cells were characterised by a brownish-red colour (6), apparent sometimes in, sometimes around the nucleus. In this case it was undoubtedly due to the hematin contained in the urine. Blood-corpuscles were contained only in small quantity in the light-yellow, rather turbid urine, so that not more than one or two were visible in the field of view at one time. These cor- puscles, especially when sparingly dispersed, may the more readily be overlooked, since part of their colouring matter is removed by the urine, and their reddish hue replaced by a greenish tinge ; the characteristic discoid depression, there- fore, and the determinate size of the discs, should not be lost sight of. Various irregular forms of blood-corpuscles are fre- quently met with, and in the urine they are always isolated, never being observed to form rouleaux. In order to complete the case, we would further add, that a drop of the urine, spread upon a piece of glass and dried, exhi- bited a wide, bluish-green border ; at the same time that crystals (/) of a faint azure-blue colour were formed, corresponding most nearly with those of chloride of sodium, and manifestly impregnated with the altered colouring matter of the urine. The sediment contained urate of ammonia, aggregated into the forms c and e, together with scattered botryoidal forms (c). With respect to the occurrence of the cylindrical coagula, we would remark that the same may be said of them, as is noticed with regard to albumen and blood in the urine, viz., that, at one time, a considerable quantity may exist in all the morbid afiections to which the name of Bright's disease has been assigned ; whilst at another time scarcely one, or even none at all, will be met with on the most careful examination. It is a well-known fact, indeed, that the exudative processes do not go KIDNEY. 259 on continuously, but intermittently, and, consequently, that intervals occur in which no exudation takes place in the kidney. The relative quantity, also, of the coagula of course depends upon the varying amount of water in the urine ; they disappear, also, in alkaline urine. The occurrence of unmixed epithelium of the tubuli uriniferi, or its preponderance in the sediment, indicates the commencement of an exudation, just as we observed to be the case in the mucous membranes, in which, owing to the fluid exudation, the epithelium is, at first, washed away in large quantities. But it is also con- ceivable that a simply congestive condition might be attended with an increased transudation, and, consequent upon this, by a death of the epithelium, a process which rapidly runs its course without any subsequent results. In fact, we actually find that, in erysipelas, scarlatina, pneumonia, &c., a large quantity of epithe- lium from the tubuli uriniferi will be discharged with the urine, and, notwithstanding this, that a rapid recovery from the disease ensues. Hofie, and several others, have observed even exuda- tion-coagula in the urine in favorable cases of this kind. The exudation, therefore, in these instances, soon terminates, with- out causing any subsequent development of morbus Brightii. Now, upon investigation of the more intimate anatomical changes in the kidneys, which, during life, give rise for a short time to the formation of cylindrical exudation-casts, and the desquamation of the epithelium of the tubuli uriniferi, as, for instance, in eclampsia parturieritium, cholera, in the commence- ment of Bright's disease, &e., the following facts will be observed. 1. In many cases, even on the most careful examination, no other prominent pathological character will be noticed beyond the readiness with which the epithelium of the tubuli uriniferi is detached, so that when the surface of a section of the cortical substance is squeezed, a turbid juice is expressed, containing rows of epithelial cells, otherwise unaltered. In viewing the loose connexion between the membrana propria and the epithelium of the tubuli uriniferi as of pathological import, regard* must be had to the degree of decomposition present, because by the latter a ready detachment of the epithelium might be induced, as a cadaveric phenomenon. A general and uniform infiltra- tion of the substance, of the kidney with a hyaline, fluid exuda- 260 EXUDATIONS. tion, might possibly existj and yet be incapable of demonstration by dissection. Nor have we succeeded, after numerous attempts at their solidification, in finding evidence of the -existence of exudations in such cases. 3. Tubuli uriniferi containing blood-corpuscles indicate the occurrence of the rupture of vessels, in consequence of which the corpuscles escape into the canal of the tubulus. The mode in which this takes place will be variously explained, accord- ing to the view taken with respect to the connexion between the tubulus urinifems and the capsule of the Malpighian body. If Bowman's view be adopted, according to which there is an immediate continuity between the cavity of the capsule and the canal of the tubulus, the hemorrhage from the Malpighian body into the latter will be readily explained, as it is by Prerichs. But if such a continuity be denied, it is necessary to admit of a rupture of the membrana propria of the tubule. If the propulsion of the blood-corpuscles and their expulsion from the tubuli are in any way prevented, they undergo a change, sometimes resembling that which is pro- duced by the addition of dilute tincture of iodine to the corpuscles ; they lose their red colour, and become of a dirty yellow, the acetabular depressions at the same time disappear- ing; their outline also is rendered more distinct, from the membrane being more strongly defined. 3. A granular investment of the Malpighian bodies, which is not visible until they are isolated, which is best done with a curved needle. In fig. 56, we have represented a convoluted vascu- lar coil (Malpighian corpuscle), taken from the kidney of a woman affected with eclampsia parturientium, who died on the fourth day of the disease. The surface is covered, partly with a fine granular substance, partly with solitary and aggregated fat- globules, which were not further changed by acetic acid or carbonate of soda ; being rendered, in fact, more distinct by the latter. The quantity of the deposit Fig. 56. KIDNEY. 261 varied, perhaps, in different corpuscles, but the difference was in- considerable. In well-marked Brightian kidneys, which were en- larged, in many places hypersemic and pervaded by minute ex- travasations of blood, and in others of a pale-yellow colour, and which afforded an abundant turbid juice upon pressure, we found some Malpighian bodies thickly coated with . a granular fatty substance, whilst, in others, the walls of the convoluted capillary vessel were covered with a hyaline matter, by which the convolutions were glued together, and the vessel rendered indistinct. Frerichs has also observed, between the glomerulus and capsule, a close layer of solid fibrinous (?) exudation, of granular constitution and mixed with numerous fat-drops. In some cases, he also noticed in the capsule, rhombic plates of crystallized cholesterin. Occa- sionally, a fatty molecular infiltration of the capsules may be seen, which are recognizable, even by the naked eye, on the surface of the kidney, appearing as minute, yellowish-white points, but are not visible until the surface is viewed obliquely and under a strong illumination. Isolated corpuscles, when dissected out, consisted solely of an aggregation of larger and smaller, brilliant molecules, which remained unchanged in acetic acid. Viewed in continuity with the surrounding sub- stance, they appeared as oval bodies of pretty nearly uniforifl dimensions with sharply defined outlines, and containing, besides the granular fatty substance above mentioned, which was often collected towards one point of the corpuscle, a structureless hyaline material. These corpuscles, though less distinctly, were also visible in the interior of the kidney. It is remarkable that in none of them were remains of the glomerulus to be found, and, consequently, the main reason for supposing them to be infiltrated Malpighian corpuscles is wanting, though, nevertheless, from their size, form, and uniform distribution^ we think they must be regarded as such. F. Simon, also, states that he has seen the vascular coil forming an irregular, contracted mass at the bottom of the capsule, a circumstance indicating the partial solution of the glomerulus within the distended capsule.^ At the same time, we are far from think- ing that in every diffuse, renal inflammation, such a remarkable ' [KM. Toynbee, on the Intimate Structure of tUe Human Kidney, ' Med.-Chir. Trans.,' 2d ser., vol. xi, p. 320.— Ed.] 263 EXUDATIONS. fatty metamorphosis of the contents of the capsules takes place, but, on the contrary, consider that in most cases a solution of the Malpighian body is brought about by the fluid exudation. 4. Fatty degeneration of the cell-contents of the epithelium in the tubuli uriniferi is of constant occurrence when the morbus Brightii has reached a certain stage. The drawing shown in fig. 57, is taken from the kidney of a woman who was attacked by cholera, had bloody diarrhoea, fell into the typhoid state, and died on the tenth day after her admission into the hospital. The kidneys were swollen, pale, of loose texture, especially in the cortical substance, and afforded, on pressure, a milky fluid; lighter-coloured streaks, also, extended into the medullary substance. Groups of tubuli uriniferi in the cortical substance were entirely crammed with fat-globules, as in fig. 57, a, in which is seen, below, the membrana propria, as a transparent folded Fig. 57. membrane. The fat-glo- ^ .s^s^ j>^ eOi bules in b, appeared of /a ^ smaller and more uni- ^® form size, and in many ^ places were so closely " ^ packed, that the tubule wF^^ was there rendered per- fectly opaque. The canal of the tubule was wholly occupied by the accumu- lated fat, as is shown at c. When the epithelium was subjected to more minute exami- nation, for which a drop of the turbid juice served, the interme- diate stages of the fatty degeneration of the cells could be readily traced, as at d. Isolated fat-globules appeared between the nucleus and cell-wall, and were soon so multiplied as com- pletely to conceal the former, which, together with the wall, was destroyed. Thus, in place of the epithelial cell, there was only an agglomeration of granules. Prom many of the lighter-coloured tubuli uriniferi, hyaline, tubular bodies, beset with fat-drops, could be expressed, which might be regarded either as remains of the dissolved epithelium or as a solidified exudation. Lastly, in several groups of tubuli, imperfect, KIDNEY. 263 brownish-yellow, crystalline forms of uric acid (/) were de- posited. The fatty degeneration of the tubuli uriniferi always com- mences in the cortical substance, and is manifested, even to the unassisted eye, by the yellowish appearance of their bundles. If, for instance, a well-marked " granular" kidney, as it is termed, be taken, and the closely approximated, light-yellow granules apparent on the surface of the organ be subjected to examination, each of them will easily be seen to consist of an entire packet of iubuli uriniferi in a state of fatty degenera- tion, which, owing to their fatty contents, appear dark by transmitted, and of a bright, light yellow, by direct light. The granular aspect is produced by the stronger bundles of connective tissue, and by the vessels, by which, in the normal condition, entire packets of tubules are encompassed. The medullary substance, when the epithelium of its tubules is in a state of fatty degeneration, presents a yellow striation corre- sponding with the disposition of the canals. We have also observed fatty degeneration of the epithelium in the kidneys of an individual affected with melituria. The organs were enlarged, and the vessels surrounding the packets of tubuli uriniferi injected, whence the surface of the cortical substance presented a granular aspect. The texture in that situation was so much softened, that the tubuli could not be drawn out to any length, breaking off in the dissection. Many of them were entirely filled with fat-drops, and the ex- pressed epithelium was in the most advanced stage of fatty de- generation. The softening of the substance was also manifested in the readiness with which the Malpighian bodies were torn asunder; even the pyramids had lost their normal consistence, especially in the basal portions. A turbid, mucoid fluid could be expressed from the papillary processes, containing the readily detached epithelial cells of the straight canals of the tubular substance. Several writers have assumed that the tubuli uriniferi are enlarged, owing to the accumulation of the exudation within them ; and Frerichs regards this distension of the tubuli as the principal cause of the enlargement of the gland. Direct measurements alone can decide this point, and its determina- tion will require the greater caution, since the size of the tubuli 264 EXUDATIONS. uriniferi varies very much, and even in the normal condition, some may be observed of considerable dimensions. At present, precise data are wanting with respect to the increase in dimensions of the tubuli uriniferi in the exudative affections of the kidney. It might be considered probable, a priori, that the tubules may be distended up to a certain maximum by the infiltration, and then give way; but their hyaline membrana propria is, perhaps, hardly capable of any great degree of exten- sion. At the same time, it should be noticed, that there is a source of error in the observation, which though obvious, may still very readily be fallen into, viz. that a partially overlapping loop of a tubule may be taken for a dilatation of it. 5. Extravasations of blood take place very frequently in the albuminous exudation of the kidney, presenting the appearance of irregular, minute, red points ; they usually occur scattered in the cortical substance, being more rare in the tubular por- tions of the gland, where they present the appearance of elongated, irregular, bloody streaks. The extravasated blood soon loses its vitality, and forms reddish-brown masses. 6. The solution of the glandular substance induced by the exudation, commences at the periphery of the cortical sub- stance, in such a way, in fact, that separate groups of contigu- ous tubuli uriniferi collapse, whence is produced a minute, shallow infundibuliform depression, known as a " cicatriform" contraction of the cortical substance; the same process may also take place in several, contiguous peripheral groups, when a shallow depression is produced, not unlike the cicatrix of an ulcer with an elevated, callous border. Upon closer examina- tion, the shrunken tubuli uriniferi filled with a dirty, brownish- yellow material, as well as the Malpighian corpuscles, reduced in size, may be discerned, the interstitial cellular tissue, con- sequently, even when not hypertrophied, being rendered the more distinct. 7. The albuminous exudation in the course of Bright's dis- ease, usually passes into one of a well-marked colloid nature. Even in the stage of infiltration, perfectly hyaline, smooth masses of various forms and sizes are frequently met with in the divided renal substance, resembling the structureless, transparent, dull-bordered, smooth masses, from the colloid thyroid gland. In the chronic forms of Bright's disease, and. KIDNEY. 265 particularly, in well-marked fatty kidney (under whicli term he understands the fatty degeneration of the epitheliutn of the tubuli uriniferi), Lehmann describes hollow cylinders with plicated walls so transparent as to be best rendered visible by the use of the stop in the microscope. He regards them as the membrana propria of the tubuli uriniferi, and warns us against the confounding of them with the croupose fibrinous cylinders (?). The hoUowness and the plication would thus dis- tinguish the bodies found by Lehmann in the urine, from those which are met with in the substance of the kidney. In the case of reiterated (chronic) exudations in the kidney, the colloid masses undergo all the morphological changes that are found to occur in other organs, and which, as regards the colloid exudations of the thyroid gland, have been placed in different categories. As a special form, it is necessary to notice one which we would designate as the radiating colloid bodies, and which also exhibit a very remarkable difference in their constituents. They form a part of the contents of the cysts of atrophied kidneys, and have been met with, by us, only a few times, in aged individuals. We distinguish the following forms : 1. Flattened, rounded bodies (^id. fig. 58, a) of various sizes, and about 0"008 — 0'03"' in diameter, presenting streaks radiating from the central point, and of a light-grey or yellowish colour. 2. These radiated bodies are surrounded with a clearer border containing a spotted substance. 3. When the border is wider, segments of rays are observable in it (c' in c), which are not, however, in any direct connexion with the rays of the central body, but separated by a distinct line of demarcation. In the middle of these voluminous, usually brownish-yellow bodies (c), the central, granular, enclosed mass is more distinct. 4. To the three layers of the last-described body, there is superadded in d, an external, transparent, enveloping layer, in the form of an annular border {d') ; and in the centre is seen a larger, punctated layer, into the periphery of which the rays are inserted. 5. The fourth exterior layer only partially surrounds the radiated body, in Fig. 58. 266 EXUDATIONS. whose centre two granular spherical masses lie, which serve as a point of insertion for the rays (e). Besides the above principal forms, others of every variety of modification are also met with. In the friable, gelatinous masses in the cysts also, are found smooth, amorphous, hyaline, jagged, and flexible plates deposited in several superimposed layers, and thence acquiring a yellowish-brown colour; these plates are not further altered by acetic acid, and should in no way be confounded with disintegrated tables of cholesterin. In our opinion, they are masses of colloid which have coalesced, and become solid. In the radiated, colloid corpuscles, is indicated a difl'erentiation of the organic substance, proper to self-organizing elementary bodies, except that in this instance the separate organic parts undergo metamorphoses which do not correspond with the cell- formations in the human organism. The radiate arrangement is in a form different from those seen in the metamorphosis of cell-contents, and must, consequently, be regarded as a peculiar pathological change of the latter, in which they are cleft by ra- diating fissures, the nucleus gradually increasing into a granular sphere, which, as in e, may itself be capablie of division. But then, how are the layers b', c', d! , to be explained ?. Are they not formed until afterwards by deposition on the radiated body, or does the body exist ah origine, and are the layers formed by a differentiation of the peripheral and central substances ? In describing the colloid exudation of the thymus, we have indicated certain elements encysted in the colloid masses, and at the same time pointed out the possible modes in which they might be formed, without declaring ourselves definitively for one or the other, viz., whether the investing layer is formed before, after, or simultaneously with the enclosed cells. Nor, also, in the instance of the radiated colloid bodies, do we think that any definite law of formation can be laid down, but hold it, in general, as more probable, that the investing layers arise subsequently, and undergo a radiating cleavage as c' in c, having previously represented simply a hyaline layer, as b' in b. On the other side, these radiated colloid bodies might be considered as being, originally, discoid masses of blastema, in which the central portion is precipitated as a granular sub- KIDNEY. 267 stance, and from which a hardening of the organic matter pro- ceeds, in the course of which process the solidification is effected precisely after the type of radiating, acicular crystallization. From what has been observed on the subject of the so- termed lardaceous spleen and liver, it might be thought that a similar anatomical change would also obtain in the larda- ceous kidney, and that the solid, dense consistence, con- joined with the remarkable deficiency of blood in the organ, might also depend upon its infiltration with colloid sub- stance. We have not as yet been fortunate enough to arrive at any satisfactory evidence of such being the true nature of the case in the " lardaceous " kidney. Thicker or thin sec- tions exhibit nothing whatever of an abnormal nature. Por- tions of kidney, thus affected, were boiled for a short time in water by which the consistence was rendered somewhat more dense, and, when dried, readily allowed thin sections to be made with the unsupported hand, which were treated first with dilute acetic acid, and afterwards with a dilute solution of carbonate of soda. Although the structure of the kidney was thus remarkably well displayed, no abnormal appearances whatever could be discerned.' Of circumscribed exudative processes in the kidneys, the most remarkable are the fibrinous, which are well known under the name of metastatic deposits. In exemplification of the more inti- mate nature of one of these deposits, we will cite an instance, in which, as usual, it was situated in the cortical substance, insinu- ated in a wedge shape between two pyramids ; it was of a lightish- yellow colour, of firm consistence and abruptly defined. The renal tissue abutting upon it constituted a dark, blood-red border com- posed of ecchymosed spots, and exhibiting a coarse vascular injec- tion. The tubuli uriniferi and Malpighian bodies in the infiltrated spots were collapsed, and between them a material was collected, sometimes of a lighter, sometimes of a darker, brownish-yellow colour, in the form of irregular, rounded, granular bodies, whose colour was unchanged by acetic acid ; the fibrin also was imbued with a yellowish-brown colouring matter. Free fat in the form of globules was collected in groups between the layers of fibrin, ' [H. Meckel (loo. cit.) notices a peculiar deposit occurring in "lardaceous" kidneys, which he terms " speck -kalk." This is probably merely an oily matter containing some earthy or uric salts. — Ed.] 268 EXUDATIONS. and granular fat-globules (so-termed granule-cells ?) in compara- tively small numbers. Deposits of amorphous, calcareous salts seemed to be also present only in small quantity. Ruby-red, very minute hematoidin-crystals were seated on the bloodless Malpighian corpuscles, and contiguous groups of similar crystals were also met with among the lubuli uriniferi; they were rapidly dissolved under the influence of the carbonated alkalies. These metastatic collections subsequently assume a puriform aspect, inasmuch as their colour presents a bluish-green tinge. But in these compact portions, apparently infiltrated with pus, no proper purulent elements are ever met with, viz., the so- termed pus-corpuscles. When these fibrinous deposits undergo involution, the mass shrinks, owing to the absorption of its fluid constituents, the fibrinous substance, containing olein in a state of minute divi- sion, pigment, and calcareous salts, being left. They arise, as Rokitansky has shown, as dark-red, indurated, infarcted portions of very various dimensions, and become gra- dually discoloured into a dirty-brown, yellow, and yellowish- white substance. Their mode of formation as infiltrations, sometimes of the size of a pin's head up to that of a walnut, and their conical form, the base of the cone being towards the surface of the cortical substance and the apex turned towards the pyramids, are connected with the mode of distribution of the vessels in the normal condition. For we know that the branches of the renal arteries run between the pyramids towards the cortical substance, subdividing into capillaries between each pair of pyramids. The capillaries are distributed to groups of the tubuli uriniferi ; and in this way, as many distinct systems of capillaries are formed as there are groups of tubuli. Now if the exudation take place only in a small system of the capil- lary plexus, the millet-seed deposits are produced ; but if it be effused throughout a large system, as, for instance, between two pyramids, we have one of the conical infiltrations. 269 § 11. Sbxual organs. With respect to these, we shall confine ourselves to a few observations, noticing, in the first place, those bodies found in the, usually, enlarged prostate of aged individuals, known under the name of concretions, or calculi, an appellation which is inapplicable to many of them^ as we shall at once proceed to show. In the usually dilated ducts of the indurated and enlarged prostate, there are frequently lodged, greyish-yellow, yellowish - red or reddish-brown bodies, which, when of larger size and darker colour, are apparent even to the naked eye, as minute, isolated points, on the surface of a section of the gland. They are readily crushed by pressure with the blade of the knife, and even in one and the same preparation usually exhibit very many varieties of shape. We have collected these in fig. 59. The size extends from p^^ ^g 0-0088'", to as much as 0-44'", or even 1-77'", or more. The principal cha- racter of a series of these bodies consists in their ex- hibiting & peripheral, con- centric striaiion. The con- centric layers resembling those of the starch-grain, are, frequently, only very few in number, though often tenormore maybe counted, lyfany of the lamellcs are distinguished by their re- gularity and sharp defini- tion, whilst many are placed at unequal distances apart, and represent interrupted, concentric markings. The central portion consists either of a molecular substance, or contains, in the latter, one or several, rounded, molecular spherules, in size resembling pus- or mucus-cor- puscles ; but sometimes, also, nucleiform elements are enclosed. The central, encysted portion may also consist of inorganic 270 EXUDATIONS. Fig. 60. parts. The fine, arenaceous, pale granules which lie scattered in the parenchyma are nodular forms of calcareous salts (fig. 60, a and b), having a rounded form, and exhibiting, on all parts of the surface, minute, tuber- cular elevations, or, perhaps, appear- ing polished, and marked with sym- metrically arranged, dark, radiating streaks. These bodies resemble, in all respects, those which are met with in the sand of the pineal gland j and are also, as when embedded in any other organic parts, rendered more distinct under the action of alkalies, since they are themselves unaffected by those reagents, whilst the sur- rounding tissues are rendered pale. They are soluble in acetic acid, with the occasional disengagement of air-bubbles. These calcareous salts in the prostate gland, are also met with enclosed in concentric layers. In c, we observe a granular mass, incompletely filling the central part of the corpuscle, sur- rounded by several thin layers of concentric stria ; in d, is re- presented a nodular, calcareous conglomerate, lying more towards the wider end of the elongated body, and surrounded by fine, well-defined lamella. In e, these are also well defined, and in close apposition with the central botryoidal substance. In the second row, we see the same bodies as in fig. 59, except that the concentric lamination is wanting; they are perfectly smooth, more rare, and unlike the laminated form, not impregnated with any yellow or yellowish-brown, colouring matter. They are softer, and when compressed, are easily fissured, the fissures proceeding from the periphery towards the centre ; in a word, they resemble in all respects the in- durated colloid masses, met with in the so-termed struma lymphatica. Before proceeding, in accordance with what has been stated, farther into the nature of these concentric structures, we shall merely premise that no change is remarked in them upon the addition of acetic acid and of dilute sulphuric acid ; carbonate of soda renders them pale and they are also distended by the same SEXUAL ORGANS. 271 reagent. Hassall^ according to a letter from Dr. Letheby, states that they are gradually dissolved in strong acetic or hydrochloric acid, and more rapidly when heat is applied ; a residuum being left, consisting of numerous fat-globules, and the remains of cells. Carbonate of potass and caustic ammonia, according to the same observer, do not dissolve them. They are carbonized under the blowpipe, leaving only a little earthy residuum. According to Virchow, these prostatic-concretions, as they are termed, are composed of a semi-soft substance, behaving towards reagents like one containing protein j and upon closer investigation, he states that he finds them to be derived from a peculiar, insoluble protein-substance, mixed with the semen. Hence it is obvious : 1, that these laminated structures are principally composed of an organic substance, and, conse- quently, that the names of " stones," and " concretions," are inappropriate to them ; and, 2, that since, in their sometimes smooth, sometimes concentric form and their behaviour towards reagents, they approximate, for the most part, to indurated col- loid masses, they might therefore be termed concentric colloid- corpuscles. Just as it is probable that pre-existing, organic elementary parts are encysted by the fluid colloid substance exuded on the inner surface of the dilated gland-ducts, and as it is evident that, as in fig. 60, the above-described calcareous conglomerates are invested by the same fluid, so also it can not be denied, a priori, that it is possible for the outer layers in the exuded masses to solidify, whilst the internal, still fluid matter, may afford origin to cells which will, consequently, be only of secondary formation. These concentric corpuscles are met with especially in old in- dividuals, in whom colloid exudations in general appear to be frequent ; they are seated, not merely in the irregularly dilated ducts in the midst of the parenchyma of the prostate gland, but also occur in the central extremities of the excre- tory ducts towards the urethra. When these bodies exist, the prostate is usually enlarged ; and together with them we occasionally also meet with hyaline, voluminous colloid- masses, in the dirty brownish-yellow fluid of the vesicula seminales. Albuminous and fibrinous exudations on the inner surface 272 EXUDATIONS. of the uterus in the puerperal state, afford a frequent subject for investigation. The frequency of their occurrence appears to he connected with the involution of the substance of the uterus, which takes place at this epoch in the normal condition. According to Heschl's statements respecting the condition of the human uterus after parturition, the proper substance of the organ undergoes such a complete transformation into molecular fat, that of the uterus as it existed before parturition, not a single fibre (?) remains. The fatty molecules are often accumulated in the contractile fibre-cells, in such a way that a whole series of the latter fill the cell, and conceal the nucleus. The vessels also, and connective tissue, retrograde in like manner. Ac- cording to this observer, the place of attachment of the placenta undergoes a rather more prolonged retrogression, which is probably due to the greater thickness of the wall in that situation. It is necessary to be acquainted with these normal forms of involution of the uterine substance after parturition, that we may not regard them as produced by any kind of parenchymatous inflammation ; an error which may very readily be fallen into, if, as is done by Virchow, the degenerative character of the elementary parts of an organ be placed in the foreground in inflammation, and at the same time, regard be not paid to the exudation and its metamor- phoses, as indispensably necessary anatomical elements for the determination of the existence of inflammation. The organization of the exudation is limited, in this situation, only to the formation of pus, or to the new-formation of, usually large, connective-tissue cells of all varieties of form, and is to be sought for especially at the site of insertion of the placenta. In many cases, however, the exudation undergoes no further organic metamorphosis, nothing remaining but a fine molecular matter; and at the same time also, a rapid solu- tion of the internal uterine substance is set up, loose flocculi of which project into the cavity. Close examination of these shows connective-tissue fibrils, which are so covered with a brownish-yellow molecular substance, that the wavy fibrous bundles are discernible only at the edges j the organic muscles are beset with pigment-molecules; their elongated, characteristic nuclei, rounded at each end, float about in numbers in the fluid ; and the walls of the blood-vessels are collapsed, and of a SEXUAL ORGANS. 273 brownish-yellow colour. In other cases, in which the exuda- tion and the infiltrated portions of tissue are not subjected to such a rapid decomposition, attended with putrescency, an oleaginous substance forms the principal constituent. The fatty metamorphosis in these cases, is set up with great rapidity in the affected uterine substance, and numerous groups of aggregated fat-globules make their appearance. Local infil- trations on the inner surface give rise to elevations marked with dirty-grey, yellowish or reddish spots, which, when the necrosed portion of the tissue is thrown off by subsequent exudations, give place to ulcerated depressions. The fibrinous deposits in the placenta, which frequently occur, as is well known, in the form of tuberous closely adherent cap-like growths, of a sulphur-yellow colour, situated upon its convex surface, or as striped bands on the borders and con- cave aspect, we must, in opposition to others, such as Scanzoni and Jager, who consider them as arising from extravasations of blood, regard as exudation -products, for, in the first place, they extend along the course and distribution of the vessels, inasmuch as the fibrinous deposit takes place around the lobules or lobes {cotyledons) of the placenta, or along the course of a vessel, as of the annular vessel ; and secondly, because the closer anatomical examination of the deposit, shows nothing in favour of its being an extravasation, the principal constituents of which it is composed being coagulated fibrin, containing imbedded in it, new-formed organic elements, usually in a state of fatty degeneration, whilst necrosed blood-corpuscles are absent. It is thence self-evident, that as in most exudations, so in these, ruptures of the smaller vessels may occur, although the quantity ofextravasatedblood does not stand in such a proportion to the quantity of the fibrinous deposit that the coagulated fibrin can be referred to the amount of blood extravasated. When the foetus has been dead for some time, gelatinous ■exudations almost invariably occur on the concave surface of the placenta ; they are deposited principally around the larger arterial branches, and give rise to new formations of connective tissue. These exudations belong to the fibrinous class, and are characterised simply by a more considerable admixture of serum. Exudations in the parenchyma of the placenta rarely assume the diffuse form, and cause the death of the foetus. In this 18 274 EXUDATIONS. condition, the substance of the organ is swollen, the individual lobes bulging so as to render the fissures more apparent than natural ; the consistence is more compact, exactly resembling that of a hepatized lung; and some parts are of a dark-red colour (loaded with blood). The villi adhere so closely together that it is impossible to separate them from each other with the needle, as usual ; at the same time, they are readily lacerated. In the infarcted portions, imbedded molecules may also be remarked, upon dividing the lobules. The same kind of adhe- sive exudation may be confined to smaller portions, and it occurs thus, more frequently than in the diff'use form. The morphological changes, undergone by the villi and their peduncles in parenchymatous exudations in the placenta, also consist, essentially, in the same forms as we have noticed in speaking of atrophy of the villi ; and, consequently, it is only the presence of the exudation which will enable us to decide whether the atrophy be substantive, or one caused by the exuda- tion; and, consequently, whether the involution of the ele- mentary parts is produced by the abstraction of nutriment, or by a disproportionately abundant supply of it. Instances of indubitable exudation in the villi are exhibited in the forms shown in fig. 61. In the enlarged villus, a, the walls of the Fig. 61. capillary plexus are covered with a dense accumulation of minute, brilliant molecules, and are manifestly, therefore, in a state of degeneration. The same thing is seen in the less enlarged villus, b. The villus, c, with a lateral process, presents BRAIN AND SPINAL CORD. 375 a peripheral, wide, clear border, whilst the interior, dark, gra- nular portion indicates a degeneration of the entire substance of the villus ; and the dark streak in the middle belongs to the central recurrent vessel visible in many of the villi, and which is also in a state of involution. In this instance, which repre- sents the placenta of a foetus at 6 months, besides the above- described atrophied forms of the villi (their being filled with a molecular substance), others existed ia which the necrosed blood in the capillaries was metamorphosed into a brownish- black pig- ment {d). § 13. Brain and Spinal cokd. Exudations in these organs are either diffuse, and at once productive of deleterious effects, or are limited to separate por- tions, and run a chronic course. The presence of the former, diffuse exudations, however, is occasionally very problematical, in the absence of any anatomical indication. Among them, per- haps, might be ranked the so-termed "yellow softening" of the brain. Rokitansky does not regard this change as a proof of inflammation, adducing the following reasons : 1. Neither in the primitive nor in the secondary, softened parts, and in no stage of the process from the moment when its nature is just recognizable, do injection and redness exist, nor is anything of the kind to be perceived around the softened portions, either far or near. 3. Nor does it afford the usual products of inflammation, nor any ele- mentary formations. In answer to which, it might be objected, that injection and redness, in parenchymatous inflammation of the brain in general, are less manifest, than they are in most other organs, and that we also see, as for instance, in serous and mucous membranes and several other parts, thin sanious exu- dations without any visible, subjacent vascular injection. The latter condition, moreover, is by no means necessary for the occurrence of this effusion, inasmuch as the increased transu- dation might, perhaps, be afforded by the circulating blood. With respect to the second reason, it should be remarked that the yellow, softened substance is coagulable by heat into a molecular mass, and that groups of fat-globules (granular cor- puscles) are found in it. We consider it therefore as the more probable supposition, that the yellow softening is not a decom- 276 EXUDATIONS. position of the cerebral substance, but depends upon an exuda- tion into the parenchyma of the organ, in which are enclosed detached fragments of the cerebral substance. A diffuse exudation appears to us to take place in traumatic tetanus. Several observers have found the nerves, at the seat of injury, covered with exudation, and beyond that point, have noticed a rose-redness of the neurilemma, without any appreciable products. We have recorded the case of a man who died with symptoms of tetanus on the twelfth day after receiving a crushed wound of the little finger, for which amputation was performed. The branches of the ulnar nerve in the palm of the hand were imbedded in a dirty-grey exudation. This consisted in great part of. a molecular substance, containing also a few groups of immature new-formations of connective tissue. The slate-grey colour of the exudation was caused by a blackish-yellow, granular, free pigment, deposited only in a few spots around vesicular nuclei. The ulnar nerve, examined higher up the arm, contained a good deal of blood, and, under a lens, the vasa nervorum could be distinctly traced for some distance, but no product could be detected in the cellular sheath upon the closest examination. Transverse sections of the cervical portion of the spinal chord made in the part corresponding to the brachial plexus, exhi- bited a decidedly greater degree of redness of the grey sub- stance than was apparent either above or below that point. But beyond this, no other textural change could be perceived. The existence of an exudation might be deemed possible in this case, notwithstanding all anatomical proof of it was want- ing, which perhaps might be afforded by better methods of investigation; So long as the exudation pervades the tissue, merely in the form of a hyaline material, it escapes observa- tion, and it is not until solid particles in the^form of molecules, fibrinous clots, flocculi, or new-formed elementary organs are developed in the protein-substance, that we have any histolo- gical indication of its presence, except in cases where it exists •in such quantity as to produce manifest swelling and infiltra- tion of the affected tissue. It should, we think, here be remarked, that in tetanus the investigation of the walls of the minuter blood-vessels has attracted too little attention. It would be as well, for instance, to look for the same exterior covering of brilliant molecules, which we have shown to exist BRAIN And spinal cord. 277 in the Malpighian glomeruli of the kidneys, at the commence- ment of Bright's disease. Coagulated Jibrinous exudations on the free surface of the ■arachnoid,'' and on the ependyma of the lateral ventricles (es- pecially on the latter), are more ravely met with, than pseudo- membranous coagula of a gelatinous, or of a more dense consistence, spread over a considerable extent of surface. They consist of a fine, filamentous network, visible only with the aid of high magnifying powers, such as is found in coagulated fibrin, and which is infiltrated with a serous fiuid, from which occasionally a fine-granular, molecular substance is precipitated. These exudations on the arachnoid, speedily take on a high degree of organization. The coagulation of a, probably, fibrinous exudation in the brain and spinal cord produces, when considerable, the callous transformation of the tissue, denominated " sclerosis." Close examination shows, that in the more indurated parts, the firm consistence depends upon a filamentous stroma, but of so deli- cate a nature, and so close a texture, as not to be visible except in very thin layers. The filaments are straight (wavy fibrous bundles are never seen), decussating with each other at all angles, and disposed in contiguous sets ; they are of immea- surable tenuity. The interstices of this stroma are occupied by a considerable quantity of molecular substance, sometimes aggregated into little, coloured masses. In these highly-con- densed spots, the nerve-tubes are wholly destroyed, and some- times not a particle even of nerve-fat, in the form of the well-known, double-bordered, irregularly shaped corpuscles, can be expressed in a dried section; sometimes it may be seen, in small quantity, collected into groups of molecules. The blood-vessels are the more rarefied in proportion as the sclerosis is more advanced. Since the question, whether this filamentous framework represent coagulated fibrin, or the sheaths of nerve-tubes simply emptied of their contents, could not be decided even by reagents, we have considered the fibrinous nature of the framework as problematical. Albuminous exudations, in the form of brownish-yellow mole- cular masses, constitute the well-known opacities and thicken- ings of the pia mater, and are the cause of the intimate 378 EXUDATIONS. adhesions constantly found in lunatics, between the latter and the cortical substance of the brain, in which the nerve-tubes and ganglion-cells are destroyed. The blood-vessels appear empty, and are covered with a fine-granular or pigmented sub- stance in greater or less quantity. In the red-softening, as it is termed, which is an inflam- matory afl'ection of the cerebral substance, an exudation is poured out, possessing but little plasticity and organizability j it soon degenerates into a fatty, molecular material, inducing at the same time a solution of the affected cerebral parenchyma. Numerous minute effusions of blood from the softened vessels accompany this process, to which the red colour is due. The encephalitic deposits are manifested, in very thin sec- tions even to the naked eye, by a greyish opacity, when viewed by transmitted light, whilst portions of cerebral substance squeezed between two glasses always retain a certain degree of transparency. Microscopic elementary analysis shows, in the first place, fat in a state of minute division, and presenting sometimes the form of isolated, smaller or larger, strongly refractive, dark-bordered globules, unaffected by acetic acid and alkalies; sometimes that of granular aggregations. It forms, also, the principal constituent of the granular corpuscles, a new-formed element {vid. supra, " granular corpuscles"), and invests the outer surface of the walls of the vessels with a thick covering. Cholesterin occurs chiefly in portions of older date, already in a state of involution, and may readily escape notice in the greyish, opaque substance. When accumulated in larger quantity, it may be recognized even by reflected light, with the aid of a powerful lens, by its iridescent coloiu-, a pheno- menon which we have already stated to depend upon the inter- ference of the rays of light. It usually occurs in the form of rudimentary, jagged cholesterin-plates, whose nature, in the absence of better marked specimens, is ascertained by their dissolving in ether. The circumstance, also, of their being unaffected by alkalies and acids, must be borne in mind, which will serve to distinguish them from a solidified protein- substance. In the cerebral substance in a state of red-softening, as has been said, there are always found minute, apoplectic effusions; in this affection, consequently, the extravasated blood undergoes BRAIN AND SPINAL CORD. 279 the various kinds of metamorphosis proper to that fluid when in a state of involution or deprived of vitality. The coherent, red corpuscles shrink up, but without losing their colouring matter, appearing, on the contrary, of a deeper red colour than when fresh. They assume the form of orange-yellow or reddish- brown masses, consisting usually of from about eight to ten coalescent granules, and not unfrequently surrounded by an in- vesting membrane. The pigment is precipitated from the hematin held in solution in the exuded fluid, in the form of a deep orange- yellow, brownish-red, or blackish-brown matter, sometimes in that of coloured molecules, or of opaque amorphous plates. The nerve-tubes and ganglion-cells in the site of the eff^usion are wholly destroyed; the vessels may still be recognized by the fine-granular material with which they are covered, and may also be distinguished by their mode of branching. The scattered bundles of connective tissue sometimes seen, appear to belong to the external coat of the smaller arteries and veins. In the brain and spinal cord, especially of aged persons, we have frequently met with scattered, discoid, oval, or, more rarely, elongated corpuscles of a pale grey colour with a tinge of brown, measuring about O'OOi — 0'008"' in diameter, and con- sisting partly of a perfectly homogeneous substance, partly ex- hibiting a concentric lamination, and thus resembling the corpora amylacea described by Virchow and Kolliker as found beneath the ependyma of the lateral ventricles. Many of them present a nucleiform body in the centre. They are not per- ceptibly afiected by acetic acid, nor by ether, whilst a solution of potass causes them to disappear very quickly. The struc- tureless bodies might be very readily confounded with fat- globules, but when closely examined diff"er in the circumstance that in the first place their border is not so sharply defined as that of the latter, and that they do not possess the same re- fractive properties ; the second form is at once sufficiently characterised by the laminated appearance, usually consisting of 3 — 3 concentric rings. " According to what has been said, we believe that these bodies should be ranked with colloid corpuscles. Those furnished with a central nucleus, would, as regards their mode of formation, have the same import, as that which we have assigned above, more at length, to the coUoid- orpuscles in the prostate gland and thymus. 280 . EXUDATIONS. They must be regarded as iudicative of an augmented colloid transudation, which, as we have seen in the case of otherorgans, may take place without any signs of hyperemia. § 13. The Eye. F. Strube, under Virchow's directions, has subjected the cornea to the most various inflammatory irritants, and par- ticularly to the most active caustic applications, and closely investigated the textural changes thence produced. These consisted, in the first place, of swelling, enlargement of the corpuscles, the formation in them of minute fatty molecules, and the multiplication and enlargement of their nuclei; the intercellular substance became clouded or even opaque, denser, and fibrillated, acquiring a more fibrous constitution, similar to that of the sclerotic; occasionally it was rendered more granular, or finely molecular, as if dusted, and in some cases fat-molecules were seen in it. In many instances these changes were permanent, constituting various kinds of opacity, ieucoma, &c. ; but in others, they were succeeded by a true softening of the corneal substance, a keratomalacia, and by sub- sequent, superficial ulceration. Virchow explains these changes by an increased quantity of material, — of exosmotic fluid — received into the elements of the tissue, the corneal corpuscles, and matrix. " But," says he, " in these cases there is no ex- udation in the sense of the term understood in the schools, either free on the surface, which on the contrary becomes drier, duller, and more clouded, or interstitial, since there is no evidence of the existence of interstices." With respect to this, in the first place, it is by no means clear, why Virchow will not allow that this increased exosmosis of fluid, which, nevertheless, is mani- festly the cause of the swelling of the cornea, is an exudation in the sense of the schools, since exudation and increased exosmosis have been regarded as perfectly analogous processes. And, secondly, he denies the existence of an interstitial exudation, though admitting the swelling of the corneal substance, and of its corpuscles. In order to satisfy ourselves that a molecular material is deposited in considerable quantity between the layers, sepa- EYE. 281 rating them from each other, and thus causing the swelling of the cornea, it is simply requisite to dry portions of the tissue thus swollen, and to subject thin sections carried through all the layers of the membrane, and moistened, some with water and others with dilute acetic acid, to observation. In proceeding to inquire into the mode in which the accu- mulation of exuded fluid takes place, we must bear in mind the' normal conditions of nutrition in the cornea. By the in- jection of various fluids, Bowman has shown the existence in its substance of a complete system of fine canals, disposed in successive planes, and which, in the same plane, are contiguous, and usually parallel though decussating with those of the neigh- bouring planes. These spaces formed by the fibres of the cornea, are analogous to the areolar passages of connective tissue, and, without doubt, in the cornea, serve for the conduc- tion of the nutritive material transuded from the capillaries at the margin. In exudative processes in the cornea, they would consequently conduce to the more ready diff'usion of the fluid product ; otherwise it would be impossible to explain how it is that a plastic fluid makes its appearance at the edges of incised wounds through the centre of the cornea, from which embryonic forms of cellular tissue are produced. Exudations, proceeding from the iris, and more especially from its anterior portions, deposit their products on the front of the membrane, more or less filling the anterior chamber. The coagulable exudations assume a pseudo- membranous aspect, are sometimes of a gelatinous, sometimes of a more viscid consistence, yellowish, frequently speckled with bloody points, and readily divisible into laminae ; they usually become organized into cellular tissue, which adhei'es to the posterior surface of the cornea, in consequence of which, irregularities of the pupil are produced. It is obvious also that the free movements of the iris will be impeded by these adhesions, and that the dilatation and contraction of the pupil will be either imperfectly performed or wholly prevented. A second, frequent metamorphosis of the exudation in question, consists in the formation of pus. This exudation is confined, usually, only to the iris ; the lens, vitreous humour, retina and choroid present no anomaly of the kind. In proportion as the exudations accumulate on the anterior 282 EXUDATIONS. Fig. 62. surface of the iris the same process takes place on the posterior, and in cases oi synechia posterior, delicate filaments of connective tissue may be traced passing to the capsule of the crystalline lens, in which filaments blood-vessels also may occasionally exist. In recent times more attention has been paid to choroiditis, and in particular has "glaucoma" been referred to this aflPection. We will here adduce an instance of this form of inflammation, occurring in the cataractous eye of an old man. Towards the inner surface of the choroid, after removal of the coloured epi- thelium, a large quantity of clear elements (fig. 62, a) of elliptical or oval form, and without any in- vesting membrane or nucleus, came into view. They were about 0013 — 0023'" in diameter and rested upon a hyaline, firm blastema, which could be easilypeeledofiF,and in which were lodged numerous fat-globules. These elements were crowded into larger or smaller groups, and when the light was too strong might readily be over- looked. Besides these, however, larger corpuscles were soon remark- ed, presenting, as a common cha- racter, a strongly defined border. Three of these bodies are shown at b, in one of which the border was indicated simply by a dark shading, whilst in the other two, scattered molecules were visible at the margin. The central portion consisted, in parts, of a structureless, hyaline sub- stance, and groups of fat-globules could be perceived in the inte- rior. The diameter of these bodies (6) reached 0-031 — 0-039'". They were usually isolated, rarely disposed in a few successive layers, and occasionally, also, were without the distinctly defined border. The hyaline, included substance, as at c, was in some, though few, of the bodies, replaced by a reddish-coloured molecular material. Although most of these bodies presented a rounded or oval shape, some occurred of an hour-glass ^orm, as at /. Nor was the peripheral border always of equal width, sometimes, as at g, having fat-globules imbedded in it. Isolated, granular corpuscles (d) of very various sizes were EYE. 283 scattered about. These various kinds of corpuscles were not to be found on the posterior portion of the choroid, nor on the ciliary processes. They could be isolated by the needle, and were unaffected by acetic acid, whilst in carbonate of soda their outlines were gradually rendered indistinct. Now what was the nature of these corpuscles ? Are they to be regarded as abortive or imperfectly developed cells, or may they be supposed to arise from a differentiation of the hetero- geneous elements of a blastema ? The complete absence of the nucleus and of a cell membrane, is opposed to their being of the nature of cells, whilst on the other hand we see precisely analogous corpuscles on the walls of the follicles of the thyroid gland, already described as being secerned colloid masses, and in which the peripheral solidified substance constitutes a border of greater or less thickness. CHAPTEE V. 5. FAMILY — ^NEW-POBMATIONS (nEOPHTTEs). An exuded fluid becomes organized when elementary organs are produced in it, which either in their character or in the mode in which they are grouped differ from those of the tissue in which the exudation has taken place. The aggregate of elementary organs arising in the exudation is termed a " new- formation." The development of these formations subse- quently, under the vital influence and other favorable circum- stances, proceeds in the same way as in the normal tissues, that is to say, their elementary organs, like those of the latter, mul- tiply by division. In comparing the formative process in these new growths with that which occurs in hypertrophies, we shall perceive an essential difl'erence between the two ; consisting in this, that in the former, the process is preceded by the forma- tion of a transuded plasma owing to disturbances of the cir- culation, from which plasma, as originally in that of the ovum, new elementary parts arise, whilst in hypertrophy this is not the case. In this condition there is merely an exaltation of the cell-life proper to the organ, owing to which a more rapid multiplication by division takes place ; or, in other words, the propagative force of the original cell is, under these circum- stances, augmented. But, nevertheless, in nature, the limits are not so sharply defined, and we have frequent opportunities of seeing hypertrophies conjoined with new-formations. In a general survey of the characters of new-formations, we cannot ascribe special characters to any growth of the kind, as regards its elementary organs, so as to be able, from any given cell, to determine to what kind of new-formation it may belong. There is no such thing as a pathological, new-formed cell, which can be regarded as foreign to the organism ; for even when in external aspect it may appear so, it would be equally erroneous to assign it a character, sui generis, as it would be in the case of monsters. In these cases the hypothesis of a special for- NEW-FORMATIONS. 285 mative nisus has in former times been raised, such productions having being supposed to arise from some monstrous formative impulse, as, for instance, that of a Cat, Dog, Pig, or Frog; whilst in later times precise anatomical research has established the fact that these monsters are produced simply by cir- cumstances interfering with the course of development. The malformation of many pathological, new-formed cells, their persistence at a definite stage of development, their occasional retrograde metamorphosis, their coalescence into groups, their excessive cell-life, on the other hand, present so many analogies with the malformations of the fcetus. In this case we see a malformation, due to an impeded development of one part or another, dependent, it must be confessed, upon circumstances still obscure ; these parts become incapable of assimilating, organically, the niitritive material supplied to them, yielding it, as it were, to other parts of the self-developing organism, which, by this superfluity of nutriment, become over developed. Consequently, we cannot assign to cancer, for instance, any more than to tubercle or pus, &c., any spfecial elementary con- stituents peculiar to it alone ; and in this sense, cannot speak of cancer-cells, tubercle- and pus-corpuscles. But in employing this expression we should not connect with it the idea that it signifies organic elementary parts peculiar to cancer, tubercle, and pus only, using it simply in the sense of expressing the fact that in cancer, tubercle, and pus, sueh and such elements are chiefly present. We are therefore never in a condition to make the patho- logico-histological diagnosis of a new-formation from a few elementary organs presented to our observation, but must, to do this, consider the newly-formed tissue in toto. Just as the pathologist establishes the diagnosis of a disease from the entire aggregate of symptoms, so must the pathological histo- logist found his diagnosis upon the particulars of the newly formed tissue viewed in their totality. After the various parts of the texture appreciable by the naked eye have been subjected to a close, comparative ele- mentary analysis, it remains to investigate the intercellular substance. This may be, either a thinfluid,a viscous fluid, at solid. The two former conditions of the inter- cellular substance 286 NEW-FORMATIONS. exhibit no more appearance of structure than do the serum of the blood, or the contents of the areolae of the vitreous humour. Consequently, in this sort of new-formations, the organic ele- mentary parts are dispersed in a structureless fluid material. When the latter is organizable, interstitial tissues are developed from it either secondary, around pre-existing elementary organs, or primary, with subsequent formations of the latter, which inter- stitial tissues, with the cells contained in them, undergo' very various organic metamorphoses, and in this way complicate the structure of the new-formation. Viewing them in this way, the new-formations (neophytes) may be placed in two great divisions: 1. The simple, with a structureless intercellular substance, which, in certain cases, coagulates, and gives the new- growth a greater or less degree of consistence. The elementary organs, also, in them, as simple new-formations, do not advance beyond a certain degree of organization. To this class belong, for instance, pus, tubercle, vitreous or gelatiniform mucus on mucous mem- branes, &c. 2. The compound, with an organized, interstitial tissue, and a manifold capability of development in the organic constituents, as for instance, sarcoma, cancer, &c. . The simple, as well as the compound new-formations, are subdivided, partly according to their general habit, partly from their predominant morphological constituents, into a series of groups, each of which we shall denominate a family-category (ideal forms). Each of these, lastlji^ particularly among the compound new- formations, consists of special forms, whose diversity of struc- ture depends upon the character and degree of the organization of which they are capable. We do not subdivide the new-formations according to defi- nite principles, either anatomical or chemical, deeming such a division, at once, as impracticable. If we were, for instance, to adopt the term " colloid tumours," as a generic name, we should, by so doing, throw together a multitude of entirely different structures, and produce . endless confusion, when it is sufficient simply to say that various kinds of tumours may contain colloid matter. And if we sought to classify new-for- mations simply from their anatomical structure, we should obtain only a dead, formal division, and, moreover, allied structures would, in this way, be separated. We would here simply indicate GRANULE-CELLS, ETC. 287 the various forms of cancer, to show the nullity of any merely morphological principle of classification. There is no need to hamper ourselves with artificial trammels wh^re our informa- tion is limitedj and lest in the end we should incur the risk of readering ourselves incapable of unprejudiced observation. Let us inquire, then, what does suffice for the character of a " family category" of new-formations ? According to what has been observed, it is at once apparent, that neither its bare morphological, nor its chemical elementary constituents, by themselves alone, afford sufficient diagnostic characters. For this it is indispensably requisite to investigate the organic life of the new-growth, and its relations to the entire organism. In the next place, we should endeavour to ascertain its developmental history, the mode and kind of its retrogression, in order to elucidate the relations in which it stands towards its parent seat. Steadily retaining the objective point of view, we shall inves- tigate the categories of new-formations in succession, com- mencing with the simple and proceeding to the compound, and at the end, subjoin some general conclusions. I. GE^NULE-CELLS, GEANULAH COEPTJSCLES, GEANULAE. MASSES. The above terms, together with that of " fatty aggregation- globules," have up to the present time frequently been employed as synonymous. We think they should be subordinated to corresponding ideas, and shall accordingly distinguish three categories of these pathological elements. 1 . In speaking of the fatty degeneration of the cell-contents, we stated that they are converted into an agglomerate of fatty molecules, so that ultimately the nucleus is rendered wholly invi- sible. Consequently, in place of the transparent cell, with fine- molecular contents and a nucleus, we have, simply, an aggregation of fatty molecules still surrounded by the cell membrane ; the fine-molecular cell becomes a granule-cell, which, according to the original figure of the cell, may be conical, fusiform, rounded, &c. The cell-membrane disappears, nothing remaining but the liberated heap of fatty molecules, which, owing to the pro- minence of some, at the periphery, exhibits a fine, indented border. This fatty degeneration, as we have pointed out in 288 NEW-FORMATIONS. the General Part, takes place not only in the original, pre- existing normal cells, but also in those of new, pathological formation, and corresponds to the involution of the old or new- cells. As good subjects for study in this regard, the epithelial cells of the tubuli uriniferi in Bright's disease, or those on the inner wall of the cysts of the thyroid gland, may be recom- mended. B. Reinhardt first propounded the law that all nucleated cells with albuminous contents, whether occurring in the normal condition in the various organs, or newly formed in the. course of pathological processes, may, under -particular circum- stances, become granule-cells ; and in a subsequent work upon the genesis of granule-cells in general, he has stated that the granule-cells (regarded as aggregations of fatty molecules) are developed from nucleated cells, fatty molecules being deposited in their contents. We conceive that the second proposition, with respect to the genesis of granule-cells from nucleated cells, is expressed too generally, as will appear in the following categories. 2. There are found, both in the brain and in the spinal cord, in parts that are the seat of inflammation, usually of some stand- ing, and which are in the condition known as "red or dirty-grey softening," vast numbers of the pathological new-formations, described more particularly by Gluge, and denominated by him " compound inflammation-globules." These are corpuscles some- gg times round or oval, sometimes of an elongated form (fig. 63, the dark corpuscles among the prinptive nerve tubes), in which shape the longitudinal diameter may even be half as much again as the transverse. In size they vary from 0004 — 0-013'"; and in rarer instances, may even exceed these dimensions. They are composed of granules, measuring 000088 — 00013"'^ and which when isolated present the aspect of dark-bordered globules, with a clear centre, like minute fat-globules. The Fig. GRANULE-CELLS, ETC. 289 superposition of these globules, so that they constitute one body, gives the latter a dark, brownish-yellow colour. In many, a round, lighter spot may be perceived, corresponding to a vesi- cular nucleus, which occasionally projects on the border, so far, as to be nearly half exposed. Those represented in the figure, were taken from the lumbar portion of the spinal cord of a paraplegic individual, and were lodged, as isolated corpuscles, among the primitive nerve-tubes. Besides these corpuscles, some elementary granules are also apparent, which, in many instances, increase in size, so as to become fat-globules, which float in considerable quantity on the surface of the water with which the preparation is moistened ; at the same time the nerve- tubes are gradually destroyed, and thin sections of the parenchy- ma will be found to have lost their proper, normal transparency. According to Vogel, these corpuscles are not changed by water ; but they are disintegrated by the prolonged, action of acetic acid and of ammonia, breaking up into the separate granules of which they seem to be composed (an effect which, according to our own observations, also ensues upon the more prolonged action of water). The constituent granules are, occasionally,, but not always, dissolved by caustic potass and by ether. The granules appear to him, from their chemical reactions, to be constituted sometimes of fat, when they are soluble in ether, sometimes of a modification of protein, some- times of earthy salts. The question now arises : whether these corpuscles are also produced from cells, like those described in the first category, and whether these supposed cells, in a state of fatty degenera- tion, should be regarded as original and normal, or of new-for- mation and pathological ? The circumstance that their mean size does not correspond with that of any degenerated ganglion- cells, and that they have been observed in the columns of the spinal cord, and even in the course of the optic nerve, allows only of our regarding them as of new-formation. Though fully acknowledging the correctness of Vogel's obser- vations with respect to the formation of his granule-cells in pneumonia, which he shows to arise from a nucleated cell, whose wall disappears, still we are unable to satisfy ourselves of the universal applicability of this theory of their formation. In the corpuscles in question, from the central nervous system, 19 290 NEW-FORMATIONS. we have never observed a cell-membrane, and are, conse- quently, without any grounds for believing that such a mem- brane has existed and been removed. We consider, therefore, that the term granule-cell is inappropriate to these corpuscles, since one attribute of a cell, viz., the wall, is wanting in them ; and think that the designation oigranular corpuscles, previously proposed for them by Biihlmann, is more suitable. Their mode of formation may consist in the preformation of a nucleus, around which the fatty molecules, united by a connecting sub- stance, are deposited ; the formation of a cell-membrane is not reached, and the cell-formation ceasing with that of the nucleus and contents, is, consequently, incomplete. 3. The fatty molecules suspended in a plastic fluid, appear to be furnished with a viscous, albuminous covering, by which, probably, they acquire the property of becoming agglu- tinated. They collect into groups, and this gradual aggregation may be observed, especially in the somewhat larger fat-globules of about 0-002 — 0-003"', a few of which appear to unite into a small group, which obviously contains no nuclear body. They represent, therefore, simply an agglomeration of fat-globules, and the expression of "granule-masses,'' selected by C. Bruch, instead of the usual one of " granule-cells," is appro- priate to them. But it seems to us, that that observer has propounded an untenable theory, when he states that the nucleus is not formed until subsequently, in the conglomerate body. Virchow employs the term, fat-aggregate-globules. From the comparison of these three categories, it appears : 1. That the granulercells represent a fatty degeneration of original or of new-formed cells ; the granular corpuscles a deposition of fatty molecules around a pre-existing nucleus; and the granule-masses a simple collection of fat-globules. 2. That the granule-cells, after the dissolution of their cell- wall, are no longer distinguishable from the granular corpuscles, and that the latter, when their nucleus ceases to be apparent, are identical with the granule-masses.^ ' [In speaking of the atrophies of tissues, we were obliged to institute two series, which morphologically are often quite indistinguishable, though essentially so genetically ; one of these series of atrophies arises in a diminished, the other in an increased transudation. The effect of these processes consists in an involution of the original tissue ; this is shown not only in a morphological transformation of the GRANULE-CELLS, ETC. 291 We may now proceed to a general exposition of the occur- rence of the three categories in the various tissues. In stagnant bhod, both within the vessels, as in larger aneurismal sacs, as well as externally to them in cases of extravasation, where the blood has been poured out into the parenchyma of the organ in consequence of the rupture of a vessel, dark-grey granule-masses arise, composed of aggregated fat-globules; these masses lie scattered among the necrosed blood-corpuscles, and not unfrequently assume a dirty-yellow or yellowish-red colour, from their being imbued with hematin. Their size varies a good deal, and is, not unfrequently, four times that of the white blood-corpuscles, so that they cannot by any means be viewed as a degenerated form of the latter. Fat appears to be formed in considerable quantity by the decompo- sition of protein-compounds, which, in a state of minute divi- sion, forms the bodies in question by the aggregation of its minute particles. Newly-formed nuclei also, under these cir- cumstances, serve as points of collection for the fat-globules. After suppuration in the interstitial connective tissue of the muscles, colossal granule- masses are, not unfrequently, left; in the same way they are deposited on the cellular sheaths of the smaller vessels, as may be observed, especially in ence- phalitic inflammations, where the presence of these cor- puscles may be observed even on the minutest capillaries. In fig. 64, are represented blood -vessels of various calibre from an inflamma- tory foms of old date in the corpus striatum. On their outer' wall, granule-masses are visible, which in parts surround the vessel like a border, constituting continu- ous chains. Their size ex- cell-contetits, &c., but also of the intercellular substance. in which an accumulation of fat in a state of minute division in separate groups often occurs, to which the name of granule-masses has been applied. Fig. 64. 292 NEW-FORMATIONS. ceeds the diameter of the capillaries. Besides these^ the outer wall is also covered by isolated granules (elementary granules), which, as we observed in speaking of atrophies, should not be confounded with the fatty forms of involution of the constituent elementary organs of the capillaries, minuter arteries, and veins {vid. fig. 24). These adherent granule-masses may arise from a transuded plasma adherent to the outer wall of the vessels, or, according to L. Tiirck, may be regarded as de- posited upon the vessels. . When the deposition of these granule-masses takes place in considerable quantity, and over a considerable space, vessels so affected, if of a certain size, are evident even to the naked eye as greyish-white streaks, and may be readily dissected out, as has already been remarked by L. Tiirck. In the larger vessels, up to the aorta, the granule-masses may be noticed not only in the cellular coat, but even in the middle and internal coats, consisting in these situations, some- times of globules, disposed in longitudinal series, sometimes of variously shaped, irregular agglomerations of globules, which occupy considerable interspaces between the reticulated fibrous layers. The appearance of granule- masses on the mucous membranes is very common in catarrhal affections, and it is yet uncertain whether, in this situation, they arise directly from mucus- or pus-corpuscles in a state of fatty degeneration. The former are met with especially in the whitish, mucous masses, on both the respiratory and digestive mucous membranes, and of the most various dimensions. The metamorphosis of the epithelium of the pulmonary air-cells into granule-cells, has been observed by B. Reinhardt in the most various pathological conditions of the lungs. He noticed this metamorphosis, several times, in portions of lung which had been compressed by pleuritic effusions, but which themselves contained no exudation in their tissue ; and, on one occasion, he noticed the same thing, very distinctly, in a case of extensive atelectasy of the pulmonary tissue in a person dead of typhus fever. Very frequently, also, in the first stage of pneumonia, he has found the epithelium filled with fatty mole- cules, whilst in red hepatization the epithelial cells, transformed into granule- cells, had disappeared. With respect to this, it GRANULE-CELLS, ETC. 293 should be remarked, that Reinhardt, under the t6rm " granule- cells/' comprehends only an agglomeration of fatty molecules, regarding them consequently as equivalent to the granule- masses. From his observations, he concludes that all the granule-masses met vith in the lungs are nothing more than altered epithelial cells, and is no longer disposed to consider them as a new-formation in the exudatiou. We do not regard this proposition as of universal application, since in other situa- tions precisely similar bodies occur where there can be no question of a fatty metamorphosis of the normal elementary organs, as for instance in the brain, spinal cord, nerves, &c. A perfectly analogous condition occurs in the kidney. In this gland the fatty degeneration of the epithelial cells is a well-known condition in morbus Brightii ; although here also we do not think that the genesis of the granule-masses from degenerated epithelial cells, can be considered as a universally established fact. B, Reinhardt has sought to explain the con- siderable size of the granule-masses, and their spherical figure, by the assumption that the flattened, polyhedral cells of the tubuli uriniferi, enlarge and acquire a globular shape from the deposi- tion of fatty molecules in their contents. In a case of puerperal endometritis, we found, on the inner surface of the uterus, at a point corresponding to the insertion of the placenta, a great number of granule-masses of very various sizes, of a globular form, some of which were three times as large as pus-corpuscles ; the latter, therefore, must undergo a considerable increase of volume unless an independent agglu- tination of the fat-granules around them be assumed to take place. In the milky, turbid fluid of the enlarged prostate, a great quantity of granule-masses may frequently be noticed ; these corpuscles together with the epithelial cells in a state of fatty degeneration are, without doubt, the cause of the milkiness of the fluid; throughout which they are not uniformly dis- tributed. The newly formed elementary organs very frequently degene- rate, as has already been stated in the General Part, and in con- sequence of the fatty metamorphosis of the cell-contents become granule- cells, granular corpuscles, or granule-masses. The latter are seen, for instance, in the juice of cancer, in portions of can- 394 NEW-FORMATIONS, cerous tissue in a state of involution, and in our opinion, afiford no reason for the assumption of the invariable pre-existence of a cell, as is apparent from the agglutinated large fat-globules, a few of which, as before stated, appear to unite into a small group, and to enclose no nuclear body. The example cited above may suffice, since, besides that, we shall have frequent occasion, in speaking of new formations, to return to the subject. The pathological import of the granule- masses, was appre- ciated by their discoverer, Gluge, vihen he stated that they were a product of the inflammation ; he termed them, there- fore " compound inflammation-globules," a designation which may be regarded as so far incorrect, since these bodies have been found in a normal secretion, viz., in the colostrum, by Donne, and may also be developed from the fatty metamorphosis of the cell-contents in genuine atrophy of an organ. B. Reinhardt regards the transformation of nucleated cells into non- nucleated corpuscles, which takes place under these circum- stances, as indicative of a retrograde process in the cells, de- pendent, as he expresses it, not upon a metamorphosis arising from the vital development of the cell, but rather upon changes to which the cell is subjected so soon as its vital activity begins to flag. But he overlooked the formation of granule-masses in the intercellular substance, before noticed by Rokitansky, which bodies, without any previous cell-formation are of the nature of fatty aggregations. That the granule-masses, even when accumulated in very large quantity, have, in many cases, nothing to do with an exudative process, is evident, especially from the very extensive researches of L. Tiirck, with respect to the secondary affections of the separate columns of the spinal cord, and their continua- tions into the cerebrum; and with regard to the effects of compression upon the optic nerve. This author has shown, that the formation of granule-masses, in parts so strictly defined as the above, takes place simply as a consequence of the paralysis (atrophy) : for if the existence of any exudation- process were assumed, such a limitation of the formation of granule-masses to the individual medullary columns, even were the presence of certain dissepiments between the latter (which are not at present demonstrable) admitted, would not be con- PUS, 295 ceivable. In such cases, therefore, we can only regard the granule-masses as products of the decomposition of the normal fluid of the tissue. U. PUS. There is but one true, genuine pus ; and the terms of " improper" or "false," pus, may be dispensed with as being wholly unscientific. In the pus, termed by practitioners bonum et laudabile, we find, as the predominant, organic morphological element, spherical corpuscles, which cannot be accurately distinguished as such under a less magnifying power than one of 300 diam. These bodies have received the name of pus-corpuscles. They are constituted of a soft, granular substance, and are of a greyish hue. In size they usually measure 0*0044'", but may be greater or less. It is as yet undetermined whether these diversities of size are connected- with the individual by whom the pus is afforded, or with the nature of the disease, as J. Vogel supposes ; who has remarked that the size of the pus-corpuscles of an abscess and of a wound is tolerably constant — in the one case they are all small, and in the other all large. Their spherical figure is satisfactorily seen when the pus is diluted with water or a weak solution of salt or sugar, and the corpuscles are made to roll about, under which circumstances they are invariably seen to retain the round form. Their globular shape may also be deduced from the conical shadow thrown by them when illuminated by oblique light. Many pus-corpuscles, particularly the larger forms, exhibit a cell- membrane, though, in most cases, they appear to be bounded, simply by a delicate granular material. When pus is left at rest in a deep glass vessel, the corpuscles subside to the bottom, constituting the greater part of the " pus-crassamentum." Under these circumstances, they cohere and form a granular, easily crushed mass. In order to understand their structure, it is requisite to observe them in various media. Of these, dilute acetic acid, is especially recommended by J. Vogel, in which they are rendered pale, and in their interior may be observed one or several corpuscles, which are regarded as nuclei. The size of the latter varies from 000088 — 0'0026"'. They are largest 296 NEW-FORMATIONS. vvheu solitary. The multiple nuclei are always united into a single group ; and as many as five have been counted in a pus-corpuscle. When two nuclei occur together, they present a biscuit-shaped or hour-glass form, three assuming that of a trefoil leaf. Henle and J. Vogel have occasionally observed nuclei of an elliptic form, and at the same time hollowed on each side like a blood-corpuscle, occasionally, spherically dis- tended or ovoid. This effect of dilute acetic acid upon the pus-corpuscles and, in particular, the manifestation of the multiple nucleus, is so characteristic, that we have in that reagent a ready means of distinguishing pus-corpuscles from other elementary bodies — as, for instance, from young connective-tissue-cells. When pus-corpuscles are acted upon by water, they visibly enlarge, becoming, at the same time, more transparent, and, in many, the simple or divided nucleus is distinctly apparent ; consequently, it cannot be assumed th^t the acetic acid pro- duces an artificial subdivision of a simple nucleus. Occa- sionally, also, when the pus-corpuscle is thus enlarged, if it be furnished with a cell-membrane, the rupture of the latter, and the escape of the nucleus and of the molecular substance, may be observed. If concentrated saline solutions — as, for instance, of common salt — be applied to pus-corpuscles, they lose part of their watery contents, shrinking visibly, and again swelling up on the addition of water. J. Vogel has instituted extensive researches with respect to the influence of various substances upon pus, with the following results. Moderately dilute solutions of most neutral salts — such as muriate of ammonia, common salt, nitre, &c. — when their action is prolonged, dissolve the investing substance and, except the nucleus, the contents also, in great part, of the pus- corpuscles, and causing even the nuclei themselves to swell, so as to lose their sharp outlines and to become fused into an ill- defined mass. The alkaline carbonates, a solution of borax, and, still more rapidly, caustic alkalies, convert the pus- corpuscles into a mucoid matter. The envelopes, as well as the nuclei, disappear, nothing remaining but extremely minute, dark molecules, probably of a fatty nature. Substances which coagulate fluid albumen — such as metallic salts, tincture of PUS. 297 iodine, alcohol, &c.^ — render the pus-corpuscles cloudy and opaque. Saliva, mucus, urine, blood, and the other fluids of the body do not usually exert any important effect upon the pus-corpuscles ; the bile only, disintegrates them. Boiled with concentrated hydrochloric acid, the corpuscles behave as do protein-compounds j they colour the fluid violet. When the above properties of the pus- corpuscles are com- pared with the elements known as white blood-, salivary, and synovia-corpuscles, no important distinctions are found to exist between them, or, at most, only such trifling differences as are insufficient for the establishment of any certain diagnosis. Acetic acid acts upon the last-named corpuscles exactly as it does upon those of pus ; and, consequently, the various dimen- sions of the latter, and the occasional existence of a cell- membrane, alone remain as indicative of any points of difference. 1. The white blood-corpuscles, in Man, never exceed in size the volume of the small pus-corpuscles — 0'0035'". 3. The saliva- and synovia-corpuscles exceed the latter dimensions, the former also presenting a comparatively large nucleus, which less frequently subdivides into multiple nuclei. The serum of pus, its fluid constituent, analogous to the hlooi-serum, presents no morphological elements beyond solitary suspended granules and floating fat- globules. The salts held in solution in it crystallize in dendritic forms upon the spontaneous evaporation of the fluid. Besides these usual constituents, fibrinous (filamentous net- works soluble in acetic acid), flocculent or granular masses are met with in the more consistent kinds of pus. Several kinds of pus contain mucin, which, upon the addition of acetic acid, is thrown down as an opaque substance, O ig'^ ^'' C_J^''^'(i-^-' and when examined under the micro- ® O o ,4?i „ B^ scope, is seen to be composed of very Q © oifSf © delicate, straight filaments (fig. 66) ; and @ j^ 0^%''^ ° it appears to be deposited in several sue- G® "' cessive layers. According to Lehmann, these wjMcira-filaments are dissolved by concentrated acetic acidy especially when warm. This substance is identical with that termed by Giiterbock pyin — a name which cannot 298 NEW-FORMATIONS. be admitted, since, as shown by J. Vogel, pyin rarely occurs in normal, and frequently exists in abnormal pus, as well as in other pathological products, as, for instance, in carcinoma. Other solid particles are frequently mingled with pus, such as red blood-corpuscles, derived from the rupture of the smaller vessels in the walls of the abscess, minute plates of cholesterin, and accidentally detached epithelial cells. Crystals of triple phosphate of magnesia and ammonia, vibrio monas and v. lineola, are seen only in putrefying pus. The pus-corpuscles are sub- ject to a fatty metamorphosis of their contents, manifested by .the appearance within them of strongly defined, brilliant mole- cules which are not removed by the action of dilute acetic acid or of a solution of carbonate of soda or potass. An instance of incipient fatty degeneration of piw is. shown in fig. 65, representing pus taken from a diffused subcutaneous abscess. In the isolated or grouped, granular pus-corpuscles, dark points will be perceived, which, when the/ocM« was well adjusted and a sufficient magnifying power employed, exhibited a clear centre. At the same time, also, sharply defined, larger and smaller fat- globules were seen, occurring free, on the surface of the prepara- tion, and which were consequently brought into view when the focus was elevated. This free fat increases as the degeneration of the corpuscles advances. In fig. 65 are also shown various admixtures, such as red blood- corpuscles, in the wrinkled and non-wrinkled condition, two epidermis-c(^s with their oval nuclei and a coagulated protein-substance in a tubular form, covered with a molecular material. In proportion as the fatty degeneration advances, the cha» racters of the pus-corpuscles are lost, nothing remaining but scattered molecules ; the periphery of the corpuscle becomes indistinct, and upon the addition of acetic acid the nucleus can no longer be plainly perceived. At the same time, also, the amount of olein in the pus-serum is augmented, and not unfrequently, in pus in this condition, after the action of acetic acid, the filaments described under the name of mucin, are met with. It is plain, that in ^ms, thus liquefied, the histo- logical diagnosis is impossible, inasmuch as the morphological constituents — the pus-corpuscles — are wanting. Virchow was the first to show that a similar degeneration takes place in the colourless blood-corpuscles (isomorphous with pus-cor- PUS. 299 puscles), and that, in proportion as they become filled with fat, they increase in size, and assume all the forms of the so-termed granule-cells or inflammation- globules. Eeinhardt has ob- served a similar process in the case of the pus-corpuscles. But the rudimentary pus -corpuscles may also wholly dis- appear as is the case in what is termed sanies. In this case the formation of corpuscles is either altogether wanting or is extremely imperfect. The fluid presents merely molecular particles,: dirty, brownish-yellow flocculi, a great abundance of fat-globules, and, occasionally, detached fragments of connective and elastic tissues imbedded in a brownish-yellow, molecular matter. Crystals of phosphate of magnesia and ammonia and vibriones very speedily make their appearance. , It must, per- haps, be assumed that as the formation of sanies advances, no development whatever of pus-corpuscles is ever attained to. Many kinds oi pus contain a large proportion of water, and are consequently thin and fluid. The pus-corpuscles of this serous pus are rarefied and swollen. Pus appears to be developed from a, principally, albuminous exudation, which, as was first remarked by Rokitansky, is in many cases combined with one of a fibrinous nature. In the latter case the amount of pus-corpuscles is less, and these, enclosed in coagulated fibrinous masses, form, according to Rokitansky, the so-termed pus-clots, or plugs. He thinks that the pus-cell is developed, not from the solid fibrinous exu- dation, but from the sero-albuminous fluid associated with it. In these kinds of pus, containing a large amount oi fibrin, young connective-tissue-formations also, are constantly met with, which appear to be produced from the fluid fibrin. The formation of the pus-corpuscles is described by J. Vogel, from his own observations made on recent wounds cleansed from blood, to take place in the following mode. There first appear in the fluid secretion of the wound, minute granules, less than j^'" in size, corresponding chemically with the molecules of pus, and insoluble in alkalies and in borax. Subse- quently, somewhat larger corpuscles, ^ — jg/" in size, make their appearance, partly around these molecules, partly inde- pendently of them. These bodies, which are soluble in alkalies, and insoluble in acetic acid, correspond with the nuclei of the pus-corpuscles. The nuclei are sometimes solitary, sometimes 300 NEW-FORMATIONS. in groups of two or three together, when they assume a trefoil figure, and thus constitute the compound nuclei. Around them is afterwards developed the cell-wall, at first as a mere transpa- rent membrane, which is subsequently thickened, and becomes granular, and thus is produced the pus-corpuscle. . This forma- tion of pus-corpuscles takes place with considerable rapidity ; he often noticed perfect corpuscles within three or four hours of the first appearance of the nuclei ; in other cases it pro- ceeded more slowly. Occasionally, he observed a simple, apparently vesicular nucleus, excentric in a transparent, ellip- tical cell- wall, with a sharp external contour. Cell-nucleus, contents, and wall, subsequently undergo, simultaneously, farther metamorphoses. In other instances, the nuclear body alone existed, surrounded by an undetermined granulo-amorphous de- posit, without any sharp outline, and, as the endosmotic condi- tions showed, without any closed cell-wall. This latter condition of the pus-corpuscles is without doubt the most frequent ; the majority of them, therefore, do not merit the name of cells, but are for the most part to be regarded as imperfect cell-for- mations. That pus- corpuscles without cell-walls, as well as complete cells, may multiply by division, and that every cor- puscle does not arise primarily from the plasma, is more than probable. This notion is, we think, supported especially by the diversity of form exhibited by the nuclei, and of size by the pus- corpuscles. The biscuit-shaped nuclei have a tendency to divide into two halves, and those of a trefoil shape into three parts. When, in this way, two, three, four, and five nuclei have been produced from one, by the process of division, they separate from each other, the contents of the pus-corpuscle subdividing into as many portions. Thus, the property of multiple division possessed by the nuclei would indicate a rapid multiplication, as may be observed on a greater scale, and more conveniently, in medullary cancer, and as has been described in our account of the cell-theory in the General Part. In speaking of pus, other elements should be noticed, which, although not belonging to the^ws as such, are yet occasionally met with in it. These bodies occur most frequently, and in the greatest abundance, in the pulmonary air-cells and bronchice, in cases of red hepatization of the lungs, and in the sputa in pneumonia. They consist of finely-granular globules PUS. 301 0008— 0-022'" in diameter, with a sharply defined cell-wall. No nucleus can, in any way, be detected in them, and they are, consequently, non-nucleated vesicles. They usually present a yellowish or yellowish-brown colour, and not unfrequently, also, contain dark, scattered pigment-molecules. In order to represent them, the sputa of a person afifected with pneumonia were taken, and treated with dilute acetic acid (fig. 66). The pus-corpiiscles are seen with very pale, scarcely distinguishable outlines, and simple or multiple nuclei, \ yw.'!'-: is >•'' \ IS't- among the filaments formed by the \ )g^ \ LW^ v4^ ° mucin. At the lower part of the {Vj^^;X|'^,''- figure are seen foui", larger, granular l]A- a^: \ globules, which, after treatment with acetic acid, did not undergo the same change as was exhibited by the pus- corpuscles. In the case of these bodies, it may be inquired whether the nucleus had previously existed, and had perished in the non-nucleated corpuscles, or whether the formation of a nucleus had not been reached, but simply that of a cell-membrane around a portion of contents. We have already stated in the General Part, that the theory of cell-formation affords too scanty means for the determination of this difficult question. It is, perhaps, probable, that there may be such things as sterile cells, which, like ova incapable of germination, are not further developed, owing to their imperfect organization, and that these non-nucleated globules not improbably represent cells of this kind. They are essentially different from the granule- masses, which consist of more voluminous granules, and have no cell-membrane, whilst the molecules of the sterile cells (?) are of immeasurable minuteness, and enclosed in a cell-mem- brane. From any kind of epithelial cells, they differ, in the absence of the nucleus, the diversity of their size, and their globular form ; consequently, there are no grounds for re- garding these fine-granular vesicles as any sort of metamor- phosed epithelial cells. These granular globules occur, as has been observed, as new- formed elements, together with pus-corpuscles, especially on 302 NEW-FOEMATIONS. the mucous membrane of the air-passages, of the intestinal canal, and of the uterus. They are found in the stools in diarrhoea, where, however, the usual, scattered pigment-mole- cules are wanting in their contents. They present the same appearance, after exudations on serous and fibrous membranes, and in the brain. We have often noticed them, also, among the elementary corpuscles in cancer. We shall now return to the pus-corpuscles, and discuss their special relations in various parts of the organism. A condition of the blood was first accurately described by Virchow, in which a superabundance of white corpuscles exists in both the arterial and venous blood, and to which he assigned the name of leukfuemia. In cases of this kind, there are found within the vessels, coagula, sometimes gelatiniform, sometimes of a consistence like that of coagulated fibrin, and of a yellowish, greyish or greenish colour. When the liquid portion of the coagulum is expressed, it is found to consist of a greyish, greyish-yellow, or yellowish-green fluid, in which chiefly, are contained the elementary organs known under the name of " white blood-corpuscles." These bodies are entangled in a finely-interwoven filamentous network (coagulated fibrin), which constitutes, as it were, the fundamental stroma of the coagulum. The red blood-corpuscles are rarefied, and even in the more bulky coagula, as, for instance, those in the cardiac cavities, otcur only sparingly in the form of blood-red streaks. This preponderance of white blood-corpuscles may be noticed even in the finer ramifications of the vessels. Whether a partial leucsemic condition is developed in exu- dative processes, cannot be positively stated, although in many cases such an occurrence may be supposed probable. If fine vascular branches are taken from proper situations around a centre of exudation by means of the scissors, white blood-cor- puscles will most probably be exhibited, disposed in rows in the interior of the vessel. But whether these corpuscles are actually of new formation, or have merely arisen from an accu- mulation of those already existing, in consequence of the MiooA-stasis, we will not venture, for reasons previously stated, positively to decide. Virchow looks upon leuccemia as indicative of an impeded development of the blood, a view which is based upon the PUS. 303 consideration that a genetic connexion exists between the red and white blood-corpuscles, but which, it must be confessed, has not yet been elucidated in all its particulars. That a transition, from leucmmia into pyeemia, takes place, or, properly speaking, that merely a distinction of gradation exists between these two conditions, is obvious from the com- parative investigation of the coagula in the various systems of vessels. In a well-marked case of leuceBtnia, with congestion of the lungs, greatly enlarged liver and spleen, the veins in the plexus choroideus of the brain were as completely filled with a purulent fluid as are the veins of the uterus in the afl^ection erroneously termed uterine phlebitis. The reticulated, fibrinous coagula had disappeared, nothing being presented but pus-corpuscles (like the white blood- corpuscles). A large quantity of pus-corpuscles is developed from the exudations, deposited on the mucous surface in catarrhal afiections; in this situation the corpuscles have received the name of mucus-corpuscles, although they exhibit no morpho- logical peculiarities whatever. The glutinous, occasionally diffluent, turbid new-formation, usually of a gelatinous con- sistence, deposited on the mucous membranes, has been desig- nated, " puriform mucus," &c., and is distinguished from what is termed normal pus, by the greater amount of intercellular material containing mucin. The cloudiness in the pathological mucous discharges in coryza, bronchial catarrh, &c., is due, not only to the pus-corpuscles, but also to the mucin, which is precipitated whilst within the organism. For immediately after the discharge of these turbid secretions, mucin-filaments may be discerned, which, after treatment with acetic acid, make their appearance in still greater abundance. The deep-yellow or yelldwish-red colour of the mucus usually depends upon the quantity of disintegrated red blood-corpuscles. The formation of pus-corpuscles from the exudation deposited on the surface of the mucous membrane proceeds with great rapidity. They do not, however, constitute the only organized new-formation ; on the contrary, often being wholly or partially absent, embryonic connective-tissue-formations presenting them- selves in the clear, gelatiniform mucous matter (gelatiniform mucus). But this subject we shall reserve for fuller discussion hereafter. 304 NEW-FORMATIONS. The exudation poured out on the surface of the mucous membrane is afforded by the close, capillary plexus of the corium, and in consequence of the effusion, the epithelium necessarily becomes loosened, and is thrown off. The secre- tion of the mucous glands may induce a modification of the exudation, but cannot be regarded as the main constituent of the latter; nor consequently, can the pus- corpuscles be re- garded as produced from the glandular secretion. The formation o( pus may take place also in the submucous tissue, owing to which, a gradual solution of the superjacent mucous membrane is effected, when its perforation at a minute point ensues. By the extension of a submucous abscess of this kind, the corresponding part of the mucous membrane is de- tached over a considerable space. We once had an opportunity of examining submucous abscesses of this sort, in great numbers, in the large intestine of a child affected with atrophy. The pus was greenish-yellow, and diffluent, presenting a great amount of broken-up pus-corpuscles with brilliant molecules; and after treatment with dilute acetic acid, was rendered remarkably turbid. The production of pus-corpuscles occurs most frequently on the nasal and respiratory mucous membrane ; in the latter of which situations, owing to local conditions, it is especially of consequence. In the finer bronchial ramifications, and in the air-cells, the rapid multiplication of these new-organisms causes a complete obstruction of the passages and cavities destined for the transmission and reception of air. In this way are pro- duced the red and the grey hepatization of portions of the lung. The pus-corpuscles in these circumstances are usually of small size, well characterized, and not unfrequently collected into coherent masses. In other cases, the characters of the pus- corpuscles are more or less lost, as they undergo a fatty degeneration. This retrograde metamorphosis may be observed in the softened parts of the lung in a state of grey hepatization, owing to which, when more advanced, the fibrous tissue of the organ becomes readily lacerable and partially dissolved. In what are termed " metastatic purulent deposits" in the lungs, a solution of the affected pulmonary substance proceeds with great rapidity, and an abscess is formed, the walls of which are constituted by infiltrated pulmonary cells containing no air. PUS, 305 When the deposit is seated at the surface of the lung, it is seen to be surrounded by a circle of injected vessels. In the external integument, local conditions occur, similar to those which are observed in the mucous membranes. The formation of pus takes place, either on the surface of the corium or beneath it. In the former case, it collects under the epidermis, which is raised in a vesicular form, as may be observed in variola, impetigo, &c. The pustules of smallpox are especially suitable for the observation of the development of the pus-corpuscles in the mode above described by J. Vogel, since, in one and the same individual, when the vesicles on the head are already filled with fully formed pus, the various stages of the formation of that product may be observed in the lower parts of the body. In the subcutaneous tissue, the development of pus, when a mainly fibrinous exudation is poured out, is limited to minute circumscribed spots, whence the intermediate portions of tissue mortify and are thrown off in the form of consistent sloughs. The best example of this form of suppuration is presented in anthrax. In a firm, tenacious slough, about 078" in diameter, of a yellowish-green colour above, and slaty- grey beneath, we noticed a considerable quantity of much convoluted elastic Fig. 67. filaments (fig. 67, a a) and bundles of connective-tissue- fibres (i), which were imbedded in a brownish-yellow or brownish-black amorphous material, and could only be seen 20 306 NEW-FORMATIONS. in thin layers. In the core from an abscess on the lower jaw, in a scrofulous individual, beneath the dead portions of tissue, torn and empty blood-vessels could be recognized, together with elastic fibres and connective-tissue-bundles. As newly formed elementary organs, not only were pus-corpuscles pre- sented, but also embryonic connective tissue. In a slough from a very extensive abscess on the trochanter, together with a molecular and flocculent matter, and agglomerations of pus- corpuscles, we also noticed fibrils of connective tissue and elastic filaments. Thus it is evident, that, just as on the surface of the mucous membranes and of the external integu- ment the epithelium and epidermis are detached by the layer of exudation and thrown off, so in the subcutaneous tissue, and in more deeply seated suppurations, in other textures, the por- tions bathed by the pus die and are thrown off. A similar necrosis, or partial solution, takes place in the investing cartilage of the joints, in consequence of suppuration in the bone. In these cases, the cartilage-cells, and even the intercellular substance, undergo a fatty degeneration, lose their transparency, and are ultimately wholly unrecognizable. In local, total destruction of the cartilaginous investment, portions assume the appearance of jagged ulcerations, at the periphery of which the above atrophied forms of cartilaginous tissue are seen, whilst on the floor of the ulcer pus-corpuscles are ap- parent. The purulent infiltration of the synovial capsule alone does not cause any necrotic changes in the osseous tissue. With the formation of pus in the joints, is very frequently associated a partial new-formation of connective tissue, which, when proceeding from the bone, also produces an ulcerous erosion, of the investing cartilage; when it takes place from the synovial capsule, it is to be regarded as an indication of incipient anchylosis. Dubois, not long ago, made the discovery, in newly born infants affected with congenital syphilis, together with a super- ficial erosion of the liver and kidneys, and with pemphigus- vesicles or erythema on the skin, of a formation of pus in the thymus. Braun and Spath, who have paid attention to this subject, have found in the lobes of the thymus thus affected several cavities filled with a purulent fluid, or a single, larger PUS. 307 central cavity, which also enclosed a yellowish turbid fluid. The latter no longer contained, as in the normal condition, the well known nucleated, grey elements, but granular globules, which after treatment with dilute acetic acid exhibited the characteristic nuclei of pus-corpuscles. In the intercellular fluid also, the straight filaments of mucin were apparent. In the more consistent portions of the walls of the cavities, in a well-marked case of this kind, a new formation of connective tissue had likewise taken place. Dr. Braun ascertained, that the mother had been affected with copious vaginal discharge, which, by her account, had existed for two years. In the abscesses of the liver, which are termed metastatic, the pus-corpuscles are usually in a state of partial fatty degene- ration, and sometimes so completely disintegrated, that not a single corpuscle can be recognized. This change is probably due to the reaction of the alkaline bile, which gives the pus a deep green or greenish-yellow colour. Of the disintegrated hepatic parenchyma, the rounded nuclei of the cells are left in the abscess. Abscesses in the liver with sinuous irregular walls, should not be confounded with collections of puriform mucus in saccular dilatations of the biliary ducts, which retain their smooth walls. In the, often numerous, minute renal ab- scesses, also, to which a metastatic origin has been assigned, the pus-corpuscles exhibit a great disposition to become disin- tegrated, which in this case perhaps cannot be referred to action of the urine, since the pus-corpuscles formed in catarrhus vesicae seem to be well preserved in the urine when passed. The venous ramules around the abscesses are injected. The solution of the parenchyma is evidenced, partly by the advanced fatty degene- ration of the epithelium of the tubuli uriniferi, partly by the liberated, spherical nuclei. When emptied of the pus the wall of the abscess in the cortical substance is found to exhibit a delicately ai'eolated aspect derived from the remaining bundles of connective tissue — the fundamental stroma of the renal paren- chyma J in the medullary substance the bundles of connective tissue, following the course of the tubuli uriniferi, are disposed in straight lines. Pus-corpuscles are seen in very great numbers in the urine, in blenorrhcea vesica, causing a considerable turbidity in the secretion. They subside to the bottom of the vessel, constituting 308 NEW-FOEMATIONS. the well-known purulent sediment. The corpuscles are charac- terised by a remarkable diversity of size, which is partly owing to the swelling consequent upon the imbibition of watery fluid. Catarrhus vesica is usually accompanied with a rupture of the smaller blood-vessels, whence the urine acquires various tints of red. The blood-corpuscles appear isolated, and are rendered pale by the removal of some of their colouring matter, or ac- quire a greenish tinge ; in more watery urine they also swell by the imbibition of water. Blood-clots subside to the bottom with the pus-corpuscles, and are not visible until the sediment has been carefully spread out. Occasionally a remarkable quantity of mucin drawn out into threads may be noticed, the pus- corpuscles at the same time becoming more rare. Urate of ammonia and crystals of triple phosphate are a not infrequent ingredient in urine of this kind. In more acute cases of catarrhus vesica, a partial mortification of the mucous membrane takes place, in consequence of which, fibrils of con- nective tissue and tolerably thick, convoluted elastic filaments are detached, and are found in the urine. This circumstance always indicates a previous infiltration of the corium of the mucous membrane, and of the submucous tissue. According to its aspect, the pus might be confounded with several other products, either normal or pathological. We will here notice only the most important. We may have to determine, for instance, whether a glutinous secretion issuing in small quantity from the male urethra, is to be referred to hlenorrhoea, spermatorrhoea, or to the prostate gland. The morphological examination wiU show in the first case, pus-corpuscles, in the second, spermatic filaments, and in the third, a clear fluid with epithelial cells. Even in dried human semen, as obtained, for instance, from the orifice of the urethra in a person who has been hanged, the spermatic filaments may still be readily recognized. The greyish, turbid fluid which may be expressed from old, encephalitic tumours, contains, as we have before more par- ticularly remarked, granule-masses and granular corpuscles with a molecular substance, together with atrophied vessels, nerves, &c. In the frequently much enlarged, very pale lymphatic glands, presenting a similarity to cancerous infiltrations, a PUS. 309 milky, turbid fluid may be expressed, containing only the well- known nucleiform elements. Pus-corpuscles are also wanting in softened tubercle, and in the juice of cancer, whose elementary constituents we shall afterwards more particularly describe. Having thus studied the subject oi pus, in its various modi- fications, we shall proceed to some general considerations with respect to its pathological import. Pus, as was first taught by J. Vogel, must be regarded as a new-formation developed out of the exudation ; it is clear, therefore, that the exudation, as such, cannot, in any way, be termed purulent. That the pus- corpuscles arise primarily out of a plasma, and cannot be viewed as a kind of multiplication of the white blood-corpuscles, is at once evident from the circumstance, that in fibrinous exu- dations which are wholly enclosed, groups of pus-corpuscles enveloped by coagulated fibrin are produced. In variola, also, we witness the production of pus-corpuscles from the limpid plasma quite independently of the rupture of a vessel, and, con- sequently, of the escape of the corpuscular elements of the blood. The opinion above expressed, and for which the reasons have been assigned, that pus-corpuscles multiply by division, is of pathological importance, inasmuch as it shows how necessary it is to eliminate or destroy these corpuscles, in ■ order to prevent the formation of pus from pus. For this reason we open an abscess, or destroy these newly formed ele- ments with caustic, in blenorrhcea of the eye, or urethra. As is the case with every new-formation, so also may the formation oi pus advance up to a certain degree, ceasing under favorable circumstances, if the nutritive fluid requisite for its multiplication be withdrawn. The defunct pus-corpuscles are now rejected from the organism in a natural way, as by the sputa in pneumonia undergoing resolution ; or the intercellular fluid, and with it the pus-corpuscles also, when they have again become liquefied, may be wholly absorbed, as happens in the case of abscesses which have undergone resorption. The cor- puscles of what is termed normal pus, do not, of themselves, appear to exert any solvent power upon the surrounding tissue, which would seem to sufl'er injury merely &om the pressure of the advancing new-formation. In what is termed unhealthy suppuration, of which there are 310 NEW-FORMATIONS. many degrees (and amongst them is to be enumerated incipient fatty degeneration), strictly regarded, we cannot speak of a dis- integration of the pus. For in fact, in these cases, perfect pus- corpuscles are not formed, inasmuch as the exuded material at once undergoes such chemical metamorphoses, that any kind of organic formation takes place only in an imperfect manner. In the highest degree, or that in which the fluid is sanious, all formation, even of imperfect elementary organs, is precluded. These morbid kinds of pus, and parti- cularly the sanious form, exert such a corrosive action upon the contiguous tissues, as to cause their solution with consider- able rapidity. Thus, in malignant smallpox, the papilla of the corium are partially destroyed, and cicatrization ensues, followed by the well-known depressions. The striped muscles lose their striation, become pale, soft, easily lacerable, or tinged with the imbibed and altered hematin ; the vessels are ruptured, and the disintegrated blood-corpuscles give up their colouring matter to the abundant, free fat, the coherent globules of which occasionally present an orange- or even a reddish-brown colour. These kinds of pus, with an incomplete formation of cor- puscles, and a preponderance of serum, would appear to be more readily capable of absorption, and it is supposed that by the admission of this liquefied, degenerated pus, a poisoning of the blood may be brought about, which again, would induce the production of metastatic abscesses. That the pus is not transferred bodily from a depdt to any other organ is clear. A true absorption of the pus, says J. Vogel, can take place only when the corpuscular portion is dissolved and liquefied. It is evident, therefore, that the pus in the vessels cannot have reached them by a true absorption through closed walls. But if we were to suppose that the pus, as such, has been introduced into the interior of the vessel through a rupture in the walls, it is not clear, on the other hand, why pus should be noticed, col- lected only in so few places in the vessels ; there is nothing to contradict the supposition that, in these situations, the pus is formed from the stagnant blood itself, as in aneurismal sacs, in leuctemia we find a mass of white blood-corpuscles to be formed ; and this notion would accord with the fact that, in what is termed phlebitis, the collections of pus coincide with a TUBERCLE. 311 local stasis of the blood. The term phlebitis, however, is im- proper, since there is no indication whatever of an inflamma- tion of the venous coats. Mucus, as a pathological product, is to be regarded only as a modified form of pus, which appears, in this instance, to be mixed with a large quantity of mucin, and is usually associated with a destruction of the tissue of the mucous membrane. The exudation, however, from which are produced the pus-corpuscles on the surface of the mucous membrane, always infiltrates the parenchyma of the membrane as well, which is thence thickened. Kepeated catarrhal afi'ections lead to the atrophy of the mucous glands, and in the afl'ected portions of the membrane the secretion of these glands is rendered more scanty. The un- absorbed exudation also, remaining in the parenchyma, causes the well-known opacities and thickenings. If the suppurative process on the mucous membranes assume a degenerative cha- racter, superficial losses of substance ensue, well known as erosions, or shallow ulcers. in. TUBERCLE, In proceeding to the histological definition of tubercle, we must, in the first place, inquire whether it is to be regarded as an organized new-formation, or whether the elements occur- ring in it, are merely the remains of the original elementary structure of the affected tissue ? The histological researches of J. Vogel, Lebert, and several others, have placed it beyond doubt, that an organized new-for- mation constitutes the basis of the pathological structure which has been designated tubercle by the morbid anatomists of modern times. The morphological elements proper to tubercle, as such, and which should not be confounded with those of the tissue in which the tubercular deposit is seated, must first be viewed in serous membranes or in the brain, since, in ^ these situations, the almost unavoidable risk (as for instance, in the investiga- tion of pulmonary tubercle) is not incurred of regarding half- destroyed tissues as new products. It is requisite, also, in order to obtain a general idea of the subject, to institute a comparative analysis of tubercle, under its different conditions, 312 NEW-FORMATIONS. as regards colour, consistence, arid form. The elements are : 1. Molecules, some of immeasurable minuteness, which, when assembled in several superimposed layers, assume a brownish- yellow colour, and entirely conceal the other elements. These granules, according to J. Vogel, do not all behave in the same way towards reagents. The greater part of the minute, coloured granules remain unaltered in acids, alkalies, and ether. That author regards them as modified protein-compounds. Together with the delicate molecules, there is visible, especi- ally in the softer or yellowish-coloured tubercle, a considerable quantity of large, strongly refractive globules, which float on the surface of the water, and resembling free fat, are soluble in ether. A third kind of these granules are calcareous salts (phosphate and carbonate of lime), grouped occasionally into amorphous masses, and soluble in acetic acid, sometimes with effervescence. They are met with especially in tubercles in a state of involution. 2. Flocculent masses, which are not seen until the substance of the tubercle is carefully spread out; they are coagulated protein-bodies, and exist more especially in the more consistent forms of tubercle. Occasionally, also, concentrically laminated colloid bodies are seen. 3. Nuclei, imbedded in a hyaline matrix, with scattered molecules ; they are 0-0017 — 00039'" in diameter, and of a rounded or oval form, and usually contain, in their interior, together with some granules, a distinct nucleus. They resist the action of acetic acid. 4. Flattened, occasionally angular, granular corpuscles, as much as 0*0052"' in size, rarely with a distinct nucleus ; acetic acid renders them transparent. We not unfrequeutly find bodies perfectly isomorphous with these, in new-formations occurring in typhus, and regard them as an abortive form of cell-formation (primitive corpuscles). They have been described by Lebert, as tubercle-corpuscles, who even regarded them as of a specific nature. He adduces, especially, the circumstance that the so-termed tubercle-corpuscles, present no nucleus when acted upon by acetic acid, whilst such things, for in- stance, as pus-corpuscles, which might perhaps be confounded with them, exhibit the characteristic, often-described nuclei. In what light, moreover, we are to regard the specific nature TUBERCLE. 313 of these bodies, appears from what Lebert says, in another place { " tubercle, therefore, in the crude state, contains an element altogether peculiar to it, and by which it is distinguished from all other morbid products," and two pages further on, he says : " in numerous instances, we have ascertained the conjunction of cancerous and tubercular matter in the same morbid product." 5. Cells with distinct nuclei, and occasionally of an elongated form, constitute, when they are present, merely the peripheral layer. From the elementary constitution of tubercle, of which the above general outline has been given, it is obvious : 1. That the organized new-formation is usually limited to the production of nuclear bodies and aborted cells. 2. That tubercle contains no positive, characteristic, morpho- logical elements. Its microscopical diagnosis, therefore, must be made per exclusionem. If a pathological new-formation consist only of the above-described elements, contain no blood-vessels or -spaces in its interior, and have nowhere a fibrous matrix enclosing the cells, it is a purely tubercular new-formation. But where the above-described elements constitute only a portion of a new-formation — for instance, of a cancerous growth — whilst in another part completely-developed cells, in their various forms of degeneration, blood-vessels, and -spaces, and an areolar matrix-tissue, existed, we could view the structure merely as a cancerous growth, in one portion of which the organization was less complete than elsewhere, remaining, as it were, at the stage of tubercular formation. The origin of tubercle can be conceived to take place only in a blastema exuded from the adjoining capillaries. This blastema, effused in a fluid condition, infiltrates the tissue, and, advancing from one point, wiU spread uniformly in all directions; on this account, the most usual form assumed by it will be the spherical. The organized new-formation must, consequently, be deposited among the elements of the tissue, and the transition from the fluid condition into the solid will take place, partly in consequence of the organization, in part, directly, in the protein-substances and (earthy) salts. The organization is mostly limited, as has been explained above, to that of the nucleus, which is frequently surrounded 314 NEW-FORMATIONS. with a hyaline, often granular substance — the future cell- contents. A cell-membrane is more rarely formed. This is probably owing to the rapid solidification and disintegration of the protein-compound, since so much fine molecular matter and free fat is met with in tubercle. But the non-nucleated, flattened, granular bodies termed tubercle-corpuscles by Lebert, would seem to be formed in another mode. They have an investing membrane, preceding the formation of a nucleus, unless we should be disposed to assume that the nucleus has become aborted. 'ihe fatty degeneration of tubercle consists in the deposition of much free fat in the form of larger or smaller globules. The substance thence assumes a yellowish colour, and its consistence is gradually rendered softer. The organic elements, however, remain. Even in cases where the softened tubercular mass is liquefied, they may still be observed. From this it is obvious, that softened tubercle, as a new-formation, cannot be deemed to possess any solvent properties ; and that the solu- tion of the surrounding tissue is rather to be referred to the repeated exudations. This yellow tubercle has been regarded as a secondary form of the grey, a view which, in many cases, is undoubtedly correct, and wholly in accord with the fatty metamorphoses of normal and of new-formed structural elements ; but it is very probable that the remains of the protein-compounds, which have not been used in the formation of the organic elementary parts, may at once undergo fatty degeneration ; and, conse- quently, that it is not absolutely necessary that the yellow tubercle should have previously been of the grey kind; important analogies with this, will be found in cancer. Tubercle undergoes a favorable metamorphosis, when, its further development ceasing, it wastes by the withdrawal of the nutritive material. It becomes drier, the organic elements unrecognizable, and its consistence cartilaginous ; at the same time, calcareous salts are deposited among the mass constituted simply of an amorphous flocculent material. This kind of atrophy, according to Rokitansky, occurs in grey tubercle, whilst cretification is the metamorphosis peculiar to the yellow form. In this case, the calcareous salts are usually found in larger amount at the periphery, whilst in the centre a pul- TUBERCLE. 315 taceous, friable substance is collected^ enclosing much free fat, aggregated fat-globules, brownish-black pigment-masses and plates of cholesterin. Softening is an unfavorable metamorphosis of tubercle. This change proceeds either from the periphery, or from the centre, the difference being determined, probably, by special causal conditions. It can scarcely be doubted that tubercle, like every other new-formation, requires a certain amount of nutritive material for its further growth, or even for its maintenance, which is afforded by the surrounding blood- vessels. Now, if repeated exudations take place around the tubercle, and if the effused products are incapable of further development, but degenerate immediately after they have been secreted, a peripheral softening of the tubercle would neces- sarily ensue. On the other hand, in the case of a tubercle of considerable bulk — of the size of a lentil or pea, or more — it is easily conceivable that the nutritive matter afforded to it will no longer suffice for the maintenance of the whole tubercle in statu quo ; and the parts most distant from the periphery — the central, namely, — will undergo a retrograde metamorphosis, and become softened. When the softening has reached the highest degree, the tissue infiltrated with tubercular matter liquefies into a puriform fluid, termed " tubercular pus," but which differs, morphologically, from true pus, inasmuch as it does not contain corpuscles corre- sponding with those of perfectly developed pus, but, mostly, solitary molecules, masses of fat-globules; nuclei, and incomplete cell-formations. To which are superadded portions of the tissue killed by the infiltration, and which may occasionally be recognized in the fragments left of them. The process of disintegration set up in consequence of the softening, appears, as it were, to infect the surrounding tissue, for fresh tubercular infiltrations are always remarked in it, and the ulcer thence acquires its thickened or callous border. Of the special conditions presented by tubercle, we shall com- mence with those presented in the serous membranes, and adduce, more particularly, an instance of tubercles in the peritoneum. They were everywhere seated immediately beneath the serous coat, so that, in fact, the latter was elevated by them. In size, they varied from a little nodule just visible, to that of 316 NEW-FORMATIONS. a lentil : in the smaller, the colour was greyish, and in the larger, presented a yellowish tinge; their consistence was everywhere dense. Some of the larger ones were surrounded by radiating vessels, from which thicker and slenderer twigs (fig. 68, a, b b) proceeded towards the tubercular nodule, and Fig. 68. gave off oblique and transverse branches. Fine ramuscnles also passed across the surface of the tubercle. These vessels are not to be regarded as newly produced, but as belonging to the striped abdominal muscles, the organic muscular fibres of the intestine, and the connective tissue. The elements con- tained in the secondary product {d) were chiefly nuclei, the larger of which, of an oval form and presenting a nucleolus, were 0'044"' in their longer diameter ; the smaller, which were rounded, were, some of them, not more than 0'0017"' in size. Many isolated nuclei were seen to be surrounded by a group of molecules, which moved with the nucleus, and consequently were intimately connected with it. This investing substance was especially evident around the larger nuclei. It has already been stated, that the matter surrounding the nucleus might be regarded as a portion of contents in process of formation, around which the future investing membrane would appear to be formed. Non-nucleated corpuscles (Lebert's tubercle- corpuscles), and minute nucleated cells, existed only in very small quantity. Among these incompletely developed, organic TUBEECLE. 317 new-formations in the tubercle, numerous elementary granules of the most minute size were interspersed. In the more com- pact portions, flocculent streaked masses were evident (e), consisting of a coagulated protein-substance, and in but a few instances, concentric colloid-corpuscles (c) occasionally with a granular central mass. Towards the periphery of the tubercle, yellowish-brown collections of fat-globules (f) were visible, together with granules either isolated or collected into very small groups. Many tubercular granulations, of the size of millet-seeds, exhibited a slate-grey ring containing sometimes free, large, dark reddish-brown pigment-molecules, sometimes reddish- brown, irregular, flattened corpuscles (retrograde re- mains of blood). The coloured border might have been formed from blood either extravasated or which had undergone metamorphosis within the vessels, or from hematin which had transuded from them. That a sanguineous congestion of this kind, readily followed by minute extravasations, takes place during the rapid formation of tubercular granulations is also seen in other serous membranes. In fig. 69 is represented a portion of the phrenic pleura. The blood-vessels beneath the serous ^^^ gg investment are so congested that a close network of vari- ously convoluted branches is apparent. At a a, are seen two tubercular nodules, transparent by transmitted light, and of a greyish colour. Over these run several delicate vessels, which do not, however, penetrate into the interior of the tubercle. At b, is a somewhat larger nodule divided into two by a transverse extravasation of blood. The hemorrhagic effusions are of very various dimensions, and usually of an oval form ; at c, d, e, are seen extravasations of this kind, differing in size ; of which those marked e, are scarcely visible to the naked eye. The blood escapes into the subserous tissue, and consequently is covered by the delicate pleura, which prevents the entrance of the blood into the cavity, and by its resistance soon puts a 318 NEW-FORMATIONS. stop to the hemorrhage. Sanguineous suflfusions of greater extent, of course, take place, only when a larger vessel is rup- tured. The blood thus removed from circulation necessarily dies, and will thereupon pass through the various metamorphoses attending the formation of pigment, and may induce a blackish coloration of the partially enclosed tubercular nodule. Tubercles of smaller size, which, when of about the dimen- sions of a millet-seed, are usually termed miliary, may, also, best be examined in the serous membranes, with respect to their transparency. For besides those of the above-described, usually greyish, clouded kind, there are also hyaline tubercles con- taining a glutinous fluid, which might readily escape careless observation, since, as clear minute vesicles, they differ but little from the tissue in which they arC' lodged. A contrast to this transparent kind is afforded in the opaque tubercles, which are more obvious from their white or whitish-yellow colour. The hyaline tubercles are most probably of younger age, and occasionally contain more perfect cells, and often cells with several nuclei. Even when the tubercle is of minute size, it may, neverthe- less, be shown that it never originates as an interstitial growth. It can never be enucleated, as it were, but is always intimately connected with the surrounding structures, sometimes with the superjacent serous membrane, sometimes with the subserous tissue. If the serous membrane be raised, the tubercular granulations remain adherent to it, nor can any sharply-defined limits be remarked around them, which, however, would neces- sarily be the case had they been enclosed, for instance, in a capsular tunic. Their contours, on the contrary, are blended with the surrounding substance. To this may be added the circumstance that in tubercles of a little larger size (that of a pin's head) connective tissue may be observed included in them. If the portion of a serous membrane investing a tubercle of the more consistent sort be dissected off, and compared with the adjacent portions, the spot corresponding to the tubercle will be seen to present a brownish-yellow colour; and the fibrous structure will be, there, less easily demonstrable than elsewhere. Tubercles of the mucous membrane, as is well known, have TUBERCLE. 319 their principal seat in the lower part of the small intestine. In this situation, they are lodged, originally, in the submucous tissue, but elevate the mucous membrane stretched over them, as in the serous membranes, projecting, in the form of nodules of a yellowish colour, and usually assembled together into several groups. In most cases, owing to the production of new tubercular granulations between the older ones, a fusion of the new-formations appears, ultimately, to take place ; and these deposits, particularly in the intestine, exhibit a great prone- ness to degeneration. They are usually of soft consistence, and contain, besides the usual elementary constituents, an abun- dance of free fat. In the case of an individual affected with miliary tubercles in the lungs, and tubercular inflammation of the right knee, yellowish nodules, varying in size from a pin's head to that of a bean, existed in the lowermost part of the small intestine ; they were seated in the sub-mucous tissue, and, together with nuclei and imperfect cell-formations, con- tained elements strongly resembling those met with in fungus medullaris. They represented comparatively voluminous forms of various kinds, oval, with a longer or shorter process (caudate corpuscles, as they are termed), ventricose, fusiform cells, with short processes, others rather more slender, with long extended processes. All these elementary organs occurred in an ad- vanced state of fatty degeneration of their contents. We shall afterwards refer more particularly to the analogies between tubercle and cancer, deeming it best to pass over theii- conside- ration in this place, as the other term of comparison is wanting. The tubercles deposited in the submucous tissue of the intestine impede the circulation of the blood in the superjacent portions of the membrane, and gradually destroy its vitality in those situations, the destruction being accelerated by the soften- ing of the tubercular substance. The newly-formed elements of the latter are mixed with the fragmentai'y remains of the mucous membrane, and, owing to their loose attachments, are readily thrown off. The intestine in these situations is de- prived of its mucous membrane, and ulcerations are formed whose shape depends, simply, upon that of the precedent tuber- cular infiltration. In the case of a single tubercle, which, after softening, has been thrown off, together with the super- imposed mucous membrane, the result is a crateriform ulcer; 320 NEW-FORMATIONS. but when a number of contiguous tubercles are fasedj as it were, into one, the sloughing of the common mass, together with that of the corresponding portion of mucous membrane, produces an extensive ulceration, with irregularly excavated borders. The deposition of tubercular matter is continued at the margins of the ulcer, whence arises the thickened border, so characteristic of these lesions. The ulceration goes on by the continual softening of the infiltrated border, and frequently attains to a considerable size. The deposition of the tubercular new- formation, however, not unfrequently continues, also, on the floor of the ulcer, and in the same way as, when deposited in the submucous tissue it destroys the mucous membrane eentripetally or towards the axis of the intestine, so, in the present case, the deposition ultimately entails the destruction of the organic muscular layers, and, lastly, of the peritoneal coat, in a centrifugal direction. The floor of the tubercular ulceration in the intestine pre- sents merely organic detritus in the form of rounded, oval, or elongated nuclei (the latter belonging to the organic mus- cular fibres), molecular material of a dirty brownish-yellow colour and fibrils of connective tissue, which, however, are so concealed by the molecular matter as to be distinctly visible, only here and there at the edges. Besides these elements, numerous, amorphous, coloured matters occur, referrible to the necrosed blood, and which cause the slaty-grey coloration of the mucous membrane ; they are probably constituted, for the greater part, of minute extravasations, which occur in con- siderable abundance associated with the vascular congestion. The lungs, as is well known, are, not unfrequently, the seat of miliary tubercles, which are distributed in all parts of the substance of the organs. The question now arises, as to whether these deposits take place in the parenchyma itself of the lungs, or, to some extent, merely in the interstitial con- nective-tissue. It is not difficult to perceive that the ultimate pulmonary vesicles are also involved in the tubercular infiltra- tion, as was long since pointed out by Gluge. For if a granular tubercle of the kind in question be dissected out, and torn in pieces, by means of needles, the appearances depicted in fig. 70 will be presented. The fibres of the pulmonary tissue, readily recognizable by their characteristic curves (c), and TUBERCLE. 321 Fig. 70. which correspond to the peripheral borders of the air-cells, are everywhere visible in the adven- titious deposit, but are so concealed in its denser portions as not to be distinctly visible until the mass has been acted upon by an alkaline car- bonate. The elements enclosed in the air-cells, and completely filling them, are sometimes flattened corpuscles (a) in which a nucleus may occasionally be dis- tinguished. But more frequently when the cells are ruptured, nothing escapes from them, but rounded or oval nuclei {b) often surrounded with a circlet of minute molecules. These constituents, a, b, should not, perhaps, be regarded as wholly of new-formation, as it is ■well known, that the internal lining of the air-cells is consti- tuted of an epithelium, whose cells are like a in form, with nuclei not unlike b. Thus, although in the air-cells infil- trated with tubercular matter, the newly formed elements cannot be certainly distinguished from the disintegrated epi- thelium, still we think it would be wrong to conclude that the elements contained in miliary tubercles of the lung merely represent the disintegrated epithelium of the air-cells. In the case of tubercles in the serous membranes we are satisfied that new-formations exist {vid. fig. 68, d), similar to those found in the pulmonary cells ; a circumstance rather in favour of the assumption that the elements represented in fig. 70, a, b, should be regarded as, in part, at any rate, of new- formation. * In miliary tubercles of a yellowish colour, numerous fat- globules are seen in the fine-molecular, interstitial substance in which the new-formed elements are imbedded. When the consistence is, at the same time, diminished, the substance of the tubercle will be more readily compressed between two glasses, and the pulmonary fibres, although still distinctly re- cognizable as such, will be seen to have lost to some extent their peculiar arching curves. It is very usual, also, in these nodular deposits in the lungs, to find free, black pigment appertaining probably to the pulmonary tissue. For it is well known that a considerable amount of pigment exists in the interstitial tissue 21 322 NEW-FORMATIONS. Fig. 71. of the air-cells, in the physiological condition, which is sub- sequently enclosed in the tubercular infiltration, and appears in them as a colouring material. Miliary tubercles are also seen in the lungs, aggregated into considerable groups, and softening down into a yellowish, pulpy substance occupying the whole of a lobule, by whose limits it appears to be bounded, and exhibiting, even to the naked eye, numerous black points of pulmonary pigment. The consistence of these agglomerated tubercles is less than in the other form, and when they are wholly coalesced into one mass, it becomes soft and pultaceous. The pulmonary lobules, when infiltrated with tubercular matter, are distinctly perceptible on the surface, and in sec- tions of the lungs. The yellowish, soft substance of which they are composed, contains : 1. Elements (fig. 71, « «) analogous to those which we have noticed as existing in the solitary, miliary tubercles in the lungs (fig. 70, a, b). 2. Numerous brilliant fat-globules. 3. Remains of the conical, ciliated cells, by which the bron- chial twigs are lined. 4. Thick bundles of pulmonary fibrous tissue (fig. 71, b b). The latter are found in the expressed pul- taceous matter, usually in a state of com- plete disintegration ; and only occasionally presenting the aspect of elongated, puck- ered or arching fibres. In this case, con- sequently, mortification of the pulmonary tissue had taken place. When the tubercular new-formation is more extensive, and the softening involves several contiguous lobules, a cavern is pro- duced, containing portions of dead pulmonary parenchyma to- gether with broken up tubercular matter, and whose walls, on the other hand, consist of the pulmonary tissue infiltrated with tubercular deposit, and in a state of disintegration. The inner surface of the cavern is covered with a dirty- yellow, grey or greyish-red fluid of a syrupy consistence, and containing merely a granular matter, in which nuclear cor- puscles constitute the only organic remains. This fluid is frequently very viscous, and then presents an abundance of threads of mucin. a TUBERCLE. 323 When the organic detritus is not so completely disintegrated, detached pulmonary fibres maybe seen in the pultaceous contents of the cavern, and may be readily recognized by the peculiar way in which they are curved. These fragments should be looked for in the sputa of phthisical patients, and are of diagnostic impor- tance, as indicating a loss of substance of the pulmonary paren- chyma. According to Schroder van der Kolk, they are more likely to be met with in the sputa, in cases when small caverns exist in a state of progressive development, than where larger ones are present, in the advanced stage oi phthisis. Beneath this layer of thick fluid, lining the inner surface of the cavern, Lebert describes the frequent occurrence of false membranes, often in the form of mere flocculi, though usually of .more extensive layers of elastic consistence and yellowish colour, and composed of a striated substance containing numerous pus- corpuscles. These false membranes are rarely, closely ad- herent to the subjacent tissues, nor did Lebert ever notice them to be connected by means of newly formed vessels. The layer, exposed by the removal of the fluid secretion, and of the false membrane, has been termed the " pyogenic layer " by Lebert. It is of a reddish colour, with a velvety surface, having an intimate vascular connexion with the subjacent pulmonary tissue, and presenting an irregular fibrous structure. It fre- quently contains but few vessels, and in proportion to this paucity is the fibrous tissue closer, sometimes presenting almost a cartilaginous aspect. This newly organized membrane lines the caverns, frequently over a pretty considerable extent, and, in rare cases, quite up to the entrance of the bronchim, with whose mucous membrane it bears some resemblance. Its perfect organization, however, is usually prevented by the sub- sequent tubercular excrescences, and this circumstance is re- garded by Lebert as one reason why tubercular caverns so rarely close. He looks upon this membrane, which we regard as a superficial, newly formed connective tissue, as an attempt at healing, on one hand, by its protecting the ulcerated surface from the direct influence of the air, and, on the other, by its causing the cicatrization of the cavity. In proportion as the cicatrization advances the tissue of the immediately adjacent portion of the lung is also rendered denser, and in the atrophied condition assumes a callous consistence. The air-cells, in this situation 334 NEW-FORMATIONS. are, for the most part, no longer to be recognized, appearing to be replaced by flocculent masses mixed with fat, indistinct nuclear bodies, the remains of elastic fibres and pigment. Concentric colloid-corpuscles in small numbers are imbedded in the indurated and condensed portions of the lung. These parts, also, not unfrequently contain earthy concretions, which have been regarded as cretified tubercular masses; besides the amorphous calcareous salts partially soluble with effervescence in acetic acid, and with sulphuric acid forming crystals of sulphate of lime, these concretions contain much fat in the form of globules and broken cholesterin plates ; nuclear bodies imbedded in a brownish-yellow molecular substance, may also be recognized in them. It is well known, that the formation of aggregations of tubercles in the lungs is usually attended with a catarrhal affection of the bronchial mucous membrane, in which, and not in any caverns in the pulmonary parenchyma, is the true source of the sputa to be sought. Formerly, and before any precise morphological investigation of the subject had been undertaken, it was thought, that the abundant, liquid sputa in phthisis were derived from the softened, pulmonary substance and tubercular matter ; but microscopic examination will only rarely discover the presence of the pulmonary fibrous tissue, which may be deemed an indisputable evidence of the death of portions of the parenchyma of the lungs. Whilst, on the other hand, if the molecular material in the sputa be regarded as tubercular matter in the liquefied condition, the assumption will be irre- concilable with the circumstance, that the same abundant molecular material also occurs in simple bronchial catarrh, independently of tuberculosis. The principal constituent in the expectoration, in pulmonary tuberculosis, is formed by pus-corpuscles, which are suspended, in great numbers, in a partly hyaline, partly streaky matrix {mucin). The addition of acetic acid produces a remarkable degree of opacity in these sputa, due to the precipitation of the mucin in the form of straight filaments ; whilst the fine- molecular matter, occasionally forming denser masses, is un- altered by it. The amount of fat-globules is increased, especially in the dirty yellowish-green, fluid sputa in the last stage of phthisis. TUBERCLE. 325 These globules float on the surface when the sputa are mixed with water, and may also be seen forming aggregate masses. The same kind of globules, containing a finely granular, occasionally coloured matter, as occur in pneumonia, also exist in pulmonary tuberculosis {vid. fig. 66, the three non-nucleated, larger, granular globules). Blood-corpuscles, likewise, as is well known, are very frequently present in the sputa, and, unless aggregated into considerable, coherent masses, are scarcely of any particular pathological import, since they are also presented in simple catarrh. Hofle has lately, again, drawn attention to the circumstance, that solitary, yellowish-white, tolerably firm, oval masses aflfording a fetid smell when crushed between the fingers, are occasionally hawked up from the trachea and bronchim, by both healthy and diseased individuals, which have heretofore frequently been regarded as crude tubercles. Upon microscopic examination, he found a confirmation of Laennec's statement, that these masses were derived from the mucous follicles of the tonsils, 'since they were constituted for the most part of epithelium (indeed, from our own observation, of the large, flattened, epithelial cells of the oral mucous membrane), pus- corpuscles(?), oil-drops, and solid, amorphous fat. In hypertrophied tonsils, cretified bodies of the same kind are known to occur, not unfrequently, a circumstance also noticed by Hofle. Many of these tonsillary concretions have, doubtless, been regarded as sputa cretacea, since they are sometimes coughed up, and sometimes got rid of by hawking. Miliary tubercles in the subperitoneal tissue of the liver, present the appearance of numerous nodules slightly projecting above the smooth surface, the peritoneal investment remaining unaltered. They cannot be regarded as belonging to the peritoneum, since they exhibit a peculiar structure. For if they are examined with a lens of moderate power, a darker spot will be observed in the centre (fig. 72, a a a) sur- rounded by a light areola. The central dark part of the nodule is sometimes a mere point, but just perceptible with a magnifying power of 4 — 5 diam., and is sometimes repre- sented by a circular spot ; its outline corresponds with that of the tubercle : when the latter is elongated, so is that of the central spot, and, consequently, the longitudinal axis of the latter 326 NEW-FORMATIONS. coincides with that of the surrounding light areola. And when the outer circumference of the FiQ. 72. tubercle is indented, as it were, on each side, so that it assumes an hour-glass shape, the dark central part corresponds in form. It is, moreover, worthy of re- mark, that these miliary tuber- cles are seated in the vascular, red-brown, dark substance of the liver (c c), whilst the lighter- coloured, yellowish substance (6 h) occupies the interspaces, in the form of irregularly shaped islands. On more close examination, the following particulars are apparent. When the peritoneum, at a point corresponding to the situation of a tubercle, is removed by means of a cataract- needle, the little nodule may be raised, and is usually adherent to the peritoneum upon its removal; it consists simply of a molecular substance of a deep-yellow colour at the dark spot, corresponding to the centre of the tubercle (as if coloured by bile-pigment). The yellowish substance (c c) presents, both within and without the hepatic cells, of which it is made up, numerous fat-globules, from which is derived the pale, light- yellow colour, when the substance is viewed by reflected light ; and which globules are wanting in the reddish-brown portion. For further remarks on this subject, we must refer to the form of nutmeg-liver described under the head of " atrophy" of that organ. A question now arises, as to the nature of the dark spots observable in the centre of these tubercles. The deep-yellow coloration renders it, perhaps, most probable that bile-pigment is there accumulated. Whether the bile be accumulated in the simply dilated extremity of a biliary duct retaining its presumed walls, or whether it be left in the central portion of the tubercular infiltration after a rupture, of some kind, of the latter, we are the less able to determine, since the relations of the peripheral bile-ducts to the hepatic cells have not yet been made out. TUBEIU'I.E. 327 These subperitoneal tubercles i\lso occur iu the form of hyaliuo, circuiuscribed vesicles, about the size of a piu's-hend, iviul scnrccly projecting above the surl'nce ; which, as they become opaque from the eeutrc outwards, assume a firmer consistence, and arc more prominent. Tubercles imbedded in the midst of llic hepatic parenchynui arc more rare. In tho case of an old woman who had tuber- cular caverns iu the lungs, isolated nodules, varying in size from that of a lentil to that of a pea, were found in the liver ; they presented a eousistent, light-yellow coat, and j!;rass-green, soft, semifluid contents. The organic constituents of the latter appeared to be rounded mtclvi containing a few molecules, and oeeasioually beset, probably externally, with fiit-globules ; they underwent no chanfjc in acetic acid, and, in form and siz-e, corrcspoiided in all respects with the ninlt'i of the hepatic cells. To!j;ether with these bodies, the proper, main clement of the softened substance was, simply, molecules, amongst which, deep-yellow bile-pigment was deposited in amorphous masses. In nodules recently dissected out, the remains of deeply-coloured hepatic cells, in a still better state of preserva- tion were found in the central, softened substance; so that there could bo no doubt that the substjiucc in question repre- sented an organic (h'tntii.t of the hepatic parenchyma. The compact, almost cartilaginous case of the uodulcs presented a ItU'go amount of young clenunUs of eelluhu" tissue with con- nect ive-tissue-librils, as it secmeil. towiu'ds the periphery, whilst, more ii\ternally, a flocculeut suhsl^iucc with scattered fat-globules of large si/.e was preseutcd. The consistent, miliary tubercles do not present the yellow central substance, but, moi'phologically, resemble the others. From tubercles of the liver, Ivokitansky distinguishes cei'tain cavities, usually of the size of a millet-seed to that of a pea, which frequently occur isolated, and ai'e filled with a viscous, mucilaginous, or gelatiuiform fluid, mostly of a dirty-green colour, often presenting several sccoudoiy sinuosities, and, after the evacuation of the fluid, exhibiting a smooth wall. These cavities occur sometimes together with tubercles in the liver, sometimes independently of them, especially iu tatty livers, associated with the deposition of tubercles in other oi^ns. Tho above-named author res:;ards them as dilatations of the 328 NEW-FORMATIONS. Fig. 73. capillary, biliary vessels, their walls being flaccid, and since they do not present the secondary tubercular deposits which elsewhere accompany the softening of tubercular masses. We have only a solitary case of this kind recorded, and observed in the thick fluid material merely a molecular substance with larger and smaller granular masses, isolated fat-globules, and orange-yellow plaques. Consequently, the rounded nuclei of the hepatic cells were wanting, which would have indicated a disintegration of the parenchyma of the liver. Miliary tubercles, when apparent on the surface of the kidneys, are attended with a hypersemic condition of the cortical substance ; the stelliform venous ramifications, and capillary plexus surrounding the tubercular granulations, are especially well seen. In fig. 73, d, is shown the point of union of several peripheral, venous ramuscules, running in the grooves on the surface of the gland. These veins arise from a capillary plexus, surrounding the superficial tubuli uriniferi ; in which plexus, as at o, b, c, grey, rather prominent tuber- cles may be seen. The congested capillaries, however, appear to have pale interspaces left among them ff,fj, not only around the tubercles, but in other spots also. Besides these, may be perceived transparent, yellowish-red, glistening points, about the size of the little circles marked e in the figure ; these points are distributed in regular order, and represent the glomeruli Malpighiani. Hypersemiated kidneys of this kind always appear granular on the surface, frequently without exhibiting any other metamorphosis of the parenchyma. The granular condition in this case depends simply upon the contiguous groups of tubuli uriniferi partially surrounded by vascular zones, and which are more promi- nent than usual, owing to the general turgescence of the organ. These miliary tubercles also occur more deeply seated, TUBERCLE. 329 especially in the cortical substance, and contain, besides a predominant molecular, flocculent material with scattered bril- liant molecules, nuclear bodies belonging to newly-formed (?) oval cells, sometimes of comparatively large size, sometimes of smaller dimensions. The aggregated tubercles of the kidney undergo softening, in consequence of which a considerable portion of the renal parenchyma is destroyed, nothing remaining, ultimately, but a cavity, whose walls are infiltrated with tubercular matter. Tubercular deposit in the brain is characterised by its dirty light-yellow, sometimes greenish colour, the dense, sometimes friable texture, and its unequal consistence. Amongst organic elements are nuclei, sometimes rounded, sometimes more angular, which occur, in very great abundance, imbedded in a fine-molecular substance. Besides these, especially towards the periphery of the tubercle, and in its immediate neighbour- hood, we find oval, or conical, finely granular corpuscles, some- times having a diameter of 0'007"' ; and in the interior of many of which an excentric nucleus may be perceived. The softer, central substance of cerebral tubercles presents dirty yellowish-brown, reddish-brown, and black pigment-masses, granule- masses, and fat-globules. We have several times had an opportunity of examining tubercle in bone, and especially in an interesting case, in which an extensive tubercular mass, external to the dura mater, and manifestly arising from the bone, enclosed several particles resembling grains of sand, which proved to be osseous fragments ; a proof that in this situation also, the tubercular new-formation takes place in the parenchyma of the bone, and induces a secondary detachment of the necrosed portions of osseous tissue. Having thus described some of the special relations of tubercle, we shall proceed to some general considerations with respect to its nature and pathological import. Virchow has propounded a general definition of tubercle, under which term he understands a metamorphosis of the tissue, produced by a destruction of the cells, whether the tissue be old or, as it is termed, physiological, or pathological and of new-formation. The tubercular metamorphosis, according to him, consists in an arrest of nutrition, in a mortification or 330 NEW-FORMATIONS. necrosis. In his view, therefore, tuberculization, is, in other words, an atrophy (involution) of the original or of a newly- formed pathological tissue. We think it improper to extend the definition of tubercular formation so as to include simple, genuine atrophies, as by so doing we needlessly place ourselves in opposition to the meaning entertained by other authors, who, under the term " tubercle," always understand a new-formation presenting special charac- ters, in its anatomical relations, in the mode of its origin, and in its course. We also look upon it as indispensable, to have regard to the genetic impulse, inasmuch as, whilst, in simple atrophy, the organ undergoes a change of form in consequence of want of nutriment, in the tubercular formation, a deficiency of formative capacity in a newly-formed blastema exists ; the organ, consequently, as such, does not enter into consideration at all. Simple atrophy, lastly, in each organ, occurs under particular modifications; if we compare, for instance, the atrophy of bone with that of the liver, the process in the two cases will be found to exhibit variations, such as do not occur in tubercle in different organs, as, for instance, in the brain, lungs, liver, and kidneys ; in all these situations the same fun- damental character of form remaining. The extension of the idea of tuberculization to various new- formations, such as pus, cancer, sarcoma, &c., as proposed by Virchow, appears to us to be the less allowable, since pus, cancer, sarcoma, &c. differ from tubercle in the aggregate of their morphological characters, but especially in their evolution and course. The application of the definition of tuberculiza- tion to the various forms of involution of pus, cancer, and sarcoma, manifestly leads to the idea that these new-formations become tubercles, a notion, however, which is certainly opposed to their whole character. Having thus, and for the above reasons, shown, that we adhere to the original notion of tubercle, and at once disclaim for it any positive, characteristic, elementary forms, it is incum- bent upon us to assign thecharaclersot tubercle in general terms. These are as follows : 1. A low degree of organization of the new-formation; it being limited chiefly to the formation of nuclei, and of incom- plete cells. The more fully developed cell-formations occa- TUBERCLE. 331 sionally met with in tubercle, are, relatively speaking, scanty in number, and deposited towards the periphery of the new- formation ; and they may also, as is mostly the case, be altogether wanting, the formation still retaining the tubercular character j they are not, consequently, an essential constituent. To employ the term "tubercle-corpuscles,'' as proposed by Virchow, for the shrunken nuclei is, in our opinion, unadvisable, since, as he himself says, there is no special characteristic element of tubercle, and yet such would be implied under the proposed term. 2. The continued development of the tubercle from a paren- chymatous infiltration, in consequence of which the included tissue is destroyed. In the present state of knowledge, we are not justified in assuming any specific exudation in the tubercular formation ; but must confine ourselves solely to the products arising from the exudation. These, at once show, that the tuberculization does not take place at all in the inter- stitial connective tissue of an organ, but in its parenchymatous portion. That an exudative process precedes the tubercle, is seen in those hyaline, gelatiniform, tubercular granulations, which are more especially evident in serous membranes, but which cannot be described as a simple mortification, or necrosis of the tissue. We agree, therefore, with Rokitansky, and, in his fundamental view, with B. Reinhardt, who regard tuber- cular deposits as products of inflammation, though dissenting from the latter in considering tubercle to be disintegrated pus. 3. Spontaneous disintegration, in which the tissues, involved in the parenchymatous infiltration, as well as the newly formed organic elements, are subjected to a process of solution. With respect to which it should be remarked, that the exudation may perish at once, or ab initio, before it has attained to the character of a new-formation. In an instance of this kind, therefore, in accordance with our definition of tubercle, the disintegrated exudation cannot be described as tubercular, but we are compelled to conclude, solely from the presence of contiguous, fully developed forms, that we have before us an undeveloped tubercle. 4. A peripheral (^secondary) formation of tubercular sub. stance is found to take place universally, where the deposit is 332 NEW-FORMATIONS undergoing the process of softening. Tubercle, therefore, whilst wasting on one side, waxes on the other. The malignancy of tubercle resides in the characters de- scribed under 2, 3, 4, since, by these properties of the deposit, a direct, widely-spreading destruction of the affected organ is brought about. IV. NEW-FOEMATIONS IN THE TYPHOID DEPOSIT. We associate these new-formations with tubercle, which they resemble in their degree of development ; and will com- mence at once with the histological analysis of the greyish- red, succulent, soft masses which are deposited in well-marked cases of typhus ; and which occur sometimes in the Peyerian patches between the mucous membrane and the muscular coat, sometimes in the latter, and in the subserous tissue of the small intestine, as well as in the mesenteric glands. This substance, which, to use Rokitansky's expression, presents the most striking resemblance to encephaloid growths, was pro- cured, in the instance here described, from isolated tumours, varying in size from that of a lentil to a hazel-nut, in the mucous membrane of the lowermost portion of the ileum. These little tumours, when divided, presented a faint, rose-red colour, were lodged in the submucous tissue, and on pressure afforded a milky, turbid juice, in which the new-formed ele- ments were suspended. The cells mostly presented an oval form, many being more or less angular ; they contained, sometimes only a single, excentric nucleus (fig. 74, a), of an elliptical or rounded shape, with a nucle- olus, occasionally very distinct; some- times, in the larger cells, two, three, or four nuclei were visible (fig. 74, b b), whose unequal sizes, and usually excentric position were remarkable. The contents of the cells were mostly finely granular, and occasionally fat-globules were ap- parent in them, as at c, which may even occur in such numbers as to con- ceal the nucleus, and occupy the entire cell. The diameter of the cells varied between 0*00354 Fig. 74. IN THE TYPHOID DEPOSIT. 333 — 0-1062'", and that of the nuclei between 0-00132 — 0-0035'". Besides these predominant^ elliptical forms, fusi- form cells {d) were also visible, containing a comparatively large, oval nucleus, with a well-marked nucleolus. That the latter elements were of new-formation, and did not belong, in any way, to the organic muscular fibres, is evident from their outline, but especially from the large, elliptical nucleus. The intermediate forms, between the elliptical and fusiform cells, and the latter themselves, existed in trifling numbers. These morphological elements, however, are not, commonly, so well marked. The most usual constituent found in the typhoid deposits, besides nuclear bodies, are only the flattened tri- or quadrangular, granular forms, unafi'ected by acetic acid, which have been described by Lebert as specific tubercle-cor- puscles. We remember a case in which they existed in great quantity in the copious, typhoid infiltration from the small intestine of a Horse. The organic new-formation ceases to be recognizable in the coating which is adherent to the surface of typhoid ulcera- tions of the intestine, as is shown at a, in fig. 75. It contains nuclei of various sizes, and a few ellipti- cal, nucleated cells imbedded in a finely molecular material, with floating fat-globules. These organic elements may in this situa- tion represent the remains of epithelium, and of the Lieberkiihnian glands. The other elementary organs represented in fig. 75, were afforded by a typhous, mesenteric gland infiltrated with a soft, succulent matter, partly of a greyish-red, partly of a yellowish colour ; it contained rounded, or polygonal cells, with one, two, three, or more nuclei j and the ceU-contents, in many of them, were in a state of fatty degeneration, in fact, so much so that the nuclei were perceptible only as lighter-coloured spots. In those cells in which the fatty degeneration was still more advanced, the cell-membrane was destroyed, the coherent fat-granules constituting the outer border. These cells, therefore, resembled a granule-mass, with one or several, light-coloured spots corresponding to the nuclei. That the elementary organs here represented in the 334 NEW-FORMATIONS mesenteric gland, thus infiltrated with typhoid deposit, were of new-formation, is evident from the examination of those glands in the normal state, in which similar elements are wanting. With respect to this, however, we must, in addi- tion, remark, that an organic new-formation of this kind is only to be sought in well-marked cases in which the typhoid deposit presents the characters above described. The organization of the exudation, which is deposited in typhus in the submucous tissue, and in the Peyerian and mesenteric glands, is limited, as it would seem, in many cases, simply to the formation of nuclei. We have several times had occasion to observe, in the abundant typhous infiltrations in the mucous membrane of the stomach and duodenum in the Horse, a considerable accumulation of rounded and angular nuclei, disseminated in a fine-molecular material, which latter could not be referred merely to mortified normal tissue. In other cases, the exudation in typhus undergoes no or- ganization at all, nothing being presented but a viscid fluid having a bloody tinge, containing, of solidified protein-sub- stances, merely a fine-molecular matter, and occasionally groups of very minute, orange-coloured hematoidin-crystals, visible only by strong magnifying powers ; together with necrosedi red blood-corpuscles, which no longer yield their colouring matter to water. The thin fluid exudation, thrown out in typhus on the sur- face of the intestinal mucous membrane, causes the epithelium to be detached, but undergoes no further organization. The blood- less villi, deprived of their epithelium, frequently shrink con- siderably, so as to present the aspect, simply, of slender, sharp- pointed processes, with granular contents; but should they, in other situations, retain their normal form, a dark, brownish- yellow molecular material, with scattered granule-masses, will be noticed, especially at the apices of the villi, as we have already remarked in speaking of the process of exudation {vid. fig. 49, c). In reviewing the newly formed organic elements in typhus, as little of a characteristic and specific nature will be observed in them, as in tubercle. The organized, typhous exudation cannot, in many cases, be distinguished from tubercular matter, whilst, in other instances, it bears a decided resemblance OF CELLULAR (CONNECTIVE) TISSUE. 335 to medullary cancer. The pathological import which these more perfectly developed cell-formations bear with respect to any determinate form ot typhus, cannot at present be assigned ; but in any case the multi-nucleated cells indicate a rapid multiplica- tion and active production of organic elements, in the same way as the fatty degeneration is indicative of a rapid involution or destruction of the organized material, which, in the mucous membrane, is productive of a partial necrosis of the tissue. In consequence of this, the portions of mucous membrane cor- responding to the infiltration are thrown oflF, and ulcerations established differing from those of tubercular origin in the circumstance, that unlike the latter, they are not attended with a secondary infiltration in the parts surrounding the ulcer j whence again, the borders of the latter appear smooth and even. V. NEW-PORMATIONS OF CELLTJLAB (CONNECTIVIl) TISSUE. The wide distribution of cellular (connective) tissue in the organism may be regarded as a reason why new-formations of a similar nature are met with so frequently and- in such a variety of organs. The character of these formations depends upon the following principal types : 1. The formation of embryonic connective-tissue-elements, for the determination of whose true nature it is necessary to have a continuous series, since, owing to the possible confusion of the isolated, elementary constituents of the cellular (connective) tissue with other elementary organs, the diagnosis of them is never possible, with any degree of certainty, from a single cell. The two principal forms of immatm-e connective tissue are the rounded and the fusiform, between which very numerous inter- mediate and derivative forms exist. The rounded, as well as the fusiform, connective-tissue cell is furnished with a mem- brane usually enclosing a fine-molecular matter, and presenting in its interior one or two nuclei. The latter, of a round, oval, or ellipsoidal shape, contain one and sometimes two nucleoli. The intermediate forms between the rounded and the fusiform arise in the equal or unequal elongation of one axis at the expense of the other ; it is in this way that are produced the 336 NEW-FORMATIONS oval, ellipsoid, singly or doubly caudate cells. From the fusi- form cells, (fusiform corpuscles, fibre- cells,) derivative forms arise with three, four, or more processes, whence, ultimately, the stellate cells are produced. The elementary organs of the embryonic connective tissue originate in a hyahne blastema in the form of scattered corpuscles, though appearing to be aggre- gated together when the cells have become multiplied by spontaneous division. The fusiform cells arrange themselves together in the direction of their longitudinal axis and surround those of a spherical form. 2. The formation of connective-tissue bundles, characterised, as has been already stated in the General Part, by the wavy course of the fasciculate fibres. Isolated filaments torn from their natural relations and connexions cannot, of course, be recognized as fibres of connective tissue, since they are in all respects isomorphous with those of coagulated fibrin ; attention must therefore always be directed to their fasciculate aggrega- tion. Another distinctive character resides in their behaviour towards acetic acid. We have already mentioned the mode of formation of the bundles of connective tissue from fusiform cells, in accordance with Schwann's theory, and the persistence of the nuclei as imbedded corpuscles. Now the latter may be demonstrated by the action of acetic acid, although they are not tq^ be regarded as a constant and prominent phenomenon, appearing to be more distinctly manifested in proportion to the immaturity of the fibrous connective-tissue. Now since the con- nective-tissue-bundles arise from the fusiform cells, they will surround the spherical and other intermediate forms of cells, although never enveloping them like a closed capsule. In this way are produced the intercommunicating areola whose form and size, in new-formations of connective tissue of complex structure, exhibit great diversities. 3. When the connective tissue is developed de novo on a free surface and therefore towards a cavity, whether the latter be one of the large visceral cavities or a simple areola in the tissue, it frequently assumes the form of a papillary projection, and of a dendritic growth arising therefrom. In serous membranes, as, for instance, on the peritoneum, new-formations of connective tissue of this sort are apparent, even to the naked eye, in the form of arborescent, subdividing bands, or as scarcely OF CELLULAR (CONNECTIVE) TISSUE. 337 visiblej sessile nodosities. More delicate ramifications and clavate elevations may be perceived with the aid of a powerful lens, exactly like those discovered by Rokitansky in the so- termed false membranes, a subject tipon which we cannot, here, enter further. The papillary new-formation, with dendritic branching of the bands of connective tissue, is not unlike the arborescent crystallization sometimes seen on the sides of vessels. The more particular anatomical description will be given in speaking of the special organs, this much only, being here observed, that these structures are very often, hollow, and contain a fluid, blastemic material, from which imma- ture, connective-tissue-elements are produced. We shall afterwards, however, see that other elementary parts, such as fat-cells, cartilage-cells, or even osseous corpuscles, are produced in the plasma contained in the cavities ; a diversity which in most cases depends upon the character of the fundamental tissue serving as a point of attachment to the dendritic vegetation. In new-growths of cellular tissue, moreover, newly formed blood is not unfrequently met with in these spaces, pre- senting the appearance of blood-red streaks within the bands of connective tissue. When a new-formation of this kind consists of an aggregation of papillary growths fiUed with blood, we have the form known under the name of telean- giectasis. The blastema contained in the saccular cavities frequently undergoes various kinds of degeneration, before becoming organized. Of these may be noticed, especially, an accumula- tion of fatty molecules, of a dark brownish-yellow, brownish- red, or black pigment, or of a serous fluid in the dilated ex- tremities of the hollows. In the latter case, consequently, is produced a pedunculated cyst. It is a fact, also, that in many cases, deposits of amorphous, calcareous salts take place in the cavity. The starting point of the new-formations of connective tissue in general, appears to be, chiefly, in the connective tissue of the organs. In many cases, however, it is indubitable, that the growth may commence independently, in a secreted blas- tema. The mode of extension may be described as twofold. 23 338 NEW-FORMATIONS 1. A concrete, in which the new-formation is limited to separate points, and consequently assumes the form of nodules or granu- lations. These granulations are, not unfrequently, assembled into groups, forming mulberry-like vegetations j the individual groups, also, are often separated by deepish grooves, whence a vegetation of this kind is divided into lobes, and to a certain extent acquires a cauliflower aspect. When more volumi- nous, and retaining their smooth surface, the granulations and little nodules become tubera, such as are seen in fibroid tumours of the uterus. It is at once obvious, that the papillary form, with its dendritic branching, belongs to the concrete class. 2. A diffuse kind of new-formation of connective tissue is observed when it extends throughout an entire organ. Ex- amples of this are seen in granular liver, and in atrophied kidneys after Bright's disease. In the former case the in- terstitial connective tissue — the so-termed capsule of Glisson - — is hypertrophied ; and in the latter also, an increase of the connective-tissne-s^rowia may be observed. The concrete and diffuse kinds of formation may coexist in one and the same organ; thus nodular new-formations occur in the liver of syphilitic persons ; and in like manner they are found in the cysts of the kidney. Should the new-formations continue to grow, they will re- quire, like all the normal tissues, a constant supply of nutritive fluid, but as this cannot reach beyond a certain distance, a new- formation of vessels with be requisite, for the nutrition and further development of the new-growth. In this way a col- lateral circulation of the blood is established, and the forma- tion of connective tissue will follow an independent direction in the multiplication of its elements. Under these circumstances, the nutrition is often inter- fered with, sometimes because the supply of nutritive fluid is irregular, and, sometimes owing to a disproportion between the growth and the nutrition. For more may be pro- duced than can be maintained, and certain portions of the new-formation will be deprived of nutriment — that is, will become atrophied, when they will undergo the same morpho- logical changes as accompany atrophies in general. Thus we have serous degenerations, accumulations of fat in a state of OF CELLULAR (CONNECTIVE) TISSUE. 339 minute subdivision, pigment, calcareous salts, and wasting of the organized substance. The new-formation of connective tissue is not subject, or only in a minor degree, to spontaneous involution, its atrophy being brought about by external circumstances affecting its nutrition. No central softening takes place in it, nor any spontaneous disintegration of the elementary organs, as we have seen to be the case in tubercular matter, and shall show to exist, even in a more marked degree, in cancer. This pecu- liarity, of not being liable to spontaneous softening, is the reason of the so-termed benignancy of tumours composed of connective tissue. When they suppurate or soften some local conditions will be found to account for it. Thus, if an exten- sive new-growth of connective tissue take place in the sub- cutaneous tissue, the superjacent corium becomes thinned, atrophied, and ultimately broken through by the new- formation. If the new-growth is attended with the formation of pus, a bare suppurating surface will be presented, but this should not be regarded as indicative of its softening. As regards the growth of new-formations of this kind we must especially consider their relations towards the organs in which they lie, or which are within their influence. These organs never present any parenchymatous infiltration, by which a disintegration of the cells of the parenchyma might be pro- duced, but the growth always appears, as it were, to be interpo- lated among the parenchymatous particles of an organ, whence a partial shrinking, and consequent wasting of the latter are induced. In proportion to the extent of the new-growth is the destruction of the parenchyma of an organ, brought about, as it were, by the constriction, and the cutting off of the supply of nutritive fluid. The new-formation, therefore, is the more dangerous the more influential is the organ affected. It is thence apparent, that little can be said as to the benignancy of these growths. If we consider the case of granular liver already referred to, we surely cannot call a new-formation of that kind " benignant ;" again, the hideous destruction which follows the ravages of lupus, an affection consisting in a new-formation of connective tissue in the corium, followed by a secondary suppuration, will hardly allow us to term such a disease benignant. But the concrete new- 340 NEW-FORMATIONS growths of connective tissue may also, by their extension in certain situations, prove dangerous to the organism, as may be seen in those which take place in the submucous tissue of the larynx or of the urethra. The new-formations usually participate, both in their out- ward form, as well as in their internal structure, with those of the basis from which they spring. Thus we find a papillary growth of connective tissue in the condylomata of the skin or mucous membrane, in cutaneous warts j and in the coloured papillary nmvi, the new-formation of vessels also shares the character of the vascular disposition in the part. Elastic fila- ments, which are a very frequent accompaniment of new- formations of connective tissue, occur in trifling number, and of delicate structure, or are wholly wanting in growths, the tissue of whose basis contains very delicate or very scanty elastic elements, or which may be wholly without any. Thus, in fibroid tumours of the uterus, we find a very close network of connective-tissue-bundles, whilst, like the substance of the uterus, they contain no elastic tissue. Exceptions to this rule, however, occur, and, in new-growths, elements may be seen which are foreign to the basis whence they spring. We need only refer to fibrous tumours which are subject to a true ossification ■ in their interior, whilst in the parent-tissue there is no vestige of an osseous basis. The consistence of these new-growths depends upon their structure and degree of development, conjointly. The greater the preponderance of cells, so much the softer are they, the consistence increasing in proportion to the development of the fibrous element. If the growth be merely of a gelatinous con- sistence, it will be found to be in the first stage of development, and to be characterised by its containing mudn, which is ren- dered apparent by the opacity produced on the addition of acetic acid, and by the appearance under the microscope of the straight filaments so often mentioned already. It is also well known, that young connective-tissue-formations, or rather such as have remained at a low stage of development, do not, like those more perfectly developed, afford the reaction oi gelatin. But the consistence of the pathological new-formed connec- tive tissue, should not be taken as a ground for the general con- clusion that the new-growths in which the formation of cells OF CELLULAR (CONNECTIVE) TISSUE. 841 predominates^ are always of later date than those in which the fibrous frame-work is the principal constituent. Instances occur, to show that soft connective-tissue-tumours, with a predominant cell-formation, retain that character for a long time, never assuming a more consistent, fibrous structure. On the other hand, fibrous forms are often seen, which are deve- loped and grow in a comparatively short time. A growth of connective tissue having attained to a certain degree of deve- lopment, may remain stationary, and undergo no further change. An example of this may be seen in those desmoid tumours which persist for years together without any altera- tion in their external aspect, or in their size. In such cases, it may be supposed, that nutritive material is afforded in exactly the proportion required for the maintenance of the tumour in statu quo, as is the case in normal nutrition. We shall now proceed to the consideration of the special relations of new-formations of connective tissue in the various organs, commencing with the simple forms, and concluding with the more complex. First, however, giving figures illus- trative of some of the formations. The embryonic forms of pathologically developed connective tissue, may be readily studied in the gelatiniform exudations of the mucous, serous, or fibrous membranes, requiring for their display, merely the snipping off with a pair of scissors of a portion of the exudation, since they lie in a transparent, structureless stroma. The gek ions, viscous coating (vitre- ous mucus), so frequently found in the neck of the «<«•«*, generally contains a large quantity of, usually very variously shaped, elementary structures. In many places, pus- corpuscles are deposited in groups together (fig. 76, b, c), in which, upon the addition of acetic acid, the multifid nuclei are manifest ; whilst other smaller coi'pusdes (a) remain unchanged, presenting the aspect of nuclear structures. But there are also, scattered granular globules, having a diameter of from 00132 ' _,-^.s^: 343 NEW-FORMATIONS — O-0177'", which undergo no change. These are the same corpuscles which are represented in fig. 66, as occurring in sputa treated with acetic acid. Occasionally, also, may be noticed, the very delicate, transparent elements, already de- scribed in the General Part, in reference to the theory of the evolution of pathological new-formed cells, and which become flattened in consequence of their mutual apposition, and assume a polygonal outline. They constitute entire chains, or are aggregated into groups. Their average diameter is from 0053 — 0"066"'. In some a nucleus is visible, not surrounded by any granular appearance. Besides these elements, elon- gated cells may be remarked, which, when of a conical form, may represent the remains of the columnar epithelium, but when attenuated on both sides, terminating in a filamentary appendage, and sometimes presenting in the enlarged central portion, an oval nucleus with a nucleolus, are equivalent to the fusiform cells of connective tissue. Even without the addition of acetic acid, delicate, microscopic, usually rectilinear filaments {d, punctate streaks) will be found in the tenacious coating taken from the cervix uteri. The filaments in question are occa- sionally not unlike a plicated membrane, and represent precipi- tated mucin. These constituent elements are frequently, for the greater part, in a state of fatty degeneration of the cell- contents, or acquire from the colouring matter of the blastema, a yellowish, or yellowish-brown hue. The embryonic forms of connective tissue are also met with in the gelatinous exudation on the nasal mucous membrane in cases of lupus. We have frequently had occasion to notice very well marked formations of immature connective tissue on the concave surface of the placenta in cases of abortion, in the latter months of pregnancy. In these instances, after the removal of the chorion, especially at the point of insertion of the umbilical cord, a pultaceous, yellowish substance removable with the scissors, in a thin stratum, and about 0'44"' thick, comes into view, which is continued towards the border of the pla- centa, gradually diminishing in thickness. In this exudation will be found, scattered elementary organs, which may be arranged in two categories : 1. The rounded, of various dimen- sions, with a vesicular, light-coloured nucleus, and usually yellow, finely granular, or, occasionally, fatty contents (fig. 77, OF CELLULAR (CONNECTIVE) TISSUE. 343 the spherical corpuscles). 3. The obhng, or fibre-cells, which present great diversities of , form. Their body, or thicker central portion, is of various dimensions, and, in general, it may be said, that the more voluminous it is, the shorter are the processes given off ! from it; and the longer these become the more at- tenuated does the body of the corpuscle appear to be rendered. In its broadest part, an oval nucleus is often apparent, which in our speci- mens was quite clear and transparent, without any trace of a nucleolus, and lay with its longer diameter in the longitudinal axis of the fusiform cells. The cor- puscle presents different forms, according as it is furnished with 2, 3, or 4 processes. The processes diminish gradually in thickness, from their insertion towards the extremity, although this is not constant, for fusiform enlargements may be noticed in the longer processes. They frequently divide also into two branches, and these again into two twigs. When three processes are given off from the corpuscle, the latter assumes a triangular shape, a whip-like appendage being placed at each angle, and should a fourth be super- added, the corpuscle becomes, as it were, drawn out into four points. The four processes, in this case, are either diametri- cally opposite, so that a stellate figure is produced, or the two secondary processes are parallel to each other, so that there are two superior and two inferior processes running in the same direction. As the processes multiply, the nucleus divides, and, ultimately, in the body of the cells furnished with four pro- cesses (quadripolar cells), two nuclei may, not unfrequently, be seen. The duplication of the nucleus may, moreover, be noticed even prior to the formation of a third or fourth process. 344 NEIW-FORMATIONS OF CONNECTIVE TISSUE These observations with respect to the fusiform cells and their transition into those with three or four processes (tripolar, quadripolar), in which a division of the nucleus may be ob- servedj clearly indicates a spontaneous multiplication in this kind of cell. It is not necessary, therefore, that they should always have proceeded from the spherical elements of connective tissue, by the formation of two diametrically opposite processes. These young elementary bodies lie scattered without any definite order, as is shown in fig. 77. It is only after repeated multiplication of the fusiform cells that entire layers are constituted of them; among which are seen, rounded, or elliptical cells with a distinct nucleus. In fig. 78 is shown an j.jg yg entire layer of fusiform cells of this kind, and, among them, rounded isolated cells with nuclei of various sizes. This specimen of connective tissue in a state of develop- ment was also taken from the concave surface of the placenta of a dead foetus in the last month of pregnancy, and repre- sents a further stage of development. In order to avoid the very possible confusion of the conjoined, fusiform cells with organic muscular fibres, the addition of acetic acid is sufficient, by which the respective nuclei are rendered more apparent; those of the former being oval, whilst in the latter tissue, they appear very much elongated, and truncated at each end. The comparison of the mode of evolution of this pathological, new-formed connective tissue with that which is presented in the stiU gelatinous connective tissue of the embryo, will show no essential difference. The only distinction resides : 1. In a difference in the size of the elements, which, in the newly formed connective tissue, is more considerable. 2. In a greater multiplicity of form, — the circumstance of the deformed cells remaining at a determinate stage of development being the cause of an endless diversity of shape. 3. In an irregularity in the nutrition of the cells, evidenced by a retrograde metamorphosis of their contents. As an instance of this may be taken the fusiform cells, in fig. 77, in a state of incipient fatty degeneration, in which change even the spherical elements are also involved. This premature involution of the pathological, new-formpd cells ON SEROUS MEMBRANES. 345 is a fact of the highest moment, bearing the impresSj as it were, of the anomalous nutrition which is an almost constant phenomenon in every new-formation. 4. The elementary or- gans of the pathological new-formation do not go through the- same phases of development in such regular order, as under normal circumstances, the process being interrupted by the premature involution. The reason of this may reside partly in the chemical difference of the blastema, partly in that unknown factor to which we give the name of formative nisus or power of the organic matrix. An unequal distribution of the chemical elements may also be conceived to take place in the pathological exudation, which in one spot will afford material only for cells of one kind, whilst in another place, cells of a different kind will be produced from it, which no longer retain the normal organic character. 5. The mul- tiplication of the cells by division is impeded by abnormal formative conditions in the latter, or by a degeneration of the cell-contents; and in consequence of this, it may, in many situations, be entirely arrested, whilst in others it proceeds with proportionately greater vigour. Thus, an inequality in the propagation of the cells is set up, evidenced by an asym- metrical form of the new-growth of connective tissue. In intimate connexion with the new-formations of connective tissue stand those of sanguiferous canals; which never occur without the former, and, consequently, may be treated of at the same time with them. § 1. Serous membranes. Very extensive new-formations of connective tissue not unfrequently occur beneath the parietal lamina of the arachnoid, containing highly developed new vessels, and which, as is well known, may be readily raised with the forceps. In the case here represented, the formation constituted a thin, membranous, orange-yellow coating of lax consistence. Only a few blood- vessels could be perceived with the naked eye. The orange- yellow colour depended upon a large quantity of flattened, oval, or polygonal, deep-yellow and reddish-brown elements (fig. 79, b) ; the pigment granules were some of them 0-0013'" in size, and almost filled the cell, so that only a narrow 346 NEW-FORMATIONS OF CONNECTIVE TISSUE border, formed by the remaining cell-membrane, was apparent, or the latter had wholly disappeared, the granules forming the delicately notched boundary. A nucleus, in the form of a Fio. 79. distinctly defined, lighter coloured spot was not unfrequently evident in these dark-coloured elements. The cells with less pigment (c) contained merely minute aggregations of pigment- molecules, by which the nucleus was in great part, or entirely, concealed. The rest of the contents consisted of a very fine- molecular matter. The cells without any pigment {d) and, at the same time, of different size, elliptical or oval, presented a granular nucleus (as may be seen in the nuclei which have escaped) ; the nucleus was comparatively larger as the size of the cell was less. Cells with two nuclei, or with one, in which division had commenced, and of an hour-glass shape, were occasionally to be seen. These various kinds of cells were imbedded in a stroma of decussating connective-tissue-bundles ; and those containiag an abundance of pigment were grouped especially around the newly formed vessels. That these cells should be regarded as newly formed, admits, perhaps, of no doubt, since, in the normal condition, no organized structures of the kind, exist in the same situation, which^ by any kind of degeneration, could undergo such a morphological change. A second question might arise, as to whether they are to be looked upon as young, connective- ON SEROUS MEMBRANES. 347 tissue cells, or ratlier as newly produced epithelial cells ? We shall have frequent occasion to remark, in newly formed con- nective tissue, the existence, not in any way on its surface, but in the midst of its substance, of flattened, epithelial-like cells, and are of opinion that no well-defined distinction can be drawn between a flattened connective-tissue cell and one of epithelial nature. Epithelium, indubitably of new-formation, is met with, sometimes on the surface of papillary connective- tissue-formations, sometimes as a lining on the inner surface of cysts. Care should be taken not to confound the inorganic elements, occasionally met with in organized exudations of the kind now under consideration, with the organic; it is for this reason that the concretions, sometimes bare, sometimes contained in capsules of colloid substance, have been represented at e e, fig, 79. These bodies sometimes assume the appearance of finely granular, sometimes of botryoidal masses. They are characterised by their abrupt, dark contours, their tuberous surface, and occasionally distinct, concentric lamination. In the present case, they were surrounded by a clear border, which was itself, sometimes, concentrically laminated, and was unaltered by acetic acid, whilst carbonated alkalies caused its disappearance, the mineral constituents being, at the same time, rendered more distinct. These concretions, morphologically and chemically, precisely resemble those of the pineal gland, and of which, in the normal condition, the brain-sand is con- stituted, composed of carbonate and phosphate of lime. They occur as a mineral new-formation in organized new-growths, sometimes isolated, sometimes aggregated into groups. In older individuals they are, not unfrequently, met with in considerable quantity in the choroid plexuses, and often in the so-termed Pacchionian granulations. The newly formed blood-vessels in these growths are of especial interest, and their anatomical relations and distribu- tion may be readily observed. Those vessels which are not included in the class of the finest capillaries, are especially prone to exhibit saccular dilatations (fig. 79, a a), assuming the form of varicose enlargements, with an increase of the calibre of the vessel, and either bulging mostly towards one side, or situated at the points of inter-communication of the branches. 348 NEW-FORMATIONS OF CONNECTIVE TISSUE when they appear more like an expansion of the dilatations usually existing at those points. When the contents of ves- sels in this condition are washed out, their simple structure is rendered evident. For although, from their size, they might be supposed to have a more complex structure, they will be found to be constituted essentially like the capillaries, and merely to present elongated nuclei, disposed at determinate distances, and placed with their longer diameter parallel to the course of the vessel. Transverse nuclei occur more rarely, and, in new-formed vessels of this kind, we have never noticed the fully developed, longitudinal and annular coats, which are elsewhere so characteristic of vessels of the same size. They are imbedded in bundles of connective-tissue-fibres. If the vessels be traced to their finest ramifications, a pecu- liar condition will be observed in many situations; resembling that which is presented in the embryonic state, attending the multiplication of the capillaries {vid. in the General Part, "Formation of Vessels,'^ p. 81). An infundibuliform pro- longation filled with blood will be noticed, given oflf from a capillary, which, running out into a filament, unites with a similar prolongation from a contiguous vessel. In other words, two slender cones, tinged with blood, will be seen with their points in apposition, and the communication between which is established by the gradual coalescence of the elementary organs of the capillaries on each side. Observations of this kind, with respect to the mode of mul- tiplication of the finest vessels, should be made in sufficiently thin sections, which are best prepared with a fine pair of scissors ; it is better, also, to employ a solution of salt or sugar, instead of water, as a moistening medium, in order to avoid the removal of the hematin from the blood-corpuscles contained in the vessels, as otherwise it would be impossible to make out the csecal diverticula of the capillaries. The new-formed vessels apparently emerge from the inner surface of the dura mater ; and are characterised by their wavy course (fig. 80). But the curves formed by them are unequal, that is to say, wide, flattened curves often alternate with short and abrupt ones. The direction taken by the vessel frequently changes suddenly; after running, for in- stance, in one direction in undulating curves, it is suddenly ON SEROUS MEMBRANES. 349 Fio. 80. bent at nearly a right angle, makes a few curves in the new direction, and again changes its course. In its course, it gives off comparatively but few branches, and, consequently, diminishes only very gradually in size until it breaks up into a fine network of capillaries, which retain the same wavy character, and terminate in loops. The capillary plexuses are aggregated into coils, and are closer in proportion as the organization of the new- formation is more advanced. If the mode of distribution of these vessels be compared with that of the vessels in normal tissues, a striking similarity between the pathological, newly formed vascular plexus, and that in the lax connective tissue (as, for instance, in the cap- sule of the kidneys) cannot 'fail to be recognized. Thus we see that the character of the new-formed connective tissue is, also, manifested in the distribution of the vessels. With respect to the question, whether these blood-vessels arise independently in the self-organizing exudation, or should be regarded merely as lateral multiplications of the original vessels, we must refer to the new- formation of blood in pleuritic exudations. We shall now proceed to the consideration of those new- formations of connective tissue which, under the name of Pacchionian glands, are well known, as existing on the upper borders of the longitudinal fissure of the cerebrum. Until quite recently, these bodies have been regarded as pathological products ; in fact, until it was shown by Luschka^ that they exist in the cerebral membranes in the normal condition, projecting more or less above the surface of the arachnoid, in the form of villous elongations of its tissue. On this account he has proposed for these Pacchionian glands, or granulations, the name of arachnoidal villi. He has also indicated a new • [MuUer's ' Archiv,' 1852.— Ed.] 350 NEW-FORMATIONS OF CONNECTIVE TISSUE and, in a pathological respect, important seat of origin of them, that part, namely, of the parietal lamina of the arach- noid which extends along the course of the longitudinal sinus. These villosities, in advanced years, and, in particular patho- logical conditions, perhaps also at an earlier period, increase considerably in volume, and new villi are superadded to the old. The minute, soft, greyish, isolated granulations which, at the time of puberty, are already perceptible to the naked eye, collect into groups which, at the borders of the longitu- dinal fissure, especially when the inner cerebral tunics are thickened, become more closely approximated, and constitute continuous chains. At the same time they, not unfrequently, assume a yellowish or yellowish-red colour, and a greater degree of consistence. With respect to their more intimate structure, the basal portion, the body, and the rounded extremity, in the hyper- trophied villi, as well as in the normal, must be considered. The former are larger in diameter, and in them the connective- tissue-bundles, radiating from the arachnoid tissue, appear closer, the mode also of their arrangement is changed j whilst, in the normal condition, the bundles run in a parallel direction, in the hypertrophied villi they decussate in various ways, forming a confused network. Upon the addition of acetic acid, Luschka noticed very numerous bundles, which appeared to be surrounded in an annular or spiral direction by an elastic fibre. The bodies of the villi, and their clavate ends, are deformed, the usual pyriform shape being thus lost. A larger or less number of smaller villi are always seated upon these enlarged ones, in the form of flask-like appendages. Closer examination readily shows that the latter growths con- sist of embryonic connective-tissue-elements; that is, the framework of the villus is composed of somewhat elongated, fusiform cells, with a well-defined, oval, excentric nucleus. As the cells are closely approximated, and the nuclei, parti- cularly after the action of acetic acid, appear very densely crowded together, it might readily, though erroneously, be conceived that the whole consisted merely of a nuclear layer. The shape of the young villi is spherical, pyriform, or conical, with all possible intermediate forms. When more elongated, they usually present several nodular enlargements. Their ON SEROUS MEMBRANES. 351 longitudinal diameter varies, on the average, between 0*004 — 0-22'". The basal portion is usually attenuated, although some occur sessile on a broad base. In the morbid growth of the arachnoidal villi the younger forms spring up rapidly, whence arises an entire group of larger ones, which are subject to all possible variations in the mode of their relative disposition. They may be so closely packed together that the entire group, viewed from above, pre- sents a mulberry-like aspect ; or if a multitude of them are placed upon a common peduncle, and the villi are all of pretty uniform length, the growth assumes an umbellate appearance. If solitary villi, or a few together, are disposed around a long peduncle we have forms resembling bunches of grapes, &c. The forms of involution to which the growing arachnoidal villi are subject, are of pathological importance j in advanced degrees of the new-formation an opportunity is always afforded of observing these changes. The most usual mode of involution is fatty degeneration, consisting in an accumulation of larger or smaller fat-globules, which, by their minute subdivision and distribution among the conuective-tissue fibres, deprive the villus of some of its normal transparency ; and may, in part, be regarded as the cause of the yellowish colour which is apparent to the naked eye. These fat-globules are closely crowded, particularly towards the summits of the villi, not unfrequently wholly concealing the connective tissue. When in a state of involution, the villi often appear to be pervaded by a dirty, yellowish-brown pigment. Colloid corpuscles, sometimes in the form of elliptical, clear discs, sometimes with concentric rings, and occasionally with a distinct, molecular central cor- puscle, may usually be found upon careful examination of a villus which has been torn to pieces ; they seem to be lodged in the substance itself of the villus, and are not changed upon the addition of acetic acid. In this situation their size does not usually exceed certain dimensions (about the volume of an epidermis cell). Their outline is usually circular, but occa- sionally oval, or reniform, and they are of a greyish colour. As instances of a morbid affection of the arachnoidal villi, especially worthy of notice, Luschka describes the deposition of earthy constituents, in the form of minute granules, dissemi- nated among the structural elements, but this is of rare occur- 352 NEW-FORMATIONS OF CONNECTIVE TISSUE rence, as, also, is the deposition in them, of a peculiar brownish matter. No trace of blood-vessels in the morbid arachnoidal villi ever occurred to his observation any more than it has to ours, a further proof of what has already been, frequently, stated, that new structures in their type of formation observe that of the parent tissue whence they spring. For instance, if the normal arachnoidal villi contained vascular loops, like the normal cutaneous papillae, we might also expect to find vessels in the pathological new-formed vilM, in the same way as we find them in the pathological new-formed papillte of the skin {condylomata). The morbid changes in the villi of the parietal lamina of the arachnoid are essentially the same as in those of the visceral layer, only from their extent they acquire a special pathological importance, as is particularly noticed by Luschka in the following words : " They compress the fibrous tissue of the dura mater against the cranium, and, in course of time, cause pit-like depressions and even holes in the latter. Prom the pressure they exert upon the veins entering the longitudinal sinus, as well as by the partial obturation of the sinus itself, they suffice to produce impediments to the circulation in the vessels of the pia mater, and will thus, undoubtedly, often give rise to those exudative phenomena, as a product of which it has usually been erroneously conceived, that the arachnoidal villi themselves were to be regarded." As a genetic cause of the growth of the arachnoidal villi, the disturbances of the circulation, which attend the natural involution of the organism in old age, might perhaps be adduced. In consequence of the impeded motion of the column of blood a modified transudation must take plafle, which — in our ignorance, it must be confessed, of its more precise nature — ^we regard as the principal cause of the increased amount of nutritive material with which the arachnoid is supplied. It should here be remarked that growths consisting of connective tissue are of very usual occurrence in advanced age — ^a circumstance which, in addition to the above reasons, may probably be explained by a defective formation of blood. With respect to the mode oi preparing the arachnoidal villi and similar dendritic, papillary, new-formations, it need only be remarked that a sufficient portion of the growth having been ON SEROUS MEMBRANES. 353 cut ofif with the scissors, the villosities, which often adhere together, may best be studied in their mutual connexion, when they have been washed rapidly backwards and forwards in cleaii water, and then placed either in a flat watch-glass, or upon a glass plate, and spread out without tearing. The preparation should be examined either by transmitted or by direct light, by means of a tolerably powerful lens, when the position of the various parts may be better adjusted by needles, and the young villi at the borders of the larger ones may be extended by gentle stroking with a cataract-needle ; superfluous portions being removed by a pair of fine-pointed scissors, when they interfere with the clearness and neatness of the preparation. It is self-evident, that in laying the covering glass upon the preparation, care should be taken not to disarrange the parts which have been duly placed, and also, that, from the size of the object, low tnagnifying powers should be employed, to exa- mine the forms in their secondary arrangement and mutual connexions, and more powerful glasses for the study in detail, particularly of the younger villi. The copious, organized layers of exudation on the pleura, are especially adapted for the examination of the various transi- tional forms of connective tissue, their complication with the spontaneous new-formation of blood, suppuration, &c. A layer, 3"21"' thick, on the parietal pleura of an individual in whom, during life, paracentesis had been performed on account of empyema, presented on the inner surface, or that which was directed towards the cavity of the thmrase, minute, level, lightish-grey, opaque patches with irregular outlines, which were caused by a purulent infiltration ; they consisted, in fact, of pus-corpuscles lying amidst flocculent and streaky masses. In the less opaque spots, nucleated elements — some elliptical, some polygonal — could be perceived, lying in groups among the solidified prOtein-corpuscles. Other portions, taken from the inner side, presented only a molecular material among the laminated substance. Beneath the light-grey patches, striated layers came .into view, containing, of organized elements, chiefly fusiform, closely approximated cells, mostly in a state of fatty degeneration. In the still deeper seated, or with respect to those just described, more external layers, minute, isolated, bloody points, and lastly, short convoluted blood-vessels to- 23 354 NEW-FOEMATIONS OF CONNECTIVE TISSUE gether with connective tissue, were Tisible. This instance manifestly shows the various organic developmental stages of the exudation in a state of progressive degeneration from with- out to within. In a gelatinous, pleuritic, organized exudation, bloody streaks could be perceived even by the naked eye, an ap- pearance produced by longitudinal rows of blood-corpuscles, which were not contained in any independent walls, but lay among the layers of reticulated fibrin. But, together with the red, a few white blood-corpuscles were also visible; more numerous stiU, however, were minute, spherical, faintly gra- nular elements, not so large as the red blood-corpuscles, which did not disappear on the addition of acetic acid, and, in fact, were then rendered more distinct by the increased transparency of the fibrinous substance. The same acid also rendered visible, elongated nuclei disposed in neat, aggregate groups. It is ob- vious, therefore, that in this case, a new-formation of red and white blood-corpuscles had taken place prior to the complete develop-, ment of the connective-tissue-cells, it being otherwise established, that the aggregated deposits of spherical and elongated nuclei are to be regarded as a developmental form of connective tissue. The following case will serve as a striking instance of the spontaneous, new-formation of blood. A tough, coriaceous, yellowish coating, in many places about 2'65"' thick, on the visceral layer of the pleura, could be raised from the surface of the compressed lung, with which it was connected by a reticular tissue. A section perpendicular to the surface of this false membrane, disclosed a space marked by bloody points (fig. 81, a) of considerable extent, and which was enclosed on both aspects by yellowish layers. The quadrangular piece was divided into halves by a section parallel to the surfaces, when the; cut surface {d d), and the corresponding surface in the other half (c) presented the following conditions : The spots indicated by the dark lines in the figure were Fig. 81. ON SEROUS MEMBRANES. 355 tinged with blood, though not with equal intensity throughout. The parts most deeply shaded were of a dark blood-red, whilst those more faintly marked exhibited only a reddish tinge. The blood seemed, as it were, to be lodged in the sinuosities of lobes, which it surrounded, and to occupy several irregular, jagged prolongations of these cavities. The more elongated bloody streaks, also, had no defined outlines, being gradually lost in the yellowish matrix. Bloody points, large enough to be seen at once by the naked eye, were scattered about, and indicated the sites of newly forming blood-corpuscles. The latter were lodged in excavations of the fibrinous substance, and were nowhere enclosed in independent walls. Between the fibrinous layers, much free fat was accumulated in places, in the form of globules, agglomerated into granule-masses. • The embryonic connective-tissue-elements were frequently in a state of fatty degeneration, though in parts, in a better state of preservation ; and they were occasionally enclosed by decus- sating bundles. In a compact, almost cartilaginous, coating on the pul- monary pleura, in the midst of the solid substance, were found irregular, occasionally wavy, bloody streaks and spots. The matrix, which, in transverse sections, was transparent, presented a laminated appearance, arising from superimposed layers containing isolated, rounded elements 0-0061 — 0"0079"' in diameter, enclosing an excentric, vesicular nucletts sur- rounded by a dirty-yellowish, granular substance. In the less transparent, greyish-yellow portions, collections of minute fat- globules and granule-masses were accumulated. Closer examination of the blood in the newly formed con- dition, shows that the corpuscles differ more in size among themselves than is the case under other circumstances. For numerous minute blood-corpuscles, 00017 — 0-0033'" in diameter, are presented, exhibiting as yet no central de- pression, of a more spherical shape, and of a modified red colour. The independent and free development of the red blood- corpuscles in an exuded protein-substance, as proved by the foregoing instances, unaccompanied by any formation of embryonic connective tissue, cannot, perhaps, be regarded as of usual occurrence. In these cases, the formation of the 356 NEW-FORMATIONS OF CONNECTIVE TISSUE Fig. 82. latter tissue is too little advanced for the production of blood- vessels, wliicli in general is only observed to take place when the formation of connective tissue has proceeded beyond the first, embryonic forms, and where the fusiform cells — the fundamental element for the development of blood-vessels — have assumed a greater degree of importance. This formation of blood in the shape of spots with irregular prolongations, streaks, and points, recalls the type so frequently met with in medullary cancer, as will be more particularly noticed in the proper place. It is well known, that after pleuritic exudations, new formations of lax connective tissue not unfrequently occur, in which a considerable number of new vessels are visible. Fig. 82 represents a vascular plexus of this kind on the visceral pleura, and which was readily remov- able by the scissors. These vessels, like those representied in fig. 80, are also cha- racterised by their irregularly serpen- tine course. The larger vessels make numerous zig - zag curves, which are alternately wider and narrower ; the smaller vessels retain the same characters in their convolutions, and terminate in a loop. Thus, upon the whole, it will be seen that the type of this vascular arrangement resembles that presented in the lax connective tissue. The pulmonary pleura, as is well known, frequently exhibits granulations of the size of a pin's head down to that of a just perceptible nodule. These are formations of connective tissue precisely similar to those described as occurring on the arach- noid. In the instance here represented, they* were rounded, of a black colour, sometimes isolated, sometimes assembled in groups of from ten to twenty together, and of a loose texture ; they could be , removed by means of a cataract-needle. The ON SEROUS MEMBRANES. 357 laxity of their texture seemed to depend upon the considerable amount of black pigment-cells, whose form approximated the polygonal, and which usually exhibited a light-coloured spot corresponding to the nucleus (fig. 83, a). Young con- nective-tissue-elements were met ^^^ gg with in less number, composed of round and fusiform cells, which, from their minute size, might be readily overlooked, and possessed a compara- tively large, light- coloured nucleus, which, in the fusiform cells, con- tained a projecting nucleolus. These elementary bodies (a, b) were enclosed by decussating, fibrous bundles (c c), of which the matrix was composed, and probably belonging, in great part, to the separated fibres of the pleural tissue. Numerous aggregations of blood-cor- puscles were also lodged in the granulations, as at d, together with an abundance of free pigment, in the form of amor- phous, black corpuscles, especially towards the periphery of the granulation. Dendritic papillary new-forrtiations of connective tissue also occur on thepleura, which have been more particularly described by R. Heschl. He has found them especially at the lower border of the inferior lobes of both lungs, and, in a few cases, extending a short distance on the outer surface of the parts in question ; and describes them as sessile growths, about half an inch long, and consisting of an axis of greater or less thickness (up to half a line), with the free end flattened and clavate, around which were seated numerous similarly shaped pro- jections, some smaller some larger than the main, central stem. He frequently noticed that both the former and the latter of these processes were subdivided at the apex into several smaller ones. These growths are stated by him to be invested with a tesselated ^itkelium, and to contain numerous fine vessels. In other respects their structure does not differ from that of the arachnoidal villi. In one instance Heschl noticed excrescences consisting (with the exception of the peripheral layers of connective-tissue-elements) of normal adipose tissue. These growths were also branched in a similar way to the 358 NEW-FORMATIONS OF CONNECTIVE TISSUE above, and presented the usual aspect of synovial excrescences composed of adipose tissue — they constituted, in fact, a lipoma arborescens. The growths on the pericardium known under the names of granulations and vegetations, also contain young connective- tissue-elements. Papillary new-formations, containing fat-cells in their interior, are more rare. The new-growths of connective tissue of a dendritic form, not unfrequently met with on the synovial membranes, and which, in a pathological respect, are of the utmost importance, originate, without doubt, in the synovial processes always existing in the normal condition, and which were first sub- jected to a minute anatomical investigation by KoUiker. These processes are mostly situated in the groove-like depression of the synovial membrane where it is inserted into the border of the articular cartilage. They consist of a cen- tral bundle of connective tissue usually enclosing one or several cartilage-cells, and of a dense layer of epithelium. In shape they present endless diversity, and the basal portion is either an elongated peduncle or a shorter and thicker stem; they are placed either isolated or in several groups together; and when shorter and more voluminous contain fat-cells or convoluted vessels. In pathological conditions these processes increase in the same way as the arachnoidal villi, and become developed into the forms described by Rokitansky under the name of " dendritic vegetations on the synovial membranes," The pathological forms of the processes, though presenting, both in their outline and in their structure, much in common with the normal ones, still afford some peculiarities : 1. Several lateral branches are given off from one stem, and from these, lateral twigs, so as when unfolded to exhibit an arborescent ramification of bands of connective tissue, projecting into the cavity of the joint with sometimes rounded, sometimes clavate or conical extremities. Denser groups of closely contiguous processes are also formed, as is the case in the normal condition. The processes thus placed in close apposition become mutually flattened and disposed in foliate plates one upon the other, or may be grouped into mulberry-like structures. Those which project further into the joint, frequently support, on a long, slender peduncle. ON SEROUS MEMBRANES. 359 elliptical or oval, consistent, little heads,^ — a shape, moreover, which is occasionally met with in joints in the normal condition. Rokitansky has also noticed that the vegetations grow parti- cularly close together in the neighbourhood of the insertion of the fibrous articular capsule into the parietal or, as it were, reflected portion of the synovial membrane, and that without doubt this circumstance explains how it is, that in that situation, instead of contiguous, isolated vegetations, a trabe- cular formation is often observed. In this case I have no doubt that the vegetations, transformed into bands of con- nective tissue, have grown together. 2. With respect to their elementary structure, it must be remarked that in the pathological forms of these growths the fibres of connective tissue are very distinct, and that an epithelial covering is wanting, at any rate, in most cases. The fibres of connective tissue usually run in fine, wavy curves, parallel to the long axis of the process, as far as to its rounded extremity, where they arch round, assuming, not unfrequently, at the same time a rec- tilinear course. Smaller growths also are commonly met with, * in which the formation of coiled, connective-tissue- bundles has not been attained to, but in which the fusiform cells are arranged in apposition, in symmetrical order, exhibit- ing their oblong nuclei, after the addition of acetic acid, at uniform distances apart, and placed in an obliquely ascending position. The very minute, hyaline, terminal branches often hardly 0-0088 '" thick, present no distinct elementary struc- ture whatever, it appearing, consequently, as if the protein- compounds in the semi-solid condition, assemble in a den- dritic form, as is so frequently the casein crystallization, where the process goes on under the eyes of the observer. The cartilage-cells, which, as has just been remarked, are normally present in the synovial processes, occur in greater numbers in many of the new-formed growths, being deposited in entire series or groups in the interior of the process. In these also, the cartilage-cell in several pathological states, undergoes a physiological metamorphosis; that is, after a previous thickening of its wall it becomes a bone-corpuscle, a metamorphosis which never takes place in the cartilage-cells in the synovial processes in the physiological condition, unless perhaps in old age. 360 NEW-FORMATIONS OF CONNECTIVE TISSUE These dendritic new-formations of connective tissue, ultimately undergo the various kinds of metamoi^jhosis which attend the involution of all new-growths ; the rounded, free extremities in particular becoming the seat of fatty degeneration, in which the cartilage-cells also participate. By the absorption of yellowish- or reddish-brown, colouring matter, the terminal portions of the vegetation assume a corresponding dark hue. 3. The plic /), which, viewed on the side, presented a broader, as it were, truncated extremity with a double contour line, which was directed towards the free surface, the other end being attenuated, and turned towards the exterior. Their shape was cylindrical, conical, or indented, and they contained a nucleus, usually of an oval form, with a nucleolus. The con- tents of the cells consisted of a fine-molecular substance. When these cells were viewed with their long axis directed towards the observer, and on the free surface, they presented Fig. 85. a polygonal form, owing to their mutual pressure [g), and when the focus was carried a little deeper, a distinct molecule was visible nearly in the centre of each — the nucleolus. Thus, they corresponded in all respects with the columnar epithelium of the intestines. On the other hand, flattened, polygonal elements occurred (A), sometimes with a rounded or oval nucleus, and frequently containing several fatty molecules, which, in many parts of this epithelium, were accumulated to such an extent as to occupy almost the entire cell. A fatty degeneration of the tesselated epithelium on the inner wall of the cyst, is of very frequent occurrence. Separate patches of the epithelium become detached very soon after death, in consequence of maceration, and probably also during life, and are met with suspended in the fluid of the cyst ; they may. ON SEROUS MEMBRANES. 365 also, be readily collected in large quantity from the greyish sediment precipitated from the fluid. It may be doubted whether the epithelium line the whole of the inner surface of the cyst, or whether it may not be absent on the projecting ridges, as observations made in the larger kind of cysts would seem to indicate. After the removal of the epithelium, and per- haps, also, together with it, various kinds of elements, were met with, which remained adherent to the blade of the scalpel when the surface was gently scraped. These were, in the first place, spherical cells, with an external membrane (a), in which at one spot an oval nucleus, with nucleolus, was lodged. The cell-contents were perfectly hyahne, without any admix- ture of molecules, and appeared to be surrounded by a proper membrane. These would seem, therefore, to represent either two cells contained one within the other, of which the inner and non-nucleated was closely embraced by the external nucleated cell, or an encysted portion of contents, closely surrounded by a proper cell-membrane. The portion of contents in the cells marked b, was seen to be divided into two parts, two closed cavities having been formed by a gradual constriction; the nucleus, when visible, retained its pristine position. Even when the contents were divided into three portions, as in the cell c, the nucleus remained in the original, solitary position. The degenerated forms {d, e) we regard as derived from the preceding, and cannot avoid remarking upon the similarity exhibited by them, — as, for instance, at e, — with the granular, non-nucleated globules occurring in pneumonic effusions. In considering the import of a, b, c, several possibilities must be taken into account, whether they are to be viewed as embry- onic cell-formations, or, with Eokitansky, are to be regarded as the elementary organs of the cysts ; and, in fact, whether a is to be regarded as equivalent to a primary cyst, containing a single, secondary cyst, b one with two, and c one with three, and thus whether they are to be considered as representing an endogenous cyst-formation? It may be taken as an ascer- tained fact, that both in vegetable and animal organisms, a multiphcation of cells, by endogenous formation, takes place, that is, new cells are formed in the interior, and appear to be surrounded by the membrane of the parent-cdL 366 NEW-FORMATIONS OF CONNECTIVE TISSUE The circumstances, however, under which this process of mul- tiplication goes on, have not yet heen fully ascertained. The question, for instance, may be asked, what becomes of the nucleus of the parent cell in this endogenous formation ? whe- ther it take no part in the division of the contents, as appears to be the case in the present instance, or in what cases it does participate in the division ? Leaving these doubtful points undecided, this much is certain, that in accordance with his- tological terminology, the forms a, b, c, must be denominated parent-cells, enclosing one, two, and, three secondary cells. Eokitansky also regards them as endogenous formations, but as connected with the development of the cysts, whose ele- mentary rudiments they represent. But such a relation seems by no means to be proved ; and we therefore think it impos- sible to assign such an import to these cells, retaining the more obvious opinion that they are connected, as endogenous cell-formations, either with the development of the epithelium, or of the connective-tissue-cells. In proceeding to investigate the cyst-waU more towards the exterior, we always find fusiform cells of very various lengths and form (fig. 85, i) ; they are often placed in whole groups together, especially on the lax, elevated ridges, very distinctly representing embryonic forms of connective tissue. They exist in all cysts, and, consequently, a new-formation of con- nective tissue may be asserted to exist in every cyst-wall. The contents of these peritoneal cysts vary considerably, even in outward appearance. The enclosed fluid is thin and clear, or viscid and clouded, or, perhaps even, towards the walls, of pultaceous consistence. The morphological, organic constituents may be reduced to two principal groups. 1. The unorganized elements, under which we reckon : (o) a fine- molecular coloured substance, forming thicker layers, and which presents precisely the same properties as the albumen precipitated from the fluid of the cyst by heat or nitric acid; (6) hyaline, amorphous, flattened, occasionally fis- sured masses, which are not further changed by acetic acid and may be regarded as of a colloid nature ; they are occa- sionally of a light- or dark-brown colour, and more rarely exhibit an indication of concentric lamination ; (c) olein, in the form of larger or smaller, sometimes solitary, sometimes ON SEROUS MEMBRANES. 367 aggregated, fatty molecules, isomorphous with Gluge's com- pound inflammation-globules ; {d) mucin, in the usual form of straight filaments, which appear in abundance in the viscous fluid contents, especially upon the addition of acetic acid. 2. The organized elements may be arranged in the following series, according to the degree of their completeness : (a) epithelial cells, which, as has been stated above, are very readily detached j (6) fusiform cells, which are, probably, rea- dily detached from the ridge-like projections ; (c) nuclei, some- times of a rounded or oval form, with a nucleolus ; occasionally, shrunken and angular; {d) parent cells, with secondary cells, are of rare occurrence in the contents, being replaced by a proportionately larger quantity of (e) those conical, finely granular corpuscles, in which an enveloping membrane may in- deed be perceived, but no nucleus, and whose contents are not unfrequently in a state of fatty degeneration. They may be regarded either as parent-cells in a state of involution, or as cells primarily without a nucleus {vid. fig. 85, d, e). In the pultaceous coating on the inner wall of the cyst, the young connective-tissue-formation may be perceived in certain spots, in the form of isolated, sometimes round, sometimes fusiform cells, from the latter of which, elongated, wavy fibres of con- nective tissue are given ofi'. The hydrochlorates and sulphates in solution iij the fluid may be exhibited morphologically when a drop is allowed to dry. The residuum on the glass crystallizes in an arborescent form. When a considerable number of papillary new-growths are seated on the peritoneal coat of the ovary so as to be in mutual contact, and some among them are gradually transformed into cysts, an involution of some of the cysts invariably takes place. Their contents become thicker, of a brownish-yellow colour, or, ultimately, even undergo cretification. In the former case we find den«e, frequently brownish-yellow, colloid masses, together with epithelial and immature connective-tissue-cells, shrunken, or, perhaps, in a state of pigmented or fatty degeneration. The blood-vessels of the cyst-wall are empty, and in its parenchyma are deposited, fatty or pigment-molecules, which deprive the wall of its previous transparency. When cretifica- tion takes place, the amorphous, calcareous salts (carbonate and 368 NEW-FORMATIONS OF CONNECTIVE TISSUE phosphate of lime) accumulate in the cavity, and formj together with the fat with which cholesterin plates are often intermixed and the remaining organic elements, a concretion enclosed in an envelope of connective tissue. § 3. External integument. New-growths of connective tissue occur very frequently in the external integumentj and are always limited to distinct portions of the papillary stratum of the true corium, or of the tunic of the sebaceous follicles, &c. We shall commence with the description of the very frequent new-growths of this tissue which take place in the papilla, and which are well known under the name of acuminated condylomata, and have been termed by Kramer, very appropriately, papillomata. They are, in fact, papillary new-formations, each of which also con- tains a newly formed vascular loop. In the investigation of a papilloma, it is requisite to proceed to the examijnation of the elementary organs in the various strata, successively. Gr. Simon, to whom we are indebted for the first accurate exposition of the structure of the so-termed condylomata, directs that the growth should be macerated for a short time in water, and thin sections then taken from it. The first thing thus brought in view are epidermis-cells belonging to the horny layer, in the form of the well-known flattened elements, swelling up on the addition of carbonate of potass; and which, particularly in the deeper parts of the condyloma, are superimposed one upon another ta a considerable thickness. A little more deeply a smaller kind of cells will be perceived belonging to the mucous layer of the epidermis ; in these cells the nucleus is more dis- tinctly seen than in the former. Lastly, if, after the removal of the epidermis, a little piece be taken with a pair of pointed forceps, or scissors, and carefully torn to pieces, the minute, young connective-tissTie-elements will be liberated. As these are very pale and delicate, it is often advantageous to colour them with a dilute solution of bichromate of potass.^ The elliptical and short fusiform cells, with proportionately large oval nuclei, will be found floating in considerable abundance at the edge of the preparation. The fibres of connective tissue, ' [Or of Iodine.— Ed.] IN THE EXTERNAL INTEGUMENT. 369 Fig. 86. towards the summits of these condylomata, are extremely delicate; but towards the base they become more abundant and firmer. This mode of examination, however, is not sufficient; and for the more complete understanding of the structure, trans- verse sections must be made. This can be done by means of a pair of fine, straight scissors, or of the double-bladed knife, in recent, moist papillomata, or with a scalpel, in growths which have been boiled either in acetic acid or in plain water, and then dried; and the sections should be made in various directions (perpendicular and transverse to the longitudinal axis oi fhe papilloma). The examination, conducted in this way, affords the following results, as regards the relations of the different parts. In the axis of a straight papilla there is always a vascular loop (fig. 86, «), consisting of an ascending and descending branch. Both vessels take a wavy course, and are disposed, not merely as re- gards their length, but also with respect to the curve described by them, according to the form of the papilla. It is intelligible, that in the various positions of the divided papilla, the vascular loops will also exhibit various shapes j thus both vessels are sometimes almost com- pletely hidden, often partially so, or merely the summit of the curve may be wanting, or its lower por- tion. The body of the papilla surrounds the vascular loop, which ascends to a considerable height into the rounded end, and it consists of a bundle of very delicate connective-tissue-fibres, occupying the axis of the papilla, and exhibiting, after the action of acetic acid, several oblong nuclei. The younger connective-tissue-elements are found nearer the periphery of the papilla, that is, the larger with more rounded nuclei. The margin of the papilla is indicated by a double contour line {b b). Thus, in the centre we find the older connective-tissue-formation serving, as it were, for a solid support, and the younger production at the 24 370 NEW-FORMATIONS OF CONNECTIVE TISSUE periphery. In very young papillary new-formations ■which are seated, as apparent projections, upon the older, this elementary diflference in the body of the papilla is not seen ; occasionally nothing being perceptible but a fine-molecular substance, with a few scattered nuclei. The epithelial (or epidermic) layer surrounding the papilla, may be regarded as double ; a deeper, usually constituted of a few series of cells placed vertically with respect to the curve of the papilla {vid. fig. 86, b, c, both sides), and an outer, com- posed of precisely similar, though transversely disposed cells (the layer from c c, outwards). The oval nuclei of the former layer of cells are arranged with their longer diameter perpen- dicular to the curved surface of the papilla, whilst the corres- ponding nuclei of the second layer assume a more transverse direction. The nuclei are indistinctly granular, but we never remember to have seen them containing pigment. The transversely placed cells increase in size, up to a certain extent, towards the periphery, at the same time becoming more flat- tened, and occasionally presenting two nuclei. The papilke, consequently, must be regarded as the rounded ends of the new-growths of connective tissue, and, by their inter-connexion, as constituting the basis of the papilloma. It is well known that the latter consists of projections, which may be seen, even by the naked eye, to terminate, sometimes in acute points, sometimes in truncated, clavate extremities, and to be supported occasionally on a slender neck, or on a broader basis J whilst sometimes a few, grouped together, rise on a common stalk, or crowded more closely, constitute a group, separated by lateral furrows, which, when viewed from above by the naked eye, exhibits a cauliflower appearance. Now, if one of these little projections be examined in its base of connective tissue, it will be readily seen to consist of a collection of papillary new-formations, surrounded by a common epithelial (epidermic) coat. For this purpose, the free extremity of one of the conical prominences must be cut off, and when it is of some thickness a slice should be taken from both sides by means of a straight pair of scissors, so that a vertical section of the conical process is obtained. Under these circumstances, if the vessels be properly injected, the variously convoluted, vascular loops may be perceived; which will occasionally be IN THE EXTERNAL INTEGUMENT. 371 Fig. 87. rendered more distinct by the addition of a dilute solution of carbonate of soda. The outlines of the papilla will not be clearly seen before the removal of the epidermic layer which is loosened by the same salt. In fig. 87 we have represented the clavate extremity of one of the conical processes of apapilloma prepared in the above way. The growth consists of an aggregation o( papilla, whose rounded extremities project in all parts. In the present case these are of some width, and frequently exhibit excava- tions, indicating the position of lateral papilla, whence its outline presents a very great diversity of aspect. Corre- sponding to the outlines of each papilla are the curves of the vascular loop contained within it. For instance, in all the lateral, more or less Ae- veloTped papilke,t'iie\esse]s run inwards, whence result the loops convoluted like the intestines, which have been described and figured by Kramer. The papilla are placed in very nume- rous groups (twenty, forty, or more, together), not only on the rounded extremity of the cone, but also on its sides. The common base of each papillary group is constituted of connec- tive tissue, consisting of thickened, fibrous bundles, in company with which the larger vessels run, ramifying in the same way as do the subdividing bundles. In the latter, when they have reached a certain thickness and consistence at the base of the cone, and after they have been treated with carbonate of soda or potass, a fine elastic network may be perceived. Primitive nerve-tubes undoubtedly exist in the divided base of the papil- loma itself, but we have never succeeded in tracing them into the cones, nor, by any means, into the papilla. The papillary groups, constituting each conical eminence, are surrounded by a common epidermic co?it, whose outer boundary line (fig. 87) presents only shallow depressions exactly as may be 372 NEW-FORMATIONS OF CONNECTIVE TISSUE observed in transverse sections of the skin. The epidermic layer varies very considerably in thickness, and it may, in general, be said that the brush-like acuminated cones are fur- nished more abundantly with protective layers of epidermis, especially on their ends, and are consequently less transparent than those with dilated clavate extremities, which are seated on short necks, in several groups together; on whose surface the aggregate papill 394 NEW-FORMATIONS OF CONNECTIVE TISSUE also, is never so smooth as that of the fat-cells, which, moreover, in the fresh condition, always exhibit a spherical form, and usually exceed in size the epidermic cells filled with fluid fat. We think that the encysted tumour described by J. Vogel con- tained such fatty epidermic cells, for he says : " the contents consisted, besides the hairs, entirely of colourless cells filled with fat (like the common fat-cells), and in close contiguity. No vessels could be seen among the fat-cells/' But in newly formed collections of fat-cells, blood-vessels are always met with ; and it sounds strange also, that the shafts of the hairs should be surrounded with true fat-cells. The epithelial cells of the encysted tumour, towards the inner surface of the wall of the cyst, are disposed more irregularly and more closely together, constituting a mem- branaceous coating. Besides the above-mentioned cholesterin plates, fat occurs also in the form of globules and crumbly masses, which latter, however, must be carefully distinguished from the cal- careous salts occasionally deposited in tumours of the present kind; the difi'erence will at once be ascertained upon the addition of reagents. The wall of the cyst is usually very thin, and consists of de- cussating connective-tissue-bundles, parallel with which blood- vessels may occasionally be seen running. Hairs and sebaceous follicles, also, are not unfrequently seated in it ; and Kohlrausch has evemioticed sudoriparous glands. A subcutaneous, encysted tumour, in the neighbourhood of the eyebrow, of a rounded form, and about 0-39" in diam., which was removed by Professor Schuh, presented a delicate wall, very vascular on the inner aspect, the blood-vessels forming a close mesh-work and elon- gated loops. When a layer of very lax connective tissue was stripped off from the inner surface, whitish points were brought into view, which proved to be enormously distended sebaceous follicles, and appeared occasionally to be perforated by a hair. The bulbs of the latter were elongated and scarcely at all enlarged; the medullary substance commenced at a greater distance from the bulb than is usually the case, and existed in many hairs not thicker than the larger kind of lanugo. The thickness of the hairs varied from that of the lanugo to that of a thin hair of the head. They were very loosely IN THE EXTERNAL INTEGUMENT. 395 implanted in the wall of the cyst, and readily fell out. The contents of the cyst were a gelatinous substance, with whitish, scattered points, the latter consisting of collections of epidermic cells ; in the for-mer were simply groups of molecules. In more rare cases, horny growths have been seen protrud- ing from encysted tumours. Horns of this kind gradually perforate the skin, and continue to grow like the nails. J. Vogel, who has had several opportunities of examining horns attached in a follicle, describes them as being of a cor- neous substance which can be readily cut and scraped. Under the microscope, the substance itself appears quite indeter- minate, almost amorphous, like that of the nails; but when digested for some time in caustic potass, the tissue breaks up into minute scales, exactly like those which are obtained by the same means from the substance of cutaneous callosities, corns, &c. He, therefore, describes these horns as local growths of the epidermis of the cyst. Thus, in these cysts, all the parts belonging to the skin may be formed, as the horny and mucous layers of the epidermis, a vascular connective-tissue-layer having hairs implanted in it, and furnished with sebaceous and sudoriparous glands, and even nail-like horns; or, in other words, the tumour may become a portion of encysted integument, whilst, in the sub- cutaneous warts, or condylomata, merely a papillary new-forma- tion takes place on the inner surface of the hypertrophied connective-tissue-tunic of the sebaceous follicle. The shedding of the epidermic cells and hair§ goes on in the tumour exactly as on the external skin ; but these parts, as well as the seba- ceous matters, and the secretion of the sudoriparous glands, not being removed, necessarily accumulate in the cyst. The growths described by many authors under the name of cutaneous polypi, also belong to the class of new-formations of connective tissue, occurring in circumscribed portions of the corium, and inducing a destruction of the t. adnexa. From a polypus of this kind, situated on the external auditory canal, when dried, very thin sections could be made, which presented two principal layers, an epidermic investment (fig. 94, c), with the horny and mucous layers, and a stratum of connective tissue, consisting of an areolated fibrous stroma. The larger, wider areola were situated towards the base of the little 396 NEW-FORMATIONS OF CONNECTIVE TISSUE tumouTj and gradually diminished in size towards the cuticular surface, the fibrous framework appearing proportionately more close (a). The areola were. Fig. 94. at any rate, some of them, filled with elementary bodies, which could only occasionally be distinguished as cells (d). In another case, of a similar growth, extirpated by Dr. Tiirck, these elements con- sisted of elliptical and oval cells, furnished with one or two processes ff), and con^ taining a nucleus and delicate molecular substance. In longitudinal sections taken from the former tumour, when dry, and examined under a lower magnifying power, light-coloured, broad stria could be distinguished, from which, not unfrequently, a clear branch was given off (e) ; the outlines of the streaks were not sharply defined, and sometimes they ap- peared short and truncated. These light-coloured streaks could not in any way be regarded as lymphatics ; and nierely represented a hyaline bldstema, collected in the intercommuni- cating areolar passages. Not, a vestige of lanuginous hairs, sebaceous glands, nor of the excretory ducts of the ceruminous glands, could anywhere be perceived, nor could any elastic filaments be discerned. The small cutaneous tumours described by many authors under the name of molluscum simplex, or non contagiosum, which are sometimes sessile, sometimes pedunculated (in which case they- have received the name of m. pendulum), have also been recognized by Rokitansky as growths of connective tissue. We, also, have observed in these tumours only a fibrous framework enclosing minute connective-tissue-cells; and, in an elastic, soft molluscum pendulum, about the size of a pea, from the pelvic i'egion, we noticed that the surface was smooth, the epidermic covering thin, and the pigment layer IN THE EXTERNAL INTEGUMENT. 397 well developed ; but that hairs, sebaceous follicles, and sudori- parous'ducts were wanting. Besides the above, a multitude af names have been applied to the cutaneous new-formations composed of connective tissue, according to the diversities in their conformation. These diversities depend upon various circumstances: 1. Upon the stage of development at which the formation of connective tissue remains. Formations of this kind are met with, especially in the subcutaneous tissue, presenting a gelatinous appearance^ and in which the development of the elementary organs remains at an embryonic stage. Their consistence is gela- tiniform, and pretty solid j when divided, their colour is light yellow, and, in moderately thin sections, they exhibit, in most parts, a considerable degree of transparency; only a very small quantity of clear, transparent, rather glutinous fluid can be expressed from them, and occasionally lamellcR of the same tex- ture may be separated ; in many cases they are found to possess great fragility ; they are always but scantily supplied with blood- vessels. These formations constitute abruptly defined, occa- sionally very extensive tumours, and not unfrequently perforate the skin, which had previously been atrophied by their pressure. They never exhibit any disposition to softening, and it is only after the skin has given way that they are subject to a superficial suppuration, which should not be confounded with softening ; on the other hand, after extirpation, they are very liable to be regenerated, although, at the same time, they have no tendency to appear in several parts of the body. Manifest transitional forms exist from these gelatinous tumours to the fibrous. Their consistence becomes denser, the colour approaches more nearly to white, and, in conformation, they are, not unfrequently, lobatej the areolar texture is more distinct, and sometimes, in fact, cysts are developed, or fissure- like areolce filled with a serous fluid. In his latest work upon ' Gelatinous Cancer,' Rokitansky, with reference to non-malignant gelatiniform tumours, also adopts the view that they represent simply embryonic con- nective-tissue-formations. The collonema of J. Miiller, a lax, transparent, gelatiniform, quivering mass, contains principally embryonic, isolated, or aggregated elements of connective tissue, imbedded in a Structureless, transparent substance. 398 NEW-FORMATIONS OF CONNECTIVE TISSUE The latter are, not till afterwards, developed into fibrous bundles, which, consequently, though at first scanty, gradually become more and more abundant. Collonema thus approaches the pature of a fibrous tumour. The gelatinous sarcoma has been divided by Kokitansky into several varieties, distinguished merely by the various stages of development of the connective tissue. The albuminoid fibrous tumour of J. Miiller is regarded by him as a distinct, species pf this form of sarcoma. It is described as an albuminous, glutinous tumour, composed of a white or whitish-yellow, solid, friable substance, of a tuberous aspect, and very scantily supplied with vessels, which exist only in the redder and softer portions. Schuh is of opinion that all the friable growths, which can be more or less readily split into lamellne, and contain gelatin and albumen in their composition, should be referred to car- cinoma fasciculatum. When the above-described, transitional forms of the gelati- nous connective-tissue-tumour are more developed, so that the fibres ultimately constitute the principal element — the amount pf connective-tissue- cells, the elliptical and fibre-cells (Virchow^'s " connective-tissue-corpuscles"), being diminished in propor- tion and existing only in very scanty numbers — we have 3, fibrous connective-tissue-tumour, to which, also, numerous names have been assigned — as fibroid, desmoid, fibrous sarcoma, ;fibrous polypus, and steatoma. We shall afterwards show that the fundamental character of all these forms is that of connec- tive tissue. 2. The conformation of these growths depends upon the form, size, and contents of the areolee. The latter may be either round, oval, or elongated ; minute, or dilated to such a size as to appear like cysts ; and they may contain a thin, albuminous fluid, or colloid matter. These tumours have been termed cysto-sarcoma and colloid tumours. 3. The elastic tissue is often wholly wanting in this kind oi cutaneous tumours, though, again, it may exist in very considerable quantity, and the new-growth thence assume a greater degree of consistence. 4. Adipose tissue frequently occurs disseminated in the .tolerably consistent connective tissue, in those tumours which IN THE EXTERNAL INTEGUMENT. 399 have received the name of steatoma. Schuh is indisposed wholly to reject this appellation, which has been entirely given up by several later writers, and claims for these tumours a well- marked glandular structure. 5. Blood-vessels in considerable abundance, or blood in large quantity, are found in the contents of the cutaneous tumours, composed of connective tissue, which have been described under the name of "fungus teleangiectodes." 6. An abundance oi pigment occurs in non-malignant mela- nosis of the skin. As illustrative of the above statements,^ the following cases may be recorded. A tumour composed of embi-yonic connective tissue was ex- tirpated by Professor Schuh, from the subcutaneous tissue on the forehead. The tumour, which was about 096" in diameter, was rounded, and the cut surface smooth, dry, of a lightish- yellow colour, and transparent at the edges, of a tolerably firm consistence, about equal to that of the liver, which organ it also resembled in its friability; it was contained in a capsule of connective tissue, and was very scantily supplied with blood- vessels. The embryonic connective-tissue-elements were very minute, and could be isolated only after the texture was loosened by maceration in water, by which the intercellular, connect- ing glutinous substance was dissolved. Fusiform elements, presenting short processes, and an obloug nucleus, were the principal constituent ; elliptical cells were more rare. The disposition of these elementary organs could be best seen in fine sections treated with acetic acid, by which the nuclei were rendered evident, in their natural position (tig. 95, a a). Darker spaces might be seen, bordered by lighter; the acetic acid having manifestly, somewhat diminished the transparency of the thin lamella. The nuclei in the rounded, more opaque parts, were surrounded by several systems of other, elongated nuclei ; and in the interstices between the concentric nuclear lamellae, oblong nuclei were again apparent, ultimately constituting a capsular investment surrounding an entire group composed of opaque portions. The disposition of the oblong nuclei presents ' The author here gives the details of several cases, to illustrate the account of these growths offered above, but as some of these instances seem to involve need- less repetitions, the editor has omitted several of them. 400 NEW-FORMATIONS OF CONNECTIVE TISSUE Fig. 95. a remarkable analogy with that of the bone-corpuscles, espe- cially as they are seen in the transverse section of a long bone. In some sections, also, a few isolated fat-cells (b b), often ar- ranged in rows, could be per- ceived, sometimes imbedded in an embryonic connective tissue, sometimes lying among the rare- fied elastic filaments (c c). In the base of the tumour, a few minute nodules were visible, which were rather more compact than the large lobes, though not differ- ing in structure. The super- jacent integument presented no striking anomalies. This tumour appears to have originated in the interstitial connective tissue of the fat-cells, and it may also be doubted, that the scanty fat-cells and the elastic filaments were a new- formation. The tissue of the corium had not suffered in consequence of the new-growth. With respect to its defi- nition, we inaintain, that anatomically, it must be regarded as an embryonic connective-tissue-tumour. In Rokitansky's classification it manifestly belongs to the class of gelatinous sarcoma ; and Schuh, in his comprehensive term of carcinoma fasciculatum, would probably regard it as an instance of that disease. A little nodule, about the size of a lentil, immediately under the skin of the knee, from an account afforded by Professor Schuh, had caused the patient the most acute pain, so that his whole body shook if any one approached the tumour with the finger. When removed, a very slender, white filament re- mained hanging to the tumour, which was supposed to be a nerve, but examination proved that it consisted merely of connective-tissue-fibrils belonging to the capsule of the nodule. Even after the application of carbonate of soda, not even a single nerve-tube could be demonstrated. The small tumour could be easily enucleated from the superjacent skin, and had a rounded form and pale colour ; the consistence was so soft, that its contents might almost have been supposed to be a IN THE EXTERNAL INTEGUMENT. 