The number and value of the contributions to microscopic pathology in this volume of Reports of the Pathological Society are such as fully to justify a notice of it in our Journal. These contributions constitute, in fact, a main feature and no little part of the book, and add very materially to its interest and utility. Their number shows the extent to which microscopical investigations of the highest practical importance are carried by the rising generation of medical men; and the manner in which they have been carried out, as displayed in this volume, is a most satisfactory proof of the technical skill and care of the observers. It is clear that the gross and coarse pathology of former periods, as well as the kindred physiology and anatomy of the same times, is rapidly and effectually giving way to the more refined analysis for which the microscope, in its improved and still improving form, affords the means.
Amongst the more generally interesting and valuable of these contributions we have only space to refer, and that briefly, to a few.
From Dr. W. Jenner we have “An Account of Crimson or Hematoid Crystals,and Calcification of the MinuteArteries of the Cerebrum ” (p. 239); “A Description of a case of Cancer in the Posterior Mediastinum ” (p. 253); “ Of a very curious case of what is here termed Colloid Disease of the Abdominal Viscera ” (p. 323). Of the microscopical appearances in this case a very careful and detailed account is given. Among the interesting points, Dr. Jenner refers to the close resemblance of certain phosphate of lime granules to olein, and to the resemblance borne by the fat imbedded in the colloid matter to cells. He directs attention especially to the close resemblance—a resemblance so close that he could give no visible characters whereby the one may be distinguished from the other—between the phosphate of lime and fat. These globules, which, judging from the eye alone, experienced microscopists pronounced to be oil, were dissolved completely in hydrochloric acid. He conceives that the phosphate of lime was deposited chiefly in the interior and nuclei of the epithelial scales lining the inner surface of the cells or cysts in which the colloid matter was contained A very nearly similar report on the same case is given by Dr. R. Quain. From Dr. Jenner we have also a “Report on the Microscopic Appearances in a Morbid Growth from the Cranial Bones” (p. 416).
Several of Dr. R. Quain’s reports have reference to cases of fatty and fibrinous degeneration of the muscular tissue of the heart. With the former of these modes of atrophy Dr. R. Quain’s name will always be intimately connected; and we need not say that what be may state on the subject is always worthy of attention.
He also gives an account (p. 247) of a “Case of Malignant Tumour in the Brain,” with reference to which it is remarked that
“ the extremely close resemblance which this tumour bore in its general appearance to an old apoplectic effusion was a remarkable fact well worth attention, and the result showed how very valuable is the aid of the microscope in determining the nature of these and similar lesions.”
In a case (p. 254) in which the rare combination of encephaloid tumour (in the anterior mediastinum) and tubercle was met with, Dr. R. Quain gives the following Report on the Microscopic Characters of the diseased Tissues:—
“ Encepbaloid Mass.
“ 1. On section of a pearly-white colour; spotted freely with vascularity and with apparently effused blood.
“ 2. Of solid (elastic) consistence, hut friable, yielding, on gentle pressure, a quantity of viscous pearlycoloured fluid or juice.
“ 3. With the microscope found to consist of a great number of cells enclosed in large meshes, formed by the interlacement of bundles of a filamentous tissue, sui generis. The cells are rather larger than blood corpuscles, are of all shapes, but generally spherical, and contain from one to five nucleoli. These are rendered more distinct by acetic acid. Few cells contain distinct nuclei. There are also numerous compound granule or mulberry cells, and in many parts oily particles. Blood-vessels and blood-globules abound.
“ Tuberculous Deposit.
“1. Of a pale yellow or buff colour, not presenting any appearance of blood or blood-vessels.
“ 2. In some portions solid and tough, in others of a cheesy consistence, and in others of that of thick cream; the solid parts not affording fluid or juice on pressure.
“ 3. With the microscope found to consist of cells, granular particles, and fragments of broken-up fibres; also to contain some fine filaments, disposed without arrangement, and evidently derived from the lung texture. The cells, which are mostly spherical, are smaller than those from the encephaloid mass, and contain apparently more numerous and much smaller granules. These, as in the latter, are rendered more distinct by acetic acid. Oily particles are seen, more especially in the softened matter. Neither blood-globules nor vessels are seen.”
In a case of fatty degeneration of the heart (p. 263), and in which rupture of that organ took place, the affection appears to have been local or circumscribed, the muscular fibre in other parts of the heart being in a remarkably healthy condition. The local degeneration or atrophy was evidently connected with a diseased condition of a branch of the coronary artery distributed to this part of the heart. Dr. Baly reports another case of rupture of the heart consequent upon fatty degeneration, and in this case also, the alteration seemed to be more local than general; but the condition of the coronary arteries is not adverted to. Fatty degeneration was present in some of the cerebral vessels in the same case. In another case of ruptured heart, with local fatty degeneration, recorded by Dr. Quain, the anterior branch of the coronary artery, leading directly to the disease, was seen to be greatly ossified, and, about the middle of its course, completely obstructed.
Dr. Bence Jones reports a case in which Sardna ventriculi was found in the urine of a boy. In the present case it seems pretty clear that this was accidental, and that the Sardna really came from the stomach, but at the same time we would observe, that it does not appear to be possible to account for the presence of Sardna in the urine in all cases in the same way. In the cases recorded by Heller (Archiv. d. Chemie, u. Mikroskopie, Heft 4, 1847, and Heft 1, neue Folge, p. 30, 1852) there seems every reason for the belief that the Sardna was produced in the urine itself. In the latter of the cases described by Heller the Sardna occurred not merely mixed with other sediments, but in such quantity as to form a loose, white deposit an inch in height, composed wholly of the Sardna, or with a slight admixture of carbonate of lime. It is interesting that in all these cases of Sardna in the urine recorded by Dr. Heller there were symptoms indicative of cerebral or other nervous lesion. Dr. J. H. Bennett, in his Lectures on Clinical Medicine (p. 214, 1851), notices a case related by Dr. Mackay.
Microscopical observations on the so-termed serous cysts in the kidney are afforded by Drs. Brinton and Bristowe and by Dr. Bence Jones, who examined their contents chemically. These observations, however, leave the vexata questio of the genesis of the cysts very much as it was.
Dr. Bristowe assigns reasons (pp. 380-1) for the conclusion that they cannot be Malpighian bodies (“ at least, not healthy ones,” he oddly adds), which do not appear to us altogether so cogent as he would seem to think them; and that they are not dilated tubuli he thinks is sufficiently shown by the circumstance that he has never seen a cyst continuous with a tube—a condition, we should imagine, not likely to occur, seeing that the complete occlusion of the tube on each side is indispensable to the formation, of the shut cyst. He also dismisses the notion of their being “ fresh formations arising from cytoblasts” as untenable; and he is consequently obliged to confess that he is unprepared to say how these cysts arise.
In the next case (pp. 381-2), which is reported upon by Drs. Brinton and Bristowe, it would appear that the microscopic cysts differed in some respects from those in the former: they were much less uniform in size—sometimes solitary and sometimes clustered: they could be readily isolated and moved about the field of the microscope. They varied greatly in magnitude, the smallest being little larger than renal epithelial cells, the largest about the size of Malpighian bodies. The observations of Drs. Brinton and Bristowe would seem to have been limited in great measure, though not entirely, to the minute microscopic cysts. Dr. Bence Jones refers more particularly to the larger ones. In the contents of these he was unable to discover any of the elements of urine, nor could any epithelial lining be detected. It is left to be inferred from this, at least we presume so, that these large cysts could not be dilated tubuli. But again, this conclusion seems to have been drawn hastily. The strongest point in the argument is perhaps the absence of epithelium on the inner surface of the cyst. But the force of this circumstance, perhaps not in itself of such very great importance, is, at all events, much invalidated by the certain fact that these cysts do occasionally exhibit an epithelial lining. Perhaps they must be examined in a very fresh state to show it; but that such a lining does sometimes exist is within our own observation. The truth of the matter after all may be this: that the serous cysts are of different kinds; that some, as in Dr. Bristowe’s first case, are due to dilated Malpighian capsules; that others, as the smaller ones in the second case, originate in dilated epithelial cells; and lastly, that the larger ones are dilated tubuli, that is, in their advanced condition. They may have originally commenced in one of the second class. This opinion, which has long appeared to us likely to afford a more satisfactory explanation of these cysts than one more exclusive can do, we are glad to find coincides with that of Kölliker (Manual of Human Histology, pp. 477-8), who also fully confirms Dr. Johnson’s view by an observation of his own.
Our space will merely allow us to refer to Mr. Toynbee’s valuable contribution to the knowledge of Tubercle (p. 385); and to Dr. Bristowe’s account, of “ A Malignant Disease of a Cystic Ovary” (p. 404, with plate); as well as to Mr. Quekett’s “ Comparative view of the Condition of the various Muscles in three cases of Non-Congenital Club-foot”—all more or less instances of atrophy. With reference to the figures (pl. xii.) belonging to this paper, we should much like to have had Mr. Quekett’s explanation of the appearance presented by fig. 2. Were not such a thing almost impossible, one might deem that Dr. Barry’s contorted views on the structure of muscular fibre had found confirmation to some extent in the hands of the Professor of Histology of the Royal College of Surgeons.
