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Sº ºne
protºnings AND TRANSACTIONS
PATHOLOGICAL SOCIETY
TORONTO
SESSION - 1889-90.
VOLUME I.
TORONTO :
Published For THE PATHological Society of Toroxto by THE J. E. BRYANT Co. (LTD.),
58 BAY STREET.
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W.
Q.
OFFICERS AND COUNCIL
OF THE
PATHOLOGICAL SOCIETY OF TORONTO
FOR THE !
SESSION 1889-90.
g
Mºresident : - Vice-President:
R. A. Reev E, M. D. J. E. GRAHAM, M.D.
Treasurer and Secretary:
J. M. MACCALLUM, M.D.
Council :
J. E. GRAHAM, M.D. J. M. MACCALLUM, M.D.
R. A. REEve, M.I). J. CAven, M.D.
A. PRIMROSF., M.B.
I./S 7" OAP MEMBERS OF 7"HE SOCIE TV.
Ordinary Members :
AcHESON (GEORGE), M.A., M.B.
AIKINs (H. WILBERFoRCE), M.D.
AIKINs (W. H. B.), M.B.
CAMERON (I. H.), M.B.
CAven (John), B.A., M.D.
CAVEN (W. P.), M.B.
FERGUson (John), B.A., M.D.
FOSTER (C. M.), M.D.
GRAHAM (J. E.), M.D.
McPHEDRAN (A.), M. D.
MACALLUM (A. B.), B.A., M.B., PH.D.
MACCALLUM (J. M.), B.A., M.I).
Nevitt (R. B.), M.D.
OLDwright (WM.), M.A., M.D,
PETERs (G. A.), M.B.
PRIMROSE (A.), M.B., C. M.
REEve (R.A.), B.A., M.D.
SCADDING (H. C.), M.D.
THISTLE (W. B.), M.D.
Wilson (R. J.), M.D.
WISHArt (D. J. G.), B.A., M.D.
WRIGHT (A. H.), B.A., M.B.
WRIGHT (PROF. R. RAMSAY), M.A., B.Sc.
i
THE PATHOLOGICAL SOCIETY OF TORON TO,
ſ OCTOBER 26, 1889. .*
e '--------
-------3º-
SARCOM A OF THE BRAIN.
Dr. H. W. Aikins presented a specimen of
sarcoma of the brain.
J. L., a healthy boy of 9, on August 13th,
1888, struck his head on a toboggan slide. He
was unconscious for a moment, then dizzy. He
was seen two weeks after the accident, and had
during that time been suffering with headache
and left internal strabismus.
Ophthalmoscopic examination by Dr. Reeve
showed double optic neuritis. During the next
two months incoordination of muscles came on
and increased so that when brought to my office
he kept falling all over the sidewalk.
On 29th of December he was unable to walk
the full length of the room, falling to one or
other side, more usually backwards. No pyrexia.
Patellar reflex exaggerated
Early in January, 1889, incontinence of urine
came on, although the sphincter ani remained
intact. Fixed mydriasis on both sides. Spas-
modic hyper-extension of extensor muscles from
the hip down. Fearful screeching during sleep,
but no pain complained of when he was wak-
ened. He had now become quite helpless.
In February he had become apathetic, wan-
dering, sleeping or dozing. Pupils wildly dilated,
no reaction to light. Morning vomiting.
The head now began to increase in size.
Slight protusion of the left eyeball, with some
swelling of left upper eyelid. Early morning
muscular spasms, in which limbs are flexed,
followed by wild screaming. Incessant rolling
of the head from side to side while dozing.
Tâche cérèbrale well marked.
Later on both eyeballs protru, led somewhat,
and there was a generally diffused swelling of
the forehead and eyelids There was a slightly
developed Cheyne-Stokes respiration. His
power to memorise was now completely gone.
In his wanderings he used expressions which
he had not employed for over 4 years. As he
dozed there would appear here and there small
irregular patches of skin, now hyperaemic, now
anaemic.
Hearing is apparently unaffected, but he
speaks in a whisper.
During the night and early morning there
were strong tonic spasms. In these spasms
while the left side of the face was dry and very
pale, the right side was almost crimson and
transpiring very freely. There was little change
d in the symptoms for the last few months of his
life, save that the spasms were followed by
vomiting. He died on May 7th.
Post mortem examination showed the usual
evidences of hydrocephalus. In the front part
of the anterior portion of the left cerebellar
hemisphere and partially imbedded in and con-
nected with it was a soft, somewhat greyish,
semi-diffluent tumor, rather larger than a man's
thumb. Microscopic examination showed this
to be a round cell sarcoma.