401 viscous fluid. A perpendicular section showed that it was composed of a soft, lightnyellowish substance, containing a few, scarcely visible, bloody points. A rather tense portiou of con- nective tissue, proceeding from the consistent capsule of the tumour, which was also composed of connective tissue, divided the enclosed substance into two segments. The soft, light-yellow material consisted of very minute elements, scarcely larger than a blood-corpuscle ; these were cells, some rounded, some an- gular, with a comparatively large, oval nucleus, which, filled nearly the whole of the cell, so as to leave merely a narrow border com- posed of the rest of the cell-contents. The fusiform cells were furnished with short, stunted, opposite processes, and also contained an oval nucleus of comparatively large dimensions. The latter cells appeared to be grouped around the former, as was evident from the disposition of the nuclei, in minute por- tions treated with acetic acid. Not a trace of nerve-substatice, could be discovered in the interior of the nodule. A portion of the tumour, dried and again moistened with acetic acid, pre- sented only a few, isolated, slender, convoluted, elastic fibres, in the substance ; they were found in larger number in the above-mentioned tense dissepiment composed of connective tissue. Blood-vessels certainly existed in but very small numbers in the interior, but were more abundant in the capsule of the tumour. The superimposed skin presented nothing abnormal, nor did the subcutaneous tissue. The anatomical examination, therefore, in this case also, showed a new-formation of connective tissue, which, at any rate, for the most part retained an embryonic character. The seat and point of origin of this small tumour must be left undetermined. At all events it is possible that the peduncle, composed of connective tissue, was in connexion with a bundle of primitive nerve-tubes,, which had been divided in the opera- tion ; and it might, moreover, be conceived that the capsule and the interstitial connective tissue of a bundle of primitive nerve- tubes may have been the point of origin of the new-forma- tion, and that the touching of the nodule was painful, only through the intermediation of the band of connective tissue. As the tumour was not seated in the continuity of a nerve, it cannot be described as a neuroma, but as representing merely the tuber culum dolorosum oi the o\Aer writers . .26 402 NEW-FORMATIONS OF CONNECTIVE TISSUE There can be no doubt that fibres of connective tissue constitute the principal element of many of these tumours, which may thence be termed fibre-cell-tissue-tumours, at least in an anatomical sense. They appear to arise in the deeper part of the corium, and the superficial portion of the adipose layer. From this point they continue to grow, circumscribed within certain limits, and elevate the corresponding part of the skin, probably inducing in it, when stretched beyond a certain degree, an obliteration of the nutrient vessels, and consequently its atrophy. § 3. Subcutaneous AniposE tissue and Interstitial TISSUE OP the muscles. It is well known that the little adipose masses visible to the naked eye are composed of groups of fat- cells, enclosed in tolerably strong bundles of connective tissue j and that the latter are associated with numerous elastic fibres, vessels, and nerves. Now from this connective tissue, existing so abundantly among the groups of fat-cells, in many cases, a new-formation of the same tissue appears to originate and secondarily to induce an atrophy of the fat-cells. We have examined embryonic, connective-tissue-formations in the adi- pose tissue, particularly beneath and in the neighbourhood of what are termed chronic varicose ulcers. The adipose tissue in these instances assumes a pulpy aspect, the fat-cells are diminished in size, appear isolated, and in their contents one or several fat-globules may be noticed, suspended in a hyaline fluid j in a word, they exhibit precisely the same con- ditions as do the cells described under the head of " atrophy of the adipose tissue." We have not, as yet, had an opportu- nity of investigating the nature of elephantiasis Graicorum, but from the anatomical data afforded us by Danielssen, we learn that in many cases a partial degeneration of the fatty tissue into cellular [connective] tissue, constitutes the proximate cause of the disease : and that the new-growth of connective tissue extends among the muscles as far as to the bones. In speaking of the atrophy of muscles, we adverted to a new-formation of connective tissue in which the muscle was IN THE SUBCUTANEOUS ADIPOSE TISSUE, etc. 403 gradually converted into a ligamentous band. But, besides this, a new-formation of connective tissue remaining at an embryonic stage of development, is likewise, though perhaps rarely, observed to occur in the muscles. We have met mth but two decided cases of this kind. One was that of a volu- minous tumour extirpated by Professor Schuh : it was seated on the pecioralis major, and so closely connected with it that an immediate transition existed between the substance of the base of the tumour, and that of the muscle. On the sides, the growth was covered by a capsule of connective tissue, in many places of considerable thickness. When this was reflected, an irregular, uneven mass, partly of a greyish-yellow, in parts of a greyish-red colour came into view, on whose polished surface no differences in texture could be distinguished. The con- sistence of the flattened nodules, which were transparent at the border, was about that of coagulated gelatin. The structure was foliated, and it was rendered more apparent in a nodule which had been placed in boiling water, by which the substance was rendered extremely friable. From a portion prepared in this way, it was more distinctly shown that each nodule or tubercle consisted of two cones flattened on each side, whose bases were directed towards the surface of the tumour, and which could again be split in the direction of their length. The radiate disposition of the fibrous lamellae was most distinct towards the centre of the tumour. The surface of a section appeared smooth, and homogeneous, and, by pressure, only a small quantity of a clear yellowish, viscid moisture could be obtained. The shades of colour, particularly of red, were rendered more distinct when the corresponding portions were treated with dilute sulphuric acid, by which the parts, infil- trated with hematin and exhibiting only a faint tinge of red, acquired a more or less intense, brownish-red hue. To- wards the centre of the tumour, vessels with thin walls, and blood-sacculi could be seen, but in general a great scarcity of vessels was noticed, nor were any of capillary dimensions, visible. In other parts, also towards the centre, there were simply blood-red spots without any defined boundaries. The flattened nodules were parted by a delicate, fibrous layer of connective tissue. The histological examination showed, in all parts, nothing 404 NEW-FORMATIONS OF CONNECTIVE TISSUE but minute cells, mostly of a fusiform shape, with two short, opposite processes, an oval nucleus, and a distinct nucleolus. These cells were disposed parallel to each other, as it were, wedged together, and occasionally, when the central part was slenderer, exhibited oblong nuclei. The elliptical cells, with a more rounded, also comparatively large nucleus, occurred less abundantly. Granule-masses were accumulated in considerable quantity, especially in the neighbourhood of the more vascular spots ; they were imbedded in a pultaceous, deep-yellow sub- stance, which was lodged in the deeper layers of the tumour, and were disposed in tolerably symmetrical, longitudinal rows. In the same situations were collections of larger and smaller fat-globules. In boiling water, the growth lost its transparency, was rendered opaque, and like coagulated albumen. Acetic acid also produced some degree of opacity, and, under its influence, fine sections assumed a brownish-yellow colour, and, on account of the diminished transparency, the nuclei were distinctly visible only at the borders of the preparation. In the alkaline car- bonates, the substance became more hyaline, and exhibited little more than a fine-molecular character. In this case, the predominant character of the tumour must be allowed to be that of a new-formation of connective tissue, distinguished by the embryonic form of its elements, and the remarkable contents composed of fluid albumen associated therewith. The fibre foliated structure may be accounted for, on the supposition, that the new-formation took place in the longitudinal areolm of the interstitial tissue of the pectoral muscle, in consequence of which the muscular substance was removed. But the question still arises, as to whether the new-growth should not be ranked with those which have been described by J. Miiller as carcinoma fasciculatum, and of which Rokitansky relates only one accurately examined instance taken from the mammary gland. The tumour just described certainly pre- sents considerable analogy with carcinoma fasciculatum, but we think, that in a purely anatomical point of view, it must be described as belonging to the class of growths composed of embryonic connective-tissue, since it exhibited neither an areolar stroma, nor that diversity and difference in the evolution and involution of the elementary constituents, which might have IN THE SUBCUTANEOUS ADIPOSE TISSUE, etc. 405 been expected to exist in a growth of such considerable dimen- sions, had it been of a cancerous nature. According to Schuh's classification, the above-described tumour must, indis- putably, be referred to carcinoma fasciculatum. In a large experience of cases of this kind, Schuh has never observed the general health to be perceptibly affected, the glands of the axilla were never enlarged, and the aspect of the disease pre- sented no peculiar characters, and could not be distinguished from a steatoma or cysto-sarcoma. The degree of malignancy he describes as very small. But he is, nevertheless, of opinion that the disease must be explained as of a cancerous nature, since it is occasionally painful, is readily regenerated, and a liquefaction may take place in the midst of the substance in con- sequence of suppuration. But in the present confused notions of what is to be termed cancer, we may be allowed, at any rate, to place a mark of interrogation against the cancerous nature of the case just described. A white, yellowish-grey tumour, of about the size of a walnut, abruptly defined, and presenting a granular aspect on section, was removed by Professor Sigmund from the pectoral muscle. It consisted wholly of minute cells, usually of an oval form, with a large, oval, nucleolated nucleus, occupying nearly the whole of the cell. Fusiform cells were more rare ; these were very small, short, and occasionally so much attenuated in the body, as to present a rod-like figure, acuminate at both ends, not unlike that of acicular crystals, but for which they could not be mistaken, even upon superficial examination, since they did not possess the sharp, angular outline of a crystal. These elementary bodies were readily disengaged, and presented everywhere the same characters. Indications of fibres were very rarely presented, and those of very delicate dimensions. We shall here add the description of a few tumours of con- nective tissue, differing in morphological character, and whose systematic position cannot be assigned with certainty* An encysted subcutaneous tumour, seated, probably, upon the tendinous sheath of the masseier muscle, of a rounded form, and about 0'96"' in diameter, was removed by Professor Dnmreicher. It had required two years to reach these dimen- sions, and, except quite latterly, had caused no pain. Its consistence was tough, the colour greyish-yellow, and it was 406 NEW-FORMATIONS OF CONNECTIVE TISSUE Fig. 96. pervaded by only a few blood-vessels; tbe structure was gra- nular, though not in all parts, for in places the granular struc- ture was replaced by a still more consistent paler substance. The yellowish granules contained the following elements: I. Rounded and oblong-cells (fig. 96, a), with a round or oval, nucleolated nucleus, which was sometimes double, and fine-granu- lar contents. 2. Cells with two opposite filamentous processes, and one or two nuclei, which were more elongated in proportion to the attenuation of the body of the fusiform cell; whilst other cells with several sub-dividing processes (multipolar connective - tissue- cells) were presented in the most manifold forms. These cells were connected by their processes with a fine filamentous net-work (6), which itself was brought more distinctly into view upon the addition of acetic acid, or of car- bonate of soda or potass, and could be traced into an almost invisible, excessively delicate plexus. This net-work presented in all respects the morphological and chemical characters of a fine elastic tissue, and was most abundant in the denser por- tions of the growth. The groups of cells constituted rounded masses (fig. 96, c, 1), whence, those which were placed at the border of the mass were viewed on the edge, and a rosette- like figure was produced. In one of the large groups, the cells could be observed in close apposition, in great numbers (c, 2), when they were not unlike epithelial-cells. Occasionally, also, they occurred in lengthened rows (c, 3), either simple or several together. The cells were lodged in the areola formed by the connective-tissue-bundles and elastic fibres. This tumour, whether it be termed sarcoma, fibroid, or stea- toma, represents, nevertheless, a new-formation of connective and elastic tissues ; the latter of which, either in the normal or in the pathological condition, never occurs alone, but always associated with the former. That the elastic fibres were not, in any way, a mere residuum of the original -tissue, may be IN THE SUBCUTANEOUS ADIPOSE TISSUE, etc. 407 positively asserted, since their quantity was very considerable. This was even more evident in the following case. A tumour ahout the size of the closed fist, was situated in the region of the parotid gland; the skin covering it was moveable ; it presented several tubercular elevations, indistinctly fluctuating. It was twelve years in reaching its present dimensions, had caused no pain, and was not accompanied by any perceptible constitutional affection. The extirpation was undertaken by Professor Dumreicher. The growth was sepa- rated from the neighbouring parts by a capsule of connective- tissue. In a section of it, two kinds of substance could be distinguished, one gelatinous and quivering like jelly when shaken, the other yellowish and tough, which latter, also enclosed gelatinous lumps of the size of a pea, contained in a kind of capsule. The surface of the section was rather dry, and only a very small quantity of clear juice could be squeezed out. The cells were of small size, and the rounded, as well as the fusiform, frequently contained two nuclei; the nucleoli were very distinct. The nucleus, in proportion to the size of the cell, was large and usually of an oval form ; only the cells in the gelatinous substance exhibited a vesicular nucleus, en- circled by fatty molecules. In the yellowish tough parts, the elastic filaments constituted the principal element (fig. 97). The Fig. 97. largest of these equalled in size the thicker filaments in the subcutaneous tissue ; they were frequently bifurcated, and at the point of division, when they were favorably placed, a toothed border could be seen on one side. Two or three rather large filaments often ran together in the same direction, separating ultimately, and when ruptured, curling up in a tendril-like manner. Occasionally also, short anastomosing 408 NEW-FORMATIONS OF CONNECTIVE TISSUE ramules could be perceived among the thicker branches, whence fissure-like interstices were produced. The slenderer fila- mentSj just like the thicker ones, were much convoluted, and, occasionalljr, spirally contorted, or bent into a hook at the end, whilst, in other places, they terminated in a very close and deli- cate filamentous network. It was obvious, that the whole elastic network resisted the action of acetic acid, and of carbonate of potass, whilst the connective-tissue-bundles, and few imbedded cells, disappeared on the application of those reagents. In order to study tumours of this kind, in section, and to display, satisfactorily, their areolar arrangement, either portions not too thick, may be simply dried, or a larger portion may be boiled in acetic acid, and then dried. It is advantageous also in many respects, to treat sufficiently thin sections with a weak solution of carbonate of soda. § 4. MtrCOtJS MEMBRANES. New-formations of connective tissue, though undoubtedly very frequent in these membranes, have hitherto not been submitted to very precise investigation. Like those of the external integument, they occur, sometimes as dendritic, pa- pillary new-formations, on the surface of the membrane ; or as embryonic or fibrous new-formations, seated in the parenchyma of the membrane, and in the submucous tissue. We once had an opportunity of examining an acuminate condyloma, situated upon the uvula, and which was removed by Professor Sigmund, and found it to be constituted exactly like those seated on the external integument. The bleeding consequent upon the operation, rendered it impossible to trace the blood-vessels with any accuracy ; but the common epithelial covering could be readily made out, spread over a numerous group of mostly short, cylindrical, and clavate papilke, which were disposed in an umbellate manner. The urethral caruncles, as they are termed, especially in the female, are also dendritic, papillary new-formations of connective tissue. We received from Professor Chiari, a very vascular tumour, which he had met with in the dead subject, at the orifice of the female urethra, in the vestibule. It was of a IN THE MUCOUS MEMBRANES. 409 somewhat elongated figure, above 0-5'" in length, and 3-1 — 3'5"' in diameter, of a bluish-red colour, and spongy texture, and exhibited, when cut into, cavities containing colloid matter. The surface was smooth, marked with shallow indentations, and evidently covered with epithelium. The matrix of the growth, was constituted of embryonic connective-tissue. The most interesting point was the distribution of the blood-vessels, which could be very distinctly traced in transverse sections, moistened with a solution of sugar, or of common salt. The ramification of the vessels precisely resembled that witnessed in the vasa vorticosa. Several considerable sized vessels enter- ing one of the lobules, divided into a multitude of smaller ones, which, though not of capillary dimensions, made numerous undulating curves, extending up to the periphery of the lobule, where they terminated in mostly short and abrupt loops (fig. 98, a a a). In favorable situations, a more voluminous vessel might be noticed towards the p,g gg^ base of the lobules, which appeared to return the blood from the peri- phery. The structure of the walls of the vessels, was everywhere simple, resembling that of the capil- laries in the normal condition ; no distinction, therefore, could be drawn between arterial and venous canals. The red blood-corpuscles contained in these vessels were re- markable from the smallness of their size, which did not reach be- yond 00017 — 00023'", whilst it is usually 0-0033'". The blood moreover, in spots, had escaped into the parenchyma of the tumour ; and in many places also, brownish-black pigment granules (necrosed blood ?) were col- lected in considerable abundance. These caruncles are sometimes met with in great numbers, and of firmer consistence. Schuh has observed that they fre- quently return after extirpation, since, even when the urethra has been slit up to some extent, minute remains of them may easily be left. When they return, he has occasionally found NEW-FORMATIONS OF CONNECTIVE TISSUE them to be of firmer consistence, and involving even the clitoris and a portion of the vagina. In cases of hypertrophy of the uterus, when the lips have a soft feel, we have repeatedly seen the papillcB considerably enlarged, with the vessels more numerous than in the normal condition, more serpentine in their course, and dilated. But, in tKese cases, we have been unable to detect any dendritic formation of connective tissue. It is highly probable that the cauliflower-like polypi of the larynx, described by Ehrmann, and which have been termed epithelial cancer (epidermic cancer, cancroid) by Rokitansky, also belong to the category of dendritic, papillary new-forma- tions of connective tissue. According to the latter observer, they are cauliflower-like, whitish-red, vascular excrescences, seated, either upon a peduncle of connective tissue covered with the mucous membrane, or upon a broader base. They constitute small, distinct tumours, or, growing in close con- tiguity with each other, cover a more extensive space, or even the whole of the mucous membrane of the larynx. They spring either from the mucous membrane, or are more deeply rooted, growing, that is to say, from the submucous tissue, frequently from a degeneration of the arytenoid cartilages, or even of the whole of the walls of the larynx. The gums are, without doubt, frequently the seat of a difiFuse new-formation of connective tissue. In a paraplegic person affected with scurvy, the gums were of a bluish-red colour, and so much swollen as to be nearly level with the borders of the teeth. When incised, there was presented, beneath the thick epithelial layer, a stratum of a dark-red colour, not unlike the crassamentum of blood, which contained, however, not simply blood-corpuscles^ but also a considerable quantity of embryonic connective-tissue-elements, together with granules of yellow, reddish-brown, and black pigment. The connective- tissue-cells were elliptical, oval, or elongated, the latter fur- nished with a single process of greater or less length, or with two opposite processes. The mostly oval nuclei, with a pro- jecting nucleolus were frequently double in these cells.^ ' [The plastic nature of the scorbutic exudation, has been before adverted to (vid. note, p. 234), and is sometimes manifested in the most remarkable way in the gums. We, not long since, observed a case in the Seaman's Hospital, in which a IN THE MUCOUS MEMBRANES. 411 A sacciform appendage" ^\i occasionally seen to remain attached to the root of teeth that have been extracted. In a case that fell under our observation, in which the tooth was carious, the growth was of about the size of a large lentil, had a rounded surface, was very vascular, and of a loose spongy structure. The vessels were serpentine, and collected into coils, the interstices being filled up by a deHcate fibrous tissue and immature connective-tissue-elements contained in a hy- aline blastema. Growths of this kind occasionally suppurate internally, and constitute the well known closed abscesses at the root of the teeth. The new-formation, in these cases, must arise from the alveolus. A layer, 0"44'" thick, of new- formed connective tissue abundantly supplied with vessels, was observed by us on the neck of a molar tooth, whose pulp had become disintegrated into a dark-coloured, pultaceous substance composed of organic detritus. The development of this new- formation, in particular cases, owing to the copious supply of nerves to the alveolar periosteum, may perhaps be attended with pain. A tumour of about the size of a pea was situated in the substance of the tongue on its inferior aspect, and on the posterior part of the middle third of the organ, which was extirpated by P. Dittel. It was surrounded by a membranous capsule of connective tissue, was pale and resistant, presenting, on the surface of a section, numerous, scattered, just perceptible, yellowish points, which, when compressed on both sides, pro- jected a little, and appeared as structureless, hyaline, flocci- form plates of irregular size, superimposed one upon another ; their borders were fissured, and they were not altered by acetic acid. The remaining elements, which could be obtained only in small quantity, by pressure, were minute connective-tissue- cells in various transitional forms. Sections made, both in the moist and in the dry condition of the tumour, displayed complete bridge was formed across the palate by the inosculation of scorbutic vegeta- tions springing from each side. After the removal of all appearance of scurvy in the tissue of the gums, this bridge remained fully organized, covered with a normal epithelium, and when removed and examined, it presented a structure in all respects corresponding with that of the gums. No more striking instance can be afforded that the scorbutic effusion is not blood in the proper sense of the term, but a peculiar, fibrinous, plastic exudation. — Ed.] 412 NEW-FORMATIONS OF CONNECTIVE TISSUE the areola enclosed by bundles of connective tissue, and filled, at any rate the majority of them, with the same amorphous masses. The latter must probably be regarded as solidified colloid matter, which had been secreted, in the fluid state, into the dilated areolm. The tumour itself was manifestly one of the fibro-cellular kind. The growths of connective tissue described as polypi of the throat and nose have only once been examined by us. The pharyngeal polypus was seated on the posterior and upper wall of the pharynx, it was of colossal dimensions, highly vascular, and very firm, especially towards the periphery, where it was of cartilaginous consistence ; towards the centre, the con- sistence was less, as well as the redness. Abundant reticular, elastic tissue was visible in all parts, and it was owing to this that the connective tissue bundles included in the tough sub- stance could be displayed only with difficulty. Towards the less consistent part, more numerous fusiform cells with oblong nuclei were visible, whose regular arrangement was rendered apparent on the addition of acetic acid. The nasal polypus was softer, consisted of larger cells, and presented wider reti- culations. Some polypi of the stomach, as they are termed, about the size of a bean, projecting from the surface of the mucous membrane into the cavity, exhibited, even under a low magnifying power, and by reflected light, a trabecular tissue with several hemispherical prominences. The substance was constituted of straight fibres arranged so as to form a wide meshwork, containing in the spacious interstices, granular cor- puscles, usually of an elliptical form, but some more or less angular, together with fusiform cells, with one or two good- sized nuclei. The pepsin-glands, in these situations, no longer existed. We regard this growth, also, as a new formation of connective tissue, arising from the connective tissue stroma of the membrane, supplanting the glandular follicles, and still retaining the epithelial coat. What is termed " hypertrophy of the membranes of the stomach, consists principally in a growth of fibrous connective tissue in the submucous stratum, to which is occasionally superadded a hypertrophy of the mus- cular substance, in the pyloric portion of the viscus. IN THE UTERUS AND CHORION. 413 Pig. 99. § 5. Uterus and Chorion. The new-formations met with in these situations occur under two forms : 1. As distinctly circumscribed tumours, encysted either in the substance of the uterus and supported on a broad base, or projecting on a peduncle into the cavity of the organ, or of the vagina, or towards that of the peri- toneum. 2. As shaggy growths thrown out upon the inner wall of the uterus. The formations of the former kind are usually termed fibroid, and when pedunculated, polypi. A uterine polypus which was ligatured by Prof. Chiari, presented an oval form, and a pale-reddish colour ; it was 2'34" long, 1"17" broad, and about 0'96" thick, tolerably consistent, and at the same time somewhat extensible, exhibiting on one side of its surface, short, pale-red fibres, which, when removed by the forceps, appeared very closely to resemble those of organic muscle. They constituted bundles (fig. 99, a, b, c), decussating under various angles, and composed of long, straight elements attenuated at each end {d) ; which were arranged parallel to each other, and in this way formed band-like streaks. The nuclei were rendered more distinct by acetic acid. On the sur- face of a section, the areola were visible, like minute pits of different sizes ; the largest of them appeared to the naked eye about the size of a pin's-head, and they were occa- sionally filled with coagulated blood. No trace of perfectly formed vessels could be detected. The constituent elements, which were obtained in small quantity by pressure, were mainly, pale, oval cells in scanty numbers, and fusiform cor- puscles with slender nuclei pointed at each end. Lastly, there was also a considerable number of flattened, hyaline masses of indeterminate form and size, usually irregularly jagged at the edges (most probably colloid in the solid state). The bundles 414 NEW-FORMATIONS OF CONNECTIVE TISSUE of connective tissue, which could be traced in thin sections, had a distinctly areolar arrangement, and decussated with each other at all angles. The various layers of slender, oblong nuclei were brought into view on tlie addition of acetic acid ; but neither by that reagent, nor by carbonate of soda or potass could any elastic filaments be displayed. As the operation had an unfortunate result, an opportunity • was afforded of examining the substance of the uterus also : this organ was considerably thickened (up to 0'094"). On its inner aspect, corresponding to the place of attachment of the polypus, there was a depression, and the adjoining substance of the uterus was, there, more vascular than elsewhere. The fibrous tissue was infiltrated with a fatty, molecular material to such a degree, that, even to the naked eye, the whitish reticular streaks produced by the deposit were visible, not unlike the reticulum of cancer. In order to obtain a more distinct view of the grouping of the elementary constituents in growths of this kind, it is advantageous to boil them in dilute acetic acid, and to take thin sections from them, when again dried. Fig. 100 repre- sents a section prepared in this way. It was taken from a uterine polypus presenting the same characters as the one just described, and which had been re- moved by Prof. Chiari, The pointed nuclei are seen disposed, at regu- lar distances apart, partly in directions pa- rallel with their longitudinal axis, partly in a sort of areo- lated, divergent fashion. These systems of nuclei enclosed spaces (a a), exhibiting, at definite intervals, rounded, or perhaps also elongated corpuscles, representing the nuclei, seen under a right, or somewhat oblique angle, of fusiform ceUs disposed in a direction vertical to the foregoing. Thus, in this instance, there existed, essentially, two systems of fusiform cells crossing each other at a right angle. Fig. 100. IN THE UTERUS AND CHORION. 415 The encysted fibroid tumours of the uterus not unfrequently present numerous nodules, varying in size from that of a lentil to that of the closed first. They are surrounded by a more or less dense sheath of connective tissue, in which are always lodged several considerable-sized vessels, and which may be regarded as the proper source of the nutrition and growth of the tumour. The consistence of these tumours is, usually, very dense. In the transverse section of a tuber of medium size, its composition of several lobe-like divisions may be observed even by the naked eye; the divisions are surrounded by a glistening, white, fibrous tissue supporting the vessels. These boundaries of the lobes arise from a fibrous structure, from which are formed secondary and tertiary subdivisions, which, when viewed by the microscope, are found to be ultimately composed of fibre-cells. Elliptical cells, also, are constantly met with, of small size, with a proportionately large nucleus ; and short fusiform cells with an oval nucleus; both in small number. The addition of acetic acid, or, still better, of a weak solution of carbonate of soda or potass brings into view very delicate, isolated, elastic filaments, which frequently occur in large quantity j whilst in other cases, again, they appear to be wholly wanting. The blood-vessels, even the larger, have very thin walls, consisting of a single layer having imbedded in it elongated nuclei, disposed in the axis of the vessel ; they fre- quently diminish in size very abruptly, and often exhibit pro- trusions. The transverse fibres which are occasionally brought into view in these vessels upon the application of acetic acid, constitute a layer of inconsiderable thickness. Bloody points, however, may also be seen, without any defined line of demar- cation, and with irregular, jagged processes. They occur altogether isolated, and have no sort of connexion with the blood-vessels. We are of opinion, that a new-formation of blood takes place at these points, which is at first unaccom- panied with the development of any proper walls. Fibroid tumours of the uterus very frequently undergo a partial involution. This change consists in the accumulation of minute fat-globules, unalterable by acids and alkalies, and composed of a brownish-yellow, or blackish-brown material. Very often, also, deposits of calcareous salts take place, some- times in a fine-granular, sometimes in a botryoidal form, dis- 416 NEW-FORMATIONS OF CONNECTIVE TISSUE appearing on the addition of acetic or hydrochloric acid, occa- sionally with the evolution of air-bubbles. When the cre- tification is more extensive, smaU concretions are formed, which are readily enucleated from the closely applied capsule composed of connective tissue, and exhibiting, in thin sections, black, irregular subdivisions of various sizes, and usually jagged at the borders; these concretions are generally im- bedded in a transparent, often streaked and granular inter- stitial substance, and might, on occasion, be confounded with bone-corpuscles. The distinction between the two cannot be more definitely stated until we come to speak of new-formations of bone, when we shall adduce an instance of a fibroid growth in the uterus, in which true ossification had taken place. The looser, softer and redder new-formations of connective tissue, sometimes pedunculated, sometimes sessile, seated on the surface of the uterine cavity, or of the uterine canal, exhibit a more embryonic character. Their cells are larger, and present a greater multiplicity of form than do those of the dense, tuberous, fibroid growths. The clear vesicles which frequently occur on the surface or in their substance, contain a trans- parent, tenacious, glutinous juice, which is rendered opaque by acetic acid. Those parts which are of a lively red colour contain an abundance of vessels. Even by means of a simple lens, a very delicate vascular plexus maybe seen, constituted of wavy, much convoluted vessels, assembled into lobate groups. As they ramify, the vessels diminish rather rapidly, in size, forming open loops at the periphery of the lobes, resembling those represented in fig. 98, as occurring in the so-termed urethral caruncles. Besides this, on the surface of sections, tolerably extensive bloody spots may be seen, with respect to which it is still very doubtful whether they should in all cases be regarded as extravasations ; at any rate, in some of these spots nothing but recent blood, without any indication of involution, can be perceived. The new-formations, which have a spongy feel, and present an indistinct fluctuation, enclose, between the lobules, fissure-like spaces, sometimes of consi- derable size, filled with a serous fluid. Solitary, or aggrcr gated fat-cells, are occasionally met with in the parenchyma of these tumours. A tumour, about as big as a hazel-nut, and of a lively-red IN THE UTERUS AND CHORION. 417 Fig. 101. colour, was seated, with a broad basis, on the inner wall of the uterus; it was of soft consistence, and constituted of several, hemispherical, projecting lobules or nodules of various dimen- sions, filled with a transparent substance, and on whose surface very delicate vessels ramified. The main constituent of these nodules appeared to be irregularly shaped, pale, flattened, structureless corpuscles, some, also, being of an elliptical or oval figure, and which were unaflPected by acetic acid. We think they must be regarded as colloid masses. In one of these lobules there was a considerable number of very curiously constructed corpuscles. Most of them were of a flattened, oval shape (fig. 101, a, b), whose outlines were occasionally indistinct. And they dif- fered so widely in size that the largest specimens were at least from eight to ten times as large as the smallest, which scarcely exceeded an epidermis-cell in size. In the centre they presented a granular mass, bounded sometimes by a round, some- times by .a more elongated line of demarcation. From this mass, again, apparent filaments radiated, which bi- furcated in their course, and when approaching the peri- phery broke up into a penicillar fasciculus. twigs belonging to one body sometimes encroached upon the limits of another, in which way' were produced com- pound forms. In many other nodules which were examined, these bodies could not be found, but, instead of them, were seen elliptical, or oval, sharply defined corpuscles, contain- ing a fine-granular material (c), and of various dimensions; hyaline structureless globules {d) of various sizes were, also, met with. The latter, as well as the granular corpuscles, were imbedded in a flattened granular body (e), or perhaps merely rested upon it. Now what is the nature of these bodies, none of which,^ 37 The terminal 418 NEW-FORMATIONS OF CONNECTIVE TISSUE perhaps, can be regarded as cells ? It appears to us most pro- bable that a, b, are colloid corpuscles, in which the centrifugal solidification has taken the filamentary form j that e represents a precipitated albuminous substance ; and d, protein-masses in a semi-fluid condition. Eepeated observations are required to elucidate these points more clearly. The so-termed ovula Nabothi are usually regarded as dis- tended follicles of the mucous membrane of the cervix uteri. But the general correctness of this opinion appears to be still very doubtful. The ovula are vesicular projections, of the size of a pin's head up to that of a pea, seated either on or in the mucous membrane ; in the latter case sinking more deeply into the parenchyma of the uterus. They contain embryonic elements of connective tissue of the most various forms, imbedded in a clear substance. The cells occasionally attain to a gigantic size, and present two or three nuclei ; their contents sometimes exhibit minute, black pigment-molecules. Pus-corpuscles, nucleated bodies, streaky masses (mucin), are found in them as well as in the transparent mucus (vid. fig. 76). Vesicular projections, exactly like the ovula Nabothi, are also found on the lips of the os uteri, where papilla only and no mucous follicles exist. Practitioners have often sent us organized bodies discharged from the uterus, with the question, whether anything like the structure of the chorion could be seen in them. They have usually been pale coloured, soft, and readily torn asunder by needles into fine fibrous fragments ; but no chorion-villus has ever been perceived in them, nothing being apparent but much divided connective-tissue-bundles and cells of various forms. A woman, at the climacteric period of life, and sufi"ering from uterine hemorrhage, discharged an oval, soft, fleshy-red body, about as large as an ovum at six weeks. Not a single villus could be observed with certainty, although the thickness of the connective-tissue-bundles, and their divisions, resembled in some degree the structure of the peduncles of villi; a multitude of minute connective-tissue-cqlls, however, of an elliptical, oval, or fusiform shape, could be seen. Now, in this case, a decision was to be made between two possibilities, whether this body were ab oriffine a new-formation of connective tissue, or a chorion in progress of degriidatioh into that tissue ? As no vestige of a IN THE UTERUS AND CHORION. 419 cavity for the reception of the ovum could be perceived^ and as, a few days afterwards, the same woman discharged a soft, fatty mass, mixed with coagula, which proved to be com- posed of connective tissue, and in which blood was likewise contained in cysts of connective tissue, without any other trace of vascularity, we regard it as more probable that we had to do, not with an aborted ovum, but with a genuine new-formation of connective tissue, which had been seated on the wall of the uterus, and been thrown off by the subsequent hemorrhage. [A very similar case, in which the mole was putrid, and, therefore, more difficult of examination, but in which no trace of villi could be perceived, is also given.] But this much is certain, that new-formations of connective tissue not unfrequently occur on the wall of the uterus, in the form of flocculi, and become detached, in consequence of hemorrhage, suppuration, putrefaction, or repeated exudations. In puerperal endometritis, we have also found, at the place corresponding to the insertion of the placenta, together with a great number of pus- and granular corpuscles, large, elliptical, oval, pyramidal, rhomboidal or fusiform cells. The nuclei were comparatively very large and oval, and the nucleolus very distinct. The nucleus was excentric, drawn out, and narrow in the more slender fibre-cells, and often double. The cell- contents were usually finely molecular, but occasionally, also, groups of fat-granules might be observed in the larger cells. The latter, with their manifold transitional forms, which, by the way, it may be remarked, presented all the characters of what have erroneously been described as the specific cells of cancer, could only be regarded as new-formed connective- tissue-cells. It has already been remarked, in speaking of the serous degeneration of the villi of the chorion, that large, embryonic, connective-tissue-cells occur, which escape in considerable abundance when the chorion of ova in the first months of pregnancy is torn asunder [vid. fig. 32, c). These cells may be placed in three categories: 1. Spherical forms {vid. c, the' uppermost row of cells) ; among which, the cells, presenting a hyaline space, occupying nearly their whole interior, may be variously interpreted. For the question arises, whether the spherical, light space which, in its excentric position, is sur- 420 NEW-FORMATIONS OF CONNECTIVE TISSUE rounded by a finely granular substance, represent a nucleus. Should it be so viewed, the latter might be regarded as in a state of serous degeneration. But the possibility may exist, that in the serous degeneration of the plasma, water is im- bibed, and forces the molecular contents towards one side. But the circumstance, that the light space is so distinctly bounded and spherical, and the fact, that if of smaller size it would neces- sarily be looked upon as a vesicular nucleus, render it far more probable that, in the dilated condition, it still represents a body of that kind. 2. The cells of an oval form also have an oval, hyaline nucleus, which is partly concealed by the more abun- dant, granular cell-contents. 3. Cells with one, two, or several, pointed processes, still always presenting the large, pale nucleus. In a case of mola hydatidosa, which occurred in the practice of Professor Klein, it was manifest that the essential character of the growth consisted in an embryonic new-formation of con- nective tissue, combined with a serous degeneration of the villi of the chorion. In this case, the vesicular mole consti- tuted a light, flocculent, racemose mass, about the size of a child^s head, and weighing one pound, and composed of innu- merable, clear vesicles, varying in size from that of a hemp- seed to that of a pea, and connected into filamentous strings. In the central substance of the mole we noticed a sacculated, softer, gelatinous portion, faintly tinged with blood, and about an inch long, at the inner . side of the periphery of which a short, filamentary body (remains of the embryo ?) depended, whilst externally a collapsed vesicle (umbilical vesicle ?) was placed. These supposed structures could not be subjected to any closer examination. Besides the villi in a state of fatty and of serous degeneration (fig. 32, d), the thin, clear, gelatinous, viscous masses, collected for the most part in the villi, trans- formed into vesicles of divers shapes, but partly also in the substance of the peduncles of the villi, attracted our atten- tion. They contained scattered, embryonic connective-tissue- elements of the most various dimensions and forms, and irre- gular traces of straight filaments, closely resembling those described as mucin-filamenis. In the distended villi of a fresh mola hydatidosa, Virchow found a substance which he distinguishes from fully developed IN THE THYROID GLAND. 421 connective tissue, as well as from colloid, by their different chemical properties, and describes as "mucus-tissue." He has pointed out the existence of this tissue in the umbilical cord, the vitreous body, and in a whole series of pathological for- mations, which have hitherto been referred to colloid tumours (as, for instance, gelatinous cancer). Embryonic formations of connective tissue, in various stages of development, may almost always be observed on the concave surface of the placenta of still-born or aborted foetuses in the last months of pregnancy {vid. figs. 77 and 78). On the convex surface, and in the parenchyma of the placenta, these new-formations are seen in the form of minute nodules, and in cases of adherent placenta they form connecting bands between it and the uterus. Dr. Braun records an instance of a very diffuse new-formation of connective tissue in the chorion of a woman affected with syphilis. The growth was of very lax consistence, discoloured, and without any clearly defined villi. The substance had degenerated into a molecular mass, with angular nuclei, which were so abundant as to produce an evident cloudiness in the water used to wash the prepara- tion. Numerous, Targe, flattened, mostly elongated cells, with a transparent nucleus, and abundant fatty molecules in their contents, were also met with, assembled into considerable groups. We consider this instance as so far remarkable that new-formations of connective tissue are, in general, frequent in syphilitic cases, and in the present instance had induced an atrophy of the parenchyma of the chorion, which, again, had caused the abortion of the embryo. § 6. Thyroid gland. Well-marked formations of this kind occur in that class of cases of bronchocele known as cystic struma, and described by Rokitansky as the second type of bronchocele. The organ is misshapen, and its surface rendered uneven, or tuberculated, by elevated nodules, of various size and number, of a rounded form, and enclosed in a dense, fibrous tunic. We have noticed the latter in speaking of exudations limited to separate por- tions of the thyroid body, and, at the same time, adduced the fact, tjiat a new-formation of connective tissue takes place 422 NEW-FORMATIONS OF CONNECTIVE TISSUE around the infiltrated lobules, followed by an increase in the number of vessels also. The more or less vascular connective- tissue-capsule now becomes, as it were, a fresh nidus, from which a new organization commences in the plasma which is continually deposited on its inner surface. The encysted portion of parenchyma of the gland, in most cases, is then wholly or partially removed, nothing remaining but a sac, filled with a more or less thin fluid, and lined with an epithelium, and which thus presents the properties of a cyst. Now, if the inner surface of this cyst be subjected to a closer examination, there will, in many cases, be perceived, even with the naked eye, short, fringe-like projections, which float out under the water, and are, apparently, affixed to the inner wall by a pedicle. Occasionally, these processes are not visible until the blood-coagula, not unfrequently collected in the sac, have been carefully washed away. This was the case in the instance here represented, in which the fringes projected be- yond the centre of a cyst nearly an inch in diameter, and, when cut ofi' at their insertion, presented the following ap- pearances : they were supported on a peduncle, which was elongated into a stem, dividing and subdividing into primary and secondary branches (fig. 102). The stems and branches Fig. 102. •s* were sometimes slender and weak, sometimes thicker, and beset with several nodular protrusions («). The terminal branches appeared rounded, assuming the form of hemispherical, cyliur IN THE THYROID GLAND. 433 drical, conicalj or clavate papillce. They were seated either in groups, or solitary upon a branch, or as wart-like elevations immediately upon the stem. The hemispherical, papillary ex- crescences which must be regarded as the most recently formed, were seated in great numbeis upon the stem seen arising at a. All the excrescences in this instance were of either a darker or lighter brownish-red, and brownish-yellow colour, and, under stronger magnifying powers, presented a distinct contour line throughout the periphery. Their structure may be deduced from those amongst them which had undergone little or no degeneration. On their surface was occasionally apparent, an epithelial investiture, con- sisting of minute, polygonal cells, almost entirely filled with an oval nucleus, which, where fatty degeneration had commenced, was seen to be surrounded with a circle of fatty molecules. In those which had no epithelium, the addition of carbonate of soda, nevertheless, still brought into view the membrana propria as a sharply defined, light-coloured border. The proper pa- renchyma was constituted of coalesced conuective-tissue-ele- ments, with elongated nuclei, which became transformed into connective-tissue-fibres. Rokitansky, who first noticed these dendritic excrescences of the cyst, regards them as hollow structures, and describes them as containing very considerable vessels, forming large loops and curves. It is highly probable that Ecker's vascular brouchocele, presenting aneurismal dila- tations of the new-formed vessels, depends upon a more luxuriant vegetation of the vascular excrescences, and should hardly be regarded, as Rokitansky has already remarked, as a distinct species of bronchocele. The development of these growths may be observed on the inner wall of the cyst. Small, hemispherical, sharply-defined projections arise from the deposition of the plasma in circum- scribed spots J their contents ai-e at first fine-molecular and opaque, afterwards becoming transpai-ent, and presenting lighter, nuclear bodies. As the excrescence increases in length, rounded protuberances are visible upon it, which, continuing to grow, become branches, and again, as it were, push out new buds, These new-formations, however, undergo a retrograde metamor- phosis, sometimes pai'tial, sometimes universal. Their contents degenerate into & fatty, molecular substance, which collects, 424 NEW-FORMATIONS OF CONNECTIVE TISSUE especially at the apices of the papilla, is unaltered on the addition of acetic acid and of the alkaline carbonates^ and appears dark-grey by transmitted, and white by direct light. By the accumulation of colouring matter the excrescences are rendered brownish-yellow and reddish-brown. They sometimes acquire a sandy feel, from the deposition of calcareous salts in a granular form. Rokitansky first ascertained that, in consequence of the in- crease of the new-formed material in the cyst, the latter at length exhibits a curious conformation, presenting the appear- ance of transparent, irregular, hollow structures, either lined with a layer of nuclei like an epithelium, or bare, and containing in their cavity, besides free nuclei, the glandular vesicles of the parenchyma of the thyroid gland, in the most various stages of development. But under these circumstances it is difficult to determine, whether the vesicular bodies are fully developed or partially developed thyroid vesicles, or distended areola furnished with an epithelium (like cysts). The structure of the normal glandular vesicles of the thyroid is described by Kolliker as consisting of a perfectly homogeneous, closed, clear, and deli- cate membrarta propria, lined by an epithelium, and filled with fluid contents. Starting from this point of view, we have pur- sued our researches. In thin sections of the lax, new-formed tissue, which are readily made by means of the scissors, it is satisfactorily shown that the matrix is formed of slender, arched fibrils, whose nu- merous subdivisions constitute a delicate network. Within these reticulations is visible an epithelium, composed of flattened, delicate, light-coloured cells, furnished with a rounded, granular nucleus (fig. 103, A, in the space a). Closer observation will show the existence of a subjacent layer of epithelial cells, which, for the sake of distinctness, have been left dark ; the very deli- cate, filamentous bundles of connective tissue stretching over the epithelium are not represented, that the clearness of the figure might not be interfered with. The areola lined with epithelium are of the most various dimensions and forms — rounded (e), oval (a, c), subdivided into two or more compartments by projecting ridges of connective-tissue-bundles (6, d), elongated (/), &c. The epithelial cells differ according to the stage of evolution or involution in which they may happen to be. In many, the IN THE THYROID GLAND. 425 nucleus is wanting j and between the cells (consequently in the intercellular substance), a finer (d) or coarser (e) molecular substance may be perceived surrounding them, and which is to bo regarded as indicative of a fatty degeneration of the intercellular fluid. The proper contents of the areolte is a transparent fluid or solid material, which, when in the latter condition, readily escapes from the areolto, when they are ruptured, and exhibits the most varied outlines. We have represented some of these in fig. 103, B. These masses, as has been stated before, under the head of " Exudations," ai-e flattened, round, oval, reniform, elongated, puckered, furnished with cuneiform processes, &c., never present any cell-wall or nucleus, and are, consequently, structureless ; in acetjc acid they either undergo no change, or, at most, assume a very finely granulai", yellowish appeai'ance to- wards the centre. We do not agree with Rokitansky in believing them to be vesicles, as they are manifestly without the invest- ing membrane j in our opinion they are mei-ely solidified colloid masses, which, in their form, partially assume that of the areola 426 NEW-FORMATIONS OF CONNECTIVE TISSUE coutaining them, and have no original connexion with the problematic glandular vesicles. Like other viscid fluid matters, they necessarily solidify from the periphery towards the centre, and it is highly probable that the concentric layers are pro- duced by a periodical solidification, just as, in consequence of a fatty degeneration of the fluid central matter, a collection of fatty granules is frequently seen in the elliptical forms. With the colloid-corpuscles, portions of epithelium {g) always escape in the dissection, often curling over at the edges. Occasionally, delicate vessels may be observed accompanying the connective-tissue-bundles, which, as at h, not unfrequently contain a considerable number of white blood-corpuscles. For the further understanding of the structure of the new- formed tissue in the cysts, the very delicate, pale, transparent parts are serviceable. They exhibit, within the investing connective tissue of the areola, oblong nuclei (fig. 104, a), lying with their lone axis parallel Fig. 104. . .. "„ ,, ^„, to the course or the fibres. The epithelial cells are un- commonly delicate, and are found even in the most minute areohs {b), which do not enclose more than three or four of them. The lace- work (c), composed of very slender bundles, surround- ing the areola, lined with epithelium, may be observed more readily, from its areolar arrangement. The involution of the tis- sues within the cyst is mani- fested, by their white aspect, diminished transparency, and dirty-yellow or yellowish-brown colour. The epithelium, from the stage of fatty degeneration indicated above, passes into one so advanced, that nothing is left of it but a granular matter unaltered in acids and alkalies. Sometimes, also, the change proceeds to the deposition of earthy salts in the granular form, which dissolve in hydrochloric or acetic acid, with the copious IN THE THYROID GLAND. 437 evolution of air-bubbles. The connective tissue is covered with fatty molecules, or calcareous particleSj or is rendered wholly unrecognizable in consequence of its infiltration with colouring matter. The blood-vessels appear more or less closely beset with fatty granules {d), or incrusted with calcare- ous salts, which can be removed by the above acids ; or the transparency of the vessel and of .its branches is so far dimi- nished by the presence of a material composed of fatty and colouring matter, that it is brought to resemble an opaque streak (c), white when viewed by direct light. Besides vessels in this condition, granule-masses, of an oval or rounded form, are often met with, or irregular groups of fatty molecules. Orange- coloured pigment (/), in the form of coarse granules, dis- posed in elongated rows, or aggregated into little masses, may also assume a dark brownish-red or black colour (/at -\-). This colouring matter is always present in large quantity when the new-formation is of a brownish-red hue, and it may be produced in various ways. For the pigment-granules may arise from the cohesion of the shrunken blood-corpuscles — from the imbibition of the fatty molecules with colouring matter — or, directly, from the precipitation of the dissolved hematin^ It has already been remarked, when we were speaking of atrophy of the blood, that the interesting metamorphoses of the red blood-corpuscles, first described and figured by Virchow, may be sought for in the red-brown deposit of these cysts. We think that we have shown in the preceding observations : 1 , that the connective-tissue-bundles are disposed in an areolar manner ; 3, that the areoke thus formed, lined with epitJielium, are, frequently, not round and vesicular, but constricted by projecting ridges of connective tissue, whence they assume an elongated form ; 3, that it is probable, that the epithelial investr ment is continued from one areola into another. We must be allowed, therefore, at present, to doubt the glandular nature of these areola, since, as stated above, the vesicles of the thyroid gland are completely closed and spherical. On the other hand, it must be allowed, that an unmistakeable similarity exists between the new-formed tissue in the cysts and the neighbouring parenchyma of the thyroid body; with respect to which, however, it must be remembered, that the latter is placed in abnormal conditions. But the possibility still re- 428 NEW-FORMATIONS OF CONNECTIVE TISSUE mains to be discussed, whether this new-formation may not depend upon a persistence of the embryonic stage in the develop- ment of the thyroid gland, in which the vesicles have not yet be- come completely closed. This latter view would be in accord with Kolliker's conjecture, that the vesicles, during the foetal period, multiply by the protrusion of rounded buds, and their constric- tion, and would thence seem to have a considerable amount of probability in its favour. The tissue contained in the cyst occasionally presents con- ditions wholly analogous with those represented in fig. 53. The embryonic glandular vesicles have in great measure been destroyed by the accumulation of a fluid containing colloid, nothing remaining but cysts, often without any epithelial lining. The enclosed tissue, moreover, may imdergo such a degree of involution, that nothing is left of it but a dirty greyish-red pultaceous matter, indistinct nuclear bodies, very numerous cholesterin-plates, and dirty brownish-yellow and brownish-red, irregular, flattened corpuscles of various dimen- sions, without a trace of any other organic structure (colloid impregnated with hematin ?). § 7. Liver. In this organ the new-formations of connective tissue appear in the diffuse and in the concrete form, that is to say, involv- ing a considerable space in a uniform manner, or limited to more circumscribed spots in the form of nodules. The former kind is seen, especially, in the granular liver {cirrhosis, Laennec). In this case the newTformation arises, without doubt, from the connective tissue accompanying the larger vessels into the lobules, and which is known under the name of the capsule of Glisson. The excessive hypertrophy of this tissue destroys the proper parenchyma — the hepatic cells — and induces a secondary atrophy of the organ, which, in many parts, may proceed so far that nothing remains but a callous, tuberculated, cicatriform tissue. Thin sections, which, in this case, are best made with the double-bladed knife, show an increase of the connective tissue, and a diminution of the proper hepatic substance. In fig. 105, a a represent the surface of the liver, the substance indi- IN THE LIVER. 429 cated by straight lines {b b) the connective tissue, ^nd the darker insulated spots (c, d, e e) represent the remains of the Fio. 105. hepatic lobules, in various stages of involution. The botryoidal surface of the liver of a man affected with dropsy and jaundice, presented a multitude of isolated, darkish spots of various sizes and colours, which, in many situations, were distinctly apparent only at some depth from the surface, and, in the section, corresponded to the insulated spaces. The divided lobule (c) presented a blackish-brown network, precisely re- sembling the portal capillary plexus ; in d, this network was interrupted by several lighter-coloured spaces. The lobules (e e) appeared of a deep yellow, and in them the coloured plexus was not so distinctly evident. The minute investigation showed that, although some of the pigment-molecules might be lodged in the hepatic cells, the greater part of them lay in the intercellular substance. The pigment exhibited very numerous shades of colour, from blackish-brown to red-brown, orange and gold yellow, all of which could frequently be observed in one and the same lobule, whose peripheral portion, for instance, might be darker, and the central more lightly tinged. The hepatic cells, in many places, appeared to be in a normal condition, whilst, in others, they were in a state of incipient fatty degeneration. In the thick tracts of connective tissue, which occasionally 430 NEW-FORMATIONS OF CONNECTIVE TISSUE accompanied the larger vessels in a half-obliterated condition, abundant fat-globules and scattered pigment-molecules were imbedded. In those situations where the connective tissue had as yet undergone no retrograde metamorphosis, that is, no fatty or pigmented degeneration, an abundance of de- velopmental forms of that tissue, principally fusiform fibre-cells of various widths, with an oval or more elongated nucleus, and flattened cells, with 1 — 3 — 4 processes, and of divers shapes, was displayed. So that, perhaps, no doubt could be enter- tained with respect to the actual occurrence of a new -formation of connective tissue ; and no ground existed upon which the objection could be entertained that the hypertrophy of the capsule of Glisson was only apparent, inasmuch as the proper glandular parenchyma was in a state of atrophy. The various shades of colour observed in the leathery, tough, dry hepatic substance, yielding comparatively but a small quantity of pulp when squeezed, and to which, in addition to the colours above enumerated, a leek- or olive-green may be noticed, are manifested more distinctly in those granular livers which are accompanied with jaundice. This condition seems to be brought about by the new-formation of connective tissue, which, advancing along the course of the vessels, and conse- quently of the biliary ducts also, causes an obliteration of the latter. Injections of the various sets of vessels would be most desirable in these cases, in order to ascertain : I, to what extent a partial close of the biliary ducts, or (3) a partial obliteration of the branches of the portal vein and hepatic arteries, takes place; or (3) whether the capillary system of the portal vein remain open to some extent, and (4) whether any kind of collateral circulation be established. It is evident that the coriaceous, tough, dry portions of tissue, a section of which is represented in fig. 105, no longer transmit any blood; the dark-coloured networks of the atrophied lobes (c, d) are derived, for the most part, from necrosed blood of the portal capillary pleams, whilst the more uniform coloration of the groups of hepatic lobules is referrible to the various changes undergone by the colouring matter of the bile. The hepatic cells, also, contain a considerable quantity of mostly ochraceous pigment-granules, exhibiting various changes of colour on the application of nitric acid. IN THE LITER. 431 Fig. 106. The incipient granular liver, so far as concerns its outward aspect, might be confounded with the nutmeg-liver {vid. fig. 28). In both may be observed, even with the naked eye, a yellowish and a brownish-red substance. The mutual relations of these two substances will be rendered clear in the surface of a section, viewed with a lens (fig. 106, b). The lobate spaces left of a light colour, correspond to the yellowish- white substance, and the in- terposed dark portions to the brownish-red. The light colour depends, in some degree, upon the presence of fat, and partly upon the deficiency of blood in the lobules, whilst the brown- ish-red substance owes its colour partly to the blood con- tained in it, and partly to the presence of pigment. The large veins, cut across in sec- tions, either transverse or ob- lique, appear as streaks or points, in both the white and in the red substances. The elementary analysis of the latter, in the incipient stages of granular liver, will, necessarily, always bring into view nume- rous fusiform cells, since, were this not the case, it could be described merely as being in some state or other of involution. In the case here represented, there also existed a remarkable complication ; the surface of the liver exhibited erosions, that is to say, level, shallow, excavations, like ulcers. The smallest, scarcely visible by the naked eye, were sometimes rounded, elongated or constituted of several irregular prolongations. The larger often presented in the middle of the floor a rami- fying bloodrvessel, which lay exposed in the yellowish-brown hepatic substance ; the peritoneal coat was wanting in all these erosions. Their existence, we think, must be referred to the occurrence of an exudative process in the peripheral lobules. The peritoneal coat would be destroyed by the subjacent exu- dation, and the hepatic substance, with its vessels, thus be 432 NEW-FORMATIONS OF CONNECTIVE TISSUE exposed. The sinuated figure of the border would, conse- quently, he due to the exudation following the disposition of the lobules. Lastly, we may add, that these erosions have, only once, occurred to our observation. The new-formation of connective tissue may, probably, originate in a plasma, afforded by the ramifications of the hepatic artery, whose terminal branches, as is well known, embrace the groups of hepatic cells, and provide for the nutri- tion of the organ, whilst the portal capillary plexus effects the secretion of the bile. Now, since the new-formation in many places may be observed very distinctly surrounding the groups of lobules in the form of a light-coloured, tolerably wide border, the opinion above expressed would appear to have some foundation. Dittrich has shown that, after inveterate syphilis, the liver frequently presents a cicatriform tissue on its sxurface, which may extend deeply into the parenchyma. We have also noticed irregular, scattered nodules, consisting, like the cicatri- form contracted parts, of connective tissue. These parts are occasionally found in a state of involution, containing an abundance of minute fat-globules and free pigment-molecules, and, when torn asunder, also presenting shrivelled nuclei. In the neighbourhood of these fibroid nodules, where the hepatic substance has already lost its normal texture, irregular, clotted masses, in which no further organization has been set up, may be observed. The callous streaks, penetrating the substance of the liver, of a lightish-grey colour, consist of wavy fibrils, occasionally crossing each other (fig. 107), which, when treated Fig 107. '^^^ acetic acid, exhibit elongated, _^_ imbedded nuclei, placed at regular H^^p distances apart. Besides this, groups ^^4 of pigment-molecules are very fre- ^^R quently seen, no longer contained ^^^ in a cell (fig. 107, the upper part), ^^B whUst, in many other situations, ^^K they are still manifesty enclosed in A well-marked instance of the new-formation of connective tissue was presented in the liver of a new-born child, covered with pemphigus-\e%\c\ei. The IN THE LIVEE. 433 mother was affected with secondary syphilis. On the concave surface of the liver, there was a yellowish spot, scarcely raised above the surface, about the size of a beau, of a rounded form, and ill defined at the border, and which gradually assumed a brownish-yellow or liver-brown colour. The lighter coloured portion of the tissue extended to about 0-39" in depth. The surface of a section was of the deepest yellow colour in the centre, and the consistence of the deposited substance in general, considerably denser than that of the surrounding hepatic parenchyma ; the texture was irregularly granular ; and on pressure, only a trifling quantity of turbid fluid could be ob- tained. The softer portions of the new-formation contained, principally, cells, of the most diverse forms, (fig. 108), furnished wifh one, two, three, or four processes, ^la. 108. and with one or two nuclei, of an oval form, with nucleoli. The nuclei were placed excentrically, and, when double, were frequently in close apposition, but occasionally, and more particularly, in the cells with a central constriction, they were situated at each end, at a considerable dis- tance apart. The fusiform cells, of the most various widths, were usually ar- ranged in obliquely ascending, parallel rows. The more con- sistent portions were constituted chiefly of fibrous bundles. The rest of the hepatic substance exhibited no striking anomalous condition. In one of the cornua of the thymus-gland in the same child, there was a central cavity, filled with a viscid, puriform fluid adherent to its walls, and containing mucin- filaments and pus-corpuscles {vid. p. 306, " pus in the thymus^'). Professor Dittrich, who was accidentally present at the examination of the liver in this case, noticed a surprising resemblance between the appearances there presented, and those which he had discovered and described in the livers of adults afibcted with inveterate syphilis. The most remarkable distinction, therefore, between the granular liver, and that affected as above, in cases of syphilis, consists mainly in the circumstance, that in the former, the new-formation appears in a diffuse, and, in the latter, in a concrete form, that is to say, is more limited to isolated 28 434 NEW-FORMATIONS OF CONNECTIVE TISSUE Fio. 109. portions of the hepatic parenchyma. The process followed in the development of the new-formation is, of course, the same in both. But whether syphilis alone produce this concrete form may, perhaps, admit of considerable doubt. After long-continued intermittent fever, the liver acquires a slate-grey colour, its texture is less distinctly recognizable, and its consistence somewhat increased. H. Meckel and Heschl have directed special attention to this structural change, and particularly adverted to the increased amount of pigment in the liver. The venous blood no longer presents the dark-red colour, and contains blackish-brown granules (fig. 109, a) of a rounded shape, and, some of them, somewhat exceeding the blood-cor- puscles in size. They are, not un- frequently, agglomerated into little masses, or disposed serially in the hepatic capillaries {a + +), whose lumen is thus obstructed. These granules, also, may be so much diminished in size, as not to exceed that of the larger, angular pigment-molecules. They cannot, however, be regarded as fully formed pigment, since they immediately disappear under the action of potass or soda, though remaining un- affected by acetic acid. They pos- sess, therefore, the properties which we have ascribed to hematin. The hepatic cells sometimes present an unusual quantity of dark pigment-molecules, which are collected, especially towards one side of the cell (b), or may even occupy the whole of the interior. Cells, thus rendered quite opaque by the accumu- lation of pigment, always retain the polygonal shape, though they are considerably diminished in size. In livers of this kind, the cells are often found to be filled with large and numerous fat-globules. Occasionally, also, a considerable abundance of rounded (c) or shrivelled nuclei, probably the remains of the destroyed hepatic cells, is met with. Lastly, cells of new-formation occur, exhibiting all the transitionary forms of connective-tissue-cells, and sometimes containing IN THE KIDNEY. 435 agglomerations of pigment-molecules (d), sometimes without any. Their predominant shape is the fusiform (e). Whether the new -formation of connective tissue demonstrable in the thickened capsule of Glisson, in the slate-coloured liver after intermittent fever, be a constant phenomenon, we cannot say, from the few instances we have had an opportunity of ob- serving. § 8. Kidney. The new-formations of connective tissue in the kidney are always associated with an atrophy of the corresponding renal substance, precisely as is the case everywhere j but a new- formation of connective tissue will not be observed in every atrophied kidney. The deposit usually takes place throughout a considerable portion of the organ, or is generally diflFused ; and Henle has rightly compared this degeneration of the kidney to cirrhosis, or granular degeneration of the liver. It occurs, as is well known, at that stage of Bright's disease which has been described as that of atrophy. In the surface of a section, a grey, dry, tough tissue is at once apparent, occupying interstices in the more or less brown, renal parenchyma. This deposit is especially evident in the cortical substance, and in the interstices of the pyramids ; it presents an areolated fibrous structure, with numerous, scattered fat-globules, and pigment-granules, together with fusiform and elliptical cells of connective tissue. The tubuli uriniferi in these situations have usually disappeared entirely, or, as well as the Malpighian tufts, are reduced to a stunted condition, in which their outlines can scarcely any longer be perceived. The clearest view of these conditions is afforded in thin sec- tions of a kidney which has been boiled in dilute acetic acid, and then dried. In such preparations it is clear that the new- formation proceeds from the interstitial tissue between the tubuli uriniferi, or, in other words, that it is a hypertrophy of that tissue, just as in the granular liver the new-formation is seated in the capsule of Glisson (the interlobular connective tissue). Henle has also observed that the fibrous tissue is more apparent in the dense, lardaceous portions, whilst the yellowish parts abound more in fat, and that those of a slaty- 436 NEW-FORMATIONS OF CONNECTIVE TISSUE grey colour contain a dark pigment. According to Frerichs, in the atrophic stage of Bright's disease, a new-formation of connective tissue takes place in the exterior of, and within the capsules of the Malpighian bodies. But he expressly remarks, that a hypertrophy of the interstitial connective tissue does not exist in every instance of this atrophy. The new-formation may occasionally be traced to the sur- face of the kidney, where it produces callous, cicatriform spots, depressed below the level of the surface ; which spots present sometimes a close fibrillar structure, sometimes one composed of clotted masses, transparent in thin sections, and unaffected by acetic acid (colloid masses), which also occur in the lar- daceous, dense portions within the substance of the gland. The botryoidal elevations seen on the surface, either with or without the cicatriform depressions, correspond, as was stated when we were speaking of atrophy of the kidney, to groups of tubuli uriniferi in a state of involution, of which various gradations may often be observed in one and the same speci- men. The tubuli are filled with a fine-molecular fat, by which their transparency is destroyed ; frequently present a brownish- yellow colour, derived from imbibed hematin ; whilst the glome- ruli are diminished in size, covered with pigment- and fat-mole- cules, and have obviously lost the power of transmitting the blood. Occasionally, round, encysted bodies, scarcely half the usual diameter of a glomerulus, are met with, filled with a dark, finely granular substance ; these probably represent a degenerated form of the Malpighian tufts ; but as we cannot discern a vestige of a convoluted vessel in them, the possi- bility still remains, that these bodies may be regarded as new- formed areolm filled with degenerated contents. The extension of the new-formation to the surface of the kidney frequently leads to an intimate adhesion of the sub- stance of the gland with the capsule, so close, in fact, that the latter cannot be raised without injury to the former. But in such cases it must not be supposed that a new-formation of connective tissue always exists, since an exudation poured out from the capsule of the kidney may also produce similar adhe- sions, as may be seen in the pia mater (p. 277), where frequently, no new-formation can, histologically, be de- monstrated. IN THE KIDNEY. 437 The process followed in the development of the new-forma- tion can only be supposed to consist in the effusion oi a. plasma, which is no longer sufficient for the nutrition of the organ, and from which the new-formation in question is at once pro- duced. The vessels of the interstitial tissue, surrounding the tuhuli uriniferi with a capillary plexus, and the capsules of the Malpighian bodies (if Frerichs' observation be correct that new connective tissue is formed without and within the capsules) might be viewed as the points whence the formation of the blastema originates. The new-formation of connective tissue in the kidneys is often accompanied with the development of cysts, which are here of especial interest, and with respect to which the most various opinions have been entertained. It is a well-known fact, that atrophies usually advance from the peripheral vascular ramifi- cations towards the central, since, in the natural involution of the organ, less nutritive matter is by degrees afforded to the peripheral parts j and that in disturbances of the circulation, and in exudations, those at the periphery in general precede those of the centre. This course is particularly manifest in atrophy of the kidneys, whether it be associated with a new- formation of connective tissue or not. In the latter case, it usually originates from the peripheral part of the organ, and, iu a direct manner, constitutes the cicatriform depressions surrounding the elevated groups of tubuli uriniferi. Now if, in this situation, formations of blastema take place, more cir- cumscribed to isolated points, following a more rapid course, and of a more fluid nature, the groups of tubuli uriniferi, en- closed by it from their base upward, are made to coalesce, and a hollow is produced, the size of which, as well as the number of hemispherical dilatations, is in proportion to that of the groups which have thus coalesced. The roof of the cavity is formed by the connective-tissue-capsule of the kidney, or by a delicate network of connective-tissue-fibres, remaining after the removal of the capsule. If one of these peripheral cysts be opened, which, as is sufficiently well known, are of various dimensions, and filled with various contents, it will always be found that the bottom is constituted of new -formations of connective tissue ; this surface is sometimes trabecular, with sinuous protrusions, sometimes beset with a sort of nodosities, or papilla, which 438 NEW-FORMATIONS OF CONNECTIVE TISSUE present the aspect of sharply defined bodies, and when viewed from above in their transverse diameter, exhibit at first sight some similarity to a Malpighian corpuscle enclosed in its capsule, though usually far less in size, and not possessing the same structure, since they contain sometimes merely a molecular substance, sometimes oval nuclei, and not the smallest trace of the remains of vessels. The inner surface of the cyst is lined with a delicate epithelium, the cells composing which are flattened, polygonal, very transparent, of various dimen- sions, often possessing a tolerable-sized oval nucleus, and disposed in a simple layer.' At the bottom of the cysts, where the connective-tissue-formations project, the epithelium is wanting. The cells are occasionally in a state of incipient fatty degeneration, when the oval nucleus is seen surrounded with a circle of fatty molecules. The clear contents of the cyst usually present opaque flocculi, consisting of detached epithelium. But when they are of greater consistence, colloid masses will be seen of various conformation, sometimes, indeed, in the shape of flattened, occasionally very small, highly transparent, rounded bodies, or furnished with sacciform elongations (fig. 110, a, b). They Fio. 110. are wholly structureless, and surrounded with a peripheral boundary line, which nearly disappears in water. They are not changed in acetic acid, nor in a weak solution of carbonate IN THE KIDNEY. 439 of soda. The laminated or conceatric colloid-masses (fig. 110, h, i) predisely resemble those which we have figured as occurring in the prostate (fig. 59) ; and they may, without doubt, be regarded as the remains of Malpighian bodies. The form which we have described as the radiating colloid-cor- puscle is more rare (fig. 58) ; and they seem to occur in cysts of an older date, with dirty-yellowish brown contents. In cystic kidneys, we have several times seen, together with a very striking hypertrophy of the interstitial connective tissue, and in fact within it, organic structures, which lay altogether free in the vacuities. The figure of these bodies was round, oval, elongated, constricted in the middle, or furnished with a shorter or longer process. They were distinctly bounded, and had molecular contents ; in the smaller corpuscles the nucleus appeared single or double (fig. 110, c), or multiplied into three {d) or several (e e e), so that the whole was not unlike a cell with numerous nuclei. The same kind of nuclear bodies, ar- ranged with some regularity, also existed in the processes {f,g). The corpuscles were imbedded in groups in the connective- tissue-substance, though not in every part; they could be isolated, presented no cell-membrane, but when treated with acetic acid were often seen to be surrounded with an annular layer of oblong nuclei. Now, can these bodies be regarded as parent-cells ? We scarcely think so ; their variable dimen- sions, and irregular form, seem to render it more probable that they belong to an entire group of cells multiplying by division, and which are developed in the areoltB of the connective tissue. The formation of cells is frequently not arrived at in the latter tissue at all, nothing being presented in it beyond an accumulation of colloid masses, imbedded in the renal sub- stance, and assuming the form o{ sinu&ted plaques, occasionally with fatty molecules arranged so as to form reticulations (A), and of rounded, yellowish, vesicles, often scarcely visible to the naked eye. A new-formation of vessels is frequently seen in the walls of the cysts, which may give rise, on the one hand, to the deposi- tion of black pigment in considerable quantity on the outer side of the cyst; and, on the other, to hemorrhages into the cavity, and the accumulation of a cherry-red, brown-red, or saflFron-yellow, amorphous material (necrosed blood?). 440 NEW-FORMATIONS OF CONNECTIVE TISSUE Minute, for the most part isolated, pedunculated cysts are often noticed on the mucous membrane of the pelvis of the kidney. These cysts have a globular or clavate form, and project into the cavity with their rounded extremity; the latter is more transparent, and contains a limpid fluid enclosed in an irregular space. Fibres belonging to the mucous mem- brane may be traced on both sides as far as to the rounded end, where they bend round, forming arches. On the addition of acetic acid, imbedded, oblong nuclei may be perceived lying with their longer axis parallel with the fibres. Embryonic forms of connective tissue are readily afforded when the sub- stance is torn asunder. Whenever the cyst is of rather larger size, blood-vessels become visible, distinguishable by the mode in which they multiply by lateral, infundibuliform elongations. The epithelium, constituted sometimes, of broad, sometimes, of oblong cells, with manifold intermediate forms, constitutes the outer investment, or that looking towards the interior of the pelvis. In the same situation Rokitansky has also noticed scalloped excrescences. ' ' Rokitansky formerly broached the notion that the cysts in the kidney were consequent upon a degeneration of the Malpighian bodies, and were constituted by a metamorphosis of the cellular layer of the body into a serous sac, caused by the pressure exerted upon its capsule by the Malpighian body crammed full of inflam- matory products, and thence enlarged. The capsule, in this metamorphosis, re- ceiving the vessels of the glomeruli into its tissue, for the production of a new- secretion. To this Frerichs has objected, that frequently no exudation is observed in the capsules of the glomeruli, and that nevertheless cysts exist. According to the later cyst-theory of Rokitansky, the cyst would be developedfrom a nucleus; and the bodies described by us as rounded, structureless colloid masses (fig. 110, a), would be sterile cells {nuclei grown into clear, structureless cells) ; and those de- scribed as concentric colloid bodies (fig. 110, A, i) would arise from several cells being contained one within another, in a pill-box fashion, in consequence of an endogenous production. With respect to this, we think it needless to do more than refer to what has been said on the subject of new-formations of connective tissue in the thyroid body, and of exudations in the prostate, and in the General Part of this work. Frerichs has again brought forward the old opinion as to the origin of renal cysts, and refers their production to a dilatation caused by an obstruction of the tubuli uriniferi, but without adducing any additional reasons in favour of this notion. Bruch also regards it as probable that the cysts arise from an obliteration, and dila- tation both of the obliterated tubuli and of the capsules of the glomeruli. This dilatation, it is asserted, reaches a certain degree, when the proper, preformed wall of the cyst (glandular membrane) which had existed up to this time, dehisces, IN BONES. 441 § 9. Bones. The new-formations of connective tissue originate either in the periosteum or in the connective tissue contained in the cancelli of the spongy bones or of the extremities of the long bones. They appear especially on the periosteum, with or without a new formation of osseous substance, and may attain to a considerable bulk, and displace all the contiguous and superjacent organs. Those growths, which commence within the bone, penetrate it in various points, and in this way become apparent ; they are rarely connected with a new- formation of bone. If the new-formations assume the form of a circumscribed tumour, they are termed osteosarcoma, and are sometimes gelatinous, transparent (gelatinous sarcoma) con- taining principally embryonic connective-tissue-elements, or solid with a predominant fibrous formation (fibrous sarcoma, fibroid, steatoma). If the new-formation of connective tissue reach that of cysts, we have what is termed osteo-cysto- sarcom,a. We shall now proceed to illustrate the more intimate histological conditions, by cases. Dr. Dittel extirpated from the antrum Highmorianum, a tumour of about the size of a small citron. It was seated on the inner surface of the antrum, and had encroached to such an extent upon the nasal cavity that it was necessary to remove a portion of the cartilaginous septum. The outer surface of the mass, looking towards the bone, was beset with a multitude of minute calcareous concretions so as, in that part, to feel quite gritty. A section of the tumour displayed a rounded, central cavity filled with a clear fluid, whose wall was lined with a tolerably thick epithelium, and felt smooth. The growth was pale, in many places about 0-39" thick, and on section it appeared glistening, striated, and afforded on pressure and the cyst is bounded only by the tissue of the organ itself. We have already admitted the possibility of the dilatation of a tubule, when in a state of infiltration ; but this condition is wanting in by far the greater number of cystic kidneys. A dilatation of the tubuli in the latter is conceivable, only when an infiltration can be shown to exist at the same time. Nor are we any better able, in every cystic kidney, to observe a dilatation of the Malpighian capsules, and are therefore of opinion that all foundation for the establishment of a theory of the kind is wanting, or rather that it is not a theory at all, but simply a hypothesis. 442 NEW-FORMATIONS OF CONNECTIVE TISSUE only a trifling quantity of a slightly turbid juice. The principal constituent was minute oblong cells, enclosing, at their wider and more truncated part, an oval nucleus of comparatively large size, and resembling the cells of cylinder epithelium. Elliptical and fusiform cells occurred more scantily, and the conuective- tissue-fibres were delicate. The superficial concretions exhibited, simply a granular substance, which upon the addition of acetic acid, disappeared with the evolution of air-bubbles. Only very fine blood-vessels could be seen, in the form of short streaks, whilst in other places diffuse, bloody spots might be observed. A tumour, also removed from the antrum, by Professor Lorinser, of the size of a small bean, was pale, soft, and readily torn in the preparation. It afforded on pressure only a very small quantity of clear fluid. The elementary constituents were for the most part elliptical, with a sharply defined, and smooth, or a worse-defined border, varying in diameter between 0-0031--0-004'", and usually beset with clear, brilliant molecules, unalterable in acetic acid, in greater or less abun- dance. In the somewhat larger, elliptical cells, from one to three nuclei could often be perceived. In many the fatty degeneration had advanced so far that they had become granule- cells. Caudate cells were met with in less number. There was no trace of earthy concretions. But it must not be for- gotten that, owing to the softness of the growth, its extirpation might not have been quite complete. These two sarcomatous growths obviously belonged to the category of tumours composed of embryonic connective tissue, and had originated in the periosteum of the antrum, which is intimately connected with the submucous connective tissue. In the former case, no advance was made beyond the mere deposition of calcareous salts, since the new-formation appeared to be incapable of taking on any higher grade of organization, and, in particular, the vascular system was far too little de- veloped to enable it to attain to the development of bone. A tumour of considerable bulk seated on the body of the superior maxilla, was tense, very consistent, moveable to a slight extent upon the bone, and it occurred in an individual having carious teeth, but otherwise, as it seemed, not suffering under any constitutional affection. The free surface, projecting IN BONES. 443 into the cavity of the mouth was covered with the mucous membrane. The surface of a section displayed a firm, dense, fibrous, dryish texture, and towards the base it contained cal- careous granules. Thin sections could readily be procured from both the superficial and deeper parts, which showed that the tumour was principally composed of fibrous bundles decussating with each other under various angles, and enclosing narrow areola. The fibrous bundles disappeared on the addition of acetic acid, and oblong nuclei were then brought into view disposed in the same direction; by the same acid also, the amorphous, scattered calcareous particles were gradually dis- solved, and in part with the evolution of air-bubbles. The connective-tissue-cells were of small size, some elliptical, fusi- form, &c., and existed only in small number. No trace of osseous or cartilaginous substance could be perceived. The blood-vessels were straight, and only here and there visible, as distant, slender, red streaks. It is almost superfluous to state that this tumour was a fibrous connective-tissue-formation, and might be termed fibrous sarcoma, fibroid or steatoma, A tumour seated on the outer aspect of the upper jaw, between the first and second molars, presented a structure differing from the preceding. Its length was about 1"17", its shape semi-oval, and it was seated on a broad base from which it projected about 039" in height; its consistence was dense and colour pale. A perpendicular section, displayed, in the centre, a portion of osseous substance, which was compact at the base and towards the periphery of the tumour, divided into pointed teeth ; this osseous growth was covered externally by a tissue, partly cartilaginous, partly gelatinous, and of a yellowish colour. The tumour had perforated the external integument, and in fact projected a little above it. On the outer surface numerous, symmetrically-disposed, bloody points were apparent, corresponding to groups of horizontal vascular loops ; no epithelial covering could be perceived. Connective- tissue-cells in various transitional forms existed in considerable number, in the gelatinous portion. The fibrous bundles had an areolar arrangement, and were mthout any admixture of clastic filaments. In the superficial, softer part of the tumour, iin indistinctly lobate division was visible ; and in the deeper 444 NEW-FORMATIONS OF CONNECTIVE TISSUE parts, towards the bony substance, the distended areola ap- peared to be filled with very numerous, flattened cells. A very careful search was made close to the osseous spicules for car- tilage-cell? ; nothing, however, could be seen but small, mostly oval cells, disposed symmetrically in the connective-tissue- bundles. We think these should be described as cartilage-cells, analogous to those which are met with at the periphery of the larger tendons (for instance of the tendo-AchiUis) . Thus the tumour presented an instance of a new-formation of connective tissue, with a tolerably well-developed, vascular system, and associated with a new-formation of cartilage and bone, the latter radiating from the surface of the upper jaw towards the outer side of the tumour. Dr. Zsigmondy removed a tumour ^bout the size of a small walnut from the head of the metacarpal bone of the fore finger, which had perforated the skin and was quite exposed, having no epidermic covering. The skin was destroyed in a space of about 0"78" in diameter, the edges of the opening being abrupt. The growth, when a section of it was made, was of a light-brown colour, smooth, exhibited a lobular structure, and afforded on pressure only a trifling quantity of a yellowish clear juice. The mass could readily be traced into the substance of the bone. The elementary organs constituting it were small, and for the greater part, rounded, though a few were fusiform and fur- nished with two, short opposite processes ; the nucleus filled the cell almost entirely ; the connective-tissue-bundles were delicate and unaccompanied with any elastic filaments. Towards the bone, the growth had a whitish -yellow colour, and the connective- tissue-elements in that situation were extensively affected with fatty degeneration. The parts surrounding the articulation were wanting. The cells of the articular cartilage were, here and there, in a state of incipient ^"'- '^^- fatty degeneration. Comparatively speaking, but few blood-vessels were met with. After maceration, the altered form of the head of the bone was manifest : it is represented as viewed from the volar aspect in fig. 111. The osseous substance be- tween the articular surface and the IN BONES. 445 shaft ot the bone, to the length of 078" and breadth of 0*57", was destroyed, as was also a portion of the articular surface (c). On the inferior surface of the ca^i^M^Mm there was a shallow excavation [b), where the growth had been attached, and whence several perforations of the bone commenced, so that nothing remained of it but some osseous bridges. At a, an isolated portion of bone projected like a process. Tumours of this kind, composed of connective tissue, are termed osteosarcoma, and when containing numerous large blood-vessels — osteoteleangiectases ; and they have, without doubt, often been confounded with cancer. The principal characters consist : 1 , in their circumscribed, independent de- velopment, from definite parts of the bone ; 2, in a sharply- defined removal of the corresponding osseous substance, of which not a vestige remains. This destruction of the bone may be deemed a process of solution caused by the formation of a blastema. The liquefied, ossific matter, may be either absorbed or be applied to the development of the new con- nective-tissue. The further characters of these growths are found, 3, in a similar, sharply defined limitation between them and the other contiguous parts afTected by their growth — as the articular capsules, tendons, muscles and skin ; 4, in a sym- metrical development of the elementary organs, consisting in their uniform size and form ; which latter becomes changed in consequence of the involution which is set up in many parts of the tumour ; 5, in the intimate cohesion of the elementary organs, so that the surfaces of sections appear smooth, and by pressure only a small quantity of a clear or slightly turbid fluid escapes. New-formations of greater extent (diffuse) also occur in the bones. The cancelli of the epiphyses of the long bones are especially the starting point whence the new-formation advances towards the articular cartilage, which, then yielding, in circum- scribed spots, presents the ulcer-like erosions which were for- merly regarded as so mysterious. Of several cases, we shall mention only one, in which the morbid process had probably ensued upon a previous fracture of the bone. The articular cartilage on the head of the humerus which had been fractured obliquely from without and above, downwards and inwards, was thinner than natural and had lost its opaline aspect, pre- 446 NEW-FORMATIONS OF CONNECTIVE TISSUE senting in several places a dirty-yellow colour and red stains from imbibition. The most striking appearances exhibited in it, were several rounded portions, surrounded with a jagged border, and in diameter about 0-18", in which the cartilaginous layer was so far removed that they had the appearance of ulcers ; the bottom of these excavations was reddened, spongy, and consisted of immature connective tissue with blood-vessels ; in conse- quence of which it was obvious that the wearing away or usure, as it is termed, of the cartilage had been effected. The contents of the cartilage-cells were altered, brilliant, minute molecules being deposited around the nuclei ; the intercellular substance appeared clouded, and in many places brownish-yellow or reddish-brown. New-formations of connective tissue in the spongy parts of the epiphyses gradually cause the destruction of the osseous trabecule, and in this way cavities are produced filled with the spongy growth ; the latter, sometimes also, presents a gelatinous aspect with bloody points and streaks disseminated throughout (commencement of the formation of vessels). The surrounding medullary substance, under these circumstances, is redder than natural. New-growths of this kind are not unfrequently ac- companied with suppuration, very abundant in many parts of them, and when the growth, attended with this complication, approaches the articular cartilage, a partial or complete detach- ment of it ensues. The necrosed cartilage then undergoes the well-known changes. Separate portions of the bone also die, their organic connexions being destroyed by the suppuration; the morphological change, therefore, corresponds with that which has been described as taking place in the case of ne- crosed bone {vid. "Atrophy"). Together with the new-formation of connective tissue, that of bone also, frequently takes place. Those parts of the bones at which the synovial capsules are implanted, are more espe- cially the seat of wart-like osteophytes. Thus are produced complex processes which have been explained in various ways, and which will be discussed more particularly under the head of " osseous new-formations." That new- formations of connective tissue also take place in the shaft of the long bones, has been already stated when we spoke of the exudations in the interior of bones {vid. p. 335) . IN BONES. 447 Fig. 112. At the seat of fracture in bones, the new-formation of an osseous substance, having a less capacity for organization, is very incomplete, and the union of the two fragments is effected mainly by a firm connective tissue. In a case of osteomalacia, under which a woman had suffered for two years, we found, in the greyish-red, liquefied medulla of theye>»Mr,verynumerous rounded cells (fig. 112, a), of various sizes (from 0'0039"' up to 0-0047'") with fine- molecular contents; the nu- clei were large and varied in diameter; the largest mea- suring as much as 0-043'", and the various forms pre- sented by them could be better studied after the ap- plication of acetic acid. They were constricted in the middle, reniform, single or double, and not unfrequently two nuclei were connected by a slender bridge ; the nucleolus was single or double (6). The cells constituted the principal elements in the medulla, and had replaced the fat-cells, which were mostly isolated and in a state of atrophy. For the salie of comparison we have represented (fig. 112, c) the new-formed cells met with in great abundance in a rib affected with osteomalacia. The bone was taken from a woman who had laboured under cancerous deposits in the uterus, liver, and lungs ; the bone-medulla in the affected part was of a dirty greyish-red colour, greasy and liquefied. The round cells, some of which were twice as large or more than others, contained a colossal, vesicular, light-coloured nucleus, which nearly filled them, and was without a trace of a nucleolus j the cell-contents were finely granular. Now what is the nature of the cells a, b, c ? In the hypersemic, reddish medulla of the articular ends of the long bones, Hasse and Kolliker have described minute, rounded, nucleated cells, whose pathological nature has been denied by the latter author, who recognizes in them a normal constituent of tlie " red, or even of the merely reddish meflfwi/a;" assigning to them the name of marrow-cells.^ If these be compared with the cells a, b, we shall observe, ' [' Manual of Human Hist.,' (Eng. Transl.), vol. i, pp. 309-311.— Ed.] 448 NEW-FORMATIONS OF CONNECTIVE TISSUE disregarding the size and manifold forms of the nucleus in the latter, a great similarity to exist between them. In this sense, consequently, the present case aflfords an instance of an excessive formation of marrow-cells. But if we lay greater stress upon the diflferent sizes, and particularly upon the diversity of shape of the nuclei in the cells a, b, we must assign a different character to them. Were they to be ex- plained as being embryonic connective-tissue-ceWs, it would be necessary to conclude that the development of the derivative forms had not in the present instance been attained to. As regards the cells (c), it is perhaps most probable that they represent new-formed elements belonging to the cancer, and in which also the development of the secondary forms had not been reached. The peculiar formation of cysts in bones, a phenomenon, according to Rokitansky, of very rare occurrence, is, probably, intimately connected with new-formatious of connective tissue. But we have had no opportunity of making observations on this subject. An extensive tumour composed of connective tissue, situated in the continuity of the bone, was sent to us for precise determination. It was seated in the sacral region, covered by the moveable integument, and had been taken from a child three days old, which presented no other, visible, outward deformity. We found a subovoid vascular tumour, about three inches long in its greatest diameter. The borders were de- fined ; and the surface, in consequence of several deep indenta- tions, presented a coarsely lobate appearance. The growth protruded on the one hand towards the surface, affording in many places an indistinct fluctuation ; and, on the other side, it encroached upon the pelvic cavity. The separate portions of the superficial lobules, exhibited, particularly under a lens, a well-developed vascular system, and, here and there, trans- parent cysts projected, the largest of which was 0-96" in diameter. The examination of the surfaces of a perpendicular section showed the following particulars: 1. Cartilaginous portions of the sacrum and coccyx (fig. 118, b b). 2. Some larger (a) and smaller cysts were opened, affording a gelati- nous, tenacious, or glutinous fluid containing flocculi; their walls, on the inside, were sometimes smooth, sometimes IN BONES. 449 famished with ridges projecting into the cavity; and they communicated with each other in such a way, that a slender probe could be pushed from p,g jj3 one of the larger cysts into the others. Some of the cysts were so small, as to be but just visible to the naked eye, like hemispherical and fissure-like depressions. 3. Groups of papillary growths, either sessile or peduncu- lated, were observed in the cysts, which appeared to be either wholly or partially filled by them. Similar growths were noticed, also, in great numbers, in simple shallow depressions (c c). Under a powerful lens, the forms of the papilla proved to be very various — hemispherical, conical, clavate, or resembling a cock^s comb. On the inner surface of the larger, and of the three smaller cysts which were opened, the remarkable occurrence of the most beautiful and perfect ciliated epithelium was observed. The ciliated cells (fig. 114, a) were usually straight, and the crowns of cilia everywhere very distinct, though of course their motion had ceased. The attached end of the body of the cell was sometimes attenuated or rounded ofi", or, in some instances, drawn out into two closely approximated points (pro- bably ciliated cells in process of division). The forms, which were rounded below, were occasionally wider in proportion to their length, and consequently resembled the ciliated cells found, for instance, on the tongue and pharyngeal mucous membrane of the Prog. The oval nucleus, as usual, was situated in the lower part of the cell. Some parts of the inner sur- FiG. 114. 29 450 NEW-FORMATIONS OF CONNECTIVE TISSUE face of the cysts were lined with the common, flattened, tesse- lated epithelial cells (fig. 114, b), the larger of which usually- presented an angular outline, and one, or perhaps two nuclei, with a very prominent nucleolus; the smaller cells were more regularly polygonal. The elevated ridges on the wall of the cysts, were not invested with the simple layer of epithelium, exhibiting nothing but loosely connected, immature connective- tissue-elements, which, as well as the epithelium, had become partially detached, and were the cause of the flocculent turbidity in the fluid of the cyst above adverted to. The vascular system was most developed in the posterior and upper part of the tumour. Large, much contorted vessels subdivided at once into slender capillaries, some of which were as fine as those of the brain (fig. 115). The delicate ramuscules were given off at an acute angle, and followed a straight course ; arched loops were, here and there, apparent. The ramifications of the vessels formed groups as if belonging to lobules. The walls, even of the largpr ves- sels, were very delicate and contained no annular fibrous coat. The parenchyma of the tumour was composed of minute connective-tissue- elements, groups of which appeared to be in a state of fatty degeneration. The con- nective-tissue-bundles had an areolar disposition, and, in many places, were beset with numerous granule-masses and brilliant fatty molecules. This highly developed growth obviously belongs to the class of new-formations of connective tissue, and, as the formation of cysts had been reached in it, it will here be termed cystosarcomcf. But besides this, as it had originated frojn bone, it might also be termed osteo-cystosarcoma. The development of the cysts in this case might be traced in an ascending series — commencing with dilated, intercommunicating areola. IN THE PAROTID GLAND. 451 § 10. Parotid gland. lu order to understand, fully, the new-formations of connective tissue, which take place in the parenchyma of these acinose glands, we must first have a clear idea of the structure of organs of this kind ; and, ahove all, is it requisite to have a distinct notion of the connective-tissue- framework. This consists of arborescent, fibrous bundles, which arch round and enclose the groups of terminal vesicles of the racemose gland, sending processes between the separate lobules. The connective-tissue-bundles are accompanied by vessels, which, like the former, split into branches and ultimately break up into a capillary plexus sur- rounding the terminal vesicles. The connective-tissue has a distinctly areolar disposition ; the terminal vesicles lying in the areolcB, and the corresponding excretory ducts of the lobules, in the areolar passages. With this brief preliminary sketch we shall proceed to the description of two tumours of connective tissue, which were situated beneath the aponeurosis parotideo-masseterica, and in all probability originated from the parenchyma of the parotid gland, Schuh has found that tumours of this kind are always beneath the aponeurosis in question, sometimes so loosely con- nected with the surrounding parts as almost to allow of their being detached with the fingers alone, but sometimes so closely united with the anterior and inferior part of the gland, that a portion of the latter must inevitably be removed with them. A tumour removed by Professor Schuh from the region in question, was about the size of a pomegranate, and sur- rounded by a strong tunic of connective tissue, closely united to the supejgacent fascia of the parotid gland. The surface presented several botryoidal projections, very tough and resistant to the feel; the surface of a section was pale, dry, partly pervaded by consistent, tendiniforip, glistening streaks, running in various directions, partly of a more lax, granular texture in the light-yellow spots, which were enclosed, as it were, in capsules of the dense, streaked tissue, and appeared like masses of a softer substance nearly filling the areolm, and which could be easily removed by means of the needle. Structures were also apparent, connected with the strong connective-tissue- 453 NEW-FORMATIONS OF CONNECTIVE TISSUE capsule either by one or by several pedicles, and which, some- times to the naked eye alone, sometimes only under water with the aid of a lens, proved to be groups of papillae ,- the groups, mostly wart-like, after their removal,left an opening, occasionally as large as a lentil. Fissure-like openings were here and there apparent. The elementary constituents were connective-tissue- cells of the smallest kind, such as are usually met with in the corium of the external integuments; the usual transitional forms of these cells were noticed. The papilla had a super- ficial layer of small, polygonal cells, enclosing an oval nucleus, whilst their proper body consisted simply of immature con- nective tissue with a few fibres. The more consistent parts were composed of very large bundles of connective tissue, enclosing narrow areola ; these bundles were also accompanied by numerous elastic filaments, and by a proportionately small number of blood-vessels. The patient had in the same region a long cicatrix, where, according to his account, a similar tumour had been removed some time before. A sarcomatous tumour, about the size of a walnut, was re- moved, also, by Professor Schuh, from the inferior maxillary region. It was pale, dense, of granular texture, and pervaded only by few vessels. The section of the somewhat projecting, equal-sized granules was not smooth, and afforded but a small quantity of fluid on pressure. The uniform granulated texture gave the growth an appearance not unlike that of an acinose gland. Each lobe was subdivided into seve- ral lobules which were parted by a fibrous tissue. The apparent gra- nules {acini) could be readily iso- lated by means of the needle, and consisted of bundles of connective tissue, giving oflf several delicate secondary branches; to each of the latter corresponded a rounded papilla, which was itself covered with an epithelium-like superficial layer composed of minute poly- gonal cells (fig. 116). These groups ^^^^■■■M^^^^^^ of papillae, supported iipon a com- FiG. 116. IN THE PAROTID GLAND. 45S mon pedicle, were always enclosed in a capsule of connective tissue. The proper parenchyma of the papillary growths con- sisted partly of rounded cells («), with an excentric nucleus occupying nearly the whole of their contents, partly of fusi- form cells {b), in which also, the nucleus was of comparatively large size. These papillee, therefore, in form analogous with the ultimate vesicles of an acinose gland, but with which they are by no means to be identified, are new-formations of con- nective tissue. They were constructed in the same way in all parts of the tumour. The main question with respect to the development of the tumour lies in the determination of the mode in which the uniform, granulated structure is brought about. In our opinion, two cases only are possible j the new-formation had originated either in the superficial investing coat of connective tissue of the parotid, or in the interstitial connective tissue of the gland. But when the uniformity of the granulated struc- ture, but more especially the, occasionally, very manifest, intimate connexion of the growth with the glandular parenchyma, are considered, the latter of these two possibilities seems by far the more probable. The processes of connective tissue noticed above, between the separate lobules, and the connective-tissue- capsules of the groups of terminal vesicles, would, consequently, have to be regarded as the proper nidus of the papillary new-formation, in consequence of which the true glandular parenchyma was destroyed. We have already found that a precisely analogous process takes place in subcutaneous con- dylomata, in which the new-formation also originates in the connective-tissue-capsule of a sebaceous gland. If we suppose a similar process to occur in the acini of an entire lobule of the parotid gland, a tumour will be produced whose fundamental framework is an areolar tissue, and whose papillary new- formations are lodged in the areolopi/^« fffj. All these productions were enclosed in a dense sheath of connective tissue, which sent down processes between the larger groups of the lamellated and papillary growths, whence were produced narrow areolee, into which the excrescences and other growths above described, projected, free, and washed by a glutinous, clear fluid. Near the points whence the lamellce radiated^ or occasionally. 456 NEW-FOEMATIONS OF CONNECTIVE TISSUE also, in other indefinite spots, there might be observed nodules, of the size of a lentil or bean, which, by reflected light, pre- sented an opalescent brilliancy, and were sometimes rounded, sometimes subdivided into several lobes by a few grooves {bb). These nodules lay quite free in the parenchyma of the tumour, and could be readily enucleated; they presented a tolerably consistent, peripheral substance (c), which, after the removal of the pultaceous, whitish, friable contents, retained the form of a sacculus. The latter, as well as the former, proved to be layers of epidermis -cells, which swelled up on the addition of carbonate of soda, together with much free, minutely divided olein in the form of globules ; cholesterin could not be detected. The more intimate structure of the papillary growths may be thus described. They had a well-defined boundary, the border presenting deeper or shallower indentations ; the super- ficial layer was composed of minute, polygonal cells, with rounded nuclei, and the parenchyma of small coimective-tissue- cells, with very prominent nuclei ; the fundamental framework was constituted of fibrous bands radiating from the base of the papilhe, and which were sometimes given ofij at a right angle, like lateral branches, from the central fibrous stem. The younger buds, seated on the parent papilla, also exhibited a well-defined outline, and contained simply a fine-molecular substance. Papillary excrescences were also observed, which, particularly towards their rounded extremity, were rendered opaque by fat in a state of minute division, and pigmentary matter, and which were, consequently, in an atrophied condi- tion. This was especially evident in many situations, aS, for- instance, towards the superficial part of the tumour. The lamelloe had essentially the same structure, the fibrous bands following the longitudinal axis. The vessels in the papillary excrescences accompanying the fibrous tissue, were wavy, and usually in small number. Bloody points and spots were visible at the apices of many of ^epapillos ; and the greater vascularity in those spots was discernible towards the cutaneous surface. The structure of the vessels themselves, proved, on the application of acetic acid, to resemble that of the capil- laries; the smaller class of vessels occasionally presented lateral protrusions, and rapidly diminished in size; blood, moreover, appeared to be contained in areola, without any IN THE MAMMARY GLAND. 457 independent walls. The vessels were also seen to give oflV very much elongated, attenuated processes, filled with blood (incipient connecting branches). Upon the addition of acetic acid, a tissue, consisting of elongated meshes, came more dis- tinctly into view in the denser portions. Convoluted, elastic filaments were, comparatively speaking, present only in small number. A large cystosarcoma of the breast, removed by Professor Schuh, presented, in many parts, a remarkably uniform, lobu- lated aspect. Each lobule was surrounded, and united to the contiguous lobules, by a tunic of connective tissue, and consisted of numerous larger and smaller nodular protu- berances (fig. 118), which nearly filled the investing capsule. The superficial coating was composed of very Fig. lis. delicate, pale cells with fine-molecular contents, but which only occasion- ally presented a distinct, oval nucleus. The pro- per parenchyma con- sisted of extremely mi- nute connective - tissue- cells, which, from their large, closely crowded nuclei, might, without care, have been mis- taken for pus-corpuscles. The stroma was consti- tuted, as in the former case, of delicate bundles _ of connective tissue. In a cystosarcoma of the breast, about the size of a pome- granate, extirpated by Professor Chiari, the apparently acinose structure was very distinctly displayed in the cut surface and in thin sections. When the latter were treated with carbonate of potass, the areolar structure of the investing connective tissue surrounding the lobules was evident ; the latter, how- ever, were contained in the areola ; it was clear, at the same time, that these areola, when distended beyond a certain size. 458 NEW-FORMATIONS OF CONNECTIVE TISSUE were filled with a serous fluid, and that only a few excrescences composed of connective tissue projected into them, whilst the investing tunic itself presented the aspect of a smooth mem- brane. The areola (cysts), which represented, as it were, only the segment of a sphere, were occupied by a light-yellow, rather turbid fluid, presenting, besides numerous, isolated fat-globules, of all sizes, aggregations of such globules, either spherical, or bulging on one side. Several of these granule-masses were of considerable size, and presented a general resemblance to the colostrum-corpuscles. The turbidity of the fluid was also increased by the presence of spherical cells with a transparent, round nucleuS) and whose contents were in a state of incipient fatty degeneration. It is, perhaps, very probable, that these cells stood in a genetic connexion with the granule-masses, which, however, without doubt, were increased by the aggluti- nation of fat-globules, since the largest granule-masses exceeded in size the largest of the cells by at least four times their diameter. Prom the nipple, which was removed at the same time, a yellowish fluid could be expressed, and the communi- cation between the lacteal ducts and the cysts was demon- strated by the introduction of bristles. The lobulated new-formations of connective tissue (apparent acini), which could be easily removed from their capsules by means of a needle, consisted of mostly fusiform, short cells, with a pale, oval nucleus and distinct nucleolus. In many parts of the tumour, moreover, immature forms of connective tissue were seen, imbedded in a gelatinous, structureless stroma. Acetic acid produced a decided opacity both in the latter and in the delicate papillary new-formations. From these instances, it appears: 1. That cystosarcoma of the breast is a new-formation originating in the inter- stitial connective tissue. We do not, therefore, coincide in Reinhardt's view, that the cystosarcoma mammm proliferum arises in a hypertrophic development of the normal glandular elements. 2. That the new-formation usually assumes a papillo-den- dritic form, and grows into the partly closed areola of the acini. 3. The proper glandular substance is sometimes suppressed by this growth, sometimes dissolved by the formation of a serous fluid. IN THE MAMMARY GLAND. 459 4. In consequence of the latter process, an apparently acinoae structure is produced ; but the proper acinus of the gland is removed and replaced by a papillary new-formation. Meckel states that these papilla are certainly solid, and arise from the glandular follicles by inversion. 5. A cyst is produced from the coalescence of several areola of a destroyed acinus. 6. The fusion appears to involve the excretory ducts also, which are surrounded with a sheath of connective tissue ; and by the dilatation of these tubular pouches, cavities are pro- duced, containing a serous fluid, which (as in the last case) occasionally communicate with the lacteal ducts, as was first noticed by H. Meckel. The fluid discharged from the nipple, under these circumstances, is not a glandular secretion, but must be regarded as a effusion deposited in the hypertrophied cystoid areohB. 7. The new-growths of connective tissue take place, in groups, in the lobules of the gland; owing to which, the lobules composed of the new-formation acquire a connective- tissue-capsule, strictly defining them from the sound paren- chyma. The growth of the cystosarcoma, according to our observa- tions, may, in general terms, be described as observing the following course : A plasma is secreted into the nutrient vessels forming the capillary plexus around each acinus, and from which the materials for its proper secretion are also afforded. This plasma, owing, probably, to its being poured out in too great a quantity at once, gives rise to a new-forma- tion. The superfluous material no longer applicable to the nutrition of the organ, remains infiltrated in the connective- tissue-capsule of the acinus, where it induces a more vigorous production of cells. On the one hand> a hypertrophy of the capsule is produced ; and, on the other, a papillary new-forma- tion of connective tissue, on its inner surface; the papilla continue to grow by a sort of gemmation, and at length fill the cavity, previously formed at the expense of the glandular substance. By reiterated transudations, which appear gradually to assume a hypertrophic character, the areola become more and more distended, whilst the papillary connective tissue and the fibrous stratum, constituting the wall of the cyst, continue to 460 NEW-FORMATIONS OF CONNECTIVE TISSUE advance from the periphery. The inner surface of the cysts, and the outer surface of the pdpillcBf acquire an epithelial covering. The pathological new-formation is characterised, as everywhere else, by its unsymmetrical organization — that is to say, by an organization much advanced in many parts whilst stunted in others, in which, portions of tissue, in a state of involution, may be observed. Rokitansky regards the verrucose, foliated, clavate growths, as originally hollow, and thinks that connective tissue is developed in their interior. According to him, they grow by a kind of protrusion of the originally hollow process. But this can only so far be regarded as hollow, that it contains a fluid, organizable blastema. In the General Part, we have already expressed our views with respect to the ideal mode in which the development of a papillary new-formation takes place J and will, here, merely add, that the protrusion theory, which also plays a part in the history of the development of these growths, does not properly deserve that name, inasmuch as the protrusion (Ausstiilpung) of any membrane without a pressure from the sides is unintelligible; but since, in that case, the bulk would remain the same, whilst, in the organic growth, a manifest augmentation of volume takes place, the notion of a protrusion is manifestly insufficient to account for the phenomenon. § 13. OVAKY. The new-formations of connective tissue in the ovary are usually, and, as is well known, very extensively associated with that of cysts, so much so, in fact, that the entire organ appears, as it were, filled with the latter. These cysts, unless, as is sometimes the case, they occur isolated in the parenchyma of the ovary, project, in very various degrees, above the surface, and contain sometimes a thin, watery, yellowish, yellowish- green, or blackish-brown fluid, or a more tenacious, gelatinous, melicerous, yellowish-brown, or Teddish-brown substance. In structure, they differ in no respect from other cysts, have some- times a stronger, sometimes a more delicate connective-tissue- tunic, in which the blood-vessels constitute very elegant plexuses, at the same time rapidly diminishing in size. These vessels, as IN THE OVARY. 461 usual in those of new-formation, are characterised by their simple structure, a circumstance which may afford a reason, in the dimi- nished resistance of the walls of the vessels, for the readiness with which hemorrhages take place into these cysts. It is obvious, that the simple layers of flattened epithelial cells, often in a state of fatty degeneration, lining the inner surface of the cyst- wall, cannot afford any effective resistance to the flow of blood, which, thus enclosed in the cavity of the cyst, dies, and passes through the well-known various metamorphoses already de- scribed {vid. " Atrophy of the Blood," p. 129). To the cyst-walls are occasionally attached papillary new- formations, enclosing a transparent cavity and branched in a dendritic form; and which, superimposed one upon another, constitute groups entirely filling the cyst, excepting a narrow space J or, on the not quite smooth parts of the inner wall of the cyst, are found trabecular networks of connective tissue, which also project, more or less, into the cavity, and are constituted of fusiform cells in close apposition, imbedded in a fibrous frame- work. The secondary cysts, seated on the inner wall of the so-termed parent-cyst, supported on a wider or narrower base, are of interest. They often occupy nearly the entire lumen of the parent-cyst, and include a tertiary formation of cysts. These pill-box cysts, also, present the structure proper to such growths. The entire mass of cysts is held together by an areolar tissue, in which more or less distended areolce, about to be transformed into cysts, may be observed. The finely curled or wavy conuective-tissue-bundles are usually imbedded in a molecular substance having nuclei disseminated throughout it. The very fine, straight, reticulated fibrous elements, unaffected by acetic acid, which occur both between the cysts and in their contents, correspond in character with mucin-filaments, and constitute, in this situation, without doubt, the " mucous tissue" of Virchow. The portions of tissue in a state of involution, which are found, in considerable abundance, in what are termed compound cystoid growths, are manifested partly by the whitish-yeUow contents enclosing a large quantity of fat, or by their contents being of a dark colour and containing pigment ; the papillary new-formations lose their transparency, and occasionally present, at their rounded extremity, a granular substance soluble in 462 NEW- FORMATIONS OF CONNECTIVE TISSUE acetic acid, sometimes with the evolution of air-bubbles, but which in other situations appears to be unaffected by that acid. The matter taken from the papillcB affords no further morpho- logical characters, and, probably, in the latter case, represents a colloid substance. The involution of the interstitial tissue of the cysts takes place in an analogous mode. It was, formerly, very generally supposed, that the cysts in the parenchyma of the ovary originated in the Graafian follicles, but no direct proof of this was ever given. Even Rokitansky, who regards it as probable that the simple cysts are, in many cases, developed from the follicles, doubts that such is their origin, in those instances in which their number far exceeds the usual number of Graafian vesicles, holding them to be new-formations. In his late work upon ' Cysts,' he has assumed an endogenous formation in those of the pill-box kind; a view which is based upon his theory already adverted to in the General Part (p. 88). With refe- rence to what we have already stated on this matter, we would, in addition, remark, that these pill-box cysts are always attached by means of a common basis upon the inner wall of the parent-cyst, and, in such cases, we conceive that the sup- position is more probable that they arise in new-formations of connective tissue in a state of serous degeneration, and growing one within the other. For, even according to Rokitansky, villosities may be observed sprouting from the inner surface of the cysts and supporting a transparent vesicle, and whose contents are manifestly in a state of incipient serous degeneration. These villosities, therefore, should be regarded as peduncu- lated cysts {vid. those on serous membranes, p. 362). The monstrous development of many ovarian cysts may be referred, either to a coalescence of several into one, or to the increase of one at .the expense of the others ; in any case, a new-formation of connective tissue, and of vessels, limited to particular portions, always exists in the cyst-walls. Those ovarian cysts from whose wall, hairs, as well as sebaceous and sudoriparous glands, teeth, and bones grow, are of high interest. Although the description of these growths does not properly belong to this place, still we shall consider them here, since they are in intimate relation with the new- formation of connective tissue. We have only once had an IN THE OVARY. 463 opportunity of examining hairs from such a situation ; their bulbs were scarcely enlarged, and in structure closely resem- bled those of the human, lanuginous hairs, that is to say, they were not rounded oflf at the extremity, but penicillar, although the hairs were several inches long, and in thickness not far behind the finer hairs of the head. They were twisted and matted together into a coil, of very various colour — ^brown, black, or light blonde, — and they occasionally contained a meduUary substance j they were glued together by a fatty, dirty yellowish-brown, lumpy, interstitial substance, in which were noticed isolated, epidermoidal deposits, composed of very flat, large cells, furnished with a comparatively small nucleus, and which swelled up on the addition of carbonate of potass. The cholesterin-crystals (of which none were observed) had pro- bably been destroyed by the process of decomposition. Sebaceous and sudoriparous glands have been found by Kohlrausch and Heschl in cysts of this kind, and disposed in the same way as in the skin. The latter of these authors noticed, in the same cyst, together with the accessory cuta- neous organs, a horseshoe-shaped bone, an inch in length, and three lines thick, which occupied the wall beneath the spot covered with hair, and attached to it by a perfectly normal periosteum, and a layer of very lax connective tissue ; it had several jagged processes, upon which conical cartilages were distinctly articulated, as large as a hempseed, and furnished loose articular capsules. R. Owen has shown that the structure of an incomplete molar tooth from an ovarian cyst was precisely analogous with that of a normal tooth. It has also been assumed that cysts of this kind, enclosing organized parts, originated from the Graafian follicles ; but the circumstance, that cysts containing hairs (Rokitansky), and even furnished with sebaceous and sudoriparous glands (Kolliker), have been found, the former in the breast, and the latter in the lungs, renders this supposition extremely doubtful. Formations, composed of fibrous connective tissue, in the form of firm nodules projecting above the surface, or of cica- triform callosities, are, in this situation, connected with a previous destruction of the follicles, whose contents, as in oophoritis, are metamorphosed into a substance resembling 464 NEW-FORMATIONS OF CONNECTIVE TISSUE coagulated albumen. The nodules, sometimes sessilCj some- times pedunculated, which are seated on the surface, arise, without doubt, from a papillary new-formation of connective tissue J and the callous thickenings are referrible to a hyper- rophy of the interstitial connective tissue. § 13. Testis and Prostate. New-formations of connective tissue rarely occur in the substance of the testis, whilst they may often be noticed on the outer surface of the tunica albuginea, in the form of sessile or pedunculated nodosities. A. . soft, yellowish-red growth, about the size of a pea, in that situation, presented a smooth surface both on the outside and in a section, and only a small quantity of a scarcely turbid fluid could be expressed. Super- ficially, the growth was constituted of layers of flattened, poly- gonal, epithelial cells, beneath which were the immature con- nective-tissue-formations, in the shape of fusiform cells, with a comparatively large nucleus, containing 1 — 2 — 3 nucleoli. These elementary parts were arranged in a lobate manner, whence the texture of the growth presented a granular aspect. Bloody points, also, were visible in these lobules — masses of newly formed blood-corpuscles, appearing, as yet, to be uncon- fined by any independent walls. We have also noticed these new-formations of very firm consistence, and pale colour, or in the form of cysts, contain- ing a clear, yellowish fluid. In one case, Schuh observed, in the cavity of the tunica vaginalis, a cyst, about the size of a lentil, of a brown colour, and floating free in the fluid ; it was firm to the feel, and contained a dark-coloured, pultaceous matter. Besides this cyst, which had lost all organic con- nexions, he also discovered a thin, membranous, pedunculated cyst, as big as a pea, on the anterior surface of the testis. He has sometimes, also, observed an excessive growth of cysts ; and has seen tumours arise in the scrotum in the course of a year, in the situation of the testis, larger than the fist, of a pyriform shape, slightly nodulated, tense, and of variable firmness in different parts. New-formations of connective tissue occur in every hydro- cele, constituting the ridge-like trabecule on the inner surface IN THE TESTIS AND PROSTATE. 465 of the sac, and which may be recognized as particles of con- nective tissue in the flocculi seen in the fluid when drawn off. In the latter, granule-masses and spermatic filaments are generally met with, which find their way into the sac through rupture of the spermatic cord, which is usually enlarged and thickened, or of some part of the epididymis. According to Rokitansky, new-formations, advancing inwards from the tunica albuginea, and inducing a secondary atrophy of the proper parenchyma of the testis, — ^the tubuli seminiferi, — are of rare occurrence.'' ' [In Virchow's ' Archiv f. Path. Anat. u. Physiol.,' vol. vi, p. 310, 1854, is a paper on the " Appendicular Structures " of the Testis, by Professor H. Luschka, con- taining interesting observations on the subject, more especially of the cystoid growths so often obseiTed connected with testis, and clearing up any remaining obscurity with respect to hydroceles containing spermatozoa. I have therefore thought it advisable here to introduce a brief abstract of the paper, so far at least as it relates to cystic growths on the testis. Professor Luschka observes, " that two kinds of these so-termed hydatids of Morgagni may be distinguished, viz., the sessile and the pedunculate. " The former are so common that their absence must be regarded as the ex- ception. They are found, almost uniformly, beneath the head of the epididymis, at a point corresponding to the anterior extremity of its lower border. In the majority of cases the cyst is solitary j and when two exist, one is considerably smaller than the other. These appendages are usually of a rounded, or well-marked foliate shape, and as big as a pea or lentil, or even of a small hazel-nut. They have nothing like a peduncle, and are inserted beneath the epididymis in such a manner as to convey the impression of their being intimately connected with the substance of the testis. " The sessile hydatid, almost always encloses a cavity, which, in many cases, communicates so openly with the seminiferous canal, that the hydatid may be taken to represent a vesicular dilatation of the extremity of the latter, projecting beneath the epididymis. Their contents always correspond with those of the sper- matic canal, and accordingly, spermatozoa, in large quantity are frequently found in them ; but occasionally only simple nuclei and cellaeform corpuscles. The communi- cation with the seminal tube, when narrower, can, however, always be demonstrated by the introduction of a bristle, or by mercurial injection. But not unfrequently, no communication of the kind can be discerned, and in these cases the cysts contain no seminal elements, their contents corresponding with those of the vesicles next to be considered, and which occur very frequently in the subserous connective- tissue of the epididymis, and less often in that of the body of the testis. " These vesicles are mostly very small, of the size of a millet-seed, or of a pea, and of a rounded form. They usually project but little above the surface, present- ing the aspect of pellucid spots on the epididymis. They are lodged in the sub- serous connective-tissne, and may be enucleated thereform. They afford no indi- cation of any connexion with the seminal canal ; nor can any trace of an obliterated 30 466 NEW-FORMATIONS OF CONNECTIVE TISSUE In the prostate, these new-formations are usually limited to particular portions, causing nodular enlargements. They are also accompanied with a new-formation of gland-substance, tuiulua to be discerned. They are, in fact, simply, serous cysts, which have no developmental relations vv'ith the constituent parts of the testis or epididymis, vrhose wall consists of dense connective tissue, with fine elastic fibres, and con- taining a clear fluid, of variable consistence, with numerous corpuscular elements. Very many of these are rounded corpuscles 0'0132"' in diameter, containing nume- rous fat-granules. But the greater part of the morphological constituents are smaller corpuscles, 0'0017 — 0-0026'" in size — nuclei, — together with a very delicate molecular matter, consisting of protein-substances mixed with fat-drops. Cysts of this kind, frequently present, besides the above elements, well-developed con- nective-tissue-corpuscles, exhibiting every phase from the elliptical shape through the fusiform corpuscle up to almost perfect connective-tissue-fibrils. These cysts have been examined, particularly by Gosselin (' Archiv. G^n. de M^d.,' 1848), who never found a trace of spermatic elements in them. They sometimes enlarge into great cysts, which cannot possibly be distinguished, except upon dissection, from a common hydrocele [the small amount of albumen in the fluid, will always, perhaps, afford a sufiScient diagnostic character from com- mon hydrocele] . The pedunculated Morgagnian hydatids have no connexion whatever with the spermatic canal ; they are less frequent than the sessile, and always solitary. The cyst is supported on a solid, slender peduncle, composed of connective tissue, and about 2-4'" long, arising from the rounded extremity of the head of the epididymis. By careful dissection, the stem may be traced downwards in the fissure between the epididymis and body of the testicle, running on the posterior aspect of the vas deferens, where it is gradually lost in the spermatic cord. The vesicular head con- tains cells, cell-nuclei, and a molecular substance with fat-drops in small quantity. But it is sometimes quite solid, and constituted throughout of connective-tissue- fibrils. It never communicates with the seminal canal. With respect to the genesis of the Morgagnian hydatids, satisfactory information is afforded in Kobelt's work, on the Parovarium in, the female (' Der Nebeneierstock des Weibes, &c.' Heidi., 1847). The Wolffian body in the foetus is furnished with a common excretory duct, which commences with a clavate dilatation. Numerous clavate tubules — the so termed csecal diverticula — open into this duct on its inner aspect. The diverticula belonging to the middle portion of the duct are longer, and more closely placed than those situated nearer the upper and lower ends of it. These middle diverticula are transformed into the seminal vessels of the coni vascwlosi I the upper ones, disappear in part without leaving any trace, and are, in part, metamorphosed into the sessile Morgagnian hydatids, which sometimes retain a communication with the seminal canal of the epididt/mis, and sometimes present the aspect of soUd, or of hollow appendages, not containing any spermatic elements. The caecal diverticula of the lower part of the Wolffian body become the vasa aierrantia Halleri (superfluous vessels of Cooper, which may, also, sometimes dilate into seminiferous cysts. The filament of Miiller running upon the anterior surface of the Wolffian body, from the moment when the male sex of the embryo is determined. IN THE TESTIS AND PEOSTATE. 467 Fig. 119. and, in that respect, deserve the name of a hypertrophy. A middle lobe of the prostate, projecting into the bladder, of an oblong shape, and about an inch in its longest diameter, was somewhat flattened on both sides, and rounded above, and, on section, displayed a consistent, lobulated structure. It had a capsular tunic of connective tissue, and was attached by a broad surface. Its main constituent was very dense connective tissue, consisting of elements of small size. The capsule also contained elastic filaments and groups of epithelial-like cells, which could not be referred to the mucous membrane, as that was removed. The lobe which, for the purpose of making thin sections, had been boiled in acetic acid, dried, and after- wards treated with a solution of carbonate of soda, exhibited only in comparatively few places any appearance of glan- dular substance, which was imbedded in the growth, appearing as sharply defined opaque masses, surrounded by fibrous bands. In many of these spots, the mole- cular stroma presented more or fewer polygonal elements, filled with dark granules (fig. 119, a), and occasionally showing a clear nucleus. loses all future significance, and is consequently atrophied. But it seldom dis- appears altogether, showing itself, at a subsequent period, on the head of the epididymis as a pedunculate Morgagnian hydatid, whose peduncle, as has been stated above, runs beneath the serous tunic, between the testis and epididymis, and is gradually lost, having no relation whatever to the seminal ducts. In the female embiyo, the Miillerian filament becomes the oviduct; and the hydatid vesicle, so often met with at the extremity of the broad ligament, corres- ponds genetically to the csecal termination of the excretory duct of the Wolffian body. The above exposition, sufficiently shows that hydroceles, in the fluid of which spermatozoa exist, have no necessary connexion whatever with the tunica vaginalis, as (notwithstanding the observation in the text), is known to be the case from daily experience.-r-Eo.] 468 NEW-FORMATIONS OF CONNECTIVE TISSUE The glandular ducts {b b), divided more transversely, contained merely a dark-grey molecular substance. The fibrous bands crossed each other in all directions, and, lodged in the areolae, groups of nuclei (c) were visible, belonging, for the most part, to the fusiform cells which lay in a transverse direction. The excretory ducts of the other two, considerably enlarged lobes of the prostate, were dilated, and furnished with sinuous protrusions ; on pressure, some afforded a clear, and others a milky, turbid fluid. The glandular lobules, sometimes before, sometimes after treatment with carbonate of soda, were seen, in sections, to be far more numerous than in the accessory middle lobe. § 14. Eye. A chalazion, removed by Professor Seidl, proved to consist of connective tissue remaining in various stages of develop- ment, and interrupted by interposed groups of aggregated, fine-molecular, brownish-yellow masses. On examining the newly formed connective tissue at the borders of a punctured wound of the cornea in the Rabbit, we noticed, so early as forty-five hours after the inflic- tion of the injury, a considerable quantity of fusiform cells, together with minute, granular cells, which might readily be confounded with pus-corpuscles. In synechia, delicate fibrous bands are seen stretching from the iris to the cornea, or to the capsule of the lens; whether these bands are always referrible to connective tissue of new-forma- tion, that is, whether they are always produced from fibre- cells, must, we think, at present, be regarded as very doubtful. We attempted to produce a prolapsus iridis at the edge of the cornea in a Rabbit, but the animal died on the second night, and we found in the wound merely a large quantity of grouped pus- corpuscles. In the anterior chamber of the eye not operated upon, there was a membraniform coagulum, which obeyed the movements of the aqueous humour ; and when the cornea, which was in a perfectly normal condition, was opened it could be readily removed by the forceps. It constituted a greyish-yellow pellicle, exhibiting, in thin portions, elongated straight, fibrillar streaks, crossing each other in various direc- IN THE BRAIN AND IN THE BLOOD. 469 tions, and without a' trace of connective-tissue-cells. These streaks bore the closest resemblance to mucin-filaments, and were manifestly referrible to a coagulation of the fluid exudation. § 15. Brain. Wavy fibrous bands, even of considerable size, are found, as is well known, in what are termed apoplectic cysts, though this name is inappropriate, since they merely constitute an irregular, ill-defined capsule of connective tissue around apo- plectic efi'usions in a state of incipient involution. They are covered with a fatty, molecular, and orange-coloured sub- stance, and should not be confounded with the delicate, reticu- lated filaments observed in old apoplectic effusions, and which are, in fact, coagulated fibrin. Very considerable layers of connective tissue, of precisely the same kind, are apparent in the cicatriform contractions suc- ceeding the absorption of exudations, in the wall of abscesses, and in the investing tissue of tubercle, and of cancer, in the brain. We have also noticed groups of formations of embryonic connective tissue on the cortical substance of the cerebral hemispheres in idiots. New-formations are, perhaps, far from rare in the very delicate, interstitial connective tissue of the brain ; but, at pre- sent, we are unacquainted with any suitable method of con- ducting the examination of sections of that organ. Professor Czermkk informs us that Purkinje has obtained very in- structive sections from portions of the brain which had been hardened in dilute chromic acid, and subsequently dried and treated with oil of turpentine. It has been already remarked that the interstitial connective tissue of the nerves may become hypertrophied, and induce a secondary atrophy of the nervous substance {vid. p. 181). § 16. Blood. Virchow has found in the blood, after intermittent fever, cells, sometimes colourless, sometimes containing black pig- ment-gi'anules, and of a round, conical, or fusiform shape. From the figures given of them we must conclude that they are con- 470 NEW-FORMATIONS nective-tissue-cells, and would at the same time refer to the precisely analogous cells, long well known, which have occa- sionally been noticed in the venous blood in cases of cancer of the liver. Dr. Planer showed us newly formed cells from fibrinous clots in the heart, which also escaped in great abundance from the coagulated fibrin, in the form of elliptical, oval, gra- nular, much-indented elements, often united in pairs, or even forming entire chains. We rank these bodies, also, with connective-tissue-cells, and would, here, merely remark that they very closely resemble the elliptical cells occurring in gelatiniform cancer. In a venous coagulum, we have also noticed various kinds of connective-tissue-cells. That these are not formed, until a blood-stasis has been established, is self- evident. § 17. Structures of an uncertain nature occurring in THE subcutaneous ADIPOSE TISSUE. In placing these, as yet undescribed, bodies at the end of the category of new-formations of connective tissue, we do not mean, by so doing, to imply that they belong to it. We have sometimes found in the sub-cutaneous adipose tissue of the scalp, and on one occasion in that of the fore-arm, and volar surface of the hand, oval or round, greyish-yellow, or brownish- yellow, sharply defined bodies, about 0-088'" in size. They consisted of a thick capsule, composed of circular fibrils and enclosed a corresponding cavity filled with granular corpuscles (fig. 120, a). In other cases the latter were less distinct, being replaced by homogeneous brownish-yellow substance (6). These capsular structures were placed at definite distances apart, in many situations, whilst in others they were wholly wanting. Time would not allow of more extended observations with respect to these bodies, which, as we learn from Professor C. Langer, are frequently to be seen in the scalp. In some researches on the structure of the skin in young specimens of Hyla viridis and Rana esculenta, we remember to have noticed, in the integument on the inner side of the thigh (more particularly in Hyla viridis) closed capsular organs, filled with a grey, nucleated substance (the nuclei being not un- OF ADIPOSE TISSUE. 471 like those in the lymphatic glands), in considerable number, and either isolated or placed in groups of ten or more together. Fig. 120. Without entering into any particular details, we would here remark that these grey, encysted nuclear masses, which are rendered more distinct by acetic acid, and ultimately disappear in the alkaline carbonates are, probably, lymphatic glands. The above-described organs in Man should also, most pro- bably, be regarded as lymphatic glands, since they enclose a substance precisely like the contents of those glands, and with respect to their structure exhibit considerable analogy with the capsules of the Peyerian glands, and of the solitary follicles of the intestine ; the one marked b would, consequently, re- present a follicle in a state of involution. Their pathological import is at present obscure. We have, a few times, noticed them in a perfectly normal condition of the skin, and once in pemphigus, on the inner aspect of the fore-arm. VI. — NEW-FORMATIONS OE ADIPOSE TISSUE. The fat-cell is characterised by its enormous productivity, which may involve the whole of the sub-cutaneous adipose tissue, and especially that of the abdominal integuments, or be circumscribed within narrower limits, when the tumours, known under the name of lipoma, are produced. 472 NEW-FORMATIONS Fig, 121. A tumour of this kind, which was removed by Professor Chiari from beneath the integuments between the scapulae, was about as large as a middle-sized fist, had a very vascular envelope of connective tissue (nutritive capsule), which was tensely spread over the lobular elevations, and sent down, broad, vaginal processes between the separate lobules. The paren- chyma was of a sulphur-yellow colour, divided by the processes of connective tissue into several compartments, of a soft, elastic consistence, and afforded on pressure a large quantity of brilhant fat-globules. The blood-vessels in the capsule of the tumour, and in the light-coloured, firm processes, were ser- pentine, and, in many places, by means of a powerful lens, a close, polygonal meshwork, formed by them, could be, here and there, perceived. The fat-cells were characterized, in general, by their enormous size and unequal dimensions (fig. 121) ; for whilst the smaller were not bigger than the nor- mal fat-cells, the larger had a diameter of 0*088"',or even more. In their contents, they presented no remark- able differences, being every- \f< where filled with a thin, fluid fat. In thin sections, taken from a dried portion of the tumour, the well - known, radiating, crystalline bun- dles of margaric acid (or margarin?) could be perceived (fig. 122) within the collapsed walls of the cells, to which the mass of crystals was ad- herent [vid. p. 111). A lipomatous tumour, removed by Dr. Zsigmondy from the back of the thigh, presented several points of considerable interest. The skin covering it was lax, coloured with a dirty, greyish-brown pigment, and readily thrown into folds, and beneath it could be felt hardish nodules, some of bony consistence. A section across the tumour at once showed that the groups of fat-lobules had entered into a state of retrograde metamorphosis. These parts had assumed a dark-yellow or brownish-red colour ; their consistence was OF ADIPOSE TISSUE. 473 Fio. 122. increased, and elasticity diminished, whilst calcareous plates could be perceived here and there ; and some lobules, of the size of a bean, were incrusted with earthy matter. The dense, light-yellow portions, contained collapsed fat-cells, in such close apposition that the folded cell- membranes constituted concen- tric layers ; fascicular masses of crystals were not observed in this situation. In the darker-coloured parts, in which, occasionally, a few, scattered, calcareous particles were imbedded, usually either no fat-cells at all, or only imperfect ones, were any longer dis- cernible, an amorphous, dark, brownish-yellow mass, forming the only morphological constituent ; which, in water, and still more distinctly on the addition of acetic acid, agglomerated itself into massss composed of larger or smaller globules. Be- sides these fat-lobules in the most advanced stage of involution, and those previously described, only a comparatively small number of lobules in a better state of preservation were visible, and even these contained numerous fat-cells, which had lost their transparency, and were filled with granulous, brownish- yellow, or brownish-red contents {vid. " Atrophy of the Fat- cells," fig. 14, a and b). In another case oilipoma, taken from an octogenarian woman, we ascertained the existence of an analogous condition, and thus a correspondence may be perceived with new-formations of connective tissue, in which, also, separate groups fall into a state of involution, whilst the development is continued in others. The new-formation of fat-cells never takes place without that of connective tissue, and the consistence of a fatty tumour depends upon the abundance of the latter. When the fat-cells are gradually replaced by a fibrous tissue, a lardaceous growth (steaioma) is produced, as has already been stated by Vogel. Fat-cells, moreover, are also met with, imbedded in the sub- stance of tumours composed of immature connective tissue; thus, in a very voluminous polypus, as it is termed, of the 474 NEW-FORMATIONS. uterus, we noticed isolated fat-cells 'disseminated throughout. They are also seen in the papillary growths of connective tissue, and in their dendritic subdivisions, especially in the syno- vial capsule of the knee-joint. They are lodged in the cavity of the ^apiW« (Rokitansky's " hollow-clavate^apW/«")> and appear like longitudinal rows of fat-cells, encircled by counective-tissue-fibres. The rather frequent occurrence of what J. Miiller has termed lipoma arborescens in the knee-joint, is probably due to the abundance of fat-cells normally contained in the plicee adiposce of that articulation, just as in the plicee adiposes of the intestinal peritoneum, a seat is aflforded for the frequent development of dendritic fatty growths. Tn. CHOLESTEATOMA. Under this term J. Miiller first described an independent kind of tumour, the nature of which, both in respect of its deve- lopment, as well as of its histological import, is, as yet, not clear. It consists of a capsule, filled with a collection of flattened cells, and limited sometimes to the size of a lentil, or it may even attain to that of a pigeon's egg. The surface of the tumour is uneven, and tuberculated, with a pearly lustre. J. Miiller states that by drying, it loses a good deal of its bulk, and, at the same time, its white, waxy aspect, becoming yellowish-brown, but the pearly lustre is not lost, an appear- ance which he refers to the interference of the rays of light caused by the thin layers, for when the capsular en- velope is removed, the lamellae, may be raised like those of an onion. They con- sist of epidermis - like, polygonal, transparent, pale cells, which, in the case recorded, of a cholesteatoma perfora- ting the dura mater, and occipital bone, and having a mean dia- meter of about 0-017'" (fig. 123), presented an elongated, brilliant nucleus, at any rate in most of them, and Fig. 123. CHOLESTEATOMA. 475 could be isolated only with difficulty. Between the lamina formed of these flattened elements, were lodged, large cholesterin- plates, together with free fat in the globular form, in some respects not unlike that of the sebaceous follicles. The second kind of crystalline fat, noticed by J. Miiller, is more scantily distributed, and occasionally forms little foliated masses; that these crystals were pointed at each end, he satisfied himself, by dissolving them in boiling alcohol or ether, from which they crystallized on cooling. Both he and Rokitansky describe the capsule as a thin, delicately fibrous, or as a structureless, striated membrane. Cholesteatoma also appears as an accessory growth, asso- ciated with other new-formations; thus we have figured it above (fig. 117, b b), in cystosarcoma of the breast. With respect to the development, it may, perhaps, be assumed as more probable, that the formation of the connective-tissue- capsule precedes that of the epithelial-like cells, than that the contrary takes place. In this case, it might be supposed that a very vigorous growth of these cells occurs in the areola of a papillary^ or more irregular new-formation of connective tissue, and that the cavity is ultimately entirely filled by them ; and that, as they are formed in layers from the periphery towards the centre, a concentric disposition will result. The contents of the cyst gradually undergo a retrograde meta- morphosis, a view which seems to be favoured by the presence of cholesteriu ; whilst nothing remains of the papillary forma- tion but a thin structureless pellicle. Cholesteatoma, therefore, should not be ranked under the new-formations of adipose tissue, its formation depending upon a precedent papillary excrescence. Just as, in the case of lipoma, the growth never takes place independently of a new-formation of connective tissue, so is it in the present instance.^ ' [The editor has lately been indebted to the kindness of Dr. Gull for the oppor- tunity of examining a portion of a tumour, about the size of a walnut, from the brain of a lunatic in the Colney Hatch Asylum. It was situated at the base of the brain, so as to compress the medulla and pom, but, as Dr. Gull was informed, had no con- nexion with the cerebrum and cerebellum. An apparently, precisely simUar case is recorded in the fifth volume of the Transac- tions of the Pathological Society of London, by Drs. Thurnam and Bristowe, and as the account of the microscopic appearances of the growth, given by the latter observer, corresponds in all respects with those exhibited in the case above noticed, 476 NEW-FORMATIONS Vm. NEW-POUMATIONS OF CAHTILAGE AJSTD BONE. These new-formations, as J. Vogel has remarked^ are so intimately allied, that they cannot, properly, be considered apart. In all new-formations of cartilaginous tissue which have reached a certain stage of evolution, transitional forms of, and even perfect, osseous tissue occur. it will be sufficient here to transcribe it in part. " The surface had a smooth, •white, glistening nacreous appearance, and a considerable degree of toughness ; but in the interior these characters were wanting, and the tissue, though white, was soft and lustreless. The superficial, pearly portion was distinctly laminated, and could be split easily into exceedingly thin, but rather tough layers of "small size ; an imperfect tendency to a like arrangement was visible in the central softer parts, the fragments torn from which assumed the characters of irregular flakes rather than of true laminse." Microscopic examination showed, " that the soft internal portions consisted of irregularly polyhedral cells, from about ^Jjth to the jjjth of an inch in diameter, interspersed with numerous crystals of cholesterin. The cells were coherent, and modified in shape by mutual pressure. Their contents appeared to be fluid, but certainly not oily, though many of them contained refractive, jelly-like masses [col- loid ?] of small but various sizes. . . . The cholesterin was external to the cells, and collected more or less into masses. " The nacreous portion of the tumour was formed of flat, polygonal, cohering epi- thelial scales, the diameter of which was generally equal to that of the cells above described. They were slightly granular, and each contained a roimd or oval nucleus about j^th or ;^th of an inch in diameter, which was remarkably distinct, con- tained one or more nucleoli, and was surrounded by a transparent zone, against the outer margin of which the granular contents of the cell were accumulated in consi- derable quantity. ... In addition to these cellseform elements, from the sur- face of many parts of the tumour, a delicate layer could be removed, which was structureless, or marked only by delicate and iiTegular lines, which appeared to be chiefly due to creasing. It seemed to be elastic, and had a considerable general resemblance to the fenestrated membrane of arteries. From the superficial portions of the tumour, all cholesterin was absent, so that the pearly appearance was solely due to the character and arrangement of the epithelial scales." The above description will amply sufiice for the distinguishing of these curious productions, but their genesis is still quite obscure. They are curious, not so much, perhaps, from their contents, which bear a not very remote resemblance to those occasionally met with in sebaceous encysted tumours, whose connexion with the tegumentary system is undoubted, as from their situation, which it would appear is always at the base of the brain, and in the neighbourhood of the medulla oHongata and pom Varolii. Another remarkable fact connected with them is the circum- stance that they appear, hitherto, to have been observed only in lunatics. Dr. Gull points out the resemblance of these pearly cholesteatomatous tumours with those noticed and figured by Cruveilhier under the name of " tumeur d'appa- rence perl^," with which they would seem, in fact, to be identical. — Ed.] OF CARTILAGE AND BONE. 477 It may, perhaps, be regarded as an established fact, that the cartilage-cells, on account of their extraordinary multiplicity of size and form, in themselves bear no distinctive character. Who, for instance, could distinguish the small cartilage- cells in the thick tendons, or those in the synovial processes, and in the ligamentum, falctforme of the knee, pointed out by Kolliker — from elliptical connective-tissue-cells, or discover any morphological difference between the oblong, fusiform cartilage- cells lying nearest to the perichondrium, and the fusiform cells of connective-tissue (Virchow^s connective-tissue-corpuscles) ? It is not the mere form of the cell that affords its character, but the history of its development. Hence it follows, that in such cases it would be altogether impossible to assign one name rather than another to the cell as such, did not its relative position, to some extent, but chiefly its subsequent metamorphosis into a bone-corpuscle, (KoUiker's bone-cavities) afford evidence that we had to do with a cartilage-cell. The latest authors agree, if not in the appellation of the cell, still in the main point — that each bone-corpuscle originates in a cell ; and the dispute ultimately resolves itself into this, whether under particular circumstances the connective-tissue-cell may become transformed into a bone-corpuscle, or whether there is such a thing as a primary cartilage-cell.^ With these few observations, we may now, without risk of being misunderstood, at once define the general process of development in the pathological new-formation of osseous tissue, as one which is preceded by a new-formation of cells, which in their general habit are sometimes cartilage-cells, and sometimes approximate to those of connective tissue. In fractures of the bones, the regeneration of the tissue ensues under various modifications, which have not as yet been sufficiently investigated, but which may be surmised from the variation in the mode of development noticed by Sharpey, Kolliker, H. Meyer, and others. We shall first proceed to adduce some well-marked cases from our own experience. An old woman, three months previous to her death, had suffered a transverse fracture of the neclc of the femur, close to the head, whose axis formed an acute angle with that of the ' Vid. KoUiker's ' Manual of Human Histology ' (Eng. transl.), vol. i, pp. 81 and 843 (Notes). 478 NEW-FORMATIONS Fig. 124. femur, and was thus partially broken. At the upper and back part the seats of fracture were superficially soldered by a firm, cartilaginous substance, which extended to a depth of about 1-77 — 2-65"'. In front and below, the two fractured ends, were united by a cribriform and delicate osseous substance, though only superficially, since in the subjacent layers nothing was visible but a gelatinous reddish material. The cartila- ginous substance presented all the characters of fibro-cartilage (fig. 124, a). The cells were mostly of an oval form, with a delicate membrane, clear contents, and granular, solitary, or multiple nu- clei (3 — 5), which latter had evidently arisen by a process of division, and were accompanied by a corresponding number of protrusions of the cell- wall ; the cells were arranged longitudinally with respect to the ends of the bones. The inter- cellular substance encom- passing the cartilage-cells, proved to be of a fibrous nature. The above de- scribed cribriform osseous and subdividing trabeculee, the bone, and the longitu- process, consisted of proceeding from both arching ends of dinal axis of the corpuscles (fig. 124, b), was usually parallel with the curve of the trabecula. The disposition of the lamellae, or rather stria, of the intercorpuscular substance, also corresponded with the curve of the trabecula, or bony spicule. The substance filling the interstices between the latter resembled connective tissue. The investing cartilage on the head of the bone, was in the normal condition, though partially removed over a space about half an inch in diameter around the insertion of the ligamentum teres ; the cartilage in that situation appearing, as it were, to be eroded, and the hollow to be filled with a reddish connective-tissue-material. OF CARTILAGE AND BONE. 479 containing considerable, branching vesselsj granule-masses, molecular matter, and brownisb-red, reddish-yellow groups of pigment-granules. The ligamentum teres was in a very soft, infiltrated condition j and the articular capsule was much in- jected on the inside. We have observed the process of ossification of the fibro- cartilage between the fractured ends of the lower jaw in a Horse. The cartilage-cells, with their granular nucleus and the fibrous interstitial substance, at the points more remote from the ends of the bones, were well characterised, whilst in parts nearer the bone a metamorphosis began to be apparent in the nuclei ; the cells lost their granular condition, becoming smooth and prominent, and angular in place of round, or, to use a better expression, minute indentations appeared at the peripheryj thewMcZews, which could still, occasionally, be recognized, ulti- mately disappeared, and nothing remained but an irregularly- jagged, clear cavity, sometimes furnished with a prolongation (bone-canaliculus). The shape of the bone-corpuscles thus formed, approached the round, oblong, triangular, fusiform, &c. ; longitudinal fissures were apparent in the interstitial substance, often constituting entire series (the incipient, fibrous, intercor- puscular substance). Vessels filled with blood appeared to enter the substance of the fibro-cartilage, and in the parts where ossification was commencing they were surrounded with concentric, fibrous layers. The condition of the cartilage-cells was different in the ossifying cartilage, which formed, with the periosteum, a con- tinuous capsule around a comminuted fracture of the tibia in a Horse, in which large fragments of bone were enclosed. The cells were small, and of an oval form ; the intercellular sub- stance consisted of connective-tissue-bundles, composed of parallel fibrils ; the whole presenting a considerable resemblance to the numerous layers of cartilaginous tissue which occur in such a characteristic manner in the thicker tendons in the Horse. It is obvious, that in order to see the delicate cartilage- cells, ex- tremely thin layers of the tissue must be viewed, for otherwise they would be concealed by the connective-tissue-fibres. The metamorphosis of the cells could not be observed as in the former case, since, in many situations, the cells imbedded in the intercellular substance already appeared as angular, pale 480 NEW-FORMATIONS corpuscles, with merely an indication of a nucleus. On the other hand, it was evident, that the intermediate connective-tissue- fibrils had disappeared, and been replaced by a lumpy, streaked, and ultimately, as it were, mottled (auftapirten) interstitial substance, in which the young bone corpuscles could be re- cognized only in extremely thin plates. Where the osseous tissue was perfectly formed, the corpuscles appeared slenderer, oblong, and jagged, and the interstitial substance presented the well-known finely porous aspect. In this case no complete medullary canals had been formed ; there existed, it is true, narrow, closed spaces, filled with a fine-granular, yellowish- brown material, which gave the thicker sections a spotted appearance, but none were observed filled with blood. From these observations it follows : 1, that a formation of cartilaginous tissue (or, if this term be objected to, a for- mation like connective tissue) precedes that of the bone, in the regeneration of the latter ; 2, that the form of the cartilaginous tissue varies; 3, that the regeneration commences from the periosteum, and that a perfect new-formation of bone may, there, have been attained to, whilst in the deeper layers, sometimes the products of exudation, sometimes, in compound fractures, dead portions of bone are found ; 4, the material known under the name of callus consisting essentially of fibre- cartilage, sur- rounds the broken ends of the bone, and is equivalent to Dupuytren's provisional callus. It is a well-known fact that the ossification continues to advance towards the centre of the bone, and ultimately fills up the medullary canal ; but, under these circumstances, it is not a compact substance which is produced, but merely one of soft consistence, with bony spicula and comparatively large cancelli which abut upon each other in the centre. The continuity of the medullary canal is subsequently restored, but the precise mode in which this is efl"ected demands further research. In fractures, the exudation is, often, only partially organized, or not at all. The formation of fibro-cartilage takes place only imperfectly, or, as it would appear, in many cases is wholly abortive, the union being effected, chiefly or solely, by a fibrous substance, lipus be produced from the exudation, the curative process is impeded, either throughout or in circumscribed por- tions, and it not unfrequently happens that an abscess is formed OF CARTILAGE AND BONE. 481 together with an excessive development of bone on the part of the periosteum, in the form of various kinds of osseous growths.. The portions of bone bathed by the pus necrose, and may, when the suppuration has ceased, and the new bone has advanced from the neighbouring parts, give rise to the formation of a sequestrum. In a histological point of view, we cannot speak of the union of a fracture by suppuration, inasmuch as the ^m* is a new-formation, which, so long as it remains, opposes the union. When the fracture is perfectly united, the line of junction is indicated on the surface of the bone, by a more or less raised, osseous swelling ; but the subjacent tissue is less com- pact than elsewhere, as may be seen in sections. A perpen- dicular section through an osseous cicatrix, the direction of which was downwards and inwards, in the inferior fourth of the tibia, displayed, above the seat of union, a dense texture appearing white by reflected light, and which was abruptly de- fined from the yellowish connecting substance. The former, by transmitted light, exhibited a grey, compact tissue (fig. 125, a), in which the me- ^lo, 125. duUary canals, divided ^ 'l^r'n^ ' - - transversely and ob- _ sN?/;TJfi?^SS^itf 5t 'S? i :* liquely, were of com- ^ ^^'^^^f^^%^X^<£^ j1 paratively small size, J ^.?^^¥;S.^a;^#?SSr;&r^ whilst the latter (6) presented a wide- meshed, delicate net- ^^^'''^^^' t^if^/^^^' f'^~"'^^W^'"^ work of osseous rays, " retaining their usual transparency. The substance with which the cancelli were filled was opaque, amorphous, and infil- trated with fat. Towards the curved surface, a more com- pact cortex, with narrower cancelli was perceptible (vid. the convex border in the figure) ; but in general a lax, spongy texture was characteristic of the connecting substance. The cure of injuries of the bones, accompanied with loss of substance, is tedious and difficult, as is shown, especially, in the openings made with the trephine. In a very instruc- tive case of a considerable loss of bone in the middle of the OS frontis, resulting from a severe fall, and a subsequent ope- ration with the trephine, Vrolick has endeavoured to show" that new cartilage- and bone-substance may be formed from the 31 482 NEW-FORMATIONS exudation afforded by the edges of the wound, independently of the dura mater and periosteum. After the removal of both membranesj there remained a cartilaginous substance, which filled nearly the whole of the opening, and in which could be perceived larger and smaller systems of bony spimUBj none of which were connected with the osseous borders of the opening. But from this, it by no means follows that the periosteum is • not concerned in the restoration of the bone, in which, on the contrary, it would appear, from the researches of B. Heine, to play the principal part. Gtinsburg describes the appearances presented in the cranium of a woman who had survived the operation of trephining for 79 years. The opening in the bone was closed, on the inner aspect, by a membrane perforated in several places, and the edges were there united with a deposit arising from the dura mater. The membrane consisted of flaky structures, and decussating fibrous bundles, which were attached to the thinned and contracted edges of the bone. The new-formation of cartilage, and its transition into osseous tissue, may be very distinctly observed in the tumours termed by J. Miiller " enchondromata," on which account we shall, here, proceed to notice them. An enchondroma of the femur, nearly as big as a child's head, was amputated by Professor Schuh, The tumour was distinctly defined, lay in the continuity of the bone, arising above the condyles, which retained their form in all its inte- grity, and extended above the middle of the femur. After the soft parts had been removed, the tumour appeared ellip- tical, with slight, tuberous elevations on its smooth surface; it was of a yellowish-grey colour, speckled with red, of a dense consistence, and covered with a shining, adherent coating. When cut, a dirty, bloody, glutinous fluid escaped, mixed with gelatinous, friable masses, which had been detached from the inner side of the large, thick walled, sinuous cavity. These gelatinous masses constituted, for the most part, the lining of the inner wall, and were, also, occasionally more consistent, projecting in the form of warts and clavate processes. An oblique section across the femur, which was bent at an obtuse angle, afibrded the following results. The thick wall (fig. 126,' a) of the sac, which extended upwards, and whose inferior extent is seen at c, exhibited, at its point of connexion with OF CARTILAGE AND BONE. 483 the compact osseous substance, numerous jagged projections, which gradually passed into an osteophyte, displaying, in the Fio. 126. a section, a triangular form {b) ; the smooth surface of the latter, constituting the segment of a circle, was applied to the wall of the cyst (a), projecting, with its irregular processes, towards the brownish, soft, cartilaginous investing substance, which, at c, assuming a flesh colour, had supplanted the compact osseous tissue of the femur. A bluish-grey, greyish-yellow mass, with a lobular border on one side {d), was lodged in the substance of the latter ; at the lower part, towards the condyle (/), and especially at p^^ 127 the point where the growth had perforated the bone (c), the substance presented a fleshy-red colour, and extended still further until it reached the compact cortew. Precisely analogous, cartila- ginous deposits were observed in the same limb at the inferior, enlarged extremity of the tibia, in whose spongy substance, and deep-red medulla,thQ bluish-grey, or greyish - red cartilagiijous growth (fig. 127, a a), was ap- parent, well defined by its lobu- 484 NEW-FORMATIONS lated contour. Similar cartilaginous masses occurred also in the bones of the tarsus, and in the first phalanx of the great toe, situated in the spongy tissue of the enlarged articular ends. The gelatinous, detached masses, in the fluid of the cyst, contained round, oval or oblong corpuscles (fig. 128, a) which were separated from each other, and presented sharply defined molecules, and one, or even two, hyaline nuclei in their con- tents ; the latter, hpw- ^'°- •'2^- ever, were not visible in the majority of these elementary bodies, ap- pearing to be hidden by the molecules, which were unaffected by acetic acid ; which re- agent, however, pro- duced, a considerable turbidity in the fluid (mucin-filaments.) In other situations, again the elements presented great varieties of form and size, as at b ; the intercellular stroma was sometimes perfectly hy. aline, sometimes indis- tinctly granular. The less transparent, deeper- coloured masses con- sisted of a dark brown- ish-yellow molecular substance, aggregated in larger or smaller quantities, in which were occasionally im- bedded very large fat-globules, some of which might also be seen floating on the surface of the fluid. Besides these elements, there were visible, granular, agglomerated nuclei, and elements resembling shrivelled blood-corpuscles, together with detached, wavy connective-tissue-bundles. The same results were afforded by the examination of the gelatinous substance attached to the bulging inner wall of the cyst. The papillary, wart-like OF CARTILAGE AND BONE. 485 projections were more consistent, less transparent, and com- posed of variously shaped cartilage-cells. The outer layer of the enchondromatous sac was formed of a dense fibrous tissue, with elastic filaments and blood-vessels; when this was removed, the opalescent, cartilaginous substance came into view, whose cells, encircled by fibres, were less distinct at the periphery, whilst towards the interior, they presented the unmistakeable character of cartilage-cells, as, for instance, from the costal cartilages. In other parts, and more internally, manifestly embryonic formations were visible in the thick wall. Other elementary bodies were observed, of polymorphous shapes, and consisting of a delicate membrane, 'with clear, transparent contents, and enclosing a round, oval, or elongated, granular corpuscle, resembling a nucleus (fig. 122, c c c c). The size of the envelope, as well as the number of the enclosed corpuscles, increased (e e e), and they became aggregated into separate masses within the tunic. In the further examination of the outer layers of the sac, ossified portions were noticed, connected, partly with the evidently cartilaginous tissue, partly with bundles of fusiform fibres. The bone-corpuscles were either very clear, and finely jagged, or opaque, with fatty molecular contents; the inter- corpuscular substance was, for the most part, finely striated. The transverse section of the femur, when closely examined, showed the cancelli, occasionally of considerable size, and filled with a cartilaginous substance, which had replaced the osseous trabecule with groups of more or less well defined and re- movable nodules or papillx. This new-formation contained fibro-cartilage-cells, with granular nuclei, not unfrequently in a state of incipient division (fig. 128, d) ; dark streaks, also, could be seen, crammed full of collections of fat-globules, unalterable in acetic acid, and surrounded by oblong or fusi. form cartilage-cells, imbedded in a hyaline stroma. A consi- derable degree of interest attached to certain elementary structures, consisting of a body, with three, four, or more radiating processes, and containing in the centre a granular nucleus (ff) ; which latter, however, was wanting in many other similar elements {g g). ' There were also groups of bodies having a rounded outline, and of various dimensions, exhibiting, in the centre, a cell (?) with hyaline contents, and 486 NEW-FOKMATIONS Fig. 129. presenting at the periphery a radiated striation {h h) ; in the smaller bodies of this kind, there was simply a granular central mass, with radiating stria abutting upon it (i i) j the outline was less sharply defined than it appears in the figure. Very numerous varieties of cartilage-tissue were met with in all parts ; for instance, rounded cells, disposed in groups or rows, with a large, granular nucleus, and an indis- tinctly molecular, or perfectly structureless intercellular sub- stance (fig. 129, a), which, in other places, presented a lamellar texture {b). Close to the larger osteophyte (fig. 126, b), elemen- tary organs occurred in the carti- laginous layers (fig. 129, e), sur- rounded with a distinct mem- brane, and enclosing a granular, occasionally radiated corpuscle, and which evidently stood in close connexion with the osteo- phyte, containing light and dark bone -corpuscles in a streaked intercorpuscular substance (/). The medulla, close to the site of the amputation, was injected with blood, contained numerous, stellate groups of crystals in its fat-cells, and, lower down, was entirely replaced by the enchon- dromatous substance. Themus- cles presented a gelatinous, pale aspect, and loose texture ; and, when torn asunder, the primitive fasciculi exhibited the same appearances as may often be observed in those of Amphibia or Fishes in the recent condition, when the muscles have been slightly squeezed or torn; that is to say, the cross striie were no longer visible, nothing being seen but transverse ruffce (fig. 139, a), and occasionally a longitudinal striation, corresponding to the primitive fibrils. When the primitive fasciculi were torn, they sometimes appeared to be connected (as at d) by a hyaline structureless band. It cannot, perhaps, be doubted that the proper muscular parenchyma had, in this instance, undergone a process of fusion, in consequence OF CARTILAGE AND BONE. 487 of which, it had been reduced to the condition of a viscous fluid, which could be drawn out of the sheath in the form of the hyaline band {d) ; and it is most probable that the ruffce, above noticed, were due to transverse folds of the sarcolemma. It still remains to speak of the histological import of several of these elementary organs. The cells, fig. 128, eee, must, per- haps, be regarded as parent-cells, with secondary cells enclosed in them, but, in this case, it should be remembered that the former have scarcely any longer the functions of true cells, and that, although the tunic may grow, they are inca- pable of further multiplication by division j they might, con- sequently, be looked upon as intermediate agents in the nutrition of the secondary cells, towards which their relations would not be unlike those of the nutritive capsule of one or several Echinococci or Cysticerci towards the animalcules. The branched elements, described by J. Miiller as jagged corpus- cles (fig. 128, //, ff g), had probably an investing tunic (as at e, in fig. 129), but which, on account of its tenuity, was not distinctly visible, and the rather so since the corpuscles in ques- tion were imbedded in the tissue. J. Vogel remarks that they resemble bone-corpuscles, with which they are, with- out doubt, related, as is rendered more evident by the re- searches of Kolliker and H. Meyer, with respect to the de- velopment of the pore-canaliculi. But the corpuscles, h h,i i, in fig. 128, admit of a more doubtful interpretation j and it has to be determined whether the larger specimens contain a car- tilage-cell in the centre, and have suffered radiating fractures at the periphery, or whether those marked i i, in particular, do not represent colloid corpuscles. With respect to the development of the above-described enchondroma of the femur, it may be assumed, with a consi- derable amount of probability, that the new-formation sprung from the periosteum, and consequently was, at first, a peripheral enchondroma, or, should another name be preferred, a cartila- ginous sarcoma, and that it did not, till subsequently, become a central enchondroma, by the deposition being continued into the parenchyma of the bone. This may be supposed from the circumstance that such a compact and large osteophyte was seated on the surface of the femur, and as it is diffi- cult to conceive how, after the perforation of the compact 488 NEW-FORMATIONS cortex of the bone, on the part of the already softened cartila- ginous tissue, such a bulky tumour should have been formed. The enchondromata in the tibia, and both the others, are central. In several other enchondromata, from the spongy portions of the long bones, and of the lower jaw, cells in close apposi- tion, with a very small quantity of fibrous interstitial substance, and with rarefied parent-cells, were chiefly noticed, an observation corresponding with those of Joh. Miiller. Not unfrequently, also, softer, yellowish spots, with a lustre not unlike that of asbestos, were observed, containing merely a collection of nuclei, with numerous, often fatty, molecular masses, and representing abortive forms, such as are displayed in most new-formations. According to Virchow's nomencla- ture, these portions would be said to be in a state of tuber- culization. The new-formed cartilaginous substance is frequently inter- rupted by interposed connective tissue, and the greater the predominance of the latter, the more does the enchondroma lose its proper character, and acquire that of a sarcoma. We had an opportunity of examining a growth of this kind. The tumour was situated external to the testis and tunica vaginalis, but intimately and inseparably united with the former. In the centre was a cavity, at least as large as the fist, containing a thick, yellow fluid, and lined with a firmly adherent, yellow coating. The wall of the cyst was, in many parts, more than an inch thick, whilst, where it rested on the testis, its thick- ness was not more than two lines. A multitude of smaller cysts were imbedded in the tissue of the sac, some very minute, others as big as a walnut. The larger ones contained the same thick, yellow liquid, and a few of the smaller enclosed a transparent wine-yellow, glutinous fluid. Lastly, small tube- rous elevations, of an opaline aspect, might be noticed, which, on section, displayed cartilage-cells, sometimes isolated, some- times assembled into groups of three or four together ; these cells contained more or fewer brilliant molecules, with a nucleus rendered manifest by acetic acid, and they were round, oval, elon- gated, fusiform, or represented the segment of a circle, or of an ellipsoid. The ossified parts were well defined, and penetrated, in the form of digitate processes, into the cartilaginous sub- OF CARTILAGE AND BONE. 489 stance, giving off, as they proceeded, jagged, osseous rays, like those which are seen in the ossification of the cranial hones of the foetus. In describing the first case of enchondroma, it was stated that the new-formation of cartilage might take place on the free surface of a cavity in the clavate or verrucose form. This appears to us to have been the case in the instance now cited of cystosarcoma of the testis. Instead of a papillary new-formation of connective tissue, we find a similar formation of cartilaginous tissue, arising from the growth of cartilage- cells in successive layers, circumscribed laterally. Precisely analogous new-formations of cartilage-tissue occur, as is well known, in cancer, which we shall afterwards notice ; in this case, as in sarcoma, they are simply accessory formations, and do not affect the essential nature of the tumour. J. Vogel has correctly observed, that the outward form and aspect of a tumour should never be held sufficient for its determination, from such characters alone, as an enchon- droma. Microscopic examination only can afford a certain diagnosis, and prove that we have to do with a cartilaginous tissue. We have already, on several occasions, remarked, that callous, and particularly colloid exudations, as, for in- stance, on the pleura, peritoneum, middle coat of the vessels, &c., deceptively resemble cartilaginous tissue, though contain- ing not a vestige of a cartilage-cell. The ossification of enchondroma has been more particularly described by Rokitansky ; he distinguishes that which results in the formation of a very dense, hard, ivory-like bone, from that which produces a dull white, very dense, though friable, coarsely granular, osseous substance. In the former case, he found the bone-corpuscles furnished with very few and short processes, and larger, though not uniformly so, than in normal bone, of a coarse shape, and in their disposition showing some indications of regularity. The lamellar texture is limited to a flaky or foliated parting of the stroma, in one or other of the rings surrounding one of the medullary canals, which are scanty, and run in all directions. In the second form, the process of ossification is incomplete, being confined, in many places, merely to the deposition of calcareous salts. 490 NEW-FORMATIONS An excessive new-formation of embryonic cells may take place in the cartilaginous tissue, in consequence of which it is rendered very soft, homogeneous, and compressible. Thus, in the soft, white, intervertebral cartilages, readily splitting into several parcels, taken from the lumbar spine of a rachitic individual, 24 years old, we found that the affected substance had lost its normal transparency. In the dissection, isolated, nucleated cartilage-cells, and rounded, or irregularly angular, granular corpuscles escaped in great abundance ; sharply defined, elliptical bodies, of considerable size, were also no- ticed, containing a larger or smaller quantity of the above- mentioned granular corpuscles (fig. 130, «, c), which were im- bedded in a fine-molecular and structureless matrix, or were sometimes wanting alto- gether, nothing remaining in the cavity but a granular sub- stance ; but they also oc- curred singly in smaller vesi- cular structures {b). Whether they were all of the nature of nuclei may well be doubt- ed, inasmuch as they appear- ed to be far too numerous ; they might, therefore, at any rate, in part, be regarded as secondary cells. That these presumed cells, like the nu- clei, entirely fill the parent-cell by their rapid multiplication, is a fact ; and that a rupture of the tunic may thence ensue, there is every reason for supposing. Larger groups of cartilage-cells, were likewise apparent, separated from each other Ijy arching, fibrous bands {d). The cells, of considerable size, enclosed one or several nuclei. Other elementary organs were also worthy of notice, presenting a concentric striation (6), and arising probably in a successive condensation of the colloid cell-contents. The first stage in the development of the cartilage-cell, ap- peared to be the formation of a hollow vesicle, in which, com- mencing on one side, a differentiation into two subdivisions was OF CARTILAGE AND BONE. 491 apparent — a hyaline pale globule being formed on the one side (vesicular nucleus), and on the other a crescentic deposit. The nucleolus did not make its appearance in the vesicular nucleus till afterwards, and, perhaps, two might be seen, like distinctly projecting granules. In the fibrous, homogeneous articular cartilages, in accor- dance with the statements of Ecker, ^olliker, and Bedfem, we have also observed voluminous parent-cells with one, two, or many secondary cells ; and besides these, cells in a state of fatty degeneration are always met with. In this case, also, a new-formation of embryonic connective tissue may be noticed on the o;ie hand, together with a retrograde metamorphosis' on the other. After a loss of cartilaginous substance, it is never replaced, the hollow being simply filled up by connective tissue; or a cretification of the entire cartilage may take place, as shown by the experiments of Dr. Redfern on animals. In the papillary new-formations of connective tissue in syno- vial membranes, new-formations of cartilage-cells may develop themselves in the hollow sacculi noticed by Rokitansky. These growths are aggregated, especially at the line of insertion of the articular capsule; — they are thick-walled, usually en- veloped by a fibrous tissue, and become ossified. Accord- ing to Rokitansky, these ossifying new-formations, when of larger size, lose the form of rounded masses seated upon simple or branched peduncles, and necessarily accommodate themselves to the normal articular structures, as well as to any kind of new-formation already existing ; they present, especially in the space between the articular capsule and the condyles, an even or sometimes slightly convex, sometimes slightly concave arti- cular surface, and besides this, where they come in contact with others, several facets ; when in considerable numbers, Eokitansky has seen them assuming the form of prismatic cones. He found that these new-formations were enclosed accord- ing to circumstances, sometimes in a thinner, sometimes in a thicker membrane, composed of connective-tissue-fibres, and that they were invested on their articular surfaces with a layer of cartilage with a fibrous intercellular substance, which is sometimes wanting, so that the osseous substance is exposed. Occasionally, also, he has noticed on them, even on their 492 NEW-FOEMATIONS articular surfaces, other vegetations ; their basis is usually formed by the meeting of several flattened bauds, which converge from various points. He has no doubt, moreover, that these growths occasionally become detached, when they consti- tute a particular form of loose cartilage in the synovial cavity. What is termed malum coxm senile, an appellation to which Rokitansky and Wernher object as inappropriate, since this form of disease does not occur exclusively in the hip-joint nor in old age, has been variously understood by different authors of late times. Whilst Wernher describes the essence of the disease as consisting in an inflammation of the coxal muscles, and regards the pathological changes in the corresponding bones as secondary, Zeis places the inflammation of the hip- joint, in the first place ; but both authors have overlooked an essential circumstance, adverted to by Rokitansky, viz., the growth J 1, of vegetations from the spongy part of the articular head, in consequence of which the investing cartilage becomes Ulamentous or felty, and its intercellular substance split up into fibres ; 3, of botryoidal, knotty, osseous growths, covered by cartilage in the recent state; and 3, of similar osseous growths around the cartilaginous articular surfaces. We re- gard these new-formations of cartilage and bone-tissue as so essential to the present disease, that they must be considered as forming part of it. But it should not be overlooked, that an exudative process is going on at the same time, not only in the articular capsule, but also in the medullary substance of the spongy tissue in the d.fl'ected head of the bone, accompanied with a hypertrophy of the bone-corpuscles, and of the so-termed osseous lamella {osteosclerosis). Thus we perceive, in this case, that three dif- ferent processes are combined together. Whilst the new-forma- tion of cartilage and bone-substance proceeds at certain points at the periphery of the spongy part of the head of the bone, inducing a secondary atrophy of the investing cartilage, the exudation is causing in other parts a fusion of the osseous tissue, and an apparent enlargement of the cancelli, which are infiltrated with an exudation in a state of involution, constituting what is termed inflammatory osteoporosis ; whilst at a third poiut, hypertrophy of the bone is apparent. In consequence of a more vigorous nutrition of one or other OF CARTILAGE AND BONE. 493 part of the bone, there is produced, in the so-termed malum coxm and analogous affections, a lamellar multiplication of the bone-corpuscles, which, of course, are derived from cells. In this way the medullary canals and cancelli become diminished, as is proved by direct observation in parts of bone in a state of sclerosis. But the increase of the osseous substance, when it exceeds a certain limit, reached at the expense of the nutritive vessels contained in the cancelli and canals, necessarily leads to the involution of the hypertrophied parts. In the cancelli also, may be noticed numerous amorphous deposits of calca- reous salts ; the spotty, unsymmetrical, and close distribution of which, conveys an impression as if these deposits took place in the bone itself. We have also noticed deposits of fatty matter and pigment, which could not be removed by acids, in the osseous substance of sclerosed portions of bone in a state of incipient involution; and the latter may present irregularly disposed, frequently, aggregated, closely crowded bone-corpuscles, varying in size and form, and manifestly indi- cating a rapid new-formation. If reiterated exudations now ensue around the sclerosed portion in a state of involu- tion, the texture becomes loosened up, or passes, as it is usually expressed, into a state of osteoporosis. The deposition of calcareous salts is very abundant in the well-known porcellanous substance on the diseased head of the bone, and contributes, next to the botryoidal new-forma- tions, to the atrophy of the articular cartilage. The same process as that which we have described as occur- ring in the articular head, may also take place in the acetabulum, whence arises a more or less complete synostosis. The true osseous connexion between the two parts of the joint — the concave and the convex — is effected by the new-formations growing on each surface. In the intermediate osseous sub- stance, comparatively large cancelli and canals are formed, usually filled with an opaque, amorphous material, yellowish- white, or dark coloured, when viewed by direct light. In the form of disease, known under the name of coxalgia, an excessive exudative process, which gives rise to the new- formation of pus and connective tissue is succeeded by that of bone. In a man, 29 years of age, affected with acute tuber- culosis of the meninges at the base of the brain, and in the 494 NEW-FORMATIONS lungs, the left acetabulum was bare of cartilage, full of warty osteophytes, and the ligamentum teres destroyed by a pulpy exudation, so that its texture could no longer be recognized ; the head of the femur was only partially covered at the border, with a thin, loosely attached cartilaginous layer, beneath which was a lobulated, soft new-formation, springing from the cancelli, and by which the loosening of the cartilage had been caused. A vertical section of the head disclosed a greyish-yellow, nodular mass (bone-tubercle), about 1-32'" in diameter, which consisted of mere nuclear formations, analogous to the grey tubercular substance in the lungs. The medullary substance was in patches, deeply reddened, and contained, in many places, embryonic connective-tissue-formations, in a state of fatty degeneration. The cellular tissue on the cervix femoris was pulpy, and infiltrated with a gelatinous matter, without any visible formation of new elements ; the connective-tissue- fibres and the elastic filaments, appearing to be forced asunder by the gelatinous exudation. It has long been satisfactorily shown, that no strict limits can be drawn between exostoses and osteophytes. Engel has laid particular stress upon the genetic impulse, stating that the former are produced by an increase of the osseous substance without inflammation (= hypertrophy), and that the latter are the product of inflammatory action, notwithstanding the existence of the most various transitionary forms. With refe- rence to what has already been stated on the subject of exudation, atrophy, and hypertrophy, we would, here, remark, from a histological point of view, that an exostosis, regarded as a partial hypertrophy of authors, is an excentric growth of the osseous substance, limited to a certain part, and 'following the type of the portion of bone affected, whilst an osteophyte represents a new-formation of osseous tissue, either not arising from any bone at all, or not conditioned according to the type of the part of the bone afiiected. But if the latter is ill defined, the criterion is, of course, deficient, and exostoses and osteopTiytes cease to represent distinct ideas. If we suppose, that from any circumstance, more nutritive matter is afforded to a portion oi the periosteum, or of a superficial part of the bone, circumscribed by the mode in which its vessels are distributed, the parts concerned will necessarily, in case an OF CARTILAGE AND BONE. 495 active organizing nisus is set up, experience a more vigorous nutrition, that is to say, systems of bone-corpuscles are deposited, which, however, do not in the direction of their growth diflfer es- sentially from those of the original system {vid. «m^., "exostosis at the root of the teeth"), but are to be regarded, as it were, as ad- ventitious, superimposed systems, which in their further develop- ment are even provided with medullary canals. In fig. 131, we have represented a perpendicular section of a perforated parietal bone. Posteriorly, the bone was perforated by an opening having a circumfereHce about that of a middle-sized chestnut, whose borders were callous and thick- ened, and on the vitreous table, both there and in several other situations, were deposits ^ of flattened, finely jagged, bifurcating bony masses ; a a corre- sponds with the outer side, which is, as usual, more compact, pervaded by smaller medullary canals, and less transparent than the central osseous substance occupying the spaces between the thicker canals of Breschet, and the cancelli {h). On the vitreous table is seen the divided, bony deposit (c), with tolerably wide medullary canals, anastomosing with those of the diploe. The transparency was again diminished in the denser, internal layer of the new formed substance. Now, should the growth in question be termed an exostosis or an osteophyte? Did it arise from an inflammation, or from an atrophy ? Is the type of the affected bone retained? In answer to which we think it necessary merely to put the two questions : Where does hypertrophy cease, and where does inflammation commence ? when can it be determined that the type is changed ? It is obvious at once, that, in enter- taining questions like these, we become involved in a maze of subtleties, and are wearying ourselves in the making of dis- tinctions which do not exist in nature. It is far rather incumbent on us to ascertain the development of new-forma- tions of this kind. Opportunities are often afforded of tracing the development of the structures denominated by Rokitansky "puerperal" 496 NEW-FORMATIONS osteophytes;" from which term, however, it must not be supposed that the formation is limited to the puerperal state exclusively. A similar formation of osteophytes on the inner surface of the cranium, is witnessed under other circumstances, as has also been remarked by Engel, especially, in tuberculosis. The osteophyte in question is formed by the nutrient vessels of the dura mater, which also penetrate into the vitreous table, through small openings, which may be distinctly perceived in the macerated bone. Now, as the greater numbei: of these vascular orifices are situated at the borders of the sutures, of the groove for the a, meningea media, and along the longitu- dinal sulcus, it is easy to comprehend why thoee situations are the principal seats of the new-formation. An exuda- tion takes place from these vessels, in which may, at -once, be noticed, together with an amorphous blastema, an organized substance, in which Virchow has remarked immature connective tissue (caudate corpuscles), or an apparently homogeneous, scarcely fibrillated connective tissue, with numerous, parallel, oval nuclei, together with very many intercommunicating, newly formed vessels, which are readily torn when the delicate layer is raised from the bone. In deeper layers, he has usually noticed the rapid development of a perfectly homogeneous connective tissue, often presenting no trace whatever of fibrillation, and in which, after treatment with acetic acid, nuclei can but rarely be rendered visible, but which is always perforated by good-, sized openings for the passage of the vessels. Of cartilage, he was never able to perceive any trace, nor of cells, beyond the .fibre- cells of the immature connective tissue. He is of opinion, therefore, that if the bone-corpuscles have any genetic relation with a pre-existing portion of the tissue, it can only, from what he has seen, be with the nuclei of the connective tissue.^ In recent preparations, we have directed our attention to the cancelli formed by the arching trabeculae of the osteophyte, and traced the fine osseous spicules to their outward termina- tion; and have thus. been able to satisfy ourselves of the exist- ence of a very delicate layer of oval, nucleated cells, placed at tolerably regular distances apart, and imbedded some- ' \_Vid. Note, KoUiker's 'Manual of Human Histology' (Eng. trans.), vol. i, p. 81.— Ed.] OF CARTILAGE AND BONE. 497 Fig. 132. timeSj in an amorphous, sometimes, in an indistinctly striated matrix. A little nearer the ossification, the rounded outlines of these cells are still very easily distinguishable (fig. 132, a), and there is very often apparent in them a space, sometimes central, some- times placed towards one side, which can scarcely be explained as a nucleus, but as a cavity in process of develop- ment, or as Rokitansky, from the examination of the process of ossification in rachitic bone, has remarked, is to be ascribed to a retraction of the cell- contents towards the nucleus. In the parts thus undergoing ossification (a), the intercellular substance presents a finely punctated aspect, and the osseous canaliculi, which mostly penetrate the bone in an oblique direction, are already perceptible as minute fissures. The inter- cellular substance, therefore, would seem to hollow passages, even before the formation bone-corpuscle.^ Besides this, two openings will be observed in the figure (a), destined for the passage of vessels. Thus, we may perceive the greatest analogy between the for- mation of the fcEtal cranial bones, and that of osteophytes seated on the vitreous table, and deduce the origin of the spherical bone-corpuscles from the rounded cells; our observations, in all other respects, with this exception, being in accord with those of Virchow. Like him, we have also noticed places, in these osteophytes, in which the above-described layer of oval cells appeared to be wanting, nothing but fibre-cells being met with next to the ossified part; but whether these belonged to the connective tissue, cannot, as we conceive, be decided from their shape, but from the transformations they undergo. The bone-corpuscles, also, in these situations, were of an oblong form (fig. 132, b), and appeared quite clear and somewhat jagged. Even to the naked eye, but still better with the aid of a lens, in these striated osteophytes, nearly parallel grooves could be perceived^ which were apparent even in extremely exhibit minute of an indented Vid. Kolliker, op. cit., vol. i, p. 361, note. 32 498 NEW-FORMATIONS thin lamelke taken from them (as in b). The bone-canaliculi, also, running in an oblique direction, were surprisingly numer- ous in these osteophytes. The roundish bone-corpuscles were proportionately of large size, having short, tooth -like processes at the periphery, and closely approximated to each other; and the interstitial substance never seemed to us so finely striated as it appears between the oblong corpuscles, especially after treatment with hydrochloric or acetic acid. In skulls that have been macerated, these osteophytes, on the smallest scale, seated on the vitreous table, appear like just perceptible, white scales, which can be readily removed, and of a soft, friable consistence; and by the inexperienced observer, they might be taken for mere calcareous concre- tions, the opaque substance apparently exhibiting no structure. But the application of acetic acid removes all doubt that they consist of true osseous tissue, for when the substance is rendered transparent by the removal of the earthy salts, the clear bone-corpuscles become visible. The usually discrete, white scales are seen, in other situations, spread over an exten- sive surface, and coalescent; and in like manner they unite to form successive layers, finally constituting compact osseous plates, which, after the skull-cap has been removed, occasion- ally remain attached to the dura mater, and in thin sections exhibit chiefly oblong, many-rayed bone-corpuscles interlaced with each other in variously formed groups. The inter- corpuscular substance in one preparation was penetrated by very distinct, freely anastomosing bone-canaliculi, which appeared as if they had independent walls. The medullary canals in the denser osteophytes are always well developed, forming a delicate network of tubes, in which the anastomosing branches gradually diminish in size as they approach the central point of union. Those osteophytes are, in many respects, of considerable interest, which occur on serous membranes. Morphologically, they differ from the above, chiefly by their papillary, globose, or clavate projections towards the free surface. Several wart- like osteophytes, seated on the arachnoid, near the falx major, projected inwards towards the sac of the arachnoid, varying in size from a scarcely visible nodule to that of a lentil. In the larger specimens, several botryoidal elevations could be per- OF CARTILAGE AND BONE. 499 Fig. 133. ceived, even by the naked eye, distributed over the whole surface. Under a low magnifying power, and by reflected light, a multitude of globose, clavate, or conical tuberosities^ with lateral nodosities, and clearly defined, could be perceived (fig. 133), the surface of which appeared smooth. These nodulated growths precisely resemble, in their configuration, the analogous productions of connective tissue, such as we have figured, for instance, from eystosarcoma of the breast (figs. 117, 118) ; and which are met with in sarcoma and cancer, projecting into the areoke in the form of cartila- ginous vegetations. It is not difficult, in carefully prepared sections of these ossified vegetations, to satisfy oneself that they possess the tex- ture of bone. The bone-corpuscles are disposed according to the outline of each projecting nodule, in lamellar series, and may also, in many places, be concealed by the opaque, brownish- yellow and brownish-black intercorpuscular substance, and these parts may very suitably be compared with new-formed papillce of connective tissue in a state of involution. These ossified vegetations, when they have reached the height and breadth of a few millimeters, also possess a system of medullary canals (fig. 134), presenting the usual characters, viz., a more or less rectilinear course, the meeting of several branches in a saccular dilatation of the canal, and the junction of the branches into a wide-meshed network. Whether these canals penetrate into the papillary excrescences we have been unable to deter- mine, though we doubt the fact Fig. 134. 500 NEW-FORMATIONS of their doing so ; whilst in recent osteophytes of this kind we have noticed a distinct vascular plexus in the furrows on the surface. We have examined the more intimate textural conditions, and particularly with reference to the disposition of the bone-corpus- cles of the nodular excrescences, in osseous plates, which were found by Dr. Tiirck in the visceral lamina of the arachnoid, on the thoracic portion of the spinal chord. The pia mater was there covered with a thick, puriform layer, 078 — 0"11 thick, extending upwards as far as the superior thoracic vertebra, which were so far destroyed by caries that in some of them no part of the body was left. One smaller and two larger osseous plates were observed, each of the latter having a longitudinal diameter of 023 — 027", and a breadth of 0-15". At their points of attachment they appeared smooth and firmly imbedded in a fibrous stroma ; on the free surface, botryoidal elevations, similar to those of the osteophytes just described, were per- ceptible. A portion of these excrescences, removed by the scissors, retained sufiicient transparency to allow of the structural details being made out. The peripheral outline was well defined, presenting numerous sinuous protrusions (fig. 135). The shape of the excrescences was characterised by its multifarious- ness, being globose, nodulated, pa- pillary, &c. The bone-corpuscles, which were mostly oblong and light-coloured, were disposed at regular intervals, with their longer diameter pretty nearly parallel with the outer surface of the growth. The intercorpuscular sub- stance presented a well-marked striated texture. The bone-canali- culi were seen in the surface ex- posed by the scissors (at a), at which point the growth was con- nected with other similar excrescences. We have also noticed an incipient ossification in a carti- laginous shell covering the convex surface of the left choroid plexus in the lateral ventricle. It occurred in an old man Fig. 135. OF CARTILAGE AND BONE. 501 affected with chronic hydrocephalus. Both plexus contained numerous arenaceous concretions, all of the same form as those in the pineal gland, and which have been figured by Valentin. The epithelial cells contained reddish-brown pigment-molecules. The shell-like growth itself consisted of a substance, splitting up at the borders into fibres, and in which round and oval, hyaline cartilage-cells might be discerned ; in the more con- sistent parts of the deposit these cells had undergone a meta- morphosis into finely toothed bone-corpuscles disposed at regular intervals. The question now arises, as to how these ossified excrescences are developed ? After what has been stated above, with respect to the papillary new-formations of connective tissue on the synovial membranes, and the formation of ossifying cartilage- cells in the hollow sacculi, it may perhaps be assumed with some probability that a blastema is deposited on the free Surface of the arachnoid in a rounded form, which gradually becomes organized. The mode of the osseous formation may be explained in two ways : either cartilage-tissue is formed immediately, from which the bone is forthwith developed j or its formation is preceded by that of an independent, capsular wall, enclosing the blastema, and consisting of an apparently structureless membrane, or of fibre-cells arranged in close con- tiguity, and which are transformed into connective-tissue- bundles. Within this wall the cartilage- and osseous tissues are produced from the blastema. Among the fibrous membranes the periosteum is chiefly the seat of very bulky new-formations of bone; and it is here especially that they assume all those forms which have been assigned by Lobstein to osteophytes in general, such as — the diffuse form, appearing as a thin layer incrusting the bone over a greater or less extent of surface, or as a fibro- reticular crust. The concrete form assumes the shape of warty granulations, pointed spicules, scale-like leaves, stalactites, styloid processes, stellate projections, and cauliflower-like ex- crescences. These terms, which might be considerably multiplied, will suffice to show the polymorphism of these growths. The various forms pass into one another, or may be combined, and, consequently, should not be regarded as distinct species. We shall here only give figures of some of them. In fig. 136 is 502 NEW-FORMATIONS. represented &a osteophyte developed after amputation of the femur; a, corresponds with the sawn surface of the hone which has been divided down the middle ; b, the site of the amputation ; c c, the osteophyte. On the side towards the place of amputation the latter presents smooth, warty, rounded elevations. On the sides of the bony deposit, numerous, larger and smaller, sinuous depressions may be noticed, leading sometimes to fissure-like cavities, sometimes furnished with several secondary excavations, which, again, are produced by projecting bony ridges. Superiorly, long, pointed spinous processes project from the hinder part of the osteophyte, occasionally enclosing infundibuliform hollows. The medullary canal of the femur, near the site of amputation, was only incompletely obstructed for a distance of about an inch by a yellowish, friable, amorphous material, which was deposited on the wall of the medullary canal, and increased in thickness towards the lower part. In this substance some reticulated, fine osseous spicules might be noticed. Higher up, where the deposit of amorphous, crumbling substance did not reach, the entire thickness of the medullary canal was occupied by a delicate, arachnoid network of osseous trabecule, which, when examined more closely, were found to be constituted of dendritic filaments projecting freely into the medullary cavity. The bone-corpuscles, disposed along the axis of the filaments, were more or less hidden by the yellowish-brown, readily lacerable, intercorpuscular substance, though still perfectly recognizable. OF CARTILAGE AND BONE. 503 In a second preparation, made by Dr. Zsigmondj, the obtu- ration of the medullary canal, after amputation of the femur, had advanced to a slight extent ; towards the site of the ampu- tation the trabecular tissue was rather closer, and bony rays could be seen projecting into the canceUi, having a slender, elongated stem, and a clavate extremity, exactly like the club- shaped new-formations of connective tissue. In the more flattened, occasionally cribriform parts, a powerful lens brought into view minute, broad, and closely adherent nodules, analogous to the hemispherical and papillary new-formations of con- nective tissue projecting into the areola. The osteophyte, which was situated on one surface of the femur, presented to the naked eye a perforated aspect ; by means of the lens, the perforations were seen to be the oblique orifices of narrow channels communicating with each other, whose walls could be accurately traced only under a somewhat higher magnifying power. At their free border, the latter presented numerous, irregular, jagged prominences (fig. 137), and elsewhere, on the surface, slight elevations and depressions, in which were visible several secondary open- ings and ridge-like elevations. Larger, also oblique, narrow fissures could be seen at un- equal distances apart, by which several systems of lamella were formed, and an appearance not unlike that of the spongy bones of the nose given to the osteophyte. These fissures, communicating with each other, are precisely analogous to those which are met with in various connective-tissue- growths. The areola of the newly formed bone had, in other places, a rounded shape, and, when of larger size, were sub- divided into secondary or accessory areola, by bifurcating, osseous projections in the form of rays. It is, hence, evi- dent that the new-formed osseous tissue presents the same type of constfuction — viz., the areolar, as connective tissue. Fig. 137. 504 NEW-FOEMATIONS and also that analogous, ossified papillary growths spring up in the areola. The formation of osteophytes of this kind, on the larger cylindrical hones, such as the tibia and fibula, may not unfre- quently be observed, in the recent state, in persons suffering from what are termed varicose ulcers. In these places, the peri- osteum appears to be considerably thickened, and more firmly adherent than usual, its vessels, also, being enlarged ; it forms a coating intimately united with the new-formed bone, and sends strong connective-tissue processes into the superjacent muscular substance, at the same time insinuating itself into all the depressions of the osteophyte. When the osseous spicules are traced in their continuity with the soft parts, the same thing precisely will be observed, as has been noticed above, as occurring in the osteophytes of the vitreous table of the skull, that is, a layer of minute, sometimes oval, sometimes fusiform cells will be perceived, which manifestly undergo a transformation into bone-corpuscles, and on that account might be regarded as cartilage-cells. The osseous new-formation proceeding from the periosteum may, especially in the larger bones, increase to such an extent, that a considerable portion of the bone is surrounded by it in a sort of capsule, and becomes necrosed. This secondary necrosis, proceeding from the periphery, has been erroneously described by many surgeons as a central necrosis. The new-formation of bone-substance is frequently asso- ciated w\th that oi pus, and this is the case, not only in the com- pact, but also in the spongy parts of bones (in caries) ; and the abscesses, as has been before stated, may contribute to the for- mation of sequestra and cloaca. The pathological process va2Ly be thus described : the hyper- trophy of the periosteum extends also to that of its vessels, which convey more nutriment, and thus is induced a locally ex- alted nutrition, and the production of new systems of boncrcor- puscles ; the latter, originating in the metamorphosis of cells resembling those of connective tissue, follow different direc- tions, and it depends simply upon their mutual relations, what form is assumed by the osteophyte. The deposition of osseous substance may be conceived of as taking place in two ways, either a blastema (exudation) is afforded from the vessels of OF CARTILAGE AND BONE. 505 the periosteum, in which new- cartilaginous and osseous tissue arisesj which is not till afterwards, in the course of its growth, brought into union with the peripheral tissue of the bone, or the new layers are deposited immediately upon the old. That the new-formed osseous tissue enters into an organic connexion with the original bone, is obvious from the inosculation of the medullary canals on both sides ; but the development of the former may take place independently, so rapidly and to such an extent, by a newly developed vascular system, that the old bone, together with its nutrient vessels, falls into a state of involution. Of ossifications occurring in unusual situations, but few have come under our observation. The ossification of the tendons, formerly described by Miescher, was noticed on one occasion, by Professor Dumreicher, in the dead body. The tendon of the biceps brachii was transformed into a bony substance, commencing at its insertion into the tuberosity of the radius, the density of the osseous substance increasing upwards. The bone-corpuscles appeared alternately elongated, and many rayed, in other places, of the round or suboval form, with short prolongations from the sharp points. The medul- lary canals formed a delicate network, and expanded into con- siderable cancelli. The osseous rays, extending along the tendon, were jagged, and imbedded in the connective-tissue substance, which, here and there, exhibited oval cartilage-cells containing a granular nucleus. This ossification of the ten- dons has but little surprising in it, since we know, from Kolliker's researches, that in the stronger tendons, towards their insertions, oval cartilage-cells exist in considerable abun- dance. At the insertions into the bone of tendons containing cartilage-cells, that author has even seen, in some degree constantly, cartilage-cells in the most various transitional stages towards bone-cells, particularly those with thickened walls, and a more or less advanced deposition of calcareous particles; and besides these, he has noticed perfect bone- corpuscles, with pores and a more homogeneous wall, still lying free in the matrix of the cartilage. Miescher has also observed genuine osseous tissue in healthy muscles in what are termed " exercise bones" (Exercirknochen) ; and Valentin describes the same thing in the osseous plates 506 NEW-FORMATIONS met with in atrophied eyes. Ignaz Meyr noticed an irregular annular ossification in the site of the cihary body in an eye in a state of atrophy, and in which the cornea was opaque, and the pupil closed. Rudolph Wagner found in the eye of a male subject a flat, discoid lens, as hard as stone ; it was con- verted into true osseous substance, and contained medullary canals. (Virchow inquires whether, in this case, an ossification behind the lens, which so often occurs, combined with its total disappearance, might not have given rise to an error in the observation.)^ In an atrophied eye, which was flattened in front, and exhi- bited a stellate cicatrix in the cornea, we observed, together with a total absence of the retina, vitreous body, and lens (the globe being filled merely vdth a thin, yellowish-red fluid), on the inner side of the choroid coat, numerous, more or less extensive, isolated, grey, resistant, and firmly adherent aggre- gations, projecting, in the form of minute nodules scarcely visible to the naked eye, into the cavity of the bulb. These little nodules consisted of bone- substance, the corpuscles in which, had sometimes the embryonic form, and were large, oval, with a faintly jagged outline, whilst others exhibited longer projections, the corpuscles themselves being slenderer. In the same way, also, the intercorpuscular substance appeared, in many places, to be composed of thick fibres, decussating in various directions, and leaving everywhere minute vacuities between them, whilst, in other parts, the fibres composing this substance were already fused into a homogeneous, finely per- forated mass. Contiguous to the ossified part, a tissue of cartilaginous consistence and yellowish colour, could be per- ceived, containing numerous, mostly oval, light coloured cells, imbedded in a fibrous matrix ; the latter cells, however, could not be distinctly viewed except in a single layer. Towards the ciliary body, the thickness of the bony substance increased nearly to 0'44"'. Beneath, and close to the cartilaginous layers, granular, flattened, oval, elementary organs, aggregated into layers, were apparent, together with shreds of the mem- • [In the ' Keport of Proceedings of the Pathological Society,' for 1850-51, p. 183, a case is recorded by Mr. Canton, in which the crystalline lens was converted into a calcareous material, but here the change seems rather to have been cretification than ossification, and to have been limited to the capsule.^ED.] OF CARTILAGE AND BONE, 507 brana limitans (?), The iris was intimately united to the cornea by connective tissue, which, in this situation, was accu- mulated in the form of a soft-lace rable, embryonic substance, into which several blood-vessels could be traced. In the optic nerve, which was reduced to at least half its diameter, not a single nerve-tube could be discerned, nor, in fact, any- thing but dense connective tissue. We noticed a very rare form of ossification in a fibroid tumour of the uterus, which was about the size and shape of a small hen's egg, presenting a tuberculated, botryoidal surface, and having, in all parts, the consistence of bone, be- neath the membranous capsular envelope. When sawn across, in the dry state^ it exhibited, towards its pointed end, a cavity about the size of a bean, smooth on the inside, and lined with a delicate membrane; and around this part the substance was manifestly more compact than else- where. More externally, as well as towards the lower end of the growth, soft cretaceous masses were insinuated between other portions, which, in the surface of a section, appeared denser and shining, and bounded by an irregularly lobate out- line. Lamince, sawn off and polished, presented a considerable diversity of structure, for whilst, in many places, the most dis- tinct bone-corpuscles were apparent, in others they were wholly wanting. These corpuscles were grouped in concentric layers around areola, filled with opaque calcareous salts, removable by acids (fig. 138, a), were sometimes of an elongated shape, and furnish- ed with numerous radiating and bifurcating canaliculi, and sometimes approached the round or polygonal form {b), in which case the rays were, generally, shorter. The differences in their size also were very remarkable, as were the irregular distances at which they stood apart. Fro. 138. 508 NEW-FORMATIONS Many of the groups formed by these corpuscles, contained per- fectly opaque calcareous masses, soluble in acids. The separate systems of bone-canalicuji, interdigitated with each other, in a manner similar to; but not so regular as, that in which they are disposed, for instance, in the compact substance of the cylin- drical bones. Of particular interest were those parts in which nothing could be distinguished but irregular, jagged, streaky masses of the most various dimensions (e) ; whilst in the inter- mediate substance, a regular bone-corpuscle could only, here and there, be perceived. These masses, however, should not be con- founded with the opaque portions (c), which can be regarded only as larger and smaller areola, filled with pigment and calcareous salts, precisely analogous to the irregular deposits in the pleura, the cysts of the thyroid gland, and in the larger vessels. The interstitial substance appeared indistinctly striated. In the ossified spots, numerous ramifying medullary canals of con- siderable size could be perceived, but these were for the most part obstructed by opaque masses, whilst those in the merely cretified portions, did not appear to be so filled ; some dark streaks might be due to shrunken blood-vessels. The membranous capsule of the osseous structure, when softened by maceration, was seen to consist of a very dense tissue of decussating fibres; no trace of a cartilaginous layer was per- ceptible. In the same uterus, moreover, besides this ossified growth, fibroid tumours of the usual kind also existed. The development of the osseous tissue in this case, took place only in parts, whilst in the intermediate portions, the growth had not advanced beyond the formation of deposits of calcareous salts in the areola, and areolar passages ; the blood- vessels, as well as the other organic structures, being in a state of atrophy. But the medullary canals in the fully formed bone-substance, and its corpuscles, were also involved in the cretification. If, with Rokitansky, we amplify the idea of an osteoid growth, it may be made to include such a new-formation as the present, but, at the same time, being non-malignant, it must be distinguished from the apparently similar growths of a different nature, described by Job. Miiller (which belong to cancer). OF THE DENTAL TISSUES. 509 IX. NEW-POEMATIONS OF THE DENTAL TISSUES. Three kinds of hard tissue, as is well known, exist in teeth — the dentin — enamel — and cementum, and the new-forma- tion of these tissues may be studied in the same order. The true nature of the bodies termed by Linderer "juice- cells" (Saftzellen), and previously described by R. Owen as " dentine-cells," was first correctly appreciated by J. Czermak, by whom they are denominated "globular masses j" whilst Kolliker terms them " dentin-globules." Their essential nature and physiological import are, as yet by no means established ; this much only having been ascer tained by pathological research, that precisely isomorphous globular masses also occur in cretified exudations (vid. fig. 51, c) They appear to us to be spherical deposits of a protein-sub stance impregnated with calcareous salts, into which the den tinal canals, furnished with independent walls, are continued. They obtain a certain pathological importance when in excessive number, and of considerable volume, and when formed in parts of the dentin where they do not occur in the normal condition. Like the globular masses, the interglobular spaces also increase in dimensions, and contain sometimes a transparent substance, though not unfrequently an abundance of calcareous salts, soluble in acids, or of blackish-brown pigment masses. In fig. 139 the latter may be seen constituting thick layers, interposed between the , , T T Fig. 139. globular masses. In the instance from which ili.^ f'f ^ the illustration was * taken, that of an in- cisor tooth in a youth of sixteen, these layers, arising from the inter- stitial substance of the cementum and dentin, could be traced across the entire thickness of the latter, in obliquely ascending lines. It is well known that, in teeth exhibiting this structural 510 NEW-FORMATIONS Fig. 140. anomaly, slight annular ridges are visible, even by the naked eye, surrounding the root, which correspond to the origins of the patches or tracts of globular masses and wide, opaque, interglobular spaces. The lamellar disposition of these masses towards the crown of the tooth is also, without doubt, connected with the lamellar formation of the dentin in alveoli (depressions), the existence of which has been shown by Kolliker's researches. The globular masses sometimes assume a dark colour; so deep, in fact, that their boundary is only rendered apparent by a light seam. They insinuate themselves, in the form of apparent canaliculi, proceeding from the outer or inner surface of the dentin, and have been variously misin- terpreted. Thus Lin- derer speaks of the for- mation of new canals in the dentin; meaning, probably, thereby, only dark globular and in- terglobular masses. In fig. 140 is shown a vertical section of the root of a dead bicuspid tooth ; at c, the small globular masses rest upon the dentin; the proper cementum, con- taining bone-corpus- cles, being omitted in- the figure. Close to c, will be noticed ir- regular, dark spaces, continuous with stria (a a a), of various forms and which penetrate deeply into the dentin. These vacu- ities, which often present varicose dilatations, are very fre- OF THE DENTAL TISSUES. 511 quently seen in the dentin of old teeth presenting no appear- ance of necrosis or caries; and when shorter, or when trun- cated at each end in the preparation of a section, have been described as bone-corpuscles. J. Czerm^k has shown the erroneousness of this notion, and expressly states that he has never seen a genuine bone-cor- puscle in the dentin. A mistake of this kind, moreover, would be the more readily made, since these dark spaces have' irregular prolongations, like the bone-corpuscles. The irre- gularity of their conformation, therefore, would afford the only criterion of their true nature. Occasionally, also, the direct communication of a fissure-like cavity, with a dentinal tubule, may be readily traced ; or it might, even, almost be said, that the latter was dilated and vari- cose. The dark mass {b, fig, 140), in this instance, extends trans- versely through the entire thickness of the dentin, becoming slenderer towards one end, and more transparent. Now, how does it happen that the globular masses advance into the substance of the dentin ; whence do they get their dark colour ; and what is their pathological import ? It has been shown that the dentinal canals represent a connected system of tubes, furnished with independent walls, and con- nected by anastomosing branches. This system, on its peri- pheral and central aspects, is covered with a layer of hyaline globular masses, separated by interstices. The dentinal tubules convey a fluid subservient at the same time to the nutrition of the dentin ; but the globular masses have also some relation to the nutrition of the dentin, with which, it must be confessed, we are not accurately acquainted. On the one hand, these masses are secreted on the inner surface of the dentin by the vessels of the pulp ; but, on the peripheral aspect, the nutritive juice which coagulates into the globular form, can only be afforded by the vessels of the alveolar periosteum, and this juice must penetrate through the cementum. Under particular circumstances, the plasma accumulates, in many places, in considerable quantity, and causes, both from without and from within, a fusion of the corresponding part of the dentin, or it may even penetrate entirely through it, especially towards the point of the fang, in the form of an apparent 512 NEW-FORMATIONS canal; and undergo, after its coagulation, retrograde meta- morphoses.^ If now, as has been stated above, the globular masses are of the nature of protein-bodies, what are the conditions displayed in their further organic development ? In the dentin, close to the cementum at the point - of the fang of an incisor tooth, whose enamel was necrosed, we noticed the mass represented at d, fig. 140; its periphery was sharply defined by a sinu- ous outline, from which radial striae might be seen running for a short distance, forming irregular furrows, diminish- ing in width towards the centre. In the latter situa- tion, an opaque mass, with unequal, jagged prolongations, was present, but which did not possess the type of a normal bone- corpuscle. The rounded, angular bodies, with a long process, in the mass d, were worthy of notice ; some of them contained a corpuscle not unlike a nucleus. In the same tooth, at a short distance from the above- described mass, another of similar kind was met with (e), in which the radial striation was still more distinct, and the central cavity filled with an amorphous, brownish-yellow sub- stance. Smaller, dark, irregularly toothed masses might also be ob- served (as at /), containing several streak-like vacuities, around which, bodies, either perfectly transparent, or composed merely of a punctiform substance [g), were found imbedded in the dentin. With respect to which, it should be remarked, that it often seems as if these masses, which are sometimes light coloured, sometimes very dark with pigment, lie free in the the substance of the dentin; but the circumstance that, in perpendicular sections of teeth, they are seen passing through it obliquely, outwards or inwards, and, moreover, the direct evidence of their radiation from the peripheral or central surface of the dentin, render still more difficult the,. ' In several instances, we have noticed, towards the point of the fang, in incisor, bicuspid, and molar teeth, a perforation through the thick cementum having the appearance of a straight, sharply defined, light or dark streak, from which occasionally, lateral branches arose. These streaks in the cementum conse- quently differ from those situated in the dentin, in the want of the hemispherical projecting masses. With KoUiker we regard them as medullary canals, and would at the same time remark, that they should not be confounded with the irregular interglobular spaces. OF THE DENTAL TISSUES. 513 a priori, improljable, supposition, that these masses may arise independently in the dentin. The globular masses are sometimes developed in a more bulky form on the inner surface of the dentin, and undergo organic metamorphoses of the same kind as those to which the dentin and osseous tissues themselves are subject. These solid new-forma- tions were known even to Prochaska, and have lately been more accurately described by F, Ulrich, who found them in the substance of the pulp, or on its surface, and mostly on the aspect directed towards the masticatory edge or surface of the tooth ; they vary in dimensions, from a size just perceptible, to a bulk nearly or completely filling the cavity of the tooth. He distinguishes two kinds of substance — one resembling bone, osteoid, and one like dentin, dentinoid — together with a combination of the two. Prom the results of our own investigations, we think it more suitable to employ for this new-formation the term osteo-dentin, selected by Owen (for the dental substance of many Fishes and some Edentata), its structure being really intermediate between that of bone and of dentin. We shall illustrate the account of it by some instances. An incisor tooth (fig. 141, a) had suffered a con- siderable loss of substance at the neck {d). In places towards the upper part of the fang, where the dentin appeared spotted, several dark vacuities extended from the cementum (a) deep into the substance of the dentin (b). This tissue, as well as the enamel (c), was removed in the site of the excava- tion («?), only a remnant of the dentin forming its floor. At this part the usual metamorphoses of necrosed dentin could be readily observed ; the most external portion was of a dirty- yellow, or yellowish-red colour, and might, inadvertently, have been taken for enamel. The colour resided in the intertubular substance, and the tubules became gradually unrecognizable. In the deeper layers, next to the carious spot, the dentin presented a chalky aspect, and had lost its proper transparency, the corresponding tubules, here and there, containing opaque granular masses. But what was of most interest, was the substance deposited on the upper surface of the dentin (e), and which exhibited other important characters ; it was more transparent, the regular disposition of the tubules was lost,, and amorphous, jagged cavities filled with an opaque substance 33 514 NEW-FORMATIONS were apparent, communicating with each other by zigzag, irregularly bifurcating tubules, immediately continuous with those of the dentin. The above-mentioned dark vacuities fre- quently exist in the osteo- F'G- 141- dentin, and should not be confounded with bone- corpuscles. Besides this, globular masses, in the form of elliptical, hyaline bodies, are invariably present in the younger states of this new-for- mation. In a molar tooth, we observed a mass of osteo- dentin, highly developed, and of unusual size (fig. 141, b) ; it was seated in the dilated pulp-cavity of the fang, of an oval form {d), and about 2-21"' '"'^ in length, presenting a peripheral dentin-substance surrounding the central, osseous part, in the form of a ring. In the latter might be seen straight, anastomosing cavities, the thicker of which were as much as 0'047"' in diameter, and filled with a dark, brownish-yellow substance; whilst the smaller, which were transparent, were scarcely 00088'" in size. Between these cavities, which are analogous to medullary canals, were lodged bone-corpuscles, characterized by their diversity of shape ; for whilst many possessed all the characters of the corpuscles of the cementum — that is, were furnished with the same fine, reticulating, and numerous canaliculi — others, still distinctly recognizable as bone-corpuscles, having a diame- ter of 0-046'", exhibited merely an indented outline. Many were widely removed from common bone-corpuscles, partly by their enormous size (00177'" more), partly on account of their irregularly bulging or straight form, though they still retained the numerous radiating canaliculi. Towards the periphery of the new-formed dentin, irregular, larger or smaller, inter- OF THE DENTAL TISSUES. 515 globular spaces filled with an opaque material were visible, presenting in many places the usual type of the similar spaces situated between the cementum and dentiuj with the minute, elliptical, globular masses imbedded in them. The tubules of the osteo-dentin (b, d) following the direction shown in the shading of the figure, appeared to be continuous, in many places, with those of the contiguous original dentin, and, at the point nearest to the apex of the fang, decussated with the latter at a right angle. The plane of radiation of the tubules of the osteo-dentin was at the periphery (that is to say, the tubules ran and ramified towards the central, osseous sub- stance, presenting, in their course, well-marked, wavy curves ; their arrangement and mode of ramification, otherwise, resem- bling those of the tubules of the perfect dentin. Krom the central substance of the osteo-dentin, several dark, globular masses insinuated themselves to some depth into the newly formed dentin. In one place, an opaque mass, bounded by a well-defined, light-coloured border, about 0-01 77'" in breadth, and surrounded by globular masses, extended almost through the dentin j and from this, short, radiating, delicate canaliculi were given ofi', which decussated with the larger tubules of the newly formed dentin. Where the tubules of the latter were not continuous with those of the original dentin, they were parted by the interposition of a transparent, globular substance; and a similar substance also existed on the free surface of the osteo-dentin, where it projected into the pulp- cavity. No structural anomaly could be discerned In the cementum (fig. 141, b, «) nor in the dentin (6) ; the enamel was necrosed over a small space. A precisely analogous instance was presented in a molar tooth. The osteo-dentin, in a transverse section, also exhibited an oval form, and a longitudinal diameter of 0'44"' ; and, like the former, it was seated on the wall of the pulp-cavity, towards the apex of the fang. The interior substance was situated excentrically, and extended in the form of an irregu- lar, much indented, elongated mass, in the longitudinal axis of the new-formation. The substance itself appeared to consist of a hyaline, globular material, from whose periphery short canals, here and there, radiated. The new-formed systems of tubules, as in the former case, presented a radial arrangement ; 516 NEW-FORMATIONS and their course was characterised by numerous zigzag curves, as well as by their giving oflf very many bifurcating branches, in such numbers, in fact, that the tubules rapidly diminished in size ; it appeared, also, as if they were directly continuous with those of the original dentin. The concentric lamination of the new-formation, indicated by faint concentric stria, was very evident towards the surface. In the same tooth, several smaller masses of osteo-dentin were found attached to the dentin, which was otherwise in perfectly normal condition. These growths varied in shape according as two or several were in contact with each other, A well-marked instance of the occurrence of numerous masses of osteo-dentin, closely attached to the inner surface of the 4entin, was afforded in the fangs of a molar tooth, of which the enamel was carious. The central substance of the new-formations resembled, to some extent, an agglomeration of opaque, variously shaped masses, which in some cases were directly conjoined by elongated processes ; whilst others dimi- nishing in size as they approached the new-formed dentinal substance, became elongated like the dentinal tubules, gave off lateral branches, and were directly continuous with those run- ning inwards from the peripheral portion of the osteo-dentin. In other instances, the opaque masses of the central substance were assembled so as to form tubes, and had coalesced. The tubules of the osteo-dentin presenting the characters above assigned to them, opened, not unfrequently, into fissure-like spaces, and in several parts were manifestly connected with the tubules of the original dentin, so much so, in fact, that it might truly be said that the latter were continued into the new-formed dentinal substance. Owing to the mutual appo- sition of so many masses of osteo-dentin, contiguous systems of dentinal tubules were presented, some encircling the rounded new -formations, others passing through them. Simpler forms of osteo-dentin occurred in an extracted incisor tooth belonging to an individual, sixteen years of age, which otherwise showed no trace of disease externally. The new-growth, which presented the form of several, suboval, sometimes isolated, sometimes coalesced masses, was lodged in the terminal portion of the pulp cavity j its longitudinal dia- meter was 0'17"'. The osteodentin, represented in fig. 143, OF THE DENTAL TISSUES. 517 contained a dark-grey, amorphous, central substance, with some, rather lighter spots, surrounded by brownish-red, irre- gular, indented masses, disposed in several successive layers. Fig. 142. and wanting the characters of perfect bone-corpuscles. We regard these as interglobular masses [spaces], which, as on the outer periphery of the normal dentin, were directly con- tinuous, with one or more dentinal tubules. The latter, in the new-formation in question, exhibited a radiate disposition, as in the case before described ; and the lamination of the dentinal substance was also evidenced by concentric streaks. The other osteo-dentinal masses in the extracted incisor (fig. 143, A, c c) afforded, in all essential particulars, similar characters. We would, here, merely add that, in the cementum {A, a), several, abnormal globular-masses were imbedded, and that the dark, obliquely ascending streaks in the dentin {A, b) represent the abundant interglobular substance (compare fig. 139). The enamel (A, d) was characterised by its dark stria- tion, an indented contour line (in the section), and its systems of enamel-prisms, which decussated with each other under other angles than in the normal condition. In another molar tooth, especial interest was excited by what, to all appearance, seemed a newly formed mass of enamel, lodged in the dentin. On the neck of the tooth, above the transverse furrow, an excavation existed, about the size of a pin's head. The tooth was divided into a right and left half; 518 NEW-FORMATIONS one of these portions, when polished (fig. 143, B), exhibited, at c, a new-formed growth, the upper segment of which consisted Fig. 143. of a circumscribed globular mass, with dark, interglobular spaces; towards the centre it presented a dirty brownish- yellow colour, and, in that situation, no determinate structure could be detected. In the lower segment, on the other hand, it was impossible to doubt that new enamel had been formed j the position of the prisms, as viewed in longitudinal and trans- verse sections, their uniformity in size, and brownish-yellow tint, affording sufficient evidence of the fact. The interspace be- tween the imbedded mass of enamel, and the upper border of the old enamel, amounted to nearly 0"44"', and was occupied by normal dentin. Lastly, the lower segment presented an oblique excavation. The other half of the tooth exhibited, at the corresponding part^ a hole about the size of a pin's head. It was evident, therefore, that the loss of substance in the dentin had been concealed by the newly-formed growth. A OF THE DENTAL TISSUES. 519 similar appearance may be observed in fig. 141, where the loss of substance at d is lined on the inside by the osteo-dentin at e. The formation of new layers of cementum takes place towards the end of the fang, either around its whole circum- ference, or in one part only ; the former is the case, as is well known, in old teeth, and the formation not unfrequently pro- ceeds to the development of medullary, canaliculi, according to Kolliker's observations, more particularly with respect to the molar teeth. These canals may also be observed in the cementum of younger teeth, mostly in connexion ydth what is termed " dry caries ;" we have noticed a clear canal, O'Ol 77'" in diameter, ascending obliquely from the point of the fang towards the dentin, in an incisor tooth affected with slight, partial necrosis of the enamel and dentin. The layer of cementum was 0'36"' thick. In a molar tooth, in a state of hyperostosis, we have seen canaliculi, sometimes branched, sometimes dilated into cancelli, which should not be con- founded with the irregular, polymorphous spaces first described by Czerm^k, and which do not appear to KoUiker to be any- thing more than hollows produced by absorption. In our opinion, they might also arise from the involution of globular masses, together with that of the interglobular spaces. On the other hand, we have often observed hemispherical, sinuous masses projecting from the globular substance interposed between the dentin and cementum, entering the latter, and are satisfied that even new-formations of bone-corpuscles may take place, within a globular mass of this kind, precisely in the same way as they are seen to be formed on the cementum of the Horse's tooth. In the second case, where the new-formation of cement- layers takes place only on a part of the root, a nodulated ele- vation is produced. A growth of this kind was situated towards the point of one of the fangs of a molar tooth affected with caries. On the dentin, which elsewhere exhibited no abnormal condition (fig. 144, a), rested numerous layers of globular masses, with large, dark interstices, looking sometimes like chinks or fissures, succeeded, externally, by many rayed, genuine bone-corpuscles in considerable number. In some places, which were extremely opaque, they seemed, as it were, to be fused together, or to be rendered less distinct by a / 520 NEW-FORMATIONS Fig. 144. brownish, intereorpuscular substance ; and in the same spots, opaque masses were collected in irregular cavities. Between the bone-corpuscles, fissure- like, irregular spaces could be seen crossing the osseous lamellte, and extending from above downwards, in an oblique direction. In many places, the latter not unfrequently exhibited un- dulating curves ; they were more distinct where the bone-corpuscles were rarer, and terminated occasionally at an obtuse angle (as at b). In the blackish- brawn portions (as at c), only an occasional glimpse could be obtained of bone-cor- puscles. The nutriment of the solid constituents of the teeth is supplied on the one side by the vessels of the pulp, and on the other by those of the alveolar periosteum ; and it is by the latter, although in the human subject they are not normally distributed in the cementum, that the nutrition of that tissue is in reality carried on. Now if, on either side, owing to an increased transudation, more nutriment be afforded, either the substance of the cementum becomes blended with that of the alveolus, or, should this be denied, the osseous substance of the latter, the position of the tooth remaining the same, must undergo a partial fusion, in order to make room for the hypertrophied cementum. The new-formation of bone may also originate in the alveolus, and be confined to it, to such an extent, in fact, that, by degrees, the cavity is nearly filled with bone ; as, for instance, after the loss of the teeth in old age. A remarkable new-formation of tooth-substance came under our observation in a body removed by Dr. Jarisch, and which, after repeated and careful examination, we cannot but regard as a malformed tooth. It was situated in the region of the right wisdom-tooth, and, after the considerable swelling of the OF THE DENTAL TISSUES. 521 surrounding parts had subsided, was removed without much difficulty by the forceps. After previous cleausing of the place, the body was at once perceived, imbedded in the sub- stance of the wisdom-tooth. When extracted, it presented a rounded figure, flat- tened beneath. Its different diameters were respectively as follows : from the centre of the base to the corresponding highest point=O-075" (height) ; from before to behind=0-082" (length) ; from side to side=0"058" (width). The surface was nodular j on the attached or basal aspect (fig. 145, b) could be seen an excavated depression, surrounded by a projecting ridge {a a), the circumference of which corres- ponded with the borders of the crown of the wisdom-tooth. Two kinds of substance could be perceived on the surface even by the naked eye; the one towards the basal portion was whiter, smoother, and with a pearly lustre, especially on the circular ridge {a a), whilst, on the surface of the other, larger and smaller holes could be perceived (as on the upper surface, c c, or on the side, d), which, when traced in a section, were found to correspond with a number of fine white striae. The consistence was compact, and the sound afforded, when struck with an iron blade, was more ringing and poorer, that is, attended with less resonance, than is the case with bone. The tone corresponded precisely with that afforded by a tooth when struck in a similar manner. The examination of the section, which had been made per- pendicularly to the basal surface, at once showed the existence of radiating canals, 00088 — 0"088'" in diameter, running from the periphery towards the base, and filled with a material resembling fat-globules. No blood-vessels could be observed in the canals, nor did they give off any branches. These vacuities, which looked like medullary canals in a state of involution, evidently opened on the surface of the structure at the orifices which were discernible by the naked eye. 533 NEW-FOEMATIONS Closer investigation proved that the main constituent of the growth was dentin-mbstance, and that the tubules differed from those of common human dentin, only in the circumstance that they were larger at their origin, their many curves more strongly marked, and the dichotomous branchings more numerous, so much so, in fact, as to cause a rapid diminution in their dia- meter. The thickness of the dentin was proportionate to the bulk of the different, adventitious substances, according to which, also, the course of the dentinal tubules was directed. These tubules originated around the surface of the medullary canals, curving, not unfrequently, at a right angle, and uniting, occa- sionally, from both sides into a single bundle ; entire fasciculi, also, of dentinal tubules might be noticed arising from the caecal ends of the medullary canals, whence they spread out in a fan-like manner. Between the systems formed by these tubules, groups of larger or smaller hyaline globules (globular masses — dentin-globules) were often interposed, and, occa- sionally, opaque, tubular, finely indented spaces, with an irre- gular outline, might be perceived between them, into which, and especially into those of smaller size, dentinal tubules could be traced. The terminal branches of the latter were in con- nexion, on the one hand with the cuneiform masses of enamel which penetrated into the substance in all parts, and on the other with the interglobular spaces and bone-corpuscles. The enamel was thickest on the above-mentioned circular ridge at the base of the production, where its thickness amounted to 0088 — 0"11"'. The colour and disposition, generally, were those proper to the enamel. Between the dentin and enamel, in the basal portion, a hyaline, struc- tureless layer could be distinctly noticed, including arched loops of the dentinal tubules. The dichotomous ramifications of the latter, close to the enamel, were too closely crowded to represent regular fasciculi. The layers of enamel extended to a considerable depth in the upper half of the malformed tooth; they ramified in various directions, projecting into the dentin like sharply defined, papillary structures, surrounded by clear concentric layers, and by the dentinal tubules running towards them. The thickness of these plates of enamel was about 0-017 — 0-23'"; their colour, in many places, was a deep brownish-yellow, such as is not unfrequently seen in human OF THE DENTAL TISSUES. 523 teeth when the enamel contains an abundant deposit of pig- ment ; their texture could not everywhere be made out with equal facility, since in many places nothing was apparent beyond a brownish-yellow substance, presenting no texture whatever, whilst, in others, the enamel-prisms were clearly displayed, divided either obliquely or transversely. A section in the long axis of the production exhibited sys- tems of dentinal tubules, running in various directions (fig. 146, a o), and ending with their p,^ i^g terminal branches, partly in the opaque globular masses surrounding the cavity (6), partly going towards the im- bedded mass of enamel (cc). True osseous substance occurred in very small quan- tity, whilst larger and smal- ler opaque, irregular, jag- ged, occasionally voluminous spaces, existed, which have already been, several times, noticed as of pathological formation; and, in normal teeth, have been described by Czerm&k as interglobular spaces. The formation of this tooth, admits of no other interpreta- tion, than that it was a vitium primce conformaiionis, consisting, as it were, in the development of numerous papillary protru- sions, on what is termed by Kolliker, the organon adamantiiuB, which were adapted to similar protrusions of the dental pulp. But the development of fangs had not been reached in these papillary new-formations. Lastly, in inquiring the relation in which the new-forma- tions, and particularly that of osteo-dentin, stand with respect to caries of the teeth — we must first understand what is meant by that term, which has long been shown, by many ob- servers, and more lately, again by Klenke, to be in- appropriate. If the notion of caries, as applied to the bones, be restricted to an exudative process, always associated with necrosis, it does not apply to the affection described by dentists 524 NEW-FORMATIONS. as caries sicca, which must be regarded as a simple decompo- sition of the organic matter, as a kind of decay, or mouldering away, caused in particular localities in the tooth and in its parts, as Ficinus has clearly shown, by special external conditions, and advancing from without to within [vid. p. 161). Conse- quently, with this restricted meaning of the term, there would simply be a caries produced by the blood-vessels of the pulp, and one connected with those of the alveolar periosteum, which would necessarily be accompanied with a partial or complete necrosis of the tooth. This caries is, perhaps, in most cases, a sequela of the " decay ,^' and so far as our experience extends, seems to stand in no causal relation with the formation of osteo-dentin. But the reverse of this proposition cannot be asserted. The formation of osteo-dentin is an independent process, which appears, perhaps, to be induced by the inward extension of the decay (fig. 141, e), but which may also be set up without that concomitant (fig. 142). But an abundant deposition of globular masses, and the formation of osteo-dentin, are so often found accompanying each other, that we have no hesitation in describing them as being intimately allied pro- cesses — not meaning, however, by this, that the osteo-dentin originates from the globular substance. That substance, as before remarked, appears to be an organic matrix, out of which, in particular situations, as on the surface of the pulp, and, perhaps, also within it, the growth of the new-formation is carried on.