Page images
PDF
EPUB

discharge of their functions, resembling in many respects the diseased tubes seen in kidneys after scarlatina. Several of these tubes were seen to be invested with a basement membrane, in the interior of which there were dense masses of large coarse epithelial cells, which completely filled the cavity and obstructed the passage. The matrix was unaffected. No trace of fibrinous or other deposit could be found in the portions examined by Dr. Jones and Mr. Simon, though Dr. Bence Jones had found a considerable quantity of free oily matter in a specimen from the same kidney. It was a question of interest regarding these specimens

. noticed by Dr. Handfield Jones, as to the probability of such changes being due to a similar cause in both organs--namely, a very acute form of degeneration, rapid in process, and unaccompanied by any traces or signs of inflammation (i. 276).

A similar condition is thus described by Mr. Simon, who seems to take a different view of the origin of such deposits. The lesion is recognised in the dead body as an abrupt change of colour and consistence in circumscribed patches of the gland. The parts affected are quite bloodless, and vary in their shades of yellow, from the lightest tint to a deep orange colour. They are surrounded by a ring of bright vascularity, and in their general appearance resemble the so-called “fibrinous deposits ” of the spleen. Their increase of consistence is very remarkable; and the appearance is due to the extreme gorging of the tubules with materials of secretion—a state similar, he remarks, to what he describes as subacute inflammation of the kidney-only it is of much greater intensity, and confines itself to patches of the gland. In such parts the tubes are crammed with secreted material, and are so compact and turgid that the passage of blood between them (the tubes) is interrupted, and the affected portion of the kidney becomes anæmiated. Hence the zone of arterial congestion at the limit of the obstructed portion (i. 282).

In illustration of these cases of minute alteration or degeneration of tissue, whether in the substances composing joints, in the tissue of such solid organs as the heart, the liver, the kidney, and the spleen, and even in the interesting cases of degeneration of the mucous tubes and glandular part of the stomach, so well described by Dr. Handfield Jones, we think that some valuable information might be got by applying the same method of research to the morbid parts as was done by Dr. Sankey in regard to the brain-namely, to observe, not only the absolute weight, but also the specific weight (see on this subject vol. v. p. 31, of the * Transactions,' and the last number [2] of Dr. Lionel Beale's Archives of Medicine').

Of some Peculiar Forms of Malignant Disease. These were exhibited by Mr. Simon, and one is worthy of note as a case in which the secondary deposit presented all the general characters of tubercle in the liver: the original disease had been in the rectum. The secondary deposit in the liver seemed compressed and coherent, but not connected by fibre or blood-vessels. The tubercular character increased towards the centre of the mass, becoming merged at the circumference in the common features of cancer. It appeared that the malignant multiplication of germs in the liver must have been of immense rapidity, so that the first-formed elements had been thrust, by successive new formations, away from bloodvessels, into the centre of a mass nourished only at its circumference. Thus these central parts (all the elements of which were imperfect cells) had undergone atrophy and compression, “ existing in the state of an excretion, and exhibiting characters analogous to those of the shrivellod cells in the centre of a follicular tumour.”

This latter sentence has been dictated by the peculiar view entertained by Mr. Simon regarding the nature of cancer-namely, that a cancer is “substantially a new excretory organ;" that it is a growth which arises for the purpose of elimi. nating from the system an unhealthy matter which is generated within it. In the absence of any proof of this theory, we are much more inclined to adopt the view advocated by not a few, that in this case the cancer elements had become tuberculized; that the tuberculization was a local process by which the secondary cancer elements in the liver became metamorphosed into tubercle by endogenous development, atrophy, shrivelling, and desiccation of the textural elements composing the cancerous exudation (i. p. 127). The association or co-existence of tubercle with cancer is a very interesting topic of inquiry. It is further illustrated and discussed at some length in vols. iii. 254, iv. 35, 41, and in a note at page 102 of the same volume.