Discussion.—Dr. J. E. Graham said that the
presence of a tumor was shown by the falling
backwards, the staggering gait, and the vertigo.
These generally indicate a lesion in the centre
of the cerebellum. Although the turnOr WaS
not in that position it may have pressed upon
the centre. The strabismus was important,
because there is said to be a connection, as yet
unexplained, between the visual centres and the
cerebellar. There is said to be a similar rela-
tion between the auditory centres and the cere-
bellum, but in this case no auditory symptons
were noticed. The strabismus also shows that
there must be some connection between co-
ordination of the ocular muscles and the cere-
bellum.
Dr. Reeve had suspected a coarse lesion at
the base of the brain, because of the develop-
ment so soon after the trauma, of the evident
paresis of the muscles, and the double optic
22
THE PATHOLOGICAL SOCI ICTY OF
TO RONTO.
neuritis. In this, as in many other cases, in
spite of the double optic neuritis the vision was
normal. Might not the sarcoma have been
forming prior to the trauma P. We know that
we have cases of cerebral abscess in which the
abscess was present before the trauma.
Dr. Peters asked why so small a tumor, situ-
ated on the outside of the brain, exerting but
little pressure on the cerebellum had produced
such marked symptoms. The pressure must
have been both slight, gradual, and exerted on
the whole brain.
Dr. W. P. Caven thought that the vomiting,
nausea, optic neuritis and other symptoms were
due not to the pressure of the tumor, but to its
location.
Dr. Graham believed that the tumor pro-
duced such marked symptoms because it was
outside the brain substance.
TYPHOID ULCERS.
Dr. McPhedran showed a specimen of typhoid
ulceration, in which in the large intestine the
solitary follicles were ulcerated from the caecum
down to the rectum. The ulcers were elevated
and hard, admitting the tip of the little finger
into the hole scooped out by loss of substance.
In the caecum and small intestine were elevated
Peyer's patches and solitary follicles. In none
had the gland substance been completely des-
troyed, but portions were gone here and there
giving to its surface an irregular worm-eaten
appearance.
The vermiform appendix, of a whitish mottled
color, was coiled up like a snail. These coils
were held together by lymph, evidently old.
The appendix was very much thickened, being
fully the size of one's little finger. The mucous
membrane of the appendix was ulcerated and
of a worm-eaten appearance. One of the
mesentric glands was caseating. In the right
lung were two small pea-sized calcareous masses.
The girl, aged 18, had been sick for a week
before coming to the Hospital. The tempera-
ture chart resembles that of tuberculosis in the
great morning falls.
Dr. Osler, of Baltimore, who had seen the
specimen, considered it to be typhoid, but in
an earlier stage than is usáally seen in the dead
house. . *
He was in doubt whether the case was one of
typhoid alone, of tuberculosis, or of typhoid
with an acute tuberculosis just being super-
added. The condition of the mucous mem-
brane of the appendix and the caseating mesen-
tric gland tend to the view of a tubercular
element being present.
EPITHELIOMATOl JS STRUCTURES.
A. B. Macallum, M. I.). : The epitheliomatous
structures referred to were observed four years
ago in all the epitheliomatous growths studied.
They may be arranged in three classes: (a)
small leucocyte-like bodies, which lie either .
within or between the epithelial cells of the new
growth ; (b) cellular elements of the same size
as, or slightly larger than, the epithelial cells
themselves and possessing special reactions to
dyes; (c) round or oval bodies usually several
times larger than the epithelial cells, possessing
a refracting membrane or capsule and contain-
ing a large number of spore-like elements
slightly smaller than the cells of class a.
These spore-like bodies have apparently a
nucleus, a certain amount of cell plasma, but
no cell membrane. They have been seen
in certain cases leaving the capsules by
diapedesis, and at points in a section one
can determine the presence of a number of
similar elements differing in varying degrees
from the elements in the capsule. It has been
found that there are forms intermediate between
the cells of the class (a) and those of the class
(b), and that there are forms apparently in var-
ious stages of transition between (?) and (c).
In other words all the structures are merely dif-
ferent stages in the development of the spore-
like body found in the capsule. The organism
may be probably one of the genus coccidium
belonging to those parasitic protozoa, Sporozoa.
From studies of the origin of the “cell nests,”
it would seem that the latter are produced or
caused by the organisms in question, the spore-
like bodies penetrating a group of neighbouring
cells, setting up gradual decay and Cormifica-
cation in these. A cell nest ultimately becomes
filled with the leucocyte-like structures which
apparently eat up the comified epithelial cells.
