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pbysical state of the chest indicated the presence of Now, it was not pneumonia only that the stethoscope broncho-pneumonia,-pneumonia situated probably at detected ; the other physical signs implied that the the root of the left lung, and an inflamed state of bronchial mucous membrane, especially in the smaller broncbial mucous membrane throughout its entire tubes, was in a state of inflammatory congestion. The extent, the intensity being greatest in the smaller post-mortem examination confirmed this, and exhibited tubes; and I formed this opinion upon the absence of to you morbid complications not unusual in the pneuany moist gurgling of large bubbles being heard in the monia of drunkards. The immediate cause of death regions where the presence of secretion in the larger in these cases is asphyxia, or death beginning at the tubes is most readily detected-namely, posteriorly lungs. The accumulated secretion of mucus in the between the scapula, and anteriorly in the mammary air-tubes as effectually obstructs the passage of oxygen region. The character of the sputa corroborated to a to the blood as any other asphyxiating agent; and when certain extent this diagnosis. They were copious and such conditions exist, coma usually for some hours much was of a pure white frothy aspect, without much precedes death. Venous blood continues to circulate tenacity; but a portion was also frotby and somewhat till the patient dies literally "poisoned by his own rust-coloured, and this portion was more tenacious blood." than the rest. Now, the pathological conditions on Many circumstances in this case co-operated to which these phenomena depend are these :-In that bring on the fatal issue. In the first place, the inportion of the lung in which pneumonia exists, a retarda- | ordinate use of intoxicating drinks at all times tends tion or stagnation of the blood in the arterial capilla- to the creation of an inflammatory diathesis. Again, ries first takes place; what is the primary cause of the the season of the year, and the particular condition of retardation or arrest to the even current of the the atmosphere--frosty, foggy, with a very elevated capillary circulation, is not known or even likely to be. barometer, most unquestionably predispose the lungs All that we can attain to is a knowledge of the con- to become the seat of inflammatory action. You ditions of any given phenomenon; the causes of those daily witness, among both out and in-patients, how the conditions are among the impenetrable mysteries of season of the year predisposes to pulmonary disorders. nature, and it is a useless expenditure of time specula- | Many circumstances co-operating, a series of morbid ting or guessing at it. All that we can state with effects followed, from which it was not reasonable to certainty, is, that the earliest change observed in the expect that the patient could survive. I have already capillary vessels of a part, the seat of inflammation, is a had occasion oftentimes to remark to you, that the stagnation of the blood-corpuscles; their onward progress co-existence of acute inflammatory action, with a is arrested, and as an effect of, or concomitant with, this general adynamic condition of the system at large, is diminished motion, is the escape of a fibrinous spon by no means rare. It is this antagonistic state of things taneously-coagulable fluid, which, filling the sur- that for the inost part renders inflammatory diseases rounding interstices of the tissue, consolidates the part, fatal; for if the powers of the system be sufficient to and gives firmness and solidity to what was previously perinit those remedies to operate, which only can elastic and extensible. In the pulinopary parenchyma arrest the progress of inflammatory action, all may do this exudation not only fills the bronchial intercellular well; but if the powers of life be low, these measures passages but the air-cells also. This accounts for the often add to the prostration, while they fail to check denseness and increased specific gravity of a portion of the advance of inflammation. Nevertheless, in such inflamed lung; and it also explains the presence of the cases they must not be neglected; and indeed it is dry crepitating sound on applying the ear to the region not unfrequently necessary to cup, blister, and give immediately over the seat of inflammation. This mercurials with one hand, while the system is sup. fibrinous exudation, the special product of capillary | ported by aminoniacal stimuli with the other. hyperæmia, contains dissolved in it much of the bæma- The treatinent of these cases requires great discrephein of the blood; its presence gives to the inflamed tion. To bleed from the arm is not advisable; rapid part the dark brown-red colour always observed in the subsidence of the vital powers often follows abstraction first stage of pneumonia. A portion of this colouring of blood from a vein. The most effectual and least matter, (hæmaphein,) dissolving and mixing with the hazardous inode of relief is by cupping between the bronchial mucus, tinges that Auid, a brown, red, or shoulders, or over the affected side. Blistering is also rust colour, and when expectorated presents us with desirable. Calomel, antimony, and opium, should be the sputa so familiar in this disease. This constitutes cautiously administered, and ammoniacal salines given the first stage of pneumonia. The next stage is the at intervals the moment the pulse, by its softness, softening or breaking down into a purulent degenera indicates their necessity. tion of this fibrinous deposit. In the case before us I wish to direct your atttention to the case which this condition had scarcely commenced, as the granular died in the same ward on the same day,-one also of state and colour of the part testified, for as softening pulmonary disease; but an emphysematous state of proceeds, all the hæmaphein of the blood is absorbed the lungs, with chronic bronchitis, were the characters out, and a grey cheesy mass is left. When examined determined by the stethoscope, and at our next under the microscope only a few corpuscles that lecture I wish to point out to you some of the chief developed nuclei by the action of acetic acid were distinguishing features of that case. observed, the mass being composed of granular exudation corpuscles.
THE LAW OF THE MORPHOLOGY OR META. | swell out to double their former size, and then burst
MORPHOSIS OF THE TEXTURES OF THE open, discharging their contents, which consist of a HUMAN BODY.
viscous Wass, mixed with molecules, and apparently
'identical in all its properties with natural or bealthy (Fourth Series of Experimental Researches.)
mucus. By WILLIAM Addison, M.D., F.R.S., Malvern.
All the mucous secretions and the saliva contain II. ANIMAL TEXTURES,
colourless cells, which cannot be distinguished by any It may with great certainty be affirmed, that the specific character from the colourless cells of the blood, blood contains the elements from which, in animal and there appears no reason to doubt that the viscous. structures, the solid textures and the secretions are matter of these secretions is an animal product elaboproduced. Blood consists of a limpid fluid, holding rated in the interior of cells identical with those which in suspension a multitude of cells of two kinds; the are seen floating or mingled with it. Moreover, both one red, the other white or colourless ; it may there mucus and saliva readily form fibrils or fibres when fore with propriety be termed a cellular or corpuscular acted on by appropriate agents. These and several Auid. On its first discharge from the living vessels, other well-known phenomena observable in the animal blood is thin--that is to say, it drops like water, but secretions may be treated of analogically, with a view it speedily becomes viscous or stringy, and then to ascertain the origin of the fibrillating elements of coagulates into a soft solid, which ultimately separates the plasipa, or lymph of blood, the element to which into two parts,-a red clot, and a yellow fluid serum. its coagulation into a coherent fibrous or fibro-corpusBut blood, before it coagulates, frequently separates cular texture is due. Milk, among others, is a cominto two fluid portions; the uppermost colourless, and plex animal secretion, elaborated in the interior of cells termed plasma, lymph, or liquor sanguinis, the or corpuscles, and set free by the thinning away, dislower red: both these portions coagulate, so that the solution, or rupture of the cell-wall. The yolk of an solid clot is in part colourless, and in part red. The egg is an analogous example, where the cells are large, colourless part of the clot, which is uppermost, and and their walls so very thin, that it is with the utmost formed by the coagulation of the plasma or lymph, difficulty they can be touched in the gentlest manner is a coherent and elastic fibro-cellular texture, ordinarily without rupture. To the unassisted eye, milk appears termed the buffy-coat ; it is usually depressed in the as a homogeneous, white, opaque, fluid ; through the centre, with thin fibrous edges, and there is frequently microscope its white appearance and opacity are found a viscous, colourless, gelatinous mucus in the cup- to be owing to myriads of minute molecules, -and it is like depression, that may be drawn out in strings like well known to contain an oily element or butter, a fibroordinary mucus.
albuminous element or curd, and a limpid fluid or The microscopic appearances in a film of blood not whey, and to the sum of each of these products erery disposed to exhibit a colourless layer of lymph or milk-cell contributes its quota. plasma, are very different from those of a film of The plasma, lymph, or colourless element, floating blood that is disposed to do so. In blood not disposed on the surface of newly-drawn blood, appears to the to exhibit a buffy-coat upon the clot, we see with the unassisted eye, when first seen, as a semi-transparent microscope numerous red corpuscles or cells, slightly colourless fluid, gradually becoming viscous, and then cohering in strings and rolls, and a few colourless ones fibrous and solid ; and it is well known to contain, oot floating in a clear limpid Auid. In blood that is dis only the solidifying fibrous, but a soluble albuminous posed to have a buffy-coat upon the clot, we see a and oily element. There are then the very same much larger proportion of colourless cells, and multi- reasons for concluding that the fibrinous and albumitudes of minute molecules floating with the red cells nous elements of the blood, plasma, lymph, or liquor in the clear and limpid Auid; the red cells adhere sanguinis, are derived from colourless cells similar more firmly to each other, and are congregated in to those found in it, as there are for concluding that larger and more irregular masses; and in the fluid, a the elements of milk, saliva, or any other complex network or tissue of interlaced filaments or fibrils is animal product, are derived from cells; and the plasma shortly observed to form. If a film of the colourless or lymph of blood, therefore, is as much entitled to the fluid, plasma, or lymph, be separately examined with term secretion,-to be considered as the products of cellthe microscope, we find it mixed with innumerable elaboration, as any of the other fluid or solid materials colourless cells and isolated molecules; within the of the structure. cells are a number of similar molecules, some of the An abundance of colourless cells, filled with a cells containing much larger ones than the others; viscous matter and molecules, are at all times disa and when the coagulation commences, it is by the charged or thrown off, mixed with a viscid mucus, formation of fibres in the fluid. When water or a from the mucous membranes, and their numbers are weak solution of potass is added to colourless blood- increased upon the slightest irritation or inflammation. cells, they immediately begin to enlarge, gradually similar cells are at all times discharged or thrown off
MORPHOLOGY OF THE TEXTURES.
from all wounded and healing textures, where the pro-actually expended in the fertilization of the embryo, cess of reparation is going on—where new and con- compared with the myriads which seem to be wasted. formable elements of growth are appearing, and in animals the analogous fact, too, may be produced in where, therefore, the process of nutrition is normal. illustration. Again, in the repair of a fractured bone, Similar cells are also discharged or thrown off from what an apparent excess of nutritive material or callus diseased textures, ulcers, and abscesses, from scrofu- ) is collected for the cure, which is subsequently removed loas joints, and from the cavities of the lung in when the fractured extremities have been united. consumption; in these latter instances more especi- Moreover, there are other facts in surgery pointing to ally the cells have received the distinctive appellation the same conclusion; for healthy granulations, copi. of PUS.
ously discharging what is called healthy pus, heal Pus varies in consistency: it may be nearly solid, or rapidly by moderate and regulated pressure, which by quite fluid, -that is to say it may be solid enough not to diminishing the amount of blood flowing through the drop like water, and in this state it is a corpuscular innumerable vessels of the young texture, dininishes terlure, analogous to the incoherent corpuscular tex. also the amount of colourless cells, whereupon the tures of the lower forms of vegetation, and the green quantity of pus diminishes, and the granulations then parenchyma of a leaf. Recently excreted pus displays becoming covered with a coherent, fibrous, nonse. under the microscope an abundance of colourless cells, creting, instead of an incoherent, corpuscular, secreting the interior contents of which, in various states of texture, are said to cicatrize or heal. Colourless cells, elaboration, present various appearances. Old pus has therefore, in all cases of nutrition, appear as the pria different microscopical aspect, which it is well should mary and active agents, the results depending upon be remembered in considering the origin of tubercles, their metamorphosis. consisting chiefly of minute molecules and granular From these facts and observations, and from others matter, resulting from the breaking down of the cell- fully detailed in former researches, I draw these walls. The cells or corpuscles of healthy or recently important conclusions :excreted pus vary in magnitude and appearance ; actire First, that in all living structures, in all plants, molecules are frequently visible in their interior, and and in all animals, the elements of growth and when water, or a weak solution of potass is added to secretion,-that is to say, the peculiar and characthem, they swell, burst, and discharge their contents, / teristic solid and fluid matters of the structure, are consisting of a viscous matter mixed with molecules. I prepared or elaborated in the interior of minute
No wounded, irritated, or abraded texture, heals or vesicular bodies, variously termed corpuscles or cells, ulcerates without the presence af a greater or less which may either be coherent, forming a strong or solid abundance of incoherent colourless cells ; and there are texture, or incoherent, forming a soft or brittle, and no certain, specific, distinguishing marks between the more or less a Auid one; and that the elaborated colourless cells of blood, lymph and pus. When, there. | material, when set free by the opening or rupture of fore, a healing wound discharges pus, it can be regarded the cell-wall, undergoes ulterior changes, or metamorin no other light than as indicating a superabundance phoses, and either constitutes a part of the solid strucof nutritive cells, which from an actual excess in nun- ture, or remaining fluid forms a secretion. ber, or some other cause, do not meet with the condi- Secondly, that the incoherent cells of the parenchyma tions required to make them deliver up their contents, of the leaf are the primary elaborating cells of vegetaand take part in the metamorphoses required for the bles, and the incoherent cells of blood, the primary reparation of the texture ; but when an ulcerating elaborating cells of animal structures. By the metawound (where there is no reparative process at all,) morphosis of the former, all the subsequent textnres and discharges pus, it would appear in that case, that all vegetable colours and secretions are produced ; and by the cells from some inherent defect have lost the the metamorphosis of the latter, all the animal textures power of a conformable metamorphosis.
and secretions. The incoherent parenchymatous cells This explanation of the appearance of colourless of the leaf are in all their stages stationary; and the cells, both in healing and ulcerating textures, implies in air necessary to their respiratory functions passes to the former case a great excess of agents in the performand fro around them by the motive power of heat. ance of a specific office or function-viz., the healing The incoherent protoplasma cells of blood flow in of the wound, and this so far from being, as might streams throughout the body, traversing in their course lastily be imagined, contrary to, is in fact quite in the walls of the coherent cellular and aeriferous texture accordance with, the usual plan of nature as observed in of the lung, into and out of which the air passes by other things, and in analagous instances. The pollen- the motive power of muscles. cells of vegetables, for example, have an important and Thirdly, that the relations subsisting between animal specific function, and in what apparently excessive textures or secretions, and the blood, are analogous to abundance are they produced. Of the myriads of those subsisting between vegetable textures or secrepolleo-cells discharged from the anther, how few are tions, and the leafy parenchyma; and therefore that the law of the morphology of animal, must be analogous to texture, which, were it still within the vital influence of that of vegetable, structure. In the latter instance, the the whole structure, would, according to its analogies, doctrines based upon the law do not profess to give any become a secreting texture; and, moreover, the mucous reason wby the parenchyma of one leaf differs from or jelly-like matter often found in the depressed centre that of another, -why oil of peppermint is formed or of the buffy coat is, in reality, the last change or secresecreted in one set of green cells, and prussic acid, tion of this altering cell-texture. “The glairy fluid opium, or bergamotte, in another; nor does it enter termed mucus, being nothing more than an altered upon the question of the differences prevailing among state of the fibrillating liquor sanguinis, the change the green granular cells of different parts of the same from the one to the other being coeval with the plants : on the contrary, the doctrines trace the form changes within the cells. Hence, if we take the red and mechanical properties, rather than the physiological portion of the buffed clot, and the red cells to represent function of the textures; so that the main features of blood, then the colourless layer of liquor-sanguinis morphology are only secondarily affected by differences (the protoplasma,) will represent the first remove from and variations in secreted products. So likewise it blood, and mucus or pus will be next; and it would appears to be in animal textures, that the morphology, appear, generally, that the nearer the cell is to, or the in respect of form, is a branch of physiology sufi- fewer the stages of its removal (by morphological ciently distinct from the morphology of secretion; changes,) from, the circulating current, the more nearly and to admit, as is the case in plants, of a separate it resembles the colourless blood-corpuscle, and the consideration.