An interesting example of the probable propagation of cancer by continuity of surface is also furnished by Mr. Simon. In a case of renal cancer, the prostate gland had been the seat of encephaloid disease, and the question suggested itself, how far this superficial cancer of the prostate was not due to the descent of cancer germs from the kidney, and their development in the mucous membrane of the prostate. The probability of this is enhanced by the fact, that in another case straggling patches of fungous growth were traced down the ureters. These did not include the submucous tissue, but were mere efflorescences of cancer on the epithelial surface. In both cases the renal disease was common encephaloid cancer (i. 128).

Medullary sarcoma of the kidney in a child from the seventh till eighteen months old, when it died: all the functions and secretions being apparently undisturbed, the diagnosis remained obscure, and disease of the kidney was not suspected. The two kidneys weighed conjointly five pounds, and had lost all resemblance to renal tissue or form of kidney. Microscopically, the proper secreting tissue was present, but in a morbid state. Its cortical portion had undergone the most complete degeneration, and in the cases scarcely any of the uriniferous tubes had a natural appearance. Several were increased in size, and lined with numerous cells, in some degree retaining the normal arrangement. A still greater num. ber of the tubes were atrophied, and contained irregularly-formed cells and granules, and were surrounded by morbid structures, consisting of a fibrous struma, ill defined, with nucleated cells, two or three times the size of blood discs, oral, spindle-shaped, caudate and doubly caudate. The disease appeared to commence by the infiltration of morbid matter, external to the proper secreting apparatus (Mr. Obré detailed the case, Dr. Quain examined the kidneys 1st March, 1847).

On some Peculiar Forms of Disease. A peculiar form of Bright's disease, exhibited by Dr. C. J. B. Williams, and believed to be uncommon, in which the kidneys were large (eleven ounces each), cortical substance of a uniform pale buff colour, devoid of granular irregularities, and exhibiting under the microscope an accumulation of large granular cells with an unusual predominance of oil globules. The predominance of fatty matter was considered sufficient to account for the non-contraction of the organs. The case was one during life attended by a peculiar ochreous diarrhea, and where the urine became almost solid by heat. Dr. George Johnson examined the kidneys, and found that the opaque dark patches upon them consisted of convoluted urinary tubes, filled, distended, and in many places ruptured by an accumulation of globules in their interior. One hundred grains dried in a vapour, left a residue weighing 314 grains, which digested in ether, left on evaporation 376 grains of fatty matter. Some of the tubes appeared quite healthy, others were shrunken and atrophied (i. 96, 10th Nov., 1846).

A boy, nineteen years of age, apparently in good health, four or five days before death had symptoms of entire suppression of urine, hæmorrhages from the nose and bowels, and coma, but no dropsy. The kidneys weighed eight ounces, were of a claret hue, and largely granulated. The tubes presented detached epithelium, but no oily or albuminous matter (i. 97, Mr. Busk, 2nd Nov., 1846).

Another form of granular kidney is described, in which those organs were large and white, the capsule stripping off with undue ease, and leaving a smooth surface, in some parts stellated with closely-aggregated white spots. These spots consisted of interstitial deposits, composed of fat. There were other large contracted spots of a deep purple colour, so that the recent kidney appeared like a piece of variegated marble. The pelvis of the organ was dilated, and the mouth of the renal artery was patulous. The renal vein was filled with a fibrinous coagulum, extending to its ultimate ramifications; regarding this, we are told that "there was evidence of the inflammatory origin of this coagulum." The patient had been under the care of Dr. Addison, in Guy's Hospital, and had on admission swollen legs and abdomen, puffy face, and dropsical conjunctiva, accompanied with much bronchial obstruction; the heart was apparently healthy; the urine of specific gravity 1.012, densely coagulable, about two pints and a half being passed in the twenty-four hours. About a month after admission a severe attack of rigors came on, with much febrile excitement and great dyspnea. The amount of urine diminished to a pint in the twenty-four hours, was densely coagulable, and contained lithates in abundance. A second attack of rigors followed nine days afterwards, with aggravation of all the symptoms, and death followed by asphyxia. The lungs were emphysematous with pleuritic adhesions on both sides; the bronchia and their divisions were also dilated; slight atheromatous deposits were observed in the aorta, but in the venous system generally no disease was seen (Dr. Barlow, 5th April, 1847, i. 98.)

Urinary Deposits. A specimen of cystine exhibited by Dr. Garrod was passed by a policeman, aged thirty-three, with dyspepsia; tongue loaded with a white fur; thirst, lips dry and cracked, acid taste in the mouth, appetite good, except when nausea prevailed, which attended the passage of small calculi, which he passed from time to time; the bowels were regular. There was often a papular eruption about the face and neck; his perspiration was sometimes very sour; no disease in the heart, lungs, liver, or spleen. His father had occasionally passed red gravel.

Characters of the deposit.-Whitish appearance, refracting light; does not disappear by heat or acetic acid, but alkalies and the mineral acids both dissolve it. The crystals are in the form of six-sided laminæ, with a tendency to aggregate, not in the form of rosettes, but arranging themselves at right angles to each other.

The urine, apart from the deposit, has a pale yellow colour, an acid reaction, which soon disappears; the fluid becoming alkaline, with the formation of crystals of triple phosphate of ammonia and magnesia, which appear on the surface and edges of the fluid as a film ; specific gravity 1.014 at 60° F. The quantity passed in twenty-four hours was fifty-four fluid ounces, and the quantity of uric acid in the same time about nine grains. The calculi passed were of pure cystine crystallized on the surface like raw sugar.

1000 parts of the Urine gave an analysis :Water.

969.009 Solid matter

10.993 Urea

10.125 Uric acid

0:375 Extracted matters, ammoniacal salts, &c.

13.059 Fixed salts

7.432 Soluble in water

5.995 Insoluble in water

1.437

It contained at the same time much more unoxidized sulphur than ordinary urine, most probably in the form of dissolved cystine.

A rare Form of Uterine Disease, associated with Mollities Ossium. It occurred in a female who died from an acute attack of pneumonia, and from whose history, detailed by Dr. J. Hall Davis, no information is obtained as to the origin of the constitutional disease (mollities ossium).

The disease in the uterus consisted of ulceration of the whole or chief part of its lining membrane, under which the parietes of the organ became softened in structure, much as they do in pregnancy, and generally irregularly thinned in substance. The cavity was considerably dilated, and contained coagula, unhealthy fætid pus, and portions of shreddy fibrin adhering with greater or less tenacity to the internal surface. The os uteri remained pervious, or was plugged by rough mucus. Cases of this form of disease were rare, had been mistaken for pregnancy, and they all had a tendency to a fatal termination. In connexion with the mollities ossium, it was interesting to note that the patient had lost eleven inches in height in the twelve years preceding her death. She had been married sixteen years, at the age of twenty, and had three living children during the first four years and a half; she then had a dead child after a severe labour, and shortly before this pregnancy the commencement of the uterine disease is dated.

Specimens of the bones were examined by Dr. Sharpey, the late Mr. Dalrymple, and Mr. John Quekett, who all remarked that the Haversian canals and the bone cells were much larger than natural; that in parts near the edges of the bone forming the wall of the Haversian canals the canaliculi were but slightly visible, or had entirely disappeared; that the bone along these edges was extremely transparent; that numerous nucleated cells, blood discs, and fatty matter, occupied the cancellated structure and some of the Haversian canals.

Examined chemically by Dr. Garrod, 100 parts of the bone dried at 212° F., yielded : Phosphate of lime

16.40 Carbonate of lime, with phosphate of magnesia

4.88 Fatty matter

20:35 Gelatine, yielding matter

58:37 Healthy bone, according to Berzelius, yielding of

Earthy matters
Animal matters

66.70
33:30*

Many very interesting topics we can now merely name, regretting that time and space prevent us doing more:

The cases of myeloid tumours related in vol. viii., pp. 380, 346, 387 (Hutchinson, Bryant, and Cooper Forster), and the remarks on the nature of these tumours, vii. pp. 336 and 368, are well worthy of notice; also :-Dr. Wilks' cases of syphilitic (?) disease of the liver in the same volume, p. 240. Dr. Bristowe's cases of dysenteric ulceration in connexion with pneumonia, vol. viii., p. 66. In vol. vi., Dr. Peacock gives an excellent account of the cysticercus fasciolaris, as it exists in the mouse's liver, with drawings, p. 372; and in connexion with the subject of entozoa, there is an excellent account of the trichina spiralis, by Drs. Rainey and Bristowe, in the fourth volume of the Transactions. In the same volume, an interesting case of epithelial cancer of the calvarium is related by Dr. Habershon, and reported on by Dr. Bristowe and Mr. Simon.

Dr. Salter's account of lesions of the teeth, and Dr. Andrew Clark's illustration of tubercle and tuberculous sputa, are specially deserving of commendation.

We have sought in the preceding remarks to place before our readers a few of the many valuable facts which, but for the Pathological Society of London, might

• Vol. 1

P.

104 and 102

not have come to light at all, or might have remained semi-buried in the private notes of a practitioner or the case-books of a hospital. We think that the Society has conferred a great benefit upon medical science, and we trust that it will continue to flourish and to advance. We might have dwelt at length on many more points of interest, which the minute examination of the first ten annual reports has suggested, but we must draw to a close, and in doing so we would say one word to the Society. If it is as flourishing as it seems to be, we earnestly impress upon it, that for its own reputation, as well as for the sake of science, some little time, labour, and money ought to be expended in carefully examining its archives, with the view of collecting from the reports before us such facts, data, and interesting cases as will undoubtedly furnish valuable information regarding the statistics of disease. By such means ultimately a system of pathology would be reared which would be an honour to the Society and a boon to science.

REVIEW X.

1. Notes on the Surgery of the War in the Crimea ; with Remarks on the Treatment

of Gunshot Wounds. By George H. B. MACLEOD, M.D., F.R.C.S., formerly Surgeon to the Civil Hospital at Smyrna, and to the General Hospital in Camp before Sebastopol, Lecturer on Military Surgery in Anderson's University, Glasgow,

&c.London, 1858. pp. 439. 2. On Gunshot Wounds of the Thorax, and the Treatment pursued for them in the

Crimea contrasted with that which was followed in former Compaigns. By GEORGE Lawson, F.R.C.S., late Assistant-Surgeon to the Rifle Brigade, Surgeon to the Great Northern Hospital and Western General Dispensary.-London. pp. 20.

We propose to review the works before us solely as they bear upon

the
surgery

of the late war in the Crimea, and therefore omit alluding to some interesting remarks by Mr. Macleod upon the history, physical characters, climate and geology of that country, as well as upon military hygiene, nursing, and transport. We must state, however, in justice to the army surgeons, upon whom it was at one time attempted to cast much unfair obloquy, that, throughout, Mr. Macleod bears impartial testimony to their energy and devotion, as well as to the perverseness with which their efforts were so lamentably encountered by the executive authorities. Early in June, 1854, as gallant and splendid an army as England ever equipped landed at Varna. Its numbers, amounting at that time to 15,000 men, were soon augmented by the addition of upwards of 10,000. The country in which it lay was of most beautiful description to the eye, but of most dangerous character to the health. The long shallow lakes, the exuberant low-lying woods, thick tangled wild flowers and verdant grass, presented, to the eye of all but the initiated, one of the most charming stations for an inactive army. But every element of its sanitary character was bad. Large surfaces of shallow water, surrounded by level spongy lands, indented by little hollows, dried and cracked by the recession and evaporation of the winter floods, low brushwood rank in vegetation, bounding uplands; these, with a high temperature and a deficiency of potable water, supplied nearly all the possible combinations of physical destructiveness. In July cholera broke out, when a better field for its ravages could hardly be imagined.

"It is not, however," says Mr. Macleod, "for the purpose of repeating the tale of the heavy losses of our army in Bulgaria that I make these remarks. It is in order to indicate what a weakening and deleterious effect the residence in that country exerted on the survivors, and how much its effects must have told on the issue of disease and accident afterwards. There is no one fact which more completely illustrates this pernicious influence, than what all surgeons who served in Bulgaria will remember, that numbers of men, without being ab

« PreviousContinue »