^ ' [A very good account of the " globular masses " of dentin, will be found in the paper, by Czermik, referred to in the text, and which is contained in Siebold and Kolliker's 'Zeitschrift f. Wiss. Zool.,' vol. ii, p. 295 (1850). A resum^ot his observations, so far as they refer to this particular subject, is also given in the ' Quart. Journal of Microscopical Science,' vol. i, p. 253 (1853), in a memoir by S. J. A. Salter, M.B., ' On certain Appearances occurring in Dentine, dependent on its mode of Calcification ;' one object of which, is stated by the author, to be the giving of a summary and confirmation of Czermak's paper, in reference to certain points in the anatomy of dentine, and partly to add some further observations of his own. The points chiefly contained in Mr. Salter's paper, concern the peculiar markings on the dentin, known as " contour lines " or " markings," and their appendages, the irregular patches of smaller interspaces which limit the outer extremities of those lines. As reference can readily be made to Mr. Salter's paper, which is illus- trated by figures, it is needless, here, to say more on the subject, than simply to observe that Czermak's supposition with respect to the nature of the globular masses CANCER, 525 X. CANCEE. What should be comprehended under the term cancer, is at present by no means established] this much only can be stated with certainty, that it is a new-formation, approaching tubercle on the one side, and on the other, allied to the em- bryonic and dendritic papillary new-formations of connective- tissue, and which may be associated with secondary formations of blood-vessels, cartilage, bone, and fat-cells ; and is subject to a spontaneous (independent of external conditions) involution. The forms under which cancer presents itself, are, as is well known, extremely multifarious ; and an attempt has been made to classify these various forms, partly from their outward habit, partly from their more minute structure. But it is now un- derstood, that such a classification is not, de facto, possible, since the forms pass into one another, and a combination of divers forms may exist in one and the same tumour. We recognize, therefore, but one cancer, whose multifariousness in external aspect, depends simply upon the stage of organization and interglobular spaces, appears satisfactorily to answer all the conditions under which they exist. He suggests that the organic material of dentin is, during the calcifying process, impregnated with earthy salts in globular forms, and that by a deeper degree of calcific impregnation the wholfi tissue is imbued with the harden- ing element, and the globules become fused together. Such a doctrine, Mr. Salter says, " is capable of explaining all the circumstances of the case ; and we have only to imagine an arrest of calcification at the globular stage over the surface of the pulp, as it exists at any one time, to explain all the phenomena of the contour markings." This view of the nature of the globular masses receives a curious confirmation in a case related by Dr. Hyde Salter, in the fifth volume of the ' Transactions of the Pathological Society of London ' (1854), p. 35, and pi. ii, of an ossific mass de- posited in the pleura. The structure of this growth, when examined microscopically, presented a striking resemblance to the globular dentin masses and interglobular spaces, and what is more remarkable still, in many parts of it " groups of tubules exactly resembling dentine tubes were seen. They were about the diameter of ordi- nary dentine tubes running with a wavy parallelism, having traces of both primary and secondary curves, and showing in some parts a disposition to branch." Dr. Hyde Salter, also notices the microscopical appearances in a section of the bony matter of an ossified aorta, in which the structure, was very similar. The development of true bone in the pulp cavity, connected with the existence of what he terms "erratic vascular canals in teeth," is recorded by Mr. J. Salter (lb., p. 115, pi. iv).— Ed.] 526 NEW-FORMATIONS. which the growth attains to, and the direction in which that organization proceeds. J. Vogel has expressly declared, that there are merely varieties of cancer, which can be characterised under the terms, at one time, usually employed, and that the fine distinction, and definition of species, from unessential characters, leads to an endless multitude of names. Regarding the subject purely in a histological point of view, we shall adhere closely to the morphological, elementary constituents, commencing with the cells. Their diversity of form depends upon : [a) the relative proportions of the three dimensions — ^length, breadth, and thickness; thus we have round, flat, and elongated cells, with every possible interme- diate form; (6) the number of processes given off from the body of the cell, whether they are single, double, or multiple, and their different points of insertion, various length, thick- ness, and mode of division ; (c) upon the cell-contents being more or less transparent, and consisting of either minute- molecules; fat, or pigment- granules ; (d) upon the relation of the nucleus to the circumference of the cell, and the number, whatever it may be, of the nuclei ; (e) upon the relations of the nucleolus to the nucleus. A specific character has often been ascribed to the cells existing in cancer (Haunqver, Lebert, Robin). Their excessive size, their breadth, the voluminous nucleus, the large promi- nent nucleolus, &c., are stated to aflford positive characters ; so much so, in fact, that Lebert says, that even an inexperienced observer will be enabled to recognize them. But we are entirely in accord with Virchow, who denies the specificality of cancer-cells. For comparative study, we should recommend the transitional epithelium on the ocular conjunctiva, the epi- thelial cells in the pelvis of the kidney, the occasionally en- larged epithelial cells of the tubuli uriniferi in Bright's disease, many kinds of ganglion-cells, the newly formed cells in the gelatiniform uterine mucus, in many gelatinous exudations, chronic ulcers, soft uterine polypus, in the epidermis of con- dylomata, warts, &c. Unprejudiced observation will then satisfy any one, that he would, but too often, be the victim of delusion, in laying too great a stress upon the value of the supposed characteristics of the so-termed " cancer-cells." CANCER. 527 In the first place, our full attention is demanded to the history of the evolution and involution (vital course) of the embryonic-cells of cancer ; with respect to which, some highly important circumstances must be regarded ; these are : 1. The inordinate nutrition of the cell, in consequence of which, its volume (in general ranging between 0'004 and 0'04"') may become very considerable; and the increase not unfre- quently extends to the nucleus and nucleolus. This excess of nutriment, however, usually induces, on the one hand, a want of symmetry in the outline of the cell, so that its shape is distorted; and on the other, may be limited to an enormous growth of the nucleus and nucleolus, or to the extension of the cell-body or process in one direction — especially in width. 2. The excessive propagation of the cells is evidenced by a remarkable multiplication of the nucleus, so that often two nuclei, and not unfrequently 3 — 8 are met with in one cell. 3. The progressive formation of the cell is arrested at a cer- tain stage, that is, round, elliptical, obtuse-angled, uni- or multipolar cells are chiefly noticed ; the bodies of the latter, and especially of the fusiform-cells remaining proportionately broad. 4. The formation of a nucleus is not reached at all, in many cells ; they consist simply of a membrane, and transpa- rent molecular contents — as is especially evident in gelatini- form cancer. 5. Not only may the formation of nuclei, how- ever, be achieved, but their spontaneous division, each sub- division being surrounded with a portion of contents, may take place, in which case, however, not a trace of an in- vesting membrane can be perceived. 6. The nutriment af- forded to the cells undergoes various anomalous changes, manifested in the alterations which take place in the cell- contents; these are gradually seen to include an increased amount of fat- globules, by which the cell is transformed into a granular-cell, and this, by the subsequent fusion of the cell- membrane, and of the nucleus, is finally metamorphosed into an aggregation of fat-globules or a granule-mass. This fatty metamorphosis of the cell-contents, which has been accurately investigated by Virchow, may be attended with a brownish-yel- low, or reddish-brown hue in the fatty granules, from the imbibi- tion of colouring matter. The molecular, transparent contents of the cells, in the pigmented metamorphosis, present larger or 528 NEW-FOEMATIONS. smaller, isolated or aggregated pigment-granules, which appear to coalesce into blackish-brown masses, a change, accompanied in many places in a cancerous growth, with an evident collapse of the cells. A serous degeneration of the cell-contents, is mani- fested by an enlargement and proneness to rupture of the mem- brane, and by a greater distance between, or a rarefaction of the molecules, associated with which, a vesicular distension of the nucleus may frequently be perceived. 7. The rapid multipli- cation of the cells takes place in a curved line. The embryonic cells arrange themselves in chains, upon which are formed lateral branches and twigs, whence we ultimately see produced an arborescent system of embryonic cell-forms, whose contents are usually in a state retrograde metamorphosis. Their line of direction, as is particularly evident from the researches made on the subject of gelatiniform cancer, sometimes approaches the circular, or spiral, and in this way, cavities or fissures are produced, filled with a hyaline intercellular fluid (cancerous blastema, or serum). In which case, the wide interspaces be- tween the separate groups of cells become incompletely filled with a trabecular frame-work, developed out of the fusiform-cells. Virchow has observed that the cancer-serum is compara- tively rather abundant, and that this circumstance may be held to explain the ready separability of the cells. It may suffer the same retrograde metamorphoses as the cell-con- tents undergo, losing a large part of its watery element, in consequence of which the protein and organizable compounds are precipitated. This involution of the serum necessarily in- duces a decay of the cells, and in these atrophied parts of the cancerous growth, we find nothing but traces of connective- tissue fibres, and disseminated among them numerous fat- globules, unaltered by acids or alkalies, free pigment, amor- phous, calcareous particles, and plates of cholesterin. In all fully formed cancerous growths there is another system of cells, whose development is continued by spontaneous division; these are the fusiform or fibre-cells. It is still a question whether these elementary organs stand in any genetic connexion with the rounded forms. We think, with Virchow, that they are developed in another direction, that is to say, into connective-tissue-bundles, whilst the other kind of cells remain in an embryonic stage, or, becoming atrophied, are CANCER. 529 no longer capable of being transformed into connective-tissue- bundles. We have already indicated, in the General Part, (p. 77), that the fibre-cell is capable of spontaneous division, and of being multiplied in a spiral ; consequently, the hollowness of the connective-tissue-fra6ecM/«, the continued development of entire chains of fibre-cells, the giving off of lateral branches and twigs, may all be explained ia this way. This arbo- rescent, branching system of fibre-cells with oblong nuclei, or of bundles of connective-tissue-fibres derived from them, is termed the cancer-framework or stroma. Its texture is esseur tially areolar. From the trabecule of this stroma, arise, in many places, (especially at the points where a branch is given off,) papillary structures, growing by the apposition of a mole- cular substance, which becomes organized into rapidly midtiply- ing cells, belonging either to the oblong or the round form, and continues to grow into the areola and areolar passages of the str-oma. With respect to what has already been stated on the process of development followed in the papillary new-formations (p. 78), it remains to be added, that, in new-formations of that kind, occurring in cancer, the constituent, elementary organs display a great tendency to degeneration, and are often found broken up into an opaque mass of fat-granules. Not unfrequently, also, there may be noticed, in the papillary new-formation, a structure- less membrane, rendered more distinct by the alkaline carbonates, and which'may be regarded as a morphological product formed, either prior, or subsequently to, the cells. In general, the former case appears to be the rarer, and in fact, is observed only when extensive papillary new-formations arise on the free surface of a mucous membrane, as for instance, of the urinary or gall-bladder, of serous membranes, or of a large cystiform areola. In this case a csecal, distended membrane, showing a double contour line, is observed, containing either fluid, trans- parent contents, or isolated cells of cancer of the most various kinds. The second case, therefore, or that in which the structureless membrane belongs to a later period, is to be regarded as the more frequent, as it so often happens that no common investing tunic can be demonstrated in the papil- lary new-formations, which consist of an aggregation of cancer- elements. 34 530 NEW-FORMATIONS, When the cancer is more highly organized, a new formation of blood and of blood-vessels takes place. It is beyond aU doubt that red and even white blood -corpuscles may arise at completely isolated points in the growth, lying free in the parenchyma, without any independent walls. In a section of a cancerous tumour, blood-red spots of the most various extent are often enough seen, which in our opinion are not extravasations — that is to say, are not blood efifused from ruptured vessels — for the corpuscles possess the characters of recent corpuscles in a state of development. Many of them are of much smaller size, sometimes less than half that of the fully-formed corpuscles, and unlike the latter, at this time, they exhibit no central depression. No defunct blood-corpuscles, moreover, are met with, nor any remains of the walls of blood-vessels ; lastly, the above statement, that blood-corpuscles are formed independently in the parenchyma of the new growth is quite in accord with the observations already discussed respecting the so-termed teleangiectases in pleuritic exudations, &c. In cancer, however, a new-formation of blood also takes place in the areoles, which are furnished with independent walls, and in fact out of the blastema enclosed in them, contained in sacculi, and in the papillary new-formations. The independent nature of these walls can only be assumed where the line of demarcation of the blood is sharply defined even under strong magnifying powers, and when, after it has been washed away, the constituent elements of the wall appear distinct, (vid. pp. 82, 83.) Virchow has also noticed groups of blood-corpuscles contained in the cells in cancer. These corpuscles when treated with water, yielded up their hematin, which was then diffused through- out the cavity of the cell, in which, after the complete removal of the colouring matter, two nuclei became evident. He regards it as by far the most probable supposition that the cell wall bursts, when the blood-corpuscles enter, and the wall immediately closes. Thus the appearance of blood-corpuscles is merely of an accidental nature ; but we cannot avoid re- marking, though the same thing is shown by Virchow's obser- vation, how readily, on careless examination, pigment-granules or fat-globules, may chance to be confounded with blood-cor- puscles. CANCER. 531 In more highly organized forms of cancer even cysts are developed, particularly in many of the organs ; as, for instance, in the ovary. These cysts sometimes exist in excessive quantity, so as to produce what is termed a compound cyst; or they may be found only in small, separate portions of the cancer. What has been observed on this subject in the General Part (p. 84, et. seq.) receives here its full application. The cyst- wall very frequently loses its epithelial investment, and its contents often fall into a state of involution at a very early period. Fpr, especially in very young cysts, arising in the papillary new-formations, a degeneration of the blastema enclosed in the cavity may be observed. A new-formation of cartilaginous and of osseous tissues, is not very rare in cancer, arising either at numerous isolated points in the growth itself, or springing from an existing bone. In the former case we have also, on one occasion, seen papillary new-formations of cartilaginous tissue seated on thick con- nective-tissue-bundles. When the new-formation arises from the bone, it is developed in precisely the same manner as are the cranial bones of the fcetus, or like osteophytes. Osseous spicules are formed, analogous to the bundles of connective tissue, and presenting like them an areolar arrangement ; and even slightly ossified, papillary new formations may be seen projecting, exactly in the manner of the soft, connective-tissue formations, into the wide areolae. Adipose tissue also, occurs in cancer, either arising from the normal, original fatty tissue of the part, and thus representing a partial hypertrophy of it; or new groups of fat-cells are developed in the parenchyma of the morbid growth. In many places, lastly, such an excessive quantity of colouring matter is presented in cancer, that sometimes only isolated parts of the growth, and sometimes the whole, are pervaded by it, in which variously coloured, often very large pigment-granules, appear in the contents of the cells, or may be seen lying free among the bundles of connective tissue. Now any particular cancer may be placed in one category or another, according to the predominant stage of its evolution and the direction it takes. If a proportionately large amount of gelatinous blastema remain, the form is termed " gelaiiniform cancer;" or if the areolce of the stroma are more distinct, it. is 532 NEW-FORMATIONS. denominated "areolar cancer." When elliptical, broad, un- equal cells, furnished with processes, and often with several nuclei, and in a state of progressive, fatty, or pigmented degeneration, exist in such abundance as to constitute, when the surface of a section of the growth is squeezed, a copious, viscid or pultaceous, milky juice — not unlike crushed brain — we have the form termed "medullary cancer" (medullary sarcoma, cellular cancer). If the growth be mainly composed of fibrous tissue, its consistence is firmer, and it becomes a "fibrous cancer" though not corresponding in all rgspects with the scirrhus of the older writers. When the fibrous bundles of medullary or fibrous cancer, in a state of retrograde metamorphosis, are infiltrated with Buch an abundance of fat- globules that the thicker bundles appear, even to the naked eye, as light streaks, decussating with each other, and constituting a more or less distinct net- work, the "reticular cancer" of J. Miiller is produced; which is considered by Meckel and Virchow as a retrograde form. In cases where a rapid decomposition of the cancerous parenchyma takes place on an internal or external surface, and it is dissolved into a fetid sanious fluid, the cancer is described as " ichorous;" but in using this term it should not be supposed that a new formation of pus-corpuscles takes place ; for which reason, also, the expression " suppurative cancer" used by many authors is very wrongly applied. If a large quantity of blood is present, either free or enclosed in vessels, the result is the "blood" or "vascular cancer" {fungus hcematodes). The existence of a hemorrhagic cancer, though supported by Virchow, cannot, we think, be maintained, since, as has been stated above, the bloody spots are not, usually, to be regarded as hemorrhagic effusions. When abundance of colouring matter exists in a cancer, and the cells, nearly throughout the growth, contain pigment, we have what is termed "melanotic ox pigment-cancer '' If osseous tissue occur in large quantity in the midst of a cancerous growth, which is most frequently the case, as is well known, in the neighbourhood of a bone, the affection receives, according to J. Miiller, the name of " malignant osteoid." To this form, also, belong most of the cases of spina ventosa of CANCER. 533 the older writers. Gerlach has proposed for this kind the name of carcinoma osteoides. When cysts are extensively developed from the papillary new- formation, or from the distended areola, there is produced the " cystic cancer" {cysto-carcinoma) of Rokitansky. If the papillary new-formation and the dendritic conforma- tion thence produced are strongly manifested^ the cancer — to adopt Rokitansky's nomenclature — is termed "villous." If the growth be constituted, mainly (but not solely), of ele- mentary organs analogous to epithelial cells, it is termed — to follow the same authority — " epithelial cancer." A. Hannover, who erroneously denies the cancerous nature of this form, has applied to tumours of the kind in question the name of epithe- lioma ; though compelled, on the other hand, to admit the exist- ence of a combination of epithelioma and cancer. Lebert, Virchow, A. Forster, [and Bennett], term this new-formation cancroid; describing it as an intermediate form, approaching cancer, so far as regards its structure, but diflfering in the scantiness or total absence of fibres in the stroma. In our opinion this distinction is untenable, since in well-marked medullary cancer, places are frequently observed in which the fibrous stroma has been replaced by flattened cells. The use of the term " cancroid" moreover, shows how uncertain our notions of cancer still are. Under the name of carcinoma fasciculatum s. hyalinum, Joh. Miiller has described a form of cancer consisting of very delicate fibres and minute cells; the growth itself being sometimes transparent, sometimes more or less opaque, and constituted of conical segments with their bases looking outwards. We have had no opportunity of forming an independent judgment with respect to this variety from personal observation, but are inclined to the opinion, that gelatiniform sarcoma has often been regarded as carcinoma fasciculatum. [Vid. observations with respect to the development of embryonic connective tissue in the interstitial tissue of muscles, p. 403.) The question of the arranging of a given cancerous growth, under one or other of the varieties enumerated above, will often prove of an embarrassing nature. For various forms may co- exist in one and the same tumour, as is not unfrequently the case, for instance, in cancer of the breast, where the growth, in its development, in one place corresponds with gelatiniform 534 NEW-FORMATIONS. cancer, in another with medullary, and in a third with fibrous cancer. Thus the character is derived solely from the preponderance of the one form or of the other, as no strict, logical distinction between them exists. A similar uncertainty also arises, when it has to be determined whether any particular case should be arranged with " medullary" or with " epithelial cancer," since the growth may exhibit the characters of the former, in one place, and of the latter, in another. The uncertainty, above adverted to, which prevails in the definition of what should be regarded as cancer, explains the existence of transitional forms, intermediate between sarcoma and cancer, and approaching sometimes more nearly to the one, sometimes to the other. Many of Lebert's fibro-plastic tumours belong to this class, and, especially, many forms of the so-termed " spongy growths" of the dura mater. The diversities in the forms of cancer depend principally upon their seat, and are influenced, as is the case with all new- formations, by the parent tissue. It is well known that medul- lary cancer is especially prone to occur in the female breast, in the uterus, in the liver, in the subcutaneous connective tissue, and in the lymphatic glands ; that cancer in the spleen reaches only a low stage of organization ; that when seated in the corium of the skin, or of a mucous membrane, it has principally the epithelial character ; that cystic formations are met with, chiefly in cancerous growths in the ovary and mammary gland ; that cancer contiguous to the periosteum becomes partially ossified, &c. The tissues which are furnished with blood-vessels can alone be regarded as capable of becoming the point of origin of cancer ; consequently that new-formation is never found to occur in the crystalline lens, the cartilages, nails, or epidermis. In glandular organs, the interstitial connective tissue appears to be the starting point ; this is indicated by the lobulated con- figuration of the growth, so remarkable, especially in the mam- mary gland and liver. But, on the other hand, it cannot be denied, that even when the growth takes place independently, on a free surface, it also presents a lobulated form. In the concrete form, a strong, vascular capsule of connective-tissue is not unfrequently seen to enclose the cancerous mass, and which may be regarded as its nutritive CANCER. 535 envelope. Opposed to this, is the diffuse form in which the line of demarcation of the growth is less sharply defined. Cancer, as an organized structure, is especially subject to spontaneous involution, as has been explained above, with respect to the cells. This change is, in general, manifested by an accumulation of olein, cholesterin, pigment, serous fluid, and even of calcareous salts; at the same time the elementary organs of the cancer undergo a gradual shrinking — a process to which the connective-tissue-bundles offer a strong resistance. In this way are caused the well-known cicatriform contractions ; but which, as Virchow has remarked, may be regarded, at the most, as only partial cures, inasmuch as the cancerous formation advances in other parts. The atrophy of the cancerous growth necessarily involves a collapse of the immediately contiguous normal tissue — as, for instance, of the nipple. Now if reite- rated cancerous new-formations arise at the periphery of the portions in a state of atrophy, and these grow rapidly, the organization of the substance in that situation is incomplete, and often remains at an imperfect cell-formation (nuclear formation). It is these parts of a cancerous growth which are described by Virchow as being in a state of tuberculization. When the cancer advances towards the surface of an organ, of the skin or of a mucous membrane, the fusion of the tissues is followed by a loss of substance, that is to say, a cancerous ulcer is formed, — the cancer occultus becomes the cancer apertus. This fusion may also take place in the interior of a parenchy- matous organ, or even in the midst of a cancerous mass, in which cases irregular cavities are produced surrounded by the latter, which, of course, should not be confounded with cysts. It was formerly, and is even still, to some extent, disputed, whether cancerous deposits be the result of inflammation, and it is well known that Broussais and his school have assumed the existence of a low degree of inflammation which they term " sub-inflammation." This theory was opposed, particularly by Lobstein, who thought that he had afibrded another explanation of the matter, in assuming the existence of a caco-plastic ma- terial no longer fitted for the production of homologous struc- tures, arising from an exalted activity of nutrition and inde- pendent of inflammation. It is evident, however, that the first question to be solved concerns the deposition of an organic 536 NEW-FORMATIONS. matrix — a blastema — out of which the cancerous new-formation originates. Whether the process necessary for the deposition of this blastema be termed subinfiammatory, or be looked upon as one of exalted nutrition, comes to the same thing in the end. It has already been shown that inflammation may be regarded as an anomalous state of nutrition with an increased secretion of nutritive matter, in the part affected, and consequently that it is intimately related to atrophies, hypertrophies, and new- formations. The cancer-blastema secreted from the blood-vessels is occa- sionally so abundant (as in gelatiniform cancer) as to be apparent in considerable quantity among the organized parts, whilst, in other cases, it constitutes merely a thin stratum of intercellular fluid. The production of the blastema is attended, in many instances, with a clearly demonstrable increase in the size of the blood- vessels, which, in our opinion, is erroneously regarded as a simple dilatation. In the capillary loops of the papillce, in cutaneous cancer, an elargement is occasionally witnessed, so considerable, that it cannot be conceived to take place without an increase of volume of the delicate, easily ruptured wall of the vessels. In this case, therefore, a hypertrophy of the elementary organs of the capillary vessels must exist. A similar increase of calibre may also be noticed in the smaller arteries and veins around the cancerous growth ; and in many cases, in fact, an evident multiplication of these vessels is superadded, as may be seen, particularly in the nutrient capsule, composed of connec- tive tissue, enclosing the growth. Now, if the increased area of the lumina of the vessels be considered, it is clear that a larger quantity of nutritive fluid will be continually afforded, and that, in one respect, this increase of the lumina stands in direct relation to the growth of the cancerous tumour. It may, moreover, with much reason, be assumed, that the conditions of diffusion in hypertrophied vascular walls differ from those which obtain in normal vessels, and that the transudations will naturally exhibit other characters, or, in other words, that the conditions under which the protein-compounds in the nutrient matter exist, are so modified that, instead of their simply main- taining the nutrition of the elements of any given organ, they give rise to the cancerous new-formation. That the vascular CANCER. 587 apparatus of a cancer is exclusively connected with the arteries, or with the veins, as a distinctive character between medullary carcinoma and fungus hcematodes, as asserted by Schroder van der Kolk, is doubted by Gerlach, who has usually succeeded in injecting the vessels in a cancerous growth more readily from the arteries than from the veins of the parent-tissue. If, then, the question be ultimately asked, — ^whether, among the new-formations, cancer should be regarded as an indepen- dent growth (circumscribed by precise limits) ? we are decidedly of opinion that the answer must be in the negative. In what would the independence of cancer lie? — in the deformity of its cells, whose special characters we have questioned? — in its areolar arrangement, or papillary new-formations, both of which also occur in new-formations of connective tissue, and may likewise be wanting, as well as the supposed specific cells of cancer, without our being justified in denying the cancerous nature in one part of a new-formation when it is distinctly present in another ? In this case it will be necessary, further to inquire, what criteria we may possess to enable us to judge that a new-growth is of a cancerous nature. These criteria are to be sought, not in the morphological condition of separate parts of it, but in the entire course of the evolution and involution of the organized new structure. The study of its evolution teaches us that the cancer-blastema (not meaning to imply, under this name, any specificality in it), may remain, in its organization, at a nuclear or imperfect cell-formation, whilst, in other places, it may achieve the development of connective-tissue fibres and papil- lary new-formations, of blood-vessels, bone, and cartilage. But, however great may be the organizability of the cancer-blastema, it is frequently impeded in its development, inasmuch as the material afforded to the elementary organs of the growth is unfit for their nutrition within the normal limits, owing to the pre- dominance of one substance or another, fibrin, albumen, colloid, fat, colouring-matter, water, or mineral constituents. The new- formed elementary organ, therefore, falls into a state of invo- lution, and undergoes the corresponding metamorphoses, whilst, in other places, in consequence of hypertrophy, it becomes asymmetrical and deformed. We consider, therefore, that the principal criteria by which we can judge of the cancerous 538 NEW-FORMATIONS OF CANCER nature of a new-formation must be sought in the multifarious- ness of its organic development, in the size, shape, and involu- tion of the cells, and of the substance formed by them ; the re- maining stationary at an embryonic stage; and in the peculiarly remarkable inequality in the stages of organization in the various tissues. § 1. External integuments. In this situation the cancerous growth seems to arise in the subcutaneous connective tissue, and to extend, partly outwards, towards the true corium and its papillary stratum, partly in- wards, towards the adipose tissue. The cancerous nodules here represented were taken from the abdominal integuments of a woman, who, besides several tumours of the same kind, had a very bulky ovarian cyst, whose walls were extremely thick, and beset on the inner surface with numerous nodules. Nodu- lar cancerous deposits were also found in the liver. The skin in the spots occupied by the nodules was half an inch thick ; it was tense, smooth, shining, and dry; lanuginous hairs were visible in only very small numbers. The corium was firmly adherent to the subjacent new-formation, and very thin. In several sections neither sebaceous nor sweat-glands could be discerned. The reie mucosum of the epidermis was comparatively of some thickness, and contained pigment of a deep, dirty, brownish-yellow colour. The surface of a perpen- FiG. 147. dicular section of the cancer-nodule displayed the thin, mar- ginal, membranous layer (fig. 147, a), and beneath this the new- growth, in which three differently coloured portions could be IN THE EXTERNAL INTEGUMENTS. 539 distinguished, viz.: greyish-red spots (indicated by the light shading), others of a blood-colour (shown by the dark shading), and some of a light-yellow (c and e e). The greyish-red substance exhibited, in many places, numerous bloody points and streaks, forming, by their coales- cence, irregular spots, and in this way passing into the blood- red substance, which was deposited as it were in the interstices of the lobulated, greyish-red, and light-yellow portion. It was worthy of notice, also, that, in many places, the greyish- red substance became gradually of a deeper red hue, without it being possible to discern any red points or streaks in it, even with the aid of a powerful lens. We are satisfied, from the repeated examination of perfectly fresh cancerous growths which had been extirpated, that a reddish-colour, an infiltration with hmmatin, may exist, independently of a single red blood-cor- puscle. The light-yellow substance, which was of firmer con- sistence, formed insulated patches imbedded in the greyish-red portion ; and between their irregular boundary-lines might also be observed, dark, blood-red spots, in the middle of which were circumscribed bloody points and bifurcating streaks of the same colour, as at e e. On one side of the new-growth the adipose tissue re- tained its integrity; the fat-cells were lodged in the areolce, surrounded by connective tissue (fig. 148, b b b), their fluid contents being of a deep-yellow colour. But beneath them the cancerous new-formation had already made farther pro- gress, and was separated from the subjacent muscular layer by a dense connective-tissue (at d) . The elementary examination disclosed, for the most part, cells of small size, 0-0044 0-0052'". With respect to the bloody spots, two possibilities may be supposed : either blood had been newly formed in those situa- tions, or minute extravasations had taken place, which might readily occur in the over-congested state of the thin-walled vessels. But, however much we may be inclined to admit the latter possibility, the former is also proved by the embryonic condition and minute size of the blood-corpuscles, the non- existence of necrosed forms among them ; and, lastly, by the absence of blood-vessels. The form of cancer liere described has been characterised by many writers as " crude," " hsemorrhagic :" it is developed 540 NEW-FORMATIONS OF CANCER with comparative rapidity, aud assumes in the form of nodules movable with the skin. A case of cancer more nearly approaching the medullary form is recorded by Professor Chiari. It was seated immediately behind the inferior angle of the labia pudendi, so that it was requisite to remove a portion of the labia majora, and of the nympkce. The growth was about 1"57" in diameter, and con- sistent; exhibited on the surface of a section a dirty-yellow colour, and a distinct, coarse, areolar texture. From the areolae, a pultaceous material, in the form of rounded granules and soft filaments could be readily expressed ; this material con- tained, on the one hand, mere nuclear formations, aggregations of fatty globules, a brownish molecular substance and isolated fat-globules suspended in a transparent fluid ; and, on the other, minute, elliptical, oval, or elongated cells and short, fusi- form fibres; the latter often exhibiting no distinct nucleus, -whilst, frequently, two to four nuclei might be seen in one cell. The superjacent skin was very thin, polished and tense, and the sebaceous follicles were atrophied, or had wholly disappeared. Gelatiniform cancer-nodules occurred in the skin of another individual, some of which were as much as 0'78" in diameter, or more ; they were seated mostly on the lower extremities, and some were covered with crusts bearing a certain resemblance to rupia. Deposits of the same kind existed to such an extent in the mucous membrane of the posterior naves as almost to obstruct them, and extended towards the epiglottis and the mucous membrane of the trachea, where they constituted extensive ulcers, covered with discoloured crusts. In the parenchyma of the lungs, and of the liver, no cancerous deposits were met with, whilst they existed in the mucous membrane of the stomach, and of the small intestine, and in the lymphatic glands. The cut surface of the cutaneous nodules was smooth, of a gelatinous appearance, and afforded, on pressure, only a very small quantity of a yellowish, slightly -turbid serum. The blood-vessels of the thickened corium were extremely congested, and dilated, which was particularly evident in the papillary loops, in which the vessels were of such a size as to be visible even to the naked eye. The cells, imbedded, in groups, in the hyaline cancer-blastema, were very delicate, sometimes rounded, sometimes more or less flattened, of a fusiform shape, and fur- IN THE EXTERNAL INTEGUMENTS. 541 nished with a comparatively large nucleus. None of these elements were present in any great abundance. Thus, in the present case, the infiltration with the cancer-blastema extended also to the papillary stratum of the corium; and to this circum- stance is to be ascribed its fusion, and the disintegration of tbe epithelium, and, ultimately, owing to the partial desiccation, the formation of crusts. We have collected three instances of the melanotic form of cutaneous cancer. The size of the nodules varied from that of a lentil to nearly that of a walnut j and their surface was mostly subdivided into unequal lobules by shallower or deeper indentations. In one case, in a growth near the toes, this sub- division had even extended to the formation of long conical processes, exhibiting a condylomatous appearance. Each lobule of the depressed papillary elevations on the surface, covered by the epidermis, appeared, when cut into, to be constituted of a rusty-brown, distinctly circumscribed group, which, when viewed from above, had usually a dirty violet, or deep-blue colour. "When the epidermis was removed, which could only be done by maceration or the application of the alkaline carbonates, opaque, punctiform elevations were apparent on the surface of the corium. Vertical sections at once showed that the sessile papillce, as well as the vascular loops contained in them, were considerably hypertrophied. The cut surface was sometimes smooth, and sometimes a turbid, grey fluid could be expressed from it in considerable quantity, the microscopic analysis of which, displayed rounded and flattened fibre-cells with one or several processes. The cell-contents were finely molecular, and filled with fatty granules, or were even composed solely of dirty brownish-yellow, brownish-red, or black groups of pigment- molecules. The dimensions of the cells varied, but in general those of small size predominated. In many places, moreover, the development had reached only to a nuclear formation. In one case, that of a woman affected with similar deposits in the brain, lungs, lymphatic-glands, liver, and spleen, we noticed subcutaneous cancerous nodules of a bluish-grey colour. Closer investigation showed that the dark pigment was deposited between the atrophied fat-cells. For in the bluish adipose lobules, no fat-cells could any longer be discerned, but only larger and smaller oil-globules, between which, dark 542 NEW-FOEMATIONS OF CANCER Fig. 148. streaks and spots were interposed (fig. 148, a, which repre- sents an atrophied fat-lobule, partially enclosed by a bundle of connective-tissue-fibres). In other places, where no pigment existed among the cells, the fat was of a remarkably deep-yellow colour. The large pigment-gran- ules cohered into irregular, larger or smaller masses, and displayed a livel}' molecular motion, which, in a current artificially produced, and viewed by reflected light with a magnifying power of 120 — 150 diameters presented a spectacle much like that shown by the pigment-granules of the eye of the Frog or of a Fish. This con- sisted in the rapid appearance and disappearance of bright points — a phenomenon which we con- ceive to depend upon the circumstance of the crystalline pig- ment-granules, in their rapid evolutions, turning sometimes their illuminated, sometimes their dark, smooth surfaces towards the observer. Besides this, numerous, minute elementary bodies were suspended in the turbid juice of the cancerous nodule (fig. 148, b), enclosing sometimes no nucleus, sometimes one or two (as at +). Whether the light spaces apparent in many cells should be regarded as nuclei in a state of serous degeneration, or as collections of a hyaline fluid in the cell-contents, remains, perhaps, in many cases, doubtful; but when a distinctly pro- jecting nucleolus is seen in the sharply defined clear space, its nuclear nature would appear to be undeniable. The areolce of the subcutaneous tissue were in many places of con- siderable dimensions (fig. 148, c) and crammed full of nuclear bodies. In cancerous growths of this kind, the pigment may be observed in various stages of formation. It makes its appear- ance in the form of brownish-red or brownish-black granules [hematin), which, when they have undergone a further meta- morphosis, are perhaps rendered paler by carbonate of soda, IN THE EXTERNAL INTEGUMENTS. 543 but do not disappear, and are ultimately no longer affected by tbat application. A form of cancer intermediate between the medullary and epithelial was observable in a growth extirpated by Professor Chiari ; it belonged to the same woman from whose pudendum the medullary cancer above described (p. 540) had been re- moved, some months before. The cancer, which sprang up again, after the operation, extended very deeply (more than an inch) under the skin. Its consistence was in general close; and in the more loosely compacted parts, nodules might be perceived, some just visible to the naked eye, some as large as a pin's head, which were seated on the inner surface of the larger areolae. On close examination, these nodules were found to exhibit a sharply defined line of demarcation, and to be invested with an epithelial covering composed of flat- tened cells, beneath which were others mostly of a rounded form, and containing a comparatively large, hyaline nucleus. In other areola, however, nothing was apparent but aggrega- tions of fat-globules, a few granule-cells and free granular pigment. The latter, as well as the fatty globules, were also present in the connective-tissue-bundles, which were united into an areolar stroma. The distribution of the blood was far from uniform, and, so far as could be seen by means of a powerful lens, it was not enclosed in any independent walls ; nor was there, at the same time, anything to favour the supposi- tion that extravasation had taken place. The skin covering the growth, was polished and tense ; a yellowish nodule, which could be seen shining through the surface of the integument, proved to be a small sebaceous follicle filled with epidermis- cells and a brownish sebaceous matter. In accordance with this was the hypertrophy of some sebaceous glands, but since these, as is well known, are of considerable size in this part of the integuments, it is self-evident that neither the hypertrophy nor the follicles had any necessary connexion with the cancerous new-growth ; but, notwithstanding this, in the present instance, the hypertrophy might have been induced by the subcutaneous cancerous new-formation, as we have shown to be the case in new-formations of connective tissue. The anatomical character of the epithelial form of cutaneous cancer, resides in its botryoidal configuration — in external appear- 544 NEW-FORMATIONS OF CANCER ance, occasionally, not unlike a condylomatous growth — its granular texture which is usually dry, though often infiltrated with a milky, turbid juice, when it approaches the medullary form — and, lastly, in the predominance of frequently large, flat, angularly jagged cells, over the fibre-cells and connective- tissue-fibres. This form of cancer is particularly apt to occur in the skin of the lips, of the anus, and of the glans penis. The cells are characterised by their gigantic dimensions, the multifarious- ness of their development, and the nature of the deformi- ties presented by them in the softest parts of the growth, which are readily crushed into a pultaceous matter. Fig. 149. The shape of the cells has occasionally been erroneously de- scribed as simply flattened, but all intermediate forms between this and the elongated are constantly met with (fig. 149, IN THE EXTERNAL INTEGUMENTS. 545 uppermost row of cells) ; their contents are finely molecular, but sometimes coarsely granular, in which case their transparency is lost J the usually solitary, more rarely double, oval nucleus cannot be demonstrated in many cells, and it readily escapes, owing to the delicapy of the walls. In this condition, the nucleus, if it have attained to a considerable size («?), might be confounded with a cell; which can be determined only by the reaction with acetic acid, and from the single or double Both the cell and its nucleus are capable of an excessive growth ; this may be observed, particularly in cancerous growths of the lip undergoing disintegration, beset with soft, discoloured nodules, and affording an extremely nauseous, mawkish odour. The irregularly jagged outline of the cell-wall, «rhich, as a distinction between it and that of simple epithelial cells, is frequently furnished with short spicular processes, passes into one of a more rounded figure. This is manifestly succeeded by the endosmosis of a clear fluid; or, in other words, the cell-contents begin to degenerate, at the same time, becoming more transparent. The nucleus, also, which is involved in this degeneration, assumes a spherical instead of an oval shape, increasing, at the same time, in size, either together with the cell or independently of it; and occasionally it appears to be subject to a process of fusion, against which, however, it might certainly be objected that, in all probability, these cells possessed no nucleus at all. But as regards the voluminous nucleus (as, for instance, that in the cell c), it should first be ascertained whether the enclosed spherical body really correspond to a nucleus. Virchow regards these large, vesicular cavities in the cell as reproductive spaces (Brutraiime), in which an endogenous nuclear and cell-formation goes on. In a large cell, with granular contents, a portion of the latter, probably correspond- ing with a defunct nucleus, appeared homogeneous and as clear as water. This portion, from the first, exhibited a sharply de- fined, tolerably tough wall, which was very soon thickened by the apposition of new matter, and acquired a double contour. No objection can be made to the reasonableness of this view, but we think, also, that no doubt can be entertained with respect to the nuclear nature of the clear vesicular spaces, whenever 35 546 NEW-FORMATION OF CANCER — as is the case in many of them — the characteristic nucleolus is apparent. They are referred, by Bruch, to the imbibition of water, and it cannot be denied that an endosmosis of this kind may produce a degree of transparency in the cell- contents 5 but it is uncertain whether the clear fluid in the cells of the cancer, be water, as it might, for instance, be a mucoid or colloid matter; nor, also, is there the least doubt, that the transparent fluid is surrounded by a proper membrane. These cavities in the cells, whose genesis is, thus, at present obscure, occasionally possess a coarsely granular investment, and sometimes their contents are finely molecular. But we. have never, so far as our present observations have extended, noticed a new-formation of nuclei in them, and are, therefore, of opinion that the employment of the term " reproductive spaces" must at present be suspended; at any rate, for those cavities which are filled with a hyaline or granular material, and are, occasionally, surrounded by an independent membrane. When the examination of the cells of epithelial cancer of the lip is continued more deeply into the tissues, and the more com- pact nodules thus reached, flattened angular cells will mostly be observed, in shape and size not unlike those of the horny layer of the epidermis, but difi'ering from them in their fre- quently finely jagged outline, though chiefly in the larger, granu- lar nucleus containing a projecting nucleolus. These flattened cells, like those of the epidermis, are, also, superimposed one upon another in such a way that each overlaps the other to some extent (fig. 149, e). In the deeper-seated layers of the growth, it usually happens, and often, also, in the more superficial, brownish-yellow por- tion, that nothing is met with but a molecular matter contain- ing pigment, with larger (/) or smaller {g) nuclei, dissemi- nated uniformly through it. These parts — in which, only an imperfect cell-formation has been reached, or a partial invo- lution of the cancerous new-formation has taken place — correspond with the tuberculoid deposits of Virchow. The stroma is constituted of distinct connective-tissue- bundles, exhibiting, as elsewhere, an areolar arrangement. Not unfrequently, also, minute fibre-cells, with an oval nucleus and prominent nucleolus, may be seen, assembled into bundles. IN THE EXTERNAL INTEGUMENTS. 547 In rarer instances, cystiform cavities may be observed,^ with papillary growths projecting into them. Now, in order to ascertain the mode of grouping of the flat cells of epithelial cancer and their relations with the stroma, it is requisite to prepare thin sections. As these cannot be readily procured from the very friable substance, in the fresh state, portions of the growth should be simply dried by exposure to the air, and the sections taken from them treated with acetic acid. In this way it is satisfactorily shown that the connective-tissue-bundles, furnished with oblong, slender nuclei, pointed at each end and placed at uniform distances apart, surround the groups of cells (fig. 150), by which the closed areola are completely filled. ^la. 150. In other places nothing is seen in the areola but molecular, pig- mented, nuclear masses, exhibit- ing the utmost multiplicity of form. The areola are of yarious dimensions — round, oval, clavate, &c.; and, occasionally, the section will display lateral passages. It is obvious, at the same time, that the areola, filled with the difi'er- ent kinds of elements, are divided in the most various directions, and that the multiplicity of their forms is due to that circumstance. In sections of this kind, as well, also, as in portions of epithelial cancer, torn up by means of needles, in the recent condition, the elements are frequently seen disposed around a central cell, whence is produced an appearance very closely resembling that of the epidermis-cells disposed around a sudoriparous duct. In the one case, as in the other, flattened cells are disposed with their edges towards the observer, around a central point, which is regarded by Virchow as a "re- productive space." We think that, with respect to this, another fact should be borne in mind; viz., that in epi- thelial caftcer, papillary bodies composed of epidermic cells, may be dissected out of the stroma, which, when cut across, necessarily display a concentric lamination, from the circum- 548 NEW-FORMATION OF CANCER stance of their being formed one within the other in a pill-box fashion. Blood-vessels occur but scantily in the morbid growth itself, and in many parts are wholly wanting, whilst, in the yellowish, browni|hj gelatinous substance beneath the cellular layer, they often exist in considerable abundance. We have never had an opportunity of noticing a vascular, nutritive capsule of connective tissue enclosing the cancerous growth. Pat-globules of any considerable size are very rarely met with free, and never, enclosed in the cells ; whilst in the soft, pultaceous, dis- integrated parts, aggregations of fat-globules and of cholesterin plates, are found in tolerable abundance. Nervous twigs may often be traced, in immediate contiguity with the new-formed groups of cells, at the base of the growth. A cancerous growth seated on the under part of the glans penis was in a state of superficial disintegration, and thus was constituted a shallow ulceration. The cancerous infiltration had extended so deeply that the anterior portion of the urethra was destroyed, and the urine escaped through the ulcerated spot. From the surface of a section of the growth, when removed, light-coloured, greyish-yellow, soft nodules could be easily expressed, which when broken up in water caused a milky opacity in it. The cells, which were mostly flattened and furnished with one or several slender processes, were of very various sizes, the longest diameter of the smaller sort being 00079— 0-0110"', of those of a middle size, 0-025'", and of the largest, 00318'", The usually oval nuclei were as much as 00079'" in diameter. Most of the cells, especially around the nucleus, exhibited minute, shining molecules, which were often accumulated in such numbers that the entire cell appeared to be filled with an opaque, granular material. The nuclei occasionally presented a vesicular enlargement, and, on one occasion, the cell was observed to be ruptured. These flattened cells were lodged, as usual, in the areolce formed by the strong bundles of connective tissue and elastic filaments. Concentrically laminated colloid-corpuscles, fat, and pigment, also occurred in many places in great abundance, and papillary growths, some as large as an intestinal villus, seiCted, with a usually slender peduncle, upon the bundles of connective tissue^ could be readily dissected out by means of needles. These IN THE EXTERNAL INTEGUMENTS. 549 papillary growths projecting into the areolae were usually beset with minute, shining molecules. A cancer, removed by Professor Zsigmondy from the lower part of the glans penis, was about the size of a chestnut. The urethra at the Corresponding part was not contracted ; and below the orifice several condylomatous, vascular growths, about the size of a hazel nut, projected. The nodule was firm to the feel, but when divided proved to be of softer consistence than had been supposed ; it presented a granular texture, and readily afibrded, on pressure, a friable matter, rendering the water rather milky, and consisting of flat cells, with large nuclei, and themselves, mostly, of considerable dimensions and the most various shapes. The contents of these cells were in a far advanced state of fatty degeneration. When portions, taken from the centre of the morbid growth, were torn up, several distinctly circumscribed, clavate papillce, containing an opaque, fatty-granular substance, and supported on slender peduncles, were displayed. In a section of the condylomatous growths, grey, irregular, conical streaks might be perceived in the centre of each lobule, even by the naked eye, upon which the very numerous, peripheral, papillary growths were seated ; the latter contained widely distended and convoluted vascular loops, which occasionally nearly filled the body of the papilla. When the very thick epithelial investment was removed the numerous, long, mostly straight and elongated papillm, with lateral, younger formations, came into view. In a penis amputated by Professor Sigmond, an ulcer ex- isted around the corona glandis, having an eroded aspect. The skin bordering upon the ulcer was swollen, callous, and of almost cartilaginous consistence. The surface - of the sore, in many places, exhibited scattered, greyish, depressed nodules, consisting of concentrically laminated, flattened cells (like those represented in fig. 149). The turbid coating of the ulcer, which had a mucoid aspect, contained the same kind of new- formed cells. In other places isolated, bloody specks and lines could be perceived, and in some of these parts even con- voluted vessels might be seen running for a short distance on the surface. Towards the under side of the penis the substance was farther disintegrated, so that, in fact, little more was left, except bridge-like bands. The fluid expressed 550 NEW-FORMATION OF CANCER from this part was pultaceous, and the elementary bodies contained in it, in a state of advanced degeneration. The infiltration of the callous borders was due to new-formed, flattened cells. The form known in England as " chimney-swfeeper's cancer," according to Virchow's researches, belongs to the same class as the one last described. ^ 3. Mucous MEMBKANES. The epithelial form is that which cancer chiefly assumes in the tcmgue. With respect to the disease in this situation also, the opinion, here and there current, of its being constituted solely of flat, epithelial-like cells, but which rests upon the most im- perfect research, has been entertained. A cancer situated on the base of the tongue and mucous membrane of the pharynx, was of soft consistence, and presented several groups of nodidar eminences projecting above the surface, and covering an extent of it equal to that of a large lentil. On the surface of a sec- tion, soft, pultaceous portions were seen, constituted chiefly of flat, angulap cells, with an oval nucleus and molecular contents Fig. 151. (fig. 151, a) ; some of these cells were perfectly isomorphous with the superficial epithelial cells of the tongue, and, like them, were superimposed one upon another (6) ; smaller forms IN THE MUCOUS MEMBRANES. 551 alternated with groups of elementary bodies (d), consisting of large, free nuclei, with a comparatively voluminous, prominent nucleolus, and of cells furnished with two, three, or several processes or nuclei. These perfect or imperfect elementary organs, were enclosed by bifurcating, fibrous bundles {g). But the areola formed in this stroma frequently included papillary, circumscribed groups of cells (e e), constituted of several systems of flat cells, disposed one within another in a pill-box fashion. Besides these, numerous rosette-like groups of cells might be observed (/), of which the central lay with its flat surface towards the observer, whilst those disposed concentrically around it, were viewed more or less on the edge. As has been stated before, these concentric layers might represent a transverse view of the papillary body, or of the cells enclosed in an areola. In the deeper layers, groups of nuclei, imbedded in a hyaline, structureless substance, were alone visible. The muscular fibres in the immediate neighbourhood of the cancerous growth, presented scattered, reddish-yellow pigment-molecules on the surface ; others, which had lost their transverse striation, were broken up into longitudinally striped bundles. Occasionally, also, a fatty degeneration of the muscular substance was evident, even to the naked eye. In these epithelial cancers, minute vacuities 'may occasionally be noticed with similar papillary structures projecting into them. In a tumour of this kind on the tongue, of the size of a hazel-nut, Hannover noticed a cavity divided by a partition, of the size and form of a small bean. The inner surface of the cavity, as well as the partition, was covered with a multitude of small, whitish-grey granules, having the appearance of minute, depressed, or pedunculated warts. That form of cancer of the stomach which has been described as scirrhus, has been defined within narrower limits by Rokitansky and Bruch ; and the difierence between cancer and hypertrophy of the membranes of the stomach, has, by the latter author, been placed in the circumstance that the areolar hypertrophy of the muscular coat, which has already been dis- cussed in speaking of " hypertrophies," is not characteristic of cancer of the stomach, and that the latter is limited to separate portions, and attended with an infiltration of aU the strata. In a histological point of view it is impossible to lay down any 552 NEW-FORMATION OF CANCER precise definition, and it is only the degenerative character of the new-formation that can allow this to be done, unless a criterion (?) he afforded in the deposition of cancerous growths in other organs. Scirrhus (fibrous cancer) of the stomach has, for its main constituent, fibre-cells, usually in a far advanced stage of fatty degeneration, and developed in the submucous connective tissue. They constitute, together with the connective-tissue- bundles, a very close, callous tissue, from which, frequently, no milky juice can be expressed ; and the elementary organs, also, are often remarkably minute. The continued advance of the morbid growth towards the glandular layer of the mucous membrane on the one side, and, on the other, towards the muscular coat, may also occur in simple new-formations of connective tissue, and should not be regarded as indicating a cancerous deposit. Even a destruction of the pepsin-glands, a softening of the texture, and a partial detachment of the mucous membrane, so as to give rise to ulcerations, displaying at the bottom a consistent formation of connective tissue, may also occur independently of cancer. We are of opinion that the scirrhous character is to be sought in the mode of evolution and of involution. Whilst, on one side of the morbid growth, especially in its marginal portions, the new-formation of cancer- substance continues to advance, and the subsequent outgrowths indicate a very rapid development, the central portions fall into a state of involution ; whence arise, on the one hand, the radiating, cicatriform, central contractions, and, on the other, the swollen borders. In the stellate, grey streaks of the central part, besides connective-tissue-bundles impregnated with fat in a state of minute division, nuclei, amorphous, flaky masses, groups of fat-granules, and comparatively few, embryonic, degenerated forms of connective tissue are met with. In the nodular, marginal portions, on the contrary, the cells and groups of nuclei are more numerous, being more abundant in proportion as the scirrhus approaches the medullary form of cancer. Under these circumstances, the scirrhus is said to be transformed into medullary cancer, but this expression is incor- rect, inasmuch as it is not the scirrhous substance itself which is so changed, but the newly added cancerous deposit which assumes the medullary character. IN THE MUCOUS MEMBRANES. 553 A striking exemplification of the coexistence of hypertrophy with a new-formation, is presented in the large growths known under the name of perforating ulcers of the stomach. In these cases, together with the scirrhous infiltration, an areolar hypertrophy of the muscular tissue will be seen around it, in consequence of which, that coat often attains to a thickness of an inch or more {vid. p. 196). Medullary cancer of the stomach, as has been above re- marked, usually occurs as a secondary product upon the scirrhous parts, and induces a rapid destruction of the mucous mem- brane, owing to the readiness with which its superficial por- tions are softened, particularly in the stomach. Hemorrhages thus readily ensue, even from the larger vessels, and the blood contained in the cavity of the stomach, dying, assumes the appearance of a chocolate-brown fluid. Medullary cancer reaches a considerable bulk, and displays a well-marked areolar tissue, with comparatively numerous, minute cells. When in a state of disintegration, the bundles of connective tissue, offering greater powers of resistance, remain in the form of finely divided fibrous shreds. Gelatiniform cancer of the stomach consists in an infiltration, mainly of a gelatinous kind, of the submucous connective tissue, in consequence of which, owing to the amount of blastema accumulated, the pepsin-glands are elevated in groups, and separated from each other ; they are also liable to a partial fusion, whence arise shallow ulcerations of the mucous mem- brane. The follicles of these glands occasionally enlarge, and are sometimes filled with a finely granular, opaque matter. The organization of the blastema is limited to the production of sometimes isolated, sometimes aggregated, elliptical, or, in some degree, angular, usually non-nucleated cells, with fine- molecular contents. Fusiform cells occur in small quantity, or are wholly wanting. Fatty granule-masses may be observed, in many places, in great abundance, and molecular masses, resem- bling precipitated albumen, may be perceived in insulated spots, which appear clouded even to the naked eye ; these are formed in part, also, by a fine fibrous felt-work, or by rows of straight fibrillar bands. This fibrillated appearance is not lost in acetic acid, but, on the contrary, is rendered more distinct, and it may be regarded as due to the presence of mucin-fila- 554 NEW- FORMATION OF CANCER ments. The rarefied, wavy, widely remote connective-tissue- bundles axe not to be regarded as of new formation, but as belonging to the original tissue. In one instance, we found the blood-vessels of the mucous membrane containing scat- tered, brownish-red granules, unchangeable in acetic acid, and readily soluble in alkalies {fusmatin), and which were visibly lodged in the lumen of the vessel. Instructive sections of the coats of the stomach, infiltrated with cancer, may be prepared, sometimes with the double- bladed knife, sometimes by means of the scissors, from parts in the fresh state. These sections must be examined especially under lower magnifying powers. For thin sec- tions it is advisable to employ preparations hardened by al- cohol, or which have been boiled in dilute acetic acid and dried. An epithelial form of cancer of the stomach, consisting, for the most part, of conical epithelial cells, has been observed by Fr. Bidder. Cancer of the small and large intestines, being seated in the submucous tissue, may extend over considerable spaces, and increase so as to form a very thick layer, without inducing any solution of the proper tissue of the mucous membrane; the latter is simply pushed inwards towards the canal of the bowel, and gradually becomes atrophied. The extended cancerous mass presents a tolerably firm consistence; its elements are small, and usually remain at the stage of rudimentary cell- formation ; in many places, the walls of the blood-vessels appear to be hypertrophied, that is, the vessel becomes con- siderably larger, an increase, which, as a single observation teaches, does not take place at the expense of the thickness of the wall. If the cancer be more of the epithelial kind, nodules, as big as a pin's head, or more, are presented, most of which are flattened, wider at one end than at the other, and contain only a few fusiform cells ; these nodules appear to be lodged mainly in the corium of the mucous membrane ; they do not encroach much upon the intestinal canal, but are prone to perforate the corium, and thus to produce ulcerations. Ac- cording to Rokitansky's observations, these forms of cancer occur only in the large intestine, and especially at the two flexures of the colon. The brownish-red, discoloured coating IN THE MUCOUS MEMBRANES. 555 on the floor of the ulcer consists of a molecular matter mixed with remains of the tissues (organic detritus). A gelatiniform cancer, seated on the wall of the rectum, and which was extirpated by Professor Schuh, displayed, when cut into, light-yellow, transparent masses, 0*44 — 0"88'" in dia- meter, and lying at tolerably uniform distances apart. These masses could be readily squeezed out by pressure with the scalpel, and exhibited a viscous, gelatinous, colloid-like, com- pressible material. Of organic constituents, this matter con- tained mostly elliptical cells, with a large, oval nucleus, and prominent, shining nucleolus ; and, frequently, two or several nuclei might be seen in one cell. The uni- or multi-polar cells were isolated and scattered, whilst the elliptical were grouped together. The fatty degeneration of the contents of the usually voluminous cells was far advanced, especially in those places which appeared opaque to the naked eye. These organic elements were lodged in a hyaline blastema, which was enclosed in a well-marked areolar, fibrous stroma. The more intimate structural analysis of this stroma dis- closed the existence of comparatively, widely distended areola Fig. 152. (fig. 152, c c c), subdivided by projecting fibrous bands into smaller loculaments; these areola of the second order were 556 NEW-FORMATION OF CANCER again subdivided, in a similar manner, into others of a third order, and so on. The fibrous bundles appeared, at first, finely pointed, and projecting free into the areola ; ultimately, however, they became united with others, and in this way formed the fibrous network. A second remarkable formation was that of the papillary kind ; this assumed, sometimes, the form of merely a depressed truncated eminence, sometimes of an extensive clavate vegetation, which either presented a sharply defined outline, or, at its rounded extremity, a fibrous bundle, projecting in the form of a pointed process {jAd. the papillee at a and b). These hemispherical, bluntly conical, club-shaped projections consisted of embryonic connective tissue, whose elements were very minute. In many of them, even a rudimentary cell-formation did not seem to have been attained to, inasmuch as they contained merely a fatty, mole- cular substance. On the mucous membrane in the lower part of the rectum, we observed an epithelial form of cancer. In this case, the papillary growths especially, were very numerous, and contained morphological elements, consisting of minute, flat- tened, polygonal cells, with a comparatively large nucleus, and not unlike epithelial cells. Larger, flat cells were noticed only on a few papillary vegetations. The latter were also seated in great number, and over a considerable extent of surface, on the skin surrounding the anus, where they constituted, by their union, condylomatous growths, resembling, in all essential particulars, those described as occurring on the^ewi* (p. 584). It was, moreover, worthy of remark, in a morphological point of view, that lighter-coloured, less resistant spots, some as large as a lentil, were apparent under the skin, affording a turbid, puriform juice. No pus-corpuscles were observed in the course of the examination, but simply, together with much free fat in state of suspension, minute nuclear bodies beset with fat-molecules on the outside. On the mucous membrane, especially of the urinary blad- der, those forms frequently occur, which were first recog- nized by Rokitansky, and minutely described by him as " villous cancer." A well-marked instance of this form of cancer was removed by Professor Schuh; it was attached to the nasal mucous membrane, and projected into the antrum. The IN THE MUCOUS MEMBRANES. 557 11 tumour, which was about the size of a walnut, was seated on the bone, so closely, in fact, that it was necessary to remove a part of the latter at the same time.. The texture was in general soft, but in several places in the section the areolar type of tissue was very distinctly recognizable. In thin sec- tions, numerous red points might be noticed; in but few places had the development of vessels been attained to. The most interesting portion of the morbid growth consisted in the very numerous rounded protuberances, which could not be seen without the aid of a powerful lens, nor their outlines dis- tinctly shown without that of the compound microscope. These processes were either seated, immediately upon the areolar, trabecular tissue, or sprang from a branching stem of considerable thickness (fig. 153) . They might be divided into the solitary (b and d), and the grouped (es a). As regards their shape, simple and compound forms might be remark- ed, the former presenting a comparatively broad, or a narrow basal portion, a longer or shorter, slen- der neck, and a globular or ellipsoidal head. The more compound forms were pro- duced by lateral indenta- tions and tuberous eleva- tions. And as regards their disposition, pa- pillary formations might be seen, grouped in an umbellate or fasciculate manner, arising from the stem or branches under a more or less acute {b, c) or right angle [d). The size of the latter was very various; the transverse diameter at the broad, clavate end varied between 0*02 — 0*088"', and the long diameter between 0-031 — 0-044 — 0*132"' ; the longer ones had a slenderer neck. I' 558 NEW-FORMATION OF CANCER They consisted of young connective-tissue-elements with well-marked, comparatively large, oval nuclei, in which were visible 1 — 3 — 3 brilliant nucleoli. The more transparent, thin- necked processes, contained fusiform cells, disposed parallel with the axis, and, in the firmer papillary growths appearing to be transformed into wavy connective-tissue-fibrils, together with a very delicate, elastic, filamentary network. Most of the papilla contained a larger or smaller amount of fatty molecules, suffer- ing no further change in acids or alkalies, and which, as in all similar structures, were accumulated more especially towards the rounded ends of the papillce, causing a diminution of the transparency in that part. From a portion of the tumour not furnished with villi, a well- marked medullary juice could be expressed, including cells in a state of incipient fatty degeneration, mostly rounded, though some were furnished with processes. The former were 0"0061"' in diameter and the nuclei contained in them 0'0031 — 0"0044"' ; whilst the length of the elongated cells amounted to 0023 — 0'0318"'. Lastly, also, flattened, multangular and elongated cells, with 3 — 3, or several oval nuclei, might be seen. On the mucous membrane of the urinary bladder of an old woman who had suffered under cancer of the uterus, and had at the same time several tuberculous [?] abscesses in the lungs, there were visible, at the point corresponding to the caput trigonum, some nodules about 1"32"' long; some of a light-grey colour, and others dotted with red, whose clavate shape could be readily perceived, even by the naked eye, when they were floated out in water. Under these circumstances they could at once, with the aid of a lens, be recognized as com- pressed, discoid, oval, club-shaped, papillary growths, having longer or shorter peduncles, and either isolated or standing in umbellate groups, seated immediately on the mucous membrane, especially around the openings of the urethra, or upon a stem springing from the corium of the membrane, and subdividing into short branches. The papilla, marked with bloody dots, contained a beautifully perfect, vascular jatows, especially at their rounded extremities, which was wholly wanting in those of a milky aspect, whilst in the smaller ones, at most, a bloody point only could be seen. Closer examination of the clavate processes showed that IN THE MUCOUS MEMBRANES. 559 Fig. 154. they were covered by epithelium, whose cells manifestly be- longed to the forms comprehended by Henle under the name of transitional epithelium. They were flattened, more or less angular cells, furnished with one, two, or three processes usually apparent on one side, having a distinct, oval, granular nucleus, and transparent contents. When the epithelium was stripped ofif, a delicate, hyaline stratum was seen, thrown into folds like a structureless mem- brane; but which, when torn up, appeared to be composed of very delicate fibres. Within this enveloping membrane, nothing but blood-vessels and embryonic connective tissue in a state of fatty degeneration could be noticed (fig. 154). The for- mer were numerous, and consisted of comparatively thick trunks, which soon diminished in size in consequence of their giving off branches under various angles. The thicker vessels exhibited numerous saccular protru- sions, whilst the smaller followed a more rectilinear course (a). The structure of these vessels was charac- terised by its simplicity; even in the largest of them no elastic nor longitudinal fibrous layers could ever be observed ; the wall, ex- actly like that of the capil- laries, consisting of a mem- brane in which oval nuclei were apparent at certain distances apart. The contents of the vessels, besides red blood-corpuscles, consisted of numerous white- corpuscles, which in many places obstructed the lumen {a', b.) The embryonic connective-tissue-elements lay isolated, among the blood-vessels, most of them having a rounded or fusiform figure. The rounded elements were, not unfrequently, in such an advanced stage of fatty degeneration, that even the clearer spot corresponding to the nucleus had disappeared, and the round connective-tissue-cell had become a " granule-mass." 560 NEW-FORMATION OF CANCER The fatty degeneration of the contents of the fusiform cells advanced from the nucleus, which appeared like a more trans- parent spot in the body, towards the processes on each side, and might be recognized even in the very slender fusiform fibres. Cells with three and four processes, corresponding to fibre-cells in a state of division, were often seen. The intercellular substance appeared of a gelatinous consistence, with minute, scattered molecules and fat-globules. Those clavate papilla which appeared of a greyish colour even to the naked eye, con- tained a larger quantity of elements in a state of fatty degene- ration. . The papillary growths of smaller dimensions, as regards their intimate structure, were constituted, in all essential respects like those, in the former case, from the nose ; they were usually seated in groups upon the mucous membrane. It would be erroneous to suppose that the larger, clavate papillce arose from the coalescence of several smaller ones, for a considerable-sized tuberous elevation might be seen springing up as such, ab origine, representing, as it were, the segment of a circle, and which was formed entirely by the deposition of a blastema in the corium of the mucous membrane. Nor was any dendritic division observable in the larger, thicker papillce. This appears to be produced from the fibre-cells of the elongated papillary structures, which are multiplied by spontaneous divi- sion, and thus become transformed into the common, bifur- cating peduncle (vid. p. 78). Precisely similar conditions are observed in villous cancer of the gall-bladder. Growths of this kind were noticed by Heschl in such great abundance upon the surface of the mucous mem- brane, that, upon every part of it covered with larger and smaller fissures, growths like the finest velvet, or of a cauliflower aspect, were apparent. Rokitansky has described similar cancerous growths in the gall-bladder, as well as in the stomach and rectum. They also occur in the upper part of the vagina, in the form of soft, rapidly growing, papillary structures. § 3. Sehous membranes. Cancer of the serous membranes usually commences in the subserous tissue, and most frequently assumes the form of IN SEROUS MEMBRANES. 561 gelatinous or medullary nodules. We have had several oppor- tunities of examining gelatinous forms of cancer on the peri- toneum I they have usually been transparent nodules of a pulpy consistence, and of considerable dimensions, (growing to the diameter of some inches,) from which, by means of scissors, instructive sections might be readily made. ■ The stroma, which, even to the naked eye, was manifestly areolar (of the kind shown in fig. 152), was wholly wanting in many places; and it is to these parts of the growths that our attention will be, here, especially directed. In a perfectly structureless, hyaline blastema, isolated groups of elementary organs were apparent, which were concatenated together, sometimes in a circular manner, sometimes in convo- luted lines, and, as they were disposed in various planes, could be traced only by the altering of the focal distance. The groups were about as far apart as a and b in fig. 155. The Fig. 155. elementary bodies themselves, were of a sub-oval shape, had a distinct cell- wall, and occasionally coarse-granular contents; the existence of a nucleus could not be made -out in most of them, even after the addition of acetic acid — they were, there- fore, non-nucleated, unless the lighter spaces perceptible in the cells might, perhaps, be regarded as indicative of the incipient formation of a nucleus. These groups of cells (a) appeared to 36 562 NEW-FORMATION OF CANCER arise spontaneously in the blastema, like points of crystalliza- tion. In other groups (as at b), one or more fusiform cells might be seen, applied to their periphery, from which was given off an elongated, delicate filament, lying in contact with the peripheral cells. The fusiform cells (c) had bodies of the most various sizes, were sometimes wider or slenderer, and furnished with 1, 2, 3 nuclei. The latter class of cells were, moreover, disse- minated in various directions, in the hyaline blastema, uncon- nected with a group of oval cells, so that there was no reason to suppose, that the fibre-cells were produced from the oval. We are of opinion, therefore, that these fibre- or fusiform cells must be regarded as of independent origin, and as formed out of the blastema. From them is produced the fibrous connective tissue (as at d), partially enclosing the groups of cells. In the areola on the left hand, in this figure, three of the larger kind of cells are represented, two of which present fine-granular contents, and a parietal, fibre-like, elongated nucleus, whilst the third cell contains a coarse-granular material on the one side, and on the other a transparent substance. In a few places, club-shaped papilla projected from the arched connective-tissue-bundles, free, into the cavities of the areola. These papilla were of various sizes, and, in the first stage of development, presented delicately granular contents, in which nuclear bodies were visible. Occasionally two clavate papilla -were seated on a common stem (fig. 155, e) ; {vid. what is said upon this point, pp. 79, 80). In the less transparent, or nebulous portions of this kind of gelatiniform cancer, the elementary organs are more abun- dant; and not unfrequently the development does not advance beyond a rudimentary cell-formation, or the new- formed cells degenerate, fat- or pigment-molecules being de- posited in them; it would even appear that they enlarge by the reception of a transparent fluid from the blastema, and sometimes, in consequence of this, may exhibit the clear spaces before noticed, in their interior. The papillary growths may also degenerate in the same way as the cells, and Eokitansky has even noticed incrustations on them. The blastema is likewise subject to a similar retrograde metamorphosis ; when IN SEROUS MEMBRANES. 563 aggregations of fat-globules are found in the areola, and numerous, larger and smallerf at-globules cover the trabeculee of connective-tissue. In many places, numerous colloid masses are deposited from the blastema, presenting the aspect of flat, amorphous, friable corpuscles, which remain unchanged in acetic acid. Concentric or radiated colloid-bodies are met with in comparatively small numbers. At the same time, all the fibrous tracts in gelatiniform cancers of this sort, should by no means be regarded as con- sisting of connective-tissue-fibres, for they are seen in many places, where not a single fibre-cell is evident, and similar fibrillar appearances may be artificially produced by the action of acetic acid. These are due, in fact, to nothing more than mucin-filaments, characterized by their straight course, and the very delicate filamentary net-work, visible only under a strong magnifying power, formed by them, which morphologically resembles that of fibrin, though differing from it chemically ; not only in its resisting the action of acetic acid, but on the contrary, by its being, as it were, evoked into existence by that reagent, in which coagulated fibrin is rendered gelatinous and invisible. If a cancerous growth of this kind be boiled in dilute acetic acid and thin sections be taken from a dried preparation thus made, the fibrous stroma will be shown in the most distinct manner, as it is, also, in old preparations in alcohol. The medullary form assumes, as is well known, the shape of nodules or tubera of the most various dimensions; the medullary juice often contains merely a few elliptical cells with large nuclei and prominent nucleoli ; the nuclei are usually of an oval form, contain a few granules in their interior, and are surrounded with a closely adherent, though not very sharply defined substance. Acetic acid causes them to shrink. The substance interposed between these cells and nuclei is composed of minute, fatty molecules, which float on the surface of the water, together with fatty granule-masses, and delicate, dull-looking molecules, resembling those of precipitated albumen. Very scanty traces of a fibrillar structure are perceptible. The pigment, which is apparent under the form of brownish- black and reddish, large granules, exists occasionally in such abundance in these medullary cancers, as to give them a 564 NEW-FORMATION OF CANCEE dark colour, when they pass into what is termed the melanotic form. We have only once noticed the occurrence of villous cancer on the peritoneum. There were extensive cancerous deposits in the omentum and uterus, and a copious bloody exudation in the abdominal cavity. In the cancerous masses which might be raised like a false membrane, roundish, fine-granular cells, with a parietal nucleus and projecting nucleolus, could be per- ceived. In these cells the nucleus occasionally appeared to be wholly wanting, and sometimes two or three might be seen in each cell. The fibre- cells with oval nuclei were assembled into bundles, giving off lateral branches, which projected freely into the abdominal cavity like terminal rows of cells, and constituted the slender filaments visible on the free surface of the false membrane. The deeper layers consisted of a dirty- yellow, filamentary net-work, having pigment-granules dissemi- nated through it, and from which, when torn to pieces, papilliform, dark, granular, sharply defined corpuscles were occasionally liberated. It cannot be doubted, that the latter are analogous with the bodies found by Rokitansky in false membranes, and described by him as "hollow clavate bodies.'^ Rokitansky notices villous, vascular growths, containing a me- dullary juice, as occurring particularly on the peritoneum of the small intestine, together with numerous cancerous nodules in the liver and omentum. § 4. On fibrous membranes. It is well known that tumours occurring on the dura mater were, formerly, all comprehended under the general name of fungi dura matris. The question whether they should be referred to cancer or to sarcoma has, we conceive, been put in too general terms, and we think that Lebert, and with him, Virchow, are wrong in denying the cancerous nature of all these tumours. With reference to this we cannot conceal from ourselves (as has been already stated) that the proper definition of what is cancer is as yet by no means established. Lebert appears to us to fail, particularly in this, — that he enumerates these soft, mostly very vascular tumours, under cancer, because they usually contain cells presenting all the characters assigned IN FIBROUS MEMBRANES. 565 by him to tlie so-termed cancer-cells. The absence of the milky juice, and of the central softening, and their solitary occurrence, are insufficient, in his eyes, to exclude them from cancer. Those delicate, villous growths seen on the inner surface of the dura mater, but which really arise in the subserous tissue of the arachnoid, are to be regarded, decidedly, as of a cancerous nature. Rokitansky has recorded a case in which a tumour, of the size of a hazel-nut, was seated on the inner surface of the dura mater, above the left anterior clinoid process. Besides this, there existed, in the same subject, large fibroid tumours in the uterus, and a mass of medullary carcinoma in the right kidney, as large as a hen's egg. The tumour on the dura mater presented a botryoidal surface and greyish colour, and, when cut across, exhibited a radiated, fibrillar structure, which arose from a mass of denser tissue at the base of the tumour, and was distinctly indicated by the corresponding course of the blood-vessels. The skeleton of the tumour consisted of a villous structure, equal in length to about two thirds of the diameter of the growth, and which rose from a basis constituted of a close, felted mass of fibres slightly interwoven with the dura mater. We observed a precisely similar structure, in a large growth situated on the falciform process of the dura mater. Its section resembled that of an acinose gland. The papillary growths, which were readily displayed by maceration, were seated, in groups, upon tolerably thick trabecule (fig. 156, a), had a broader, or narrower base, and occasionally exhibited a neck- like constriction ; they were simple, or furnished with smaller lateral nodosities ;' in many places they presented a nodular conformation (6), or one resembling that of the intestinal villi (c). Their length varied between 0-07 — 0-29'", and breadth between 0-053 — 0-070'" ; and, at the same time, they were manifestly flattened. Occasionally, a delicate fibrous bundle might be seen passing from the point or from the side of some of the papilla:, which bundles, most probably coalesced with others of the same kind, and were destined for the increase of the trabecular tissue. The foundation or central part of each of the larger papilla, was formed by a fibrous bundle, around which were disposed, sometimes oblong, sometimes elliptical, 566 NEW-FORMATION OF CANCER thin-walled cells, with a large, excentric nucleus. Blood-Vessels could not be seen in any part of the papilla. The trabecule Fig. 156. ^)^' / 4. consisted of slender, fusiform cells, with oval nuclei, and, \iphen further developed, presented delicate connective-tissue- bundles. A tumour, about the size of a small hen's-egg, growing from the dura mater into the anterior half of the left cerebral hemisphere, we also think, must be regarded as of a cancerous nature. When cut into, it had a medullary aspect, was consistent, spotted with red, and, in the softer parts, of a yellowish hue ; occasionally, however, the yellow portions were of firmer con- sistence, and, on the whole, bore some resemblance to portions of cancer in a state of involution. The cells, which, in many places, could be expressed in considerable quantity, in the form of a turbid juice, had sometimes a flattened figure and fatty, granular contents, but, for the most part, were furnished with one or two elongated processes. Cells with several nuclei (three to six) were comparatively rare. The principal mass was constituted of bundles of fibre-cells, with an oval nucleus, a prominent nucleolus, and having the two opposite processes running out into a wavy, convoluted filament. The bands of connective-tissue-bundles formed the proper stroma, and were rounded off here and there into villous eminences, standing in groups. IN FIBROUS MEMBRANES. 567 Considerable interest attaches to the development of blood- vessels, both in this tumour, and in another of the same kind, consisting of two lobes about the size of a walnut, which was situated at the base of the cerebellum, and had compressed the medulla oblongata. The bloody points visible to the naked eye, were seen, with the aid, merely, of a powerful lens, to be sharply defined, irregularly sacculated corpuscles. Closer exa- mination of their structure showed that these were closed succuli (fig. 157, a), with walls composed of a lax, embryonic Fio. 157. connective tissue, with imbedded, oblong nuclei. The cavity was abruptly defined by the closely crammed, red, blood- corpuscles. The prolonged portion of the sacculus was occa- sionally enlarged, by the addition of one, or of several, lateral protrusions, into a sort of secondary sac (as at b), or the numerous processes, furnished with varicose dilatations, were 568 NEW-FORMATION OF CANCER continued to a greater length without giving off branches, or ultiinately became dilated into an irregular sacculated diverti- culum (c). Occasionally, also, blood-vessels might be seen as much as 0-053'" in diameter, running in abrupt curves, presenting numerous lateral, rounded protrusions, and, in their winding course, becoming suddenly reduced to a half, or even to a third of their original calibre. The loops formed on these arching vessels might, on superficial examination, be taken for csecal protrusions ; but this error was corrected by a more accurate adjustment of the focus, and especially after the part was treated with water and acetic acid, the greater transparency arising from the removal of the red blood-cor- puscles then allowing the turn of the loop to be more distinctly seen. The walls of the blood-vessels never exhibited any trans- verse fibrous layer, but merely elongated nuclei, placed at certain distances apart, and disposed in the long axis of the vessel, and which doubtless belonged to short fibre-cells. With regard to the theory of the origin of these blood-con- taining sacculi, we must refer to what has been said in the General Part, (pp. 79 and 82), and at the same time would remark, that the excessive productivity of the cells, witnessed more especially in cancer, is also manifested in the fibre-cells of the walls of the vessels, and in the densely crowded multi- tudes of blood-corpuscles. The latter arise in the blastema which is enclosed by the groups of fibre-cells. The red-corpuscles presented a greater disparity of size than is usually observed to exist in ordinary blood. The majority were of small size, without the central discoid depression, and of a pale colour. Besides the sanguiferous sacculi, others also existed, exhi- biting a clavate, csecal, terminal enlargement, and fine-mole- cular contents (fig, 158, a). When traced further, these were found to constitute a network composed of bifur- cating, much convoluted tubes (c c c), filled with similar contents. But in other tubes, both larger and smaller, the contents appeared to consist of fatty granules ; and the indivi- dual fat-globules occupying the entire lumen of the tube reached a diameter of 0-00026 — 0-00354.'". The fine and coarse granular contents in other similar tubes, with rounded, villus- like ends, or in their prolongations, formed merely a central, slender tract (fig. 158, b). No nuclei could be perceived in the IN FIBROUS MEMBRANES. 669 Fig. 158. walls of these tubular structures, even after treatment with acetic acid, the substance of which they were composed appearing to be homogeneous, and furnished with nodular enlargements. Now what do these struc- tures represent ? Their ho- mogeneous, fine-molecular or fatty contents, certainly bear some resemblance to lymph, but we hesitate before ascrib- ing to them the nature of lymphatic vessels, notwith- standing their mode of rami- fication, since they do not possess the nodular enlarge- ments peculiar to the lym- phatics (at any rate, the forms a and c). At most, would those represented at {b), alone, seem to correspond with lymphatic vessels. A tumour situated at the base of the brain and extend- ing from the left internal auditory foramen, to the amygdala on the same side of the cerebellum, was of an oval form and about the size of a small citron ; its surface rendered lobulated Fig. 159. by bulging eminences {vid. fig. 159, a a), was smooth, shining, and of a dark cherry-red colour, passing into a dirty yellowish- 570 NEW-FORMATION OF CANCER red. Comparatively large blood-vessels might be seen running on the periphery of each lobule. At the part corresponding to the meatus auditorius internus, the tumour was intimately connected with the acoustic nerve (c). The corresponding cut surfaces [b h) of the divided tumour, also displayed a lobular arrangement in their interior. A variety of colours was ob- served in many places, grey and reddish-yellow alternating with bloody streaks and dots, the latter of a very deep hue. The consistence was about that of the normal thyroid gland. The scanty juice expressed from the substance of the tumour was slightly nebulous. The numerous bloody points proved to be either vessels cut across, or to correspond with caecal cavities enclosed by delicate connective tissue, and assuming divers forms like those shown in fig. 157. The lumina of the vessels were comparatively wide, and lateral diverticula were frequently appa- rent. The cells composing the proper parenchyma of the morbid growth were of small size, oval, and furnished with one or two, short processes and a nucleus. In the softer por- tions, the cells were about twice as big, and in those situa- tions, numerous fatty granule-masses, with many isolated fat-globules, disposed in layers, might also be perceived ; in such abundance in fact, as, in thin sections, to constitute opaque masses. In the more consistent, deep yellow parts, orange- yellow pigment was accumulated in considerable quantity, and from these parts, when torn up, hyaline, amorphous plates, (colloid?) were liberated. The stroma ap- peared to be constituted throughout of con- nective-tissue-bundles crossing each other in various directions. In the /ellow, clearer, transparent, and almost gelatinous lobules, tubular canals, united so as to form a net-work, were apparent, filled with a fine- molecular substance, (fig. 160), These vessels presented all the characters assigned by KoUiker to the lymphatics, and corre- sponded with those observed by us in cede- matous adipose tissue. We may, here, be allowed to remark that the structures de- scribed and figured by Forster as the villous commencements Fig. 160. IN BONE. 571 of newly-formed lymphatic vessels, in a sarcoma of the spinal marrow, might, perhaps, have been nothing more than Rokitansky's dendritic vegetations. Now, with respect to the designation of this tumour, we find applied to it the names of: — fungus hmmatodes (of the older writers), " fibro-plastic tumour," (Lebert), sarcoma, (Virchow), and cancer, (Rokitansky). Virchow has been in- duced to dispute the cancerous nature of these tumours, principally upon two grounds — that they occur solitary in the organism, and do not exhibit any central softening. We have already stated that these reasons cannot be re- garded as sufficient, and think that it is impossible, with our present vague notions respecting the last-described form, to arrive at any decisive conclusion. Reasons for ascribing to them, at any rate a relationship to cancer, are afforded by the spontaneous, fatty, and pigmented involution in the central parts of the tumour, and the excessive (as regards size and number) formation of blood-vessels. 5. Bone. Many forms of cancer are met with in the bones, which, as everywhere else, do not occur exclusively, each by itself, but usually in combination. The gelaiinous form arising from the penosteum, has twice occurred to our observation. In both cases it consisted of numerous large tumours, presenting a coarse, lobulated aspect, arising from the existence of deep, widely distant indentations. The capsule of the fluctuating lobes, which had attained to about the size of a man's fist, was in many places of cartilaginous density. The smaller, younger tumours arising from the periosteum, seated upon a comparatively broad base, were less transparent, and of softer consistence. The surface of sections displayed various conditions; the fundamental character remained that of the well-known areolar texture, but this in many places was partially destroyed, and no longer recognizable. The viscous, tenacious juice, sometimes also of a gelatinous consistence, was in other places, by the reception of water, converted into a thin, transparent fluid, and 572 NEW-FORMATION OF CANCER in this condition was often enclosed in considerable areolee. Besides this, spots having a bloody tinge, or of an almost cartilaginous consistence, might be observed. In sections of due thinness, which could be readily prepared by means of the scissors or scalpel, rounded or elongated groups of granular cells could be perceived, lodged in a transpa- rent, structureless, intercellular substance, which gradually assumed more and more of a striated texture, appearing in fact, to be disposed in concentric layers around the corre- sponding groups of cells. Upon the addition of acetic acid the formation of these layers might be distinctly noticed, where they were inapparent before its application. Under these circumstances, also, nodular, slender, elongated enlarge- ments became visible in the artificially produced fibrous layers, which have formerly been erroneously described as fibre-cells ; but as it is impossible that cells of this kind could be produced in a structureless material by the action of acetic acid, we think we are justified in esteeming them not as nuclei at all, but as a coagulated substance. For even in rapid crystallization, as, for instance, of common salt, sal ammoniac, &c., nodular enlarge- ments may be seen to arise, from which the solidified substance thins off on both sides. This fibrillar formation, produced by the precipitation of the fluid mucin, occurred in many places so abundantly, that the cells appeared to be quite overwhelmed by it. In many parts the latter were in an advanced stage of fatty degeneration, and transformed into fatty granule-masses. These places were perceptible, even to the naked eye, as milky white spots, which were in part also referrible to the accumulation of free, fat- globules, and of a fine, brownish-yellow, molecular substance. Reddish-brown and black, amorphous, lumpy masses were like- wise seen imbedded in the substance, probably new-formed blood in a state of involution, since areolcR might also be observed filled with blood in the normal condition. In one instance, numerous osseous new-formations pro- jected from the inner surface of the ilium, which when ex- amined with a lens after maceration and drying, exhibited the utmost diversity of form. They were characterized, gene- rally, by the delicacy, softness, and porosity of the osseous rays, which were arranged essentially on the areolar type, IN BONE. 573 though even in this respect, innumerable varieties were dis- played. A cribriform aspect was given to these neophytes, when the areolae corresponding to the medullary cancelU of the spongy bones, were of pretty nearly equal size, and placed at tolerably uniform distances apart. Into these areohe, projected, sometimes pointed, sometimes truncated, occasionally dichoto- mous processes, precisely resembling those papillary growths which grow from the trabecule of the soft cancerous stroma into the areola, {vid. fig. 152) ; it may, therefore, be said with perfect correctness, that the osseous framework corresponds in all respects with the soft stroma ; the same embryonic connective- tissue-elements, moreover, being contained in the one as in the other. In many places, cystiform cavities were formed by the deficiency, and, as it were, mutual suppression of the arching osseous rays, which were filled with a nuclear, fatty substance, rendering the water milky. A foliated, areolar aspect, was produced when the osseous substance was disposed in straight, finely-perforated lamellae standing at certain distances apart. The latter, under these circumstances, mostly terminated in acute spinous processes. Lastly, in macerated fragments of this bony structure, very delicate, transparent, occasionally perforated membranes might be noticed stretched across the areolae, but by no means completely closing them, which were immediately con- tinuous with the bone and structureless. The osseous tissue close to the borders of the rays consisted of oval elements resembling cartilage-cells ; the bone-corpuscles, ac- cording to the degree of their evolution, were angular, or furnished with distinctly radiating and bifurcating canaliculi. The intercorpuscular substance appeared, sometimes streaked, sometimes finely punctate. It is well known that medullary forms of cancer also, are developed from the bones, in which, numerous, occasionally widely-spreading osseous rays, extend from the bone into the tumour. A case of this kind came under our notice in the cranium of a boy twelve years old. The fungus was situated on the outside of the right frontal bone, arose from the peri- osteum, and extended backwards as far as the squamous por- tion of the temporal bone. The osseous spicules, seated on the 574 NEW-FORMATION OF CANCER outer table of the frontal bone, were parallel to each other, and extended to a distance of from 3-54^-4-4"' into the fungous growth, some slender, bony lamella penetrating still more deeply into it. On the anterior part of the right side of the basis eranii, a similar, jagged osseous mass, projected inwards towards the substance of the brain. The medullary morbid growth consisted, chiefly, of variously shaped nuclei, oval, biscuit- shaped, or of a trefoil form, which occasionally cohering to- gether, constituted, as it were, an ill-defined, peripheral sub- stance; they shrank a little under the action of acetic acid, but their original form was unaltered. These numerous, nuclear bodies, contained 1 — 2 — 3 prominent nucleoli, together with delicate granules, which did not convey the optical expression of fat-globules. Fully formed cells, with an investing membrane, were but rarely apparent. Olein, in a state of minute division, might also be seen in many of the fatty granule-masses. The osseous substance presented the. same conditions as existed in the former case. In the latter case, therefore, the new-growth seems to have been developed, as it were, in two directions. On the one hand, we see a gelatinous, and on the other a medullary form of cancer, attaining to a considerable bulk, whilst in both instances immature osseous-substance was developed from the bones. May not this twofold type of formation originate in the different kinds of vessels from which the growth receives its blastema ? The vessels of the periosteum communicate, on the one side, with those of the lax investing connective tissue, and on the other, with those proceeding from the cortical substance of the bone ; affording, in the latter case, the nutriment for the peripheral part of the bone, whilst in the former, they subserve the nutri- tion of the elementary organs of the connective tissue. When the cancer is seated in the substance of the bone, its growth usually continues at the expense of the latter, and a rare- faction of the osseous tissue is the result. Or the parts of the bone enlarge, together with the cancerous substance, and become the osseous framework of the morbid growth. Among the different forms of cancer, as it occurs in bones — the gelatinous (areolar), medullary, fibrous, epithelial, and melanotic — the first and last, as is well known, are very rare. The fibrous form of cancer was apparent in several of the ribs of a woman IN BONE. 575 Fio. 161. who had numerous cancerous nodules in the liver. The nodules of the morbid growth were some of them as big as a walnut. The sub- rotund cells reached a diameter of 0-004 — 0-007'", and the comparatively large nuclei measured 0'004 — 0'005"', (fig. 161, ffl). These cells were not numerous, and alternated with the binucleated and oblong kind {b), which latter presented 1 — 4 processes, and gradually diminished in size. The connective-tissue-bundles (c), of con- siderable dimensions, must also be regarded as of new-formation, for bundles of such a thickness are never observed in the medulla of the ribs under normal circumstances. Elastic fibres could not be perceived. Yellowish-brown, or black groups of pigment-granules were scattered, here and there, throughout the fibrillar tissue. The flattened, irregularly jagged corpuscles, occasionally covered with a few granules {d), would seem, most probably, to be colloid plates j they were unchanged by acetic acid. Their differential diagnosis, from accidental epidermis -cells, con- sists in their diversity of sii,e and shape, and in the circum- stance of their not swelling in acetic acid nor in diluted alkalies. Lastly, there were apparent numerous flattened bodies with several (4 — 20) oval nuclei, with regard to which, it is perhaps extremely doubtful, whether they should be regarded as multi- nuclear cells. In any case they are analogous to the large cor- puscles discovered by KoUiker in the foetal marrow of the tibia in a child one week old. On account of their great number, they must, we think, at any rate, be viewed as pathological new- productions, and, in accordance with Kolliker^s opinion, be described as embryonic forms. The osseous tissue was de- stroyed in the parts infiltrated with the cancerous matter. The medullary form appearing as a reddish-grey, thick, grumous substance occupying the cancelli, though not distinctly circumscribed, consists of chiefly round cells with large nuclei ; the fibre- cells are scanty, whilst there is abundance of free 576 NEW-FORMATION OF CANCEE fat, and numerous fatty granule-masses. The neighbouring medulla is often of a deep red colour. It is well known that the aiFected bones, under these circumstances, lose some of their rigidity, and acquire a certain degree of flexibility. This is the case, in a more marked degree, when the medullary cancer ap- pears, not as a circumscribed growth, but as a more or less dark-red, dirty, thin pultaceous substance replacing the marrow. In cancers of this kind, round elementary organs are chiefly met with {vid. fig. 112, c). The softened, flexible, osseous sub- stance, when viewed in thin plates, no longer presents the normal structural condition ; the intercorpuscular tissue assumes a broadly striped appearance, the stria decussating in various directions; the bone-corpuscles appear at first as light spaces, and are ultimately wholly unrecognizable in the fissure-like vacuities. After the application of diluted hydrochloric acid, the striated texture of the softened bone is rendered far more distinct than it is in the normal condition. The epithelial form is characterized, as in other tissues, by the granular texture; the individual granules of which it Pjj, ^g2 is composed may be the more readily expressed in proportion as the morbid growth is of softer consistence. The majo- rity of the cells composing the growth are of the flattened kind, and in many places their forms have a surprising re- semblance with those of the oral epithelium (fig. 162, a) ; but on the comparison of a considerable number, the jag- ged outlines above described will be remarked. More- over, in cancerous growths, of this kind, large, flattened corpuscles with jagged processes and numerous nuclei, are occasionally presented in large quan- tity (6), which are isomorphous with those represented in fig. 161, e; and with respect to which, the same observa- tions will apply. The large, flat, usually uni- or binucleated cells, exhibit a fatty degeneration of their contents, very IN THE LUNGS. 577 general and far advanced; and these correspond with the soft parts by which the water is rendered slightly milky (from minutely divided olein in suspension). We had an opportunity of observing this in an extensive cancer of the lower jaw and of the cranium. In cells of this kind, the nuclei may also be seen becoming larger and larger, and ultimately the vesicular spaces above noticed, filled with a hyaline or granular fluid ("reproductive spaces," Virchow), make their appearance. A morbid growth degenerated in this way is always accompanied with a more rapid destruction of the osseous substance ; and ultimately very considerable portions of the bone may be removed, as in the medullary form. It is manifest, more particularly in the epithelial form of cancer of the bones, that the intermediate family of cancroid diseases, proposed by several authors, stands in such intimate connexion with those growths whose organic development and retrogression characterize them as cancer, that the establish- ment of a distinct family, under the name of " cancroid," does not seem to us a scientific postulate. The not unfrequent combination of the epithelial with the medullary form, also indicates an intimate relationship be- tween the two. § 6. Lungs. In these organs, cancer occurs in the form of nodules, project- ing above the surface, or imbedded in the substance, of tolerable consistence, and affording on pressure a pultaceous turbid mate- rial. When the latter is treated with water, the suspended cells are rendered distinct, whose predominant form is some- times the flattened or discoid, sometimes the fusiform; the nuclei are single, double, or multiple. The size of the cells not unfrequently varies in dififerent nodules, but in most cases they are of a medium size. The fatty degeneration of the contents is especially manifest in the soft, pultaceous nodules; and in these, after the loosely adherent cells have been washed away with water, the fibrous bundles constituting the cancer- stroma, also infiltrated with fat, are readily brought into view. After treatment with the alkaline carbonates, numerous elastic filaments are rendered apparent, in which, in several of the cases examined, the characteristic arches of the pulmonary cells were 37 578 NEW-FORMATION OF CANCER no longer recognizable; but it is, nevertheless, highly pro- bable that the elastic element is not of new-formation, and has only been displaced from its natural position by the cancerous infiltration. But we have seen many instances in which characteristically convoluted pulmonary fibres together with the black lung-pigment lay in the midst of the cancerous growth. No doubt, therefore, can be entertained that the cancerous new- growth, like that of tubercle, occupies the air-cells. In the case above noticed, of a woman having cancerous deposits in most of the organs, the lungs were studded with numerous nodules, from the size of a pin's head to that of a lentil, of a pale-yellow colour, tolerable consistence, and ex- hibiting, on section, an apparently homogeneous substance. To the naked eye, there was apparently no morphological character by which these growths could be distinguished from tu- bercle; and even microscopical examination afibrded none of those elements which have been erroneously ascribed to cancer. In the molecular, flaky matrix, nothing could be seen but numerous nuclei (fig. 163, a), and flattened, subpolygonal cells Fig. 163. (^)j occasionally exhibiting a nucleus and some fatty molecules in their contents; corpuscles with an attenuated process (6 + ) were not unfrequently observed. The fatty degeneration of the cells had reached such an advanced stage, that ultimately they became transformed into an agglomeration of fatty mole- cules. The brownish-red pigmented cells (e?) were probably derived from those in a state of fatty degeneration, by the reception of colouring matter. It cannot be demonstrated that all these elementary organs were of new-formation, inasmuch as the mere nuclei, especially, might represent the remains of the epithelium of the pulmonary cells; but it is certain that the majority of these elements belonged to the cancer, since the latter formed nodules pro- jecting considerably above the surface of the lung. Another, far more important result, however, flows from the elementary constitution of these growths. If the numerous nodules disseminated throughout the lungs had been observed IN THE LUNGS. 579 by themselves alone, one might certainly have been puzzled to determine whether they should be arranged with the tuber- culous or with the cancerous new-formations; but as they occurred in an individual who was almost universally affected with cancerous deposits, no hesitation could be felt in assigning them to the latter. It will be seen, therefore, that we have been guided in the designation of this morbid growth, not by its mere anatomical characters, whatever they might he, but by a comparison with other growths in the same organism. Such a variable nomenclature, however, is a sufficient proof that we are striving to set up strongly- defined boundaries where none exist in nature. Now, whether the nodule in question be regarded as cancer remaining at the stage of development commonly ascribed to tubercle, or as a tubercle developed simultaneously with cancerous formations in other organs, comes, pretty nearly, to the same thing. It must be allowed that our ideas of tubercle and of cancer are not widely remote, but merely expressions (categories) indispensable in anatomical language, and requisite for the designation of particular modes of development of certain new- growths. The institution of categories of this kind proceeds from the methods pursued in human thought; at the same time it should not be forgotten that these indispensable cate- gories have such numerous vacancies and deficiencies, that they can only be regarded as ideal, and not as things having an actual existence. Nature shows, that in one and the same individual a fibroid tumour may be formed in the uterus, and a medullary cancer in the liver : Where, then, is our supposed cancerous dyscrasia ? It is well known that decided tuber- culosis of the lungs, with cavities, &c., occurs together with cancer in other organs, with intermediate forms. Where, then, is the boundary between cancer and tubercle ? Cancer usually occurs as a secondary affection, in the lungs. On one occasion. Dr. Braun noticed some rounded nodules, as much as 0'39" in diameter, in the lungs of a new-born child, rather towards the surface. On pressure, these nodules afforded a medullary juice, containing the various kinds of cells, mostly in a state of fatty degeneration, which are com- monly met with in cancer. Besides this, a puriform mucus flowed from the divided bronchi. According to Dr. Braun, 580 NEW-FORMATION OF CANCER there were no other cancerous deposits in the body. The mother appeared healthy. § 7. Liver. The medullary form of cancer, which is that most usually met with in this organ, has been subdivided by several writers into the "crude" and the "true medullary." But it has been shown by Rokitansky that these two forms merely represent different degrees of development. We have figured a well-marked encephaloid cancer-nodule in fig. 164. It pro- FiG. 164. jeeted above the surface of the liver, and was divided into two halves by a vertical section. The sharply defined outline pre- sented a lobulated appearance, which was particularly evident towards the surface of the liver ; but the lobular conformation is also shown in both surfaces of the section. On the left side may be observed a rather large cavity, subdivided, by depressions, into several diverticula, and having no membra- nous lining. Blood-vessels ran in its soft, uneven wall. In the right half may also be seen some infundibuliform depres- sions, which, as well as the larger ones on the opposite side, were filled with a greyish-red, creamy juice. The blood-vessels were very abundant, assembled in numerous insulated groups, and bore some resemblance, as regards their course in wavy, interrupted lines, to that of the vessels in connective tissue. IN THE LIVER. 581 TLe hepatic substance in immediate contiguity with the can- cerous growth was separated into a dark brown and dirty yellow. The hepatic cells, particularly those immediately around the morbid growth, contained pigment ; in the yellow places, the cells were mostly in a state of fatty degeneration. The parenchymatous cells of this cancer were for the most part fusiform, and in an advanced stage of fatty degeneration ; by their fusion, and that of the areolar fibrous stroma, were formed areola, from whose walls (particularly of the larger ones) dendritic fibrous bundles depended, as was best seen when the parts were viewed under water, the bundles then floating out like minute villi. The blood was contained, partly, in vessels characterized by their simple structure, and partly had the appearance as if it were lodged in mere areolce. The corpuscles were mostly of smaller size than usual, and the groups constituted of them manifestly corresponded with isolated new-formations of blood, as might be satisfactorily seen in the examination of the surface of sections of the several lamellcB of the cancerous nodule. The cells which occasionally form the main constituent in well-marked encephaloid cancer are large and round, and enclose mostly large, elliptical nuclei with 2 — 3 nucleoli; the less abundant, fusiform cells with oblong nuclei are disposed in dendritic bundles. The cells frequently contain some fat and pigment-molecules ; and fat and pigment may also be observed in large quantity in many parts of the cancer where the process of involution is further advanced ; so abundantly, in fact, as, in these parts, to render the recognition of the fibrillar structure difficult. In these places, also, dirty red-brown masses (ne- crosed blood?) are very often met with, as well as cholesterin, and hyaline, concentric plates (colloid) ; and after treatment of the denser portions with the alkaline carbonates, a large quantity of convoluted, elastic filaments. From the rather more succulent portions of the cancer, moistened with water, a precipitate is obtained, by the use of acetic acid, consisting of straight filaments (mucin). Now, when the fibrous stroma .of a cancerous deposit of this kind is examined more closely, — which is to be done by taking a very thin lamella and waving it backwards and forwards briskly in water, by which means, especially at the edges, 583 NEW-FORMATION OF CANCER the loosely adherent cells will be washed out of the areolm — no undulating connective-tissue-bundles will be displayed, and only a streaky appearance, more resembling that of a closely phcated membrane, or of mucin-filaments in close apposition ; occasionally, also, a network will be perceived, composed of short filaments, resembling those of coagulated fibrin. If a portion of this stroma be treated with acetic acid, either no increase whatever will be perceived in its transparency, or none approaching to that which might be expected to take place in connective tissue. Thus, we see a confirmation of the proposition before stated (p. 78), that a chiefly fibrous or mucoid framework may constitute the sole or the secondary stroma. This fibrous framework is also formed without any previous cell- formation, simply from the precipitation of the protein- substance ; for, in very minute cancerous nodules of the liver, treated with boiling water, or immersed in a weak solution of corrosive sublimate and dried, so as to be fitted to afford thin sections, a trabecular tissue is displayed, occasionally enclosing in its areola, no cells, but only a hyaline substance. These cribriform portions are immediately surrounded by the hepatic parenchyma and its vessels. When the sometimes round, oval, elongated, much sinuated, and occasionally angular vacuities are somewhat larger, they may be recognized even by the naked eye, and very well by the aid of a powerful lens, both by direct and by transmitted light. But in most cases, the trabecular tissue is so concealed by layers of cells, as not to be clearly seen, except in very thin parts of the sections, and after a careful, partial removal of the cells. In close connexion (not as regards their genesis, but with respect to contiguity) with this fibrous framework are the fibre-cells with their oval or oblong nuclei; and these cells fall into a state of involution, together with the interstitial fibres, a large amount of fat and, occasionally, of pigment- molecules, being deposited in them. In consequence of which, the places in which they exist, even to the naked eye, exhibit a yellowish, reticular aspect; the network appearing opaque by transmitted light. Not long since, we had an opportunity of viewing a reticulum of this kind, displayed, in the most distinct manner, in some cancer-nodules of the liver. IN THE LIVER. 583 If portions be taken from these nodules where the texture is more lax and to some extent granular, and little fragments be cut from these, either with the scalpel or with scissors, while floating under water, villous or papilliform processes arising from the trabeculce, and filled with a molecular material, will not unfrequently be seen either solitary upon a long peduncle or, more rarely, in sessile groups. These distinctly circumscribed, sharply defined growths, described by Rokitansky as " hollow, clavate papillae," must not be confounded with projecting, fibrous bundles torn across. The more consistent nodules, affording on pressure only a trifling quantity of turbid juice, and presenting a deep-yellow, or red, speckled aspect, which have by many authors been de- scribed as crude forms of cancer, contain mostly small, often aborted cells ; blood-vessels, in spite of the most careful search, cannot be found in them, the blood being collected in irregular areola. This new-formation of blood may take place to such an extent, that circumscribed spots, occasionally 0'39" and more in diameter, formed of it, and appearing on section infiltrated with blood, are visible, projecting somewhat above the surface of the liver. These little tumours have been described by some as ecchymoses, and formerly, by Rokitansky, as cavernous swellings, but are, for the most part, referrible to cancer, since they contain, together with bulky blood-corpuscles, very numerous fatty granule-masses, oval or round nuclei, elliptical and fibre-cells, with one or several pro- cesses. The slender, elongated, fusiform cells alternate with long fibres presenting numerous varicosities. If the blood-corpuscles together with the cells be gently removed, and, besides, the still adherent parts be in a great measure washed away with a stream of water, the stroma, composed of a delicate, narrow-meshed, trabecular tissue is brought in view. This form of cancer, there- fore, belongs to what has been described as " blood-cancer." Medullary cancer of the liver, by the assumption. of pigment, passes into pigmented cancer {fungus melanodes), acquiring a dirty grey, greyish-red, reddish-brown, or even black-brown colour. The usually elliptical or ellipsoidal cells attained, in one case of this kind, to a diameter of 0047'", whilst the smallest were scarcely so much as 0'0079"' in size ; the largest nuclei were 0*0123"' in diameter, the average size being 00079'"; 584 NEAV-FOEMATION OF CANCEK the least occurred in the smallest cells, their size being but little below that of the latter. The largest nucleoli pre- sented a diameter of 000158'", the small, one of 0-00079'", the smallest being even less than that. There were not unfre- quently 2 — 8 nuclei in a single cell ; and parent-cells also occurred with distinctly apparent walls to the secondary cells. The cell-contents were frequently in a state of advanced fatty degeneration ; large, red-brown pigment-molecules were present in comparatively few cells ; they occurred in far greater number free, among the cells and fibres. Rokitansky has also noticed in a fungus of this kind, and particularly in the fluctuating, soft tubera, very loosely connected, villus-like structures, appearing to the naked eye as white, fibrillar tracts with extremely nu- merous blood-vessels running in the same direction as the fibres. On closer examination, he found in these fibrillar tracts, long, hyaline bands, composed of wavy, contorted, connective-tissue- fibrils, with numerous, but only simple or clavate protrusions. Cystic cancer of the liver, or, in other words, a medullary form with well formed cysts, once came under our obser- vation, in an old Bear. One of the larger cysts, which pro- jected above the surface of the liver, partly out of the cancerous mass, was about 0'78" in diameter. Its contents were a thin fluid, and slightly turbid from the presence of fatty granule- masses and suspended fat-globules, whilst its inner surface was lined with flattened, various-sized cells, containing a parietal, oblong nucleus ; its outer investment was constituted of fibrous connective tissue, with orange-coloured pigment-granules im- bedded in it. The cancerous mass was tolerably consistent, containing abundance of blood and fat, with cells, of only small size, in a far advanced state of fatty degeneration. The dense trabecular tissue, after treatment with the alkaline carbonates, exhibited numerous, elastic, fibrous networks. The parenchyma of the liver was very fatty. In the blood of the portal vein, down to its fine ramifications having a capillary structure, were found numerous deposits of isolated, brownish-black, and perfectly opaque granules, which disappeared, in part, under the agency of the alkaline carbonates. They had manifestly been formed from the hcematin of the necrosed portal blood. We are satisfied, also, that in Man, in cases of cancer of the liver, a considerable quantity oihcematin is precipitated in the blood of the portal vein. IN THE LIVEE. 585 Of great interest, in many points of view, are the cancerous elements in the portal blood, which were first accurately de- scribed by Virchow. They occur, sometimes combined with cancer in other organs, sometimes in conjunction with hepatic cancer. In an instance communicated to us by Dr. Bamberger, the former was the case. The liver was considerably enlarged, of dense texture, and tuberous on the surface, each elevation being surrounded by a bloody area (probably blood extrava- sated from the portal veins around the groups of lobules). The parenchyma of the liver, of a grey and greenish-yellow colour, was in many plapes constituted of hepatic cells in a state of tolerable preservation, whilst in other parts the cells were far advanced in fatty degeneration, and had become disintegrated, nothing remaining but round nuclei and granule-masses, A serous fluid could be expressed from the substance of the tumours. Thin sections of the hepatic substance displayed only sanguineous spots, whose outlines were not very distinct, owing to the circumstance, that the infiltration of the parenchyma with fat had rendered it of a grey colour, and to some extent imper- vious to transmitted light. In the larger branches of the portal Vein, the lumen was occupied by dirty-yellow, yellowish- red, and brownish plugs, readily divisible into smaller parcels, and in many places of softer consistence, which, on pressure, afforded a juice rendering the water turbid. Under water, nodular prominences and short processes might be perceived floating out, even by the naked eye. The elementary analysis showed the presence of cells, mostly of the sub-elliptical form, with an oval nucleus and distinct nucleolus ; elongated cells were also met with, with one or both ends drawn out to a point. The elliptical cells were disposed in chains, and were also connected together by very delicate fibrinous filaments. When the sub- stance was torn up, in addition to these, distinctly circum- scribed corpuscles, some as much as 0053'" in diameter, and having lateral protrusions, were liberated ; these bodies bore some resemblance to rudimentary, papillary new-formations of connective tissue. This indubitable occurrence of the elements of cancer in the blood cannot, of course, be put to the credit of any theory respecting the propagation of cancer from one organ to another by hypothetical elements.^ ' A very accurate description of the rare gelatiniform cancer in the liver, has 586 NEW-FORMATION OF CANCER § 8. Kidney. The cancer-nodules, sometimes enclosed by the renal sub- stance as in a sort of capsule, sometimes coalescent with it at their periphery, are either of firm consistence and of a dirty yellow colour, often spotted with red, — when they correspond with the crude cancer of Virchow, — or softer, and afford on pressure a considerable quantity of a milky juice. The more consistent nodules, not unfrequently connected with Bright's disease, occasionally exhibit, notwithstanding they may have attained to a considerable bulk, an apparently homoge- neous structure without a trace of vascularity. The cells existing in this kind of nodule are small, comparatively scanty, and the fibrous framework very close. The new-formed red blood-corpuscles are enclosed in areolae without independent walls, and constitute, when present in large number together, the sanguineous spots. In a considerable number of nodules, some are usually of softer consistence, and these are pervaded by blood-red, often blackish points, about the size of a pin's head. In one case of this kind, in which cancerous deposits occurred in several organs, we found, for the most part, flattened cells in an ad- vanced stage of fatty degeneration, so closely resembling the epithelial cells of the tubuli uriniferi, that in that respect it could not be determined whether they represented the remains of the renal parenchyma or were of new-formation. In other places, again, fibre-cells appeared to be the main constituent. The reddish-brown and black pigment was deposited in isolated groups in the morbid growth. A new-formation observed in the cortical substance of the kidneys of an old, dropsical woman, we think, should be des- cribed as approaching nearest to villous cancer. In the situa- tion in question, there were several cysts, some as big as a been given by Luschka, who is also satisfied that the walls of the alveoli (by us always termed areolts), are not by any means independent, isolated membranes, but an integral constituent of a lamellar framework, composed of a corresponding fibrous tissue. The inner surface of the large areola, he noticed, to be invested with a frequently very distinct epithelium. He also supposes that the straight, not undulating, fibres, arise immediately out of the blastema. IN THE LYMPHATIC GLANDS. 587 pigeon's egg • one, of the latter dimensions, completely filled with a new-formed substance, was seated on the convex bor- der of the gland. The consistence of this substance appeared softer than that of the kidney ; it was of a dirty yellowish-red colour, and afforded on pressure a tolerably abundant turbid juice. With the assistance of a lens, brownish-yellow vegeta- tions could be readily extracted from it, which occasionally assumed the figure and size of the intestinal villi, had lateral prolongations, and were surrounded by numerous, convoluted blood-vessels. The elements to which the turbidity of the juice was due were flattened, polygonal, mostly brownish cells, with an oval, excentric nucleus, and were thus distinguished from hepatic cells in a state of fatty degeneration, to which they bore the closest resemblance in outward form and in size. These cells also occurred in groups of 8 — 10 or more, imbedded in a hyaline, depressed, discoid matrix-substance, and formed the main constituent of globular, conical, villous growths, of very soft consistence, and which became disintegrated under the prolonged action of water. In addition 'to the above, there were also noticed elongated, saccular organs, in diameter about equal to the middle sized tubuli uriniferi, convoluted, and con- taining granule-masses, here and there, in the interior. Oval and ellipsoidal nuclei lay at regular distances apart in their transparent wall, and by these the new-formed sacculi were distinguished from the tubuli uriniferi, whose membrana propria, as is well known, contains no nuclei. The sacculi were occa- sionally dilated into csecal, closed spaces, whose outer wall was formed by a wavy fibrillar structure. Fusiform cells, crossing each other in various directions, were apparently lodged in the wall of the sacculus. Since the walls of the blood-vessels and their caecal terminations exhibited essentially the same struc- ture, and were, consequently, distinguished only by their organic contents — the white and red blood-corpuscles — it is clear that they were not developed from the hyaline blastema until the latter had become enclosed in independent walls. § 9, Lymphatic glands. The usual forms of cancer seen in these organs are the medullary and fibrous, and, not unfrequently also, aggregations 588 NEW-FOEMATION OF CANCER. of black granular pigment may be observed. We noticed a well-marked instance of villous cancer in a bronchial gland of an individual affected with cancerous deposits in several organs. The swollen gland, when incised and compressed, afforded an abundance of milky, turbid fluid, after the washing away of which, a fine network, composed of very delicate grey trabecule, came into view. Portions cut off with the scissors, and drawn several times through clear water, displayed these trabe- cule, floated out, and gradually sub-dividing into finer and finer branches. If these were so displayed that but few layers were superimposed upon each other, the mode of division could be accurately traced with a magnifying power of 60 — 90 diam. The thicker trabecule, some of which even exceeded 0"088"' in diameter, became gradually so mucb attenuated by their arbo- rescent branching, as to be reduced below 0-0066 — O'OOM'". As regards their structure, considerable diversity was apparent; some consisting of connective-tissue-bundles, running in the direction of their longitudinal axis, whilst in others oblong nuclei were perceptible, disposed at regular distances apart. Many of these trabecules appeared to enclose a canal, and thus to be hollow ; occasionally, also, parts of them were infiltrated with fat- and pigment-molecules, and, consequently, were in a state of re- trograde metamorphosis. Numerous p&.pillary excrescences, usually standing in groups, were seated on the middle-sized trabeculcB ; and on many of the thinner trabecules divided into short internodes, these pedicellate papillary groups resembled the ultimate vesicles of an acinose gland. The indented border of the hemispherical papillary growths was sharply de- fined, and in many instances they seemed to contain a hyaline blastema. The substance, composed, for the most part, of imperfectly developed cells, which constituted the milky, ex- pressed juice, was lodged in the interstices of this trabecular system and its csecal prolongations. It was, in fact, composed principally of rounded, grey nuclei, about 0-0031 — 0-0044'" in diameter, surrounded by a narrow indistinctly defined bor- der indicating the cell-contents ; a perfect membrane existed in comparatively but few of them. RETROPEEITONEAL CANCER. 589 § 10. Retroperitoneal cancer. Lobstein, as is well known, assigns the name of retroperito- neal growths to those tumours which always commence behind that portion of the peritoneum which lines the posterior walls of the abdomen. He expresses the opinion that they com- mence on the vertebral column, but this notion cannot be regarded as holding good in all cases. A cancerous tumour, as large as a child's head, situated beneath the stomach, and for the most part of a soft medullary consistence, extended, it is true, as far as the vertebrte, but the bones were not implicated. The tumour consisted of several nodular lobes, several of which, of firmer consistence, presented a cartilaginous, cortical portion, and a central substance of a structure resembling that of a spongy bone. The cartilage-cells, towards the ossified portion, were rounded, elongated, triangular, quadrangular, &c., con- tained a granular rounded nucleus, and were either isolated or assembled in groups of two, three, or several together (fig. 1 65, a) ; the intercellular substance was in parts clear and structureless, and, in parts, presented a striated texture [b). Towards the surface, the cartilage- cells, which were loosely im- bedded in the interstitial substance, and had consequently here and there fallen out, were filled with fine-molecular contents (c), and the nucleus, which was of considerable size, was some- 590 NEW-FORMATION OF CANCER times concealed, sometimes appeared to be altogether wanting ; the nucleolus had the aspect of a sharply-defined, comparatively large granule. The ossified portion, which was of a well- marked areolar type {d), could not be distinctly viewed until the softer tissues adherent to it were washed away. The spaces, of various dimensions, existing in the osseous frame- work were sub-divided into several loculaments by short, pointed or truncated, projecting processes. The longer, pointed or rounded papillary processes sprung from the anastomosing ossified tra- beculcB, and corresponded in all respects with the analogous pro- ductions of the soft cancerous stroma ; occasionally, also, fibrous bands proceeded from them, which united with corresponding bands from other ossified processes, so as to form bridges. In this way the soft cancerous framework was immediately con- tinuous with that which was ossified. The soft cancerous matter contained principally a mere nu- clear substance ; the nuclei were sometimes small and round, and resembled, also, in the bulky accumulations formed by them those met with in the thymus, lymphatic glands, &c. ; whilst in other places, from their great dinlensions, and the large size of the round or elongated nucleolus, they might be confounded with cells. But that this was not their nature was shown by the use of acetic acid. Perfect cells were comparatively rare, whilst aggregations of fatty molecules, on the other handj occurred abundantly. The blood was free, or enclosed in wide vessels ; and in many places it was necrosed, as indicated by the existence of dark-orange or reddish-brown masses of cor- puscles, which no longer yielded up their hcemaiin to water. § 11. Mammary gland. The medullary form, which frequently occurs in this situa- tion, assumes the shape of nodules having a lobulated structure, whose external surface is usually spotted with red, so as to lead to the supposition of the existence of minute extravasations of blood ; but this is not the case. These spots correspond, far more probably, with collections of new-formed blood, which may also be observed enclosed in independent walls: in fact, the blood-vessels are developed in proportion to the thickness of the investing layer of connective-tissue, which may IN THE MAMMARY GLAND. 591 occasionally be distinctly raised. This peripheral layer of blood-vessels is subservient, without doubt, to the nutrition and development of the cancerous growth. The fatty tissue, usually surrounding the morbid growth, is in parts very vascular, and presents a deeper yellow colour than elsewhere. In a section, the colour of the lobules presents remarkable diversities; for whilst in the one part they appear of a rose-red hue, in another this passes into a greyish-red, yellowish-grey, and brownish- yellow tint. The portions marked with red spots, or pervaded by distinct blood-vessels, are usually situated at the points of radiation of, and in the interstices between, the lobules. The consistence of an entire group of the latter may be so soft, and their connexion so lax, that they break up into a pultaceous substance, conveying an apparent fluctuation to the feel, which has occasionally given rise, in the diagnosis of such tumours in the living subject, to the confounding of them with cystosarcoma ; whilst the consistence of other groups of lobules is so much increased, as to equal the density ascribed to scirrhus ; these portions of the cancerous growth, together with those evolved in another direction, are in a state of involution. Tlie material composed of cells, which may be expressed in the form of pultaceous, friable masses, presents the utmost diversity in the shape of its elements. These are rounded, oval, uni-, bi-, and multipolar cells, whose excentric, oval nucleus often en- closes 2 — 3 nucleoli (fig. 166, a). The processes of these cells frequently expand in a peniciUar manner, exhibiting varicose enlargements, and bifurcations. The multinuclear cells (5) are broader and misshapen ; the nuclei, which either remain in connexion, or are separated by an intervening portion of con- tents, differ considerably in size, and often collect towards one side of the cell. As the latter increases in volume, a globular body becomes apparent in the interior, enclosing a mass of agglomerated granules {b b). With respect to an appearance of this kind, it has already been said that we regard this body as a vesicular nucleus, since the stages of its evolution, up to a certain size, may be followed. In Virchow's opinion it would be a "reproductive space" (Brutraum), and the central cor- puscle would not be analogous to the nucleolus. For the reasons above stated, however, we are compelled to regard it as such, and are able also to observe the stages of transition 593 NEW-FORMATION OF CANCER up to this size. If the nucleolus were wanting, the supposition might be entertained of the possible coalescence of several Fig. 166. nuclei into a single vesicle. The fatty degeneration of the cell- contents may be traced into the prolongations of the fibre-cells (a) ; the fat-globules do not project beyond the contour of the cellj but are disposed in longitudinal series in the interior of the process. Occasionally, also, brownish-red pigment occurs in the interior of the cells. When the degeneration of the cell is further advanced, it is reduced to a simple agglomeration of fat-granules, or of coa- lesced fatty molecules, the areolar stroma collapses, and an abundance of granular fat, cholesterin, orange- and brownish-red pigment, occasionally associated with calcareous salts, will be seen, imbedded in the atrophied cancerous growth. In the softer, diffluent, rapidly growing nodules, the produc- tion of nuclei only is achieved ; and in this case the division of the latter, as described above (p. 63), may be very readily observed, owing to the large size of the nuclei and nucleoli, and IN THE MAMJIARY GLAND. 593 to tlio cii'camstauce that, at this time, no cell-membrane is formed. After perforating the skin, the cancerous muss con- tinues to grow; and towards its surface may be observed numerous bloody points, which, in vertical sections, lu-e seen to constitute a border or seam of the same colour, below the level of the outer surface, and exhibit no trace of any vascular rami- fication. This new-formed blood is analogous to that which is observed in the so-termed " fleshy warts " in cicatnces in process of formation. The puriform and sanious matter on the surface of the ulcex* contains no pus-corpuscles, but simply the disintegrated cancerous parenchyma. The areohe of the medullai'y cancer become enlarged by the partial fusion of the more delicate trabeaihe of the stroma, and aie thus ti'ansformed into cystic cavities, filled with a thick, milky fluid containing abundance of minutely divided, fat, granule-masses, and cells in a state of fatty degeneration. In this way is produced the form of cancer termed q/stocarcinoma. We have not hithei-to met with an instance, in which the inuer surface of these cysts was smooth and covered with an epif he- lium ; instead of which, it appears to be invested with a delicate villosity constituted of groups of cells. Occasionally, also, a delicate, dendritic, trabecular tissue, with cells adherent upon it, projects into the ca\ity. la fibrous caiiciT, only a trifling quantity of turbid juice can be expressed, the consistence is tolerably firm, and frequently, also, grey streaks may be observed, here and there assuming a greyish- yellow colour, and uniting, so as to form a network. In this way is produced the form termed " reticulai' cancer " by Joh. Miiller. The blood-vessels are scanty. Fibre-cells, as is well known, constitute the main element of the growth ; but groups of rounded cells ai'e also pi'cseuted, fui'nished with one or several, large, oval tiurlei containing 1 — 3 prominent nucleoli, and which may also be seen, collected into large masses by them- selves. The portions where this is the case, in fibrous cancer, are of less consistence, and approach more neai-ly to the cha- racter of the medullai'y form. In other portions of the same growth the nuclei are very often of fai' smaller dimensions, corresponding to other stages of development. The reticulum, as before stated, is constituted of strong fibrous bundles, infiltrated with fattv matter in a state of 88 594 NEW- FORMATION OF CANCER minute division ; but tracts may also be observfed which, when cut across, are seen, even by the naked eye, to enclose a canal, and which are, therefore, hollow. These may be either arterial vessels in a state of involution, or may represent the hollow trabecuhB of the cancerous stroma pointed out by Rokitansky. Fat-cells occur not unfrequently, imbedded in the morbid growth, either isolated or assembled into considerable groups. Elastic tissue exists in parts in very large quantity. The ■ subcutaneous vessels of the corresponding part of the skin are enlarged as the growth rises, present varicose dilata- tions, and, by degrees, the affected integument becomes involved in the cancerous infiltration. In parts, also, the skin may be observed, apparently infiltrated with pus, but it contains simply an innumerable multitude of granule-masses of the most various dimensions, with an abundance of isolated fat- globules. This is succeeded by the destruction of the skin involved in the morbid growth, and the formation of an ulcer, at whose base and borders the cancerous new-formation with a medullary character is developed, in some places, whilst in others the involution of the new-formation results in cicatri- form contractions. We have only once had an opportunity of examining the rarer form of gelatinous cancer. The tumour had been removed some years before from the breast of a woman, toge- ther with a portion of the superjacent skin, and the specimen had been preserved in alcohol. Its size might have equalled that of a large walnut, and it was circumscribed by a distinct envelope of connective tissue. Even with the naked eye, a delicate areolar texture might be distinguished on the surface of a section, the areolae in which, were filled with yellow, trans- parent, gelatinous masses, besides which white points and streaks were observable. In longer sections, which were readily made with the scalpel, a fi- brous tunic could be perceived at the borders of the growth (fig. 167, a), from which an areolated fibrous tissue penetrated through all parts of the pa- renchym i of the tumour. In the consti- tution of this framework the larger fibrous bundles (c c) gave off arching. IN THE UTERUS. 595 arborescent branches^ which united with others coming from diflFerent sides. In the interior of these areolte, brownish-yellow agglomerations were visible (i), whose form and connexions could not be accurately ascertained with a less magnifying power than one of 100 diameters. The outlines of these brownish-yellow corpuscles were characterized by their multifariousness ; they were round, indented in various ways, club-shaped, furnished with lateral, verrucose elevations, &c., and frequently presented well-defined vacuities. These bodies, moreover, could be traced to their point of origin, — viz., the fibrous stroma, upon which they were seated, sometimes as short and small, sometimes as elongated outgrowths. With higher magnifying powers, nuclear bodies might, in many places, be clearly distinguished in the brownish-yellow masses; no doubt, consequently, could be entertained as to their representing an agglomeration of cells. The fibrillation was usually of the straight, rigid kind (like that of mucin- filaments) ; wavy connective-tissue-bundles were rarer. The oblong corpuscles imbedded in the gelatinous substance, pro- longed on each side into a fine point, lying in parallel direc- tions, and at pretty uniform distances apart, should not, we think, be described as nuclei, regarding them rather as the rudiments of the coagulating mucin. They were also morpho- logically distinct from the nuclei of the fibre- cells, observable in many places. Rokitansky has described a precisely analogous case, and expresses the opinion that the rounded openings in the club- shaped excrescences, arise from absorption ; but the explanation would seem to be more obvious that these excrescences, by their extension, and their throwing out of lateral processes which again unite with the stem, embrace the pre-existing trabecules, and, consequently, that a hole must exist where the latter pass through. These various forms of cancer occur in combination, some portions of a tumour presenting a well-marked medullary character, others that of a fibrous cancer, whilst smaller por- tions, at the periphery, exhibit a gelatiniform condition. 596 NEW-FORMATION OF CANCER § 12. Uterus. Medullary cancer is frequently found in this situation, in the dead subject, in a state of sanious decomposition. The connective-tissue-fibres, which are more slowly disintegrated, constitute the main part of the fringe-like, dependent portions. In many places groups of nuclei may still be recognized in the organic detritus. The dirty, brownish-red colour of the putre- fied tissue is due to decomposed blood. The cells of every variety of form are not distinctly apparent, except in those parts of the new-formation which are more deeply seated, and by which the tissue of the vaginal portion of the organ is infil- trated. The consistence of the infiltrated tissue is greater in proportion to the paucity of these cells and the smallness of their size ; but when more numerous and individually larger, the corresponding part of the uterus enlarges, owing to the opening up, as it were, of the fibrous tissue of which it is constituted. The new-formed blood-vessels, in morbid growths of this kind, are not, unfrequently, of considerable volume, and, in consequence of the decomposition advancing from below upwards, give rise to hemorrhages. Occasionally the cancer grows on the lips of the uterus, and assumes more or less of a cauliflower appearance. This form, which has been described under various names, such as " cauli- flower excrescence" by Clarke, "cancroid" by Virchow, and by Rokitansky as " epidermic cancer," and as analogous to villous cancer, has been once submitted to our observation. The tumour was flattened, oval, about half an inch in diameter, and had a cauliflower aspect, exactly like the analogous condy- lomata. In the recent state it possessed a bluish-red colour, and was divided by deepish indentations into lobes, which were again subdivided by shallower grooves into lobules, from which club-shaped prominences arose. After the growth had lain for a short time in very dilute sulphuric acid (10 — 15 drops of acid to an ounce of water), the rusty-coloured ramifications, with their irregular offsets, could be recognized by the naked eye. Their colour was of course due to the action of the acid upon the hamatin. When more closely examined, the much convoluted course of the vessels, the coils formed by them and their volu- IN THE UTERUS. 597 minous terminal loops, could be readily traced. The transverse area of one of the vessels, constituting the loop at the apex of a papilla, amounted to four or five times that of the normal loops in the papillce of the lips of the uterus. Not unfrequently one branch of the loop was concealed by the other, so that the appearance was presented of a reddish-brown, sacciform protru- sion of the vessel. The dilute sulphuric acid, moreover, coloured the tissue, constituting the proper stroma, of a yellowish hue, whilst the epithelial layer remained white. Owing to this, the surface of a section exhibited, very beautifully, even to the naked eye, the appearance of branches springing from a base of connective tissue, and splitting into twigs which, towards the surface, were covered with a thick layer of epithelium. The connective-tissue-stroma was more or less lax in its texture, and the papillce had a clavate or hemispherical figure, according to the stage of their evolution. The epithelium consisted of large tesselated cells, which, towards the surface of the papillce, were replaced by cells of minute size and polygonal form (belonging to the mucous layer). A tumour, removed by Professor Chiari from the lips of the uterus, consisted of a few lobes, the largest of which was about the size of a hen's egg. It was of a light-grey colour with faint-red spots, of a lax consistence, and granular texture ; the surface exhibited slight elevations and depressions ; and, on section, the substance afforded, when squeezed, a milky juice, containing, as its principal morphological constituent, elemen- tary organs resembling epithelial cells. These were of tole- rably uniform size, and had an angular outline, one of the angles being occasionally protracted into a short process (fig. 168, a). The contents of these cells were fine-molecular; the nuleus oval, with a prominent nucleolus. The flattened, broad forms passed by degrees into the extended {b), the pro- cesses becoming elongated, and the middle portions or bodies of the cells slenderer, and in this way the cells approached more nearly to fibre-cells. The rounded cells (c) had a vesi- pular, clear nucleus without nucleolus ; it was excentric, and encompassed by a crescentic portion of cell-contents. Multi- nuclear cells were also met with [d), essentially different from other forms (e), manifestly arising from agglomerations of cells. The latter are to be regarded as sectional views of papillary 598 NEW-FORMATION OF CANCER growths filling the areoliE, formed by delicate fibrous bundles. In the transverse section of the smaller papilUe (at e), a mole- cular central mass may be seen, sm-rounded by concentric layers of flattened cells, whilst in the centre of the larger papilks a molecular substance, with imbedded oval nuclei, is apparent. At i, is given a longitudinal view of one of these papilla, in which the superficial, polygonal cells are brought into view after removal of the deeper layers. Fig. 168. The concentric colloid bodies {/) occurred but rarely, whilst granule-masses (one of the larger of which is represented at ff) occurred, in many places, in considerable quantity. In these agglomerations of fat-globules, hyaline spaces (h) were also occasionally visible, most probably corresponding with the remains of the hyaline nuclei of masses of cells in a state of fatty degeneration. In a similar growth from the os uteri, the medullary cha- racter was strongly expressed. The tolerably large cells were mostly of the elongated form, with comparatively large nuclei IN THE OVARY AND TESTIS. 599 and nucleoli. The fibrous bundles were often opened out in an infundibular manner, and in the areolee thus formed, the delicate cells, flattened by mutual pressure, were lodged, not unfrequently, in the manner of a tesselated epithelium. In the less-organized parts of the tumour, the development merely of gelatinous masses was reached, in which were imbedded, in a hyaline, structureless, only occasionally striated matrix, scattered, immature connective-tissue-elements. Gangrenous, brownish-black, highly fetid portions towards the base of the tumour, contained a dirty, brownish-yellow, molecular substance, with reddish-brown masses of decomposed blood. § 13. Ovary and Testis. In new-formations of connective tissue in the ovary, a great tendency is exhibited towards the formation of cysts, and the same is the case with cancerous growths in that situation. A tumour of this kind was, in one case, dilated into a sac as large as a child's head, containing blood and a gelatinous substance. The outer surface of its wall was smooth, the tissue towards the exterior firm and fibrous, and, towards the interior, of a looser texture. The united thickness of the two layers was from 2"2I — 2"65"' up to 0'57"; from the outer, firmer layer, fibrous bands, having a tendinous aspect, extended towards the cavity and formed wide, infundibuliform, firm dissepiments, which seemed to serve as points of attachment for the tissues contained in the areolee, and which gradually became more and more delicate and soft in their texture. Diflferent parts of the growth, again, exhibited the most various forms of development. One of the areolae, for instance, might be seen subdivided by lateral, fibrous bundles, enclosing infundibuliform spaces between them, into loculaments, which, gradually becoming smaller and smaller, at length constituted entire systems of a progressively finer and finer network. This network, again, was occupied, either with cysts, also diminishing successively in size, or cauliflower-like (papillary) vegetations projected into, and more or less filled, the areolae. These vegetations were manifestly seated in closely contiguous groups upon the fibrous mesh-work, and had a light-grey, speckled aspect, occasionally marked with bloody dots. They consisted 600 NEW-FORMATION OF CANCEB simply of agglomerations of cells, and it was of these groups, usually in a far advanced stage of degeneration, that were con- stituted the peripheral, papillary projections. The cells were of a subelliptical form, and the voluminous nucleus was often double. There was also a transparent sort of these papillary new-formations, surrounded by a kind of plicated membrane, enclosing contents as clear as water, and, consequently, repre- senting pedunculated cysts. On the inner wall of these trans- parent papillce, groups of cells and an areolar mesh-work might also occasionally be perceived. Denser masses lying towards the interior contained cysti- form cavities, some as large as a lentil, which were at once displayed when a section was made. Of considerable interest were the numerous, minute, perfectly isolated, bloody points, some of which were but just perceptible to the naked eye. These points consisted of larger or smaller groups of blood- corpuscles, closely surrounded by a perfectly closed envelope composed of several layers of concentric, not wavy fibres. Parallel with these fibres, might be noticed slender, oblong corpuscles, 0-00044"' broad, and 00035 — 0-0044"' long. There can, perhaps, be no doubt, that this fibrous tissue should not be referred to connective-tissue-fibres j in their straight course, and their not disappearing in acetic acid, the fibres most closely resembled mucin-filaments, and we also at present regard it as problematical whether the oblong corpuscles should be regarded as nuclei, or whether it be not far more probable that they represent coagulated mucin. In the walls of many of the cysts the blood-vessels were well developed, and after the action of acetic acid they were seen to be lined with a delicate, longitudinally striated membrane, which was succeeded by a layer of transverse and longitudinal nuclei, disposed at uniform distances apart. These nuclei were mostly 0-0053'" long, and 0-0008'" broad, and not unfrequently curved in an undulating manner. The following instance will serve as a further proof that blood is formed at isolated points in the parenchyma of cancer. A tumour about the size of a small fist, situated in the scrotum, and which was removed by Professor Dumreicher, when cut into, presented the following appearances. Light-coloured spots, of a yellowish tinge (fig. 169, a a), formed islands over IN THE OVARY AND TESTIS. 601 Fig. 169. the surface, often throwing out tongue-shaped prolongations, and occasionally projecting a little above the level of the inter- stitial, greyish-red substance (in- dicated in the figure by the dark shading) . In each of these light- coloured masses, there existed, in the first place, numerous fat-globules and granule-masses, contained in a close-meshed, fibrous tissue. Immediately around this tissue, whose light- yellow tint was due to the quantity of olein contained in it, bloody points and streaks were seen in abundance (c c) ; and in the latter, the commencement of a vascular ramification might occasionally be observed. From the greyish-red sub- stance a very milky juice could be expressed, whose predominant element consisted of rounded cells of small size, with compara- tively large nuclei. Multinuclear cells were frequent, as well as cells in such an advanced stage of fatty degeneration, that they were transformed into an aggregate of fat-globules with one or several light-coloured spots (corresponding to the nuclei.) The parts in a state of involution were also indicated by the cretification which had taken place in them. Thus, at b, a rounded, hardish nodule, of the size of a small lentil, was observed containing, besides organic remains, chiefly amorphous carbonate of lime, which, after the reaction of sulphuric acid, attended with effervescence, exhibited crystals of sulphate of lime. In other places, as, for instance, at d, an orange-coloured pigment was collected. This medullary form of cancer, which, as is well known, is that most frequently met with in the testis, is of interest as contrasted with the frequency of the cystic form in the ovary, as has been already noticed by Eokitansky. The strong areolar connective tissue which exists in the ovary as well as in the mammSry gland may constitute a morphological reason for the great tendency exhibited in those organs to the formation 602 NEW-FORMATION OF CANCER of cysts out of the numerous and large areol, c, and d) belong to the annular fibrous coat ; at {d) are seen layers of fat in a state of minute division, disposed concentrically around the vessel ; («) conneotive-tissue-sheath. X 300 diam. Eg. 26, p. 158. — Portion of a dried emphysematous lung viewed by reflected light. In it are seen csecal cavities of various size and form, corresponding to groups of atrophied air-cells. X 4 diam. Pig. 27, p. 162. — Small metamorphosed cells from a fatty liver, in chronic tuberculosis. Those in the uppermost row contain pigment, the others olein. X 300 diam. Pig. 28, p. 164. — Interlobular fatty liver (nutmeg liver), {a) Large quantity of free fat-globules between the lobules ; {b and c) parts in which the portal capillary system, filled with blood, is apparent. X 60 diam. Pig. 29, p. 165. — ^Pigmented nutmeg-liver. • (a) A lobule with the vena centralis {intralobularis) divided nearly in its longitudinal axis, at * ; the vein contains an amorphous pigment-substance; {h) lobule showing the central vein empty, and divided transversely ; (c) lobule with the central vein divided nearly transversely, and filled with pigment. A pigmentation resembling a capillary plexus is seen around the central portion of the lobules, caused by the collection of pigment-molecules towards one side of the hepatic-cells. X 90 diam. Pig. 30, p. 170. — Placental villi filled with a greyish-brown molecular sub- stance, taken from an aborted foetus, 18 inches long, (a) Villus with its clavate end entirely filled with a fine-granular opaque material ; (A) one only partially so filled at the summit. X 300 diam. Pig. 31, p. 172. — Chorion belonging to an ovum at the eighth or tenth week, in a state of serous and fatty degeneration, {a) A villus, much enlarged towards its clavate extremity, covered with large oval nuclei of the epithelium ; seated upon it are two other villi, one globular and the other of a retort shape ; {b and d) outlines of enlarged extremities of villi, with the punctated hyaline spaces, ccc and ee; {g) stem of a villus, with fibre-cells, in a state of fatty degeneration; (Ji) granule-masses, which in many places entirely cover the stem of the villus. X 300 diam. Pig. 32, p. 174. — Dropsical chorion, (a) Villus from an ovum at four weeks ; {b) young villus, from the same ; (c) immature connective-tissue-elements ; {d) villus from a mola h/datidosa. X 300 diam. Pig. 33, p. 175. — Dissolved embryo, at about the third month, (a) Outline of the chorion ; {b) collapsed amnion, the upper half of which has been removed ; (c) the umbilical vesicle on its outer surface ; the navel-string (e) projected into the cavity of the amnion, with a fimbriated body hanging from it. Nat. size. Pig. 34, p. 175. — Vesicular cedema of the umbiUoal cord of an embryo, about 0-785" long. Nat. size. Pig. 35, p. 182.— Cataractous lens of an old man, the cortical portion, clouded and of a grey colour. On the anterior surface are several radiating furrows ; the nuclear portion transparent. X 4 diam. 616 DESCRIPTION OF FIGURES. rig. 36, p. 183.— Lens with central opacity, from a Rabbit, (a) Posterior surface ; (b) lateral view. X 2 diam. Kg. 37, p. 191. — Wartlike navm maternus ; hypertrophied papillis. (a) Epidermis-cells, whose nuclei were completely concealed bv a blackish- brown pigment ; (b) epidermis-cells, with the nuclei only partially surrounded with pigment ; (c) cells without pigment ; (d) reddish-brown pigment in the substance of the papilla; (e) scattered nucleiform bodies ; (/) a wavy vascular loop. X 350 diam. Kg. 88, p. 195. — ^Elementary structures in a hypertrophied heart, (a) A subdividing fasciculus, with dirty-yellow pigment molecules in the sarcoUmma ; (b) a slender dichotomous fasciculus; (cj anastomosing muscular fibre; ((/) laminated, (e) smooth colloid corpuscles. X 350 diam. Eig. 39, p. 197. — Transverse section of the hypertrophied muscular coat of the stomach, boiled in acetic acid and dried, (a a) Organic muscular fibres, divided transversely; (bb) connective-tissue-bundles. X 350 diam. Eig. 40, p. 200. — Eibrinous stroma of an exudation in the pericardium. (The symptoms o( pericarditis had existed only a few days.) X 450 diam. Eig. 41, p. 201. — ^Vascular injection in the subserous tissue in peritonitis, (a) Congested vessels in the longitudinal layer of organic muscular fibres of the intestine ; in the upper part of (fi) are seen the vessels of the adipose layer, and in the lower, those of the submucous tissue. X 15 diam. Eig. 42, p. 203. — Laminated, soft pleuritic exudation, constituted of super- imposed plates, with numerous imbedded olein- (fat-) globules, cholcsterin- plates, and calcareous salts. X 350 diam. Eig. 43, p. 204. — Cretified pleuritic exudation, (a) Calcareous salts in the botryoidal form, placed in groups; (b) smaller forms of the same kind; {c c) long, opaque, occasionally bifurcating streaks (obliterated blood-channels ?), and between them dark fissure-like vacuities and spaces. X 350 diam. Eig. 44, p. 207. — Perpendicular section of the skin of the thigh in a case of variola, (a, b) Papillary stratum after removal of the epidermis ; the dark parts represent sanguineous spots ; (c) opaque epidermis ; {d) layer of hyaline exudation ; (e) exsanguineous corium, with its areolar fibrous tissue ; (_/) adipose tissue ; {g) hair-bulb surrounded with fat-cells. X 15 diam. Eig. 45, p. 209. — ^Membranaceous deposit obtained by the heating of the Aedx^yyAia. pemphigus, (a) The plicated membrane expanded ; (4) the same rolled up. X 800 diam. Eig. 46, p. 212. — Varicose cutaneous vessel of the antis. (a) Saccular dilatation, sometimes of a flask shape, sometimes with lateral bulgings, in the veins of the subcutaneous cellular tissue; (b) the papillary stratum removed horizontally, whose vessels are also in the dilated condition ; the light-coloured groups oi papilla exhibited in their interior, sinuated red spots — vascular loops, X 60 diam. ; (c) varicose vessels in the caput trigonum vesica, X 300 diam. (belonging to the mucous membrane). Eig. 47, p. 213. — Streaked, consistent exudation-layers in a case of hydro- cele, in parts where the skin of the scrotum was destroyed, (a) Horizontal dirty-yellow layers, with imbedded pigment-granules; (b) another place, in which brownish-yellow, pigmented, spherical or elongated bodies were apparent between the layers. X 300 diam. Eig. 48, p. 214. — Vascular congestion and sugillation of the mucous mem- brane of the small intestine (cholera), (a) Villus, with the hypersemiated capillary plexus, and the central recurrent vein ; (4) villus, with lateral recur- rent vessels, X 150 diam. ; (c) disposition of the recurrent veins in four villi. DESCRIPTION OF FIGURES, 617 X 25_diam..; (d) sanguineous suffusion of the mucous membrane of tlie small intestine ; the ught, oval spaces correspond to the Lieberkiihnian glands, X 50 diam. Pig. 49, p. 218. — Oval, delicate, granular bodies, without cell-membrane and nucleus, in an exudation on the intestinal mucous membrane ; {b) summit of a villus, with large, opaque pigment-granules ; at +, the recurrent vessel ; (c) the summit oi a. villus, filled with fine Drownish-yellow molecular substance ; (d) a similar part, with scattered granule-masses. X 300 diam. Kg. 50, p. 220. — Vascular injection around an enlarged solitary gland of the intestine, in typhus, (a) Closed, enlarged capsule, with the looped capillaries ; (b 6) groups of villi, with the recurrent, congested vessels ; (c c c) larger veins of the submucous tissue, into which the coronary venules of the gland (a) empty themselves. X 20 diam. Fig. 51, p. 227. — Aneurism of the aorta, (a) lamina taken from the inner layer of the vessel, resting upon the atheromatous deposits; grouped and solitai-y fat-globules are interspersed between the lamella; (jb) horizontal section of a cretified part, presenting irregular spaces, of various dimensions, filled with carbonate of lime. X 350 diam. Kg. 52, p. 239. — Hyperostosis of the occipital bone, in a case of syphilis. {A) Horizontal section ; {a a) dense, external table, the internal containing dilated cancelli filled with fat (viewed by refiected light), x 3 diam. ; (JE) in the middle is an elongated cancellus, nearly filled with fat, and divided transversely, surrounded with light-coloured bone-corpuscles, whilst those represented at C, from the outer table {a a), are filled witn calcareous salts, and opaque. B and C, X 350 diam. Eg. 63, p. 243 — Areola filled with colloid, from three lobules of the thyroid gland in an individual suffering under tuberculosis, x 15 diam. Fig. 54, p. 246. — Elements of the thymus-gland of a new-born child affected •m\h pemphigm, enclosed in layers of colloid, {a a) Corpuscles furnished with several, peripheral, concentric layers, and containing a central substance, either molecular or constituted of minute nuclei; (jb) one or several partially nucleated elements imbedded in the hyaline central substance ; (c) a group of brownish-yellow globules, closely surrounded by layers of colloid; {d, e, f) colloid masses, enclosing several elementary bodies of various forms and dis- position. X 350 diam. Eg. 55, p. 257. — Different corpuscles, in the urine of a woman suffering under eclampsia, (a) Cylindrical, exudation-co«^«fem (so-termed fibrinous cylinders?) ; at -I-, epithehum from the tubuli uriniferi; {b) flattened brownish- red epitheUal cells; (c and e) urate of ammonia; (