more decidedly and visibly its fluid contents, when they "If we consider,” says Mohl—and he is speaking escape, fibrillate ; whereas, the further the cell is, or the of the cells of plants—"the place at which, in the greater the number of stages of its removal (by morinterior of a cell, new cells are on the point of being phological changes,) from the circulating cells, the formed, and at which the nuclei have already made larger it is, and the less perfectly do its Auid contents their appearnace, we find that the future mother-cell fibrillate." + contains a viscous colourless mass, mixed with minute “The blood can hardly be said to be organized, yet granules; and since this viscous mass everywhere from the physical characters of coagulated fibrin, it is
evident that while circulating in the body it holds a considered justifiable, if I propose to designate it by peculiarly endowed animal principle, (fibrin,) requiring the word protoplasma, a term which recalls to mind I only a moments rest to constitute solid
only a moments rest to constitute solid, organized (I its pbysiological function.*
do not say vascular,) tissue. The texture, formation, Now it is evident, in the universally-existing process cohesion, toughness, and elasticity, are all proofs of its of cell elaboration, and whether the result be new cells, organized nature, and it at once, without further aid or or permanent, cellular, or fibrous structure, or fluid assistance, assumes all these properties, even after its secretion, that two distinct stages are recognised. In removal from the body in venesection, or after death in the first, the elaborating matter,--the protoplasma or its own vessels. There seems then, to be but one step primary element, (adopting the term proposed by between the microscopic capillaries and the fibrin of Moal,) is in progress of preparation within the cell, the blood ; the former are minute fibrinous chapshut out from all extraneous or exterior agents, except nels, the latter may (not inappropriately,) be termed those specially admitted through the cell-wall to assist organized tissue, circulating with the blood.” (Medical in the elaboration. In the second, the elaborated Gazette, March 26th, 1841.) These are sentiments matter having been set free by the opening or rupture expressed upwards of five years ago, and subsequent of the cell-wall, undergoes its ulterior metamorphosis, researches have confirmed the idea I then entertained. subject to the action of new agents, which may in The term 'fluid texture,'may be objected to, nor can I fuence conformably or unconformably, the completion contend for the congruity; but this does not alter the of its permanent phase.
fact that the blood is a cellular fluid, and a clot of The liquor sanguinis or lymph which rises to the blood a fibro-cellular texture. The incoherency or surface of newly-drawn blood is, if we adopt Mohl's brittleness of the lower portion of the clot is owing to term, the protoplasma of animal structures, and the the predominence of cells; the coherency and toughness buffy coat, is a protuphasma, a fibro-corpuscular of the upper part to the predominence of fibres.
rst solid fo
• See Moul's paper “On the Circulation of the Sap in Prot-aphorismus-the mucus having the same relation Plants," in the “ Annals and Magazine of Natural History," to the solid fibro-cellular texture that the protoplasma bas July, 1846. (Translated from the Botanische Zeitung for to the incoherent cells of blood. Jan, and Feb., 1846.) This author objects to the term +"Second Series of Experimental Researches," p. 16, mucilage, employed , by Schleiden to designate this sub. &c.-Churchill: London, stance, as the term “vegetable mucilage," in the sense in wbich it is ordinarily used in chemical works, conveys |
(To be continued.) a totally different meaning. The protoplasma of Moul is termed" plastic element”in my " Researches,"&c.
A CASE OF FATAL PHLEBITIS OF THE IN. thirst, little urine, the bowels were nearly regular ;
| her tongue clean, but dryish, and her pulse small, FERIOR VENA CAVA, WITH REMARKS.
frequent, and irregular; she, however, had no cough By J. BLACK, M.D.,
nor dyspnea, nor could any bruit be heard in the Senior Physician to the Manchester Union Hospital. | region of the heart. I may also mention, that though (Read at the Manchester Medical Society, Jan 6, 1846.) | her lower limbs were disposed to ædema since she
came into the hospital, yet, at this period, the 17th, Martha Wright, aged 26, unmarried, a domestic
they had become much infiltrated up to the hips, servant, but wbo, from the history of her habits, had
| though they retained their natural warmth. Conled somewhat of a wandering and irregular life, was
sidering the general debility of her system, it was not admitted on the 14th of August, 1846, into the Union
thought expedient to apply even leeches, but her Hospital, labouring under sub-acute rheumatism of the
saline diuretics were increased, along with half-ounce fibrous character, attended with simple derangement of
doses of the bitartrate of potass every second mornthe stomach and bowels. She was forthwith confined
ing, and the constant application of emollient catato bed, put upon low diet, and the Vinum Colchici, with Nitre in Julep of Acetate of Ammonia was pre
plasms and oily liniments. scribed for ber.
By these means, the indications that were in view, of On the 17th, she had, in addition to the above,
promoting a safe hydrocatharsis, and an increased flow which was then given in intermittent doses only, a pill
of urine, were fulfilled, but there was no amelioration to every night, of calomel and antimonial powder, two
the increasing tumefaction and tension of the abdomen, grains of each, along with half a grain of opium.
and to the swelling of the thighs and legs. In addition On the 20th following, from her complaining of a
to the enlargement, which was early evidently owing to paid in the right hypochondrium, she had a blister
a fluid, from the very characteristic fluctuation elicited, applied, and her pill was given in the morning as well
there was by the 24th, observed all over the anterior as at night.
aspect of the thorax and abdomen, well-marked en. Under this treatment she was entirely relieved from
largements of the epigastric and external mammary her rheumatism ; and on the 24th, the colchicum mix
veins, both of which sets of vessels were perceived ture was omitted, as well as her pill in the morning.
to inosculate freely and directly with each other. She was then considered so far convalescent as to be This appearance in a few days became still more permitted to leave her bed during the day. On the evident and interesting; the main branches became 27th, her pill at night was also omitted, from her larger than swan-quills; and in passing the finger gums becoming a little tainted by the mercury, and across the tract of many of them, a perceptible deshe bad simply at bed-time, a small dose of Dover's pression was felt, equal to the depth of half the powder, along with generous diet daily.
cylinder of the respective veins, while they became On the 4th of September, she was seized with the full and distended below, and relaxed above the point diarrhea that, more or less, prevailed at that season of pressure. Some internal obstruction to the return as an epidemic, for which she took the cretaceous mix of the venous blood to the heart from the lower parts ture, and trom the complaint being rather persistent, of the body was now evident, but on what it depended she was again confined to bed, and on the 10th she was a problem not easy to resolve. No tumour bad had a pill every six hours, composed of the diacetate been detected nor even suspected in the abdomen of lead and opium, which soon relieved the urgency during her period of diarrhea, and nothing could be of her symptoms.
elicited from the chest or heart that could account for Within the subsequent four days, her diarrlica had this sudden enlarged and vicarious venous circulation. entirely ceased, but along with its cessation, her The only conclusion that was come to at the time was, abdomen began to be very tense and painful, and that the rapid effusion into the abdomen, along with scarcely allowed the least pressure of the hand. In the tensive resistance of the parietes, had acted as a
f large emollient poultices, and cooling saline counter pressure on the abdominal cava, and so medicin nes to act upon the kidneys, the swelling and impeded its transmission of the blood from the inferior tension continued to increase, with much restlessness parts of the body. With this view our medicines and pain.
were continued, along with the Linimentum HydrarThe case having by the 17th put on a very important gyri et Linimentum Camphoræ, and caloınel with a and serious character, it was more strictly investigated, little opium was readministered on the 27th. and the conclusion then arrived at was, that it was The disease, however, suffered no remission; for one of rapid and diffuse peritonitis, of an adynamic though the bowels acted freely when required, and nature, with effusion into the carity of the abdomen. the urine was kept to a normal amount of excreThis result was supposed to be occasioned by the tion, with a diminution of the tension and pain in the quick stoppage of the diarrhea, and the repellent abdomen, yet the amount of effusion seemed to increase effect of cold, while attempting to go about at the with more encroachment on the capacity of the thorax; time she was constitutionally influenced by mercury; the anastomosing veins continued enlarging, and the she was besides of a delicate frame of body, and I had vital forces of the body and powers of the mind some reasons to think that she had been previously evidently began to give way under the incumbent intemperate. Her skin was at this stage warm through- affliction. out; ber abdomen rather hot to the hand; there was On the 8th of October,regular medicines were omitted,