These peculiar structures have been noticed
by two other observers quite recently in cancer
of the stomach, intestine, and of the breast.
Whether they are the irritating elements in
epitheliomata cannot as yet be determined.
The fact that coccidia cause carcinomatous
a y
THE PATHOLOGICAL
SOCIETY Ol' TORONTO.
ck
growths in parrots and in the oesophagus of
sheep points definitely to an affirmative answer
in this matter. Paget's disease has been deter-
mined by some to be due to coccidia.
ABSCESS OF BRAIN.
Dr. McPhedran : The patient had been
struck on the head with an axe. The wound
was dressed by a druggist as a mere skin wound.
On the sixth day after the injury he was
seen by Dr. McPhedran. The wound was
Stinking. The skull was trephined twice, re-
moving bone and giving exit to pus. The
patient died on the 13th day after the injury,
the only noteworthy symptom being free
haemoptysis which occurred twice.
Post mortem examination showed nothing in
the arachnoid space. Diffuse suppurative in-
flammation of the pia mater. A large abscess
in the right anterior lobe of cerebrum opening
into the lateral ventricle. . .
Dr. John Caven said that the haemoptysis
was not due to pyaemia nor to disease of the
lung. In a series of cases of diseases of the
brain we often find pulmonary hacmorrhage,
usually in the form of apoplexy, not of haemop-
tysis. As yet no explanation had been given.
MULTIPLE ABSCESS OF BRAIN.
Dr. H. W. Aikins: The notes of this case have
been supplied by Dr. Stark, at whose request I
made a post mortem examination.
T. B., aet. 38.
First seen by Dr. Stark on 17th of August
last, had been attended by another medical
man, and was supposed to be recovering from a
somewhat serious attack of bowel colic. His
temperature at that time was I oo, his pulse 95.
He was comparatively comfortable, and was
then anticipating an early recovery. -
Next seen on Sept. 3rd ; was found in pretty
much same condition, though considerably
reduced in strength. His skin was hot and dry,
although he transpired freely at night time
Tongue slightly coated, and bowels somewhat
constipated. Was very nervous and excitable,
very restless at night, and what sleep he
procured was almost altogether in the day.
Appetite poor. Pain in epigastrium. Pupils
about normal, no vomiting, no cerebral symptom.
He remained in this condition until about a
couple of weeks before he died, sometimes |
feeling much better, and again worse, but well
enough to be able to go out for a drive once or
twice.
On Sept. 20th he became somewhat more
nervous and excitable, and very much depressed.
On the 25th was still very nervous, excitable,
and sleepless, and toward evening, while reclin-
ing on a lounge, called to his wife to say that a
very strange feeling had passed over him ; this
lasted only a moment, however. On the next
day, the 26th, he was exceedingly drowsy, but
could be roused from his lethargy to answer
questions with a “yes” or “no.” Incontinence
of urine. On the 27th, his pupils became
slightly dilated, and he was very much more
drowsy, semi-comatose. On the 28th, he was
seen by Dr. H. H. Wright in consultation ; he
was completely comatose, pupils widely dilated,
left arm paralysed, but irritation of the sole of
his left foot was followed by drawing up of the
member. On the 29th, there was complete left
hemiplegia, with continued incontinence of
urine, though the faeces were retained. There
was full paralysis on both sides on the 3oth, and
he died during the course of the day.
Throughout his illness his pulse ranged from
90 to Io9, and his temperature varied from 98%
to Ioo, his bowels were slightly constipated, he
did not vomit, and throughout his whole illness
he did not complain of headache.
The abdominal and cranial cavities alone were
opened at the post mortem examination.
All the organs examined in the abdomen,
with the single exception of the liver, were found
in an apparently healthy condition.
The liver was riddled with very recently
formed abscesses.
During the removal of the brain, quite a
quantity of pus was found welling up in the
front part of the longitudinal fissure. It was
also found freely distributed over the pia mates
at the base of the brain Also a small super-
ficial abscess in the right cerebellum on its
under surface.
Upon section, a number of abscesses (I.2 or
13) were found in different parts of the cere-
brum, for the most part small, and containing
the usual greenish-coloured pus. The walls of
the right ventricle were soft, with pus in the
cavity itself. The cerebral substance otherwise
firm and healthy.
\
4

-4 o) –
e &–sº _0
Reprinted from The Canadian Practitioner, Dec. 16, 1889.

->
5
THE PATHOLOGICAL SOCIETY OF TORONTO
- NOVEMBER 30, 1889.
——-3º-
Dr. Reeve, President, in the chair.
Adjourned discussion on case of Multiple
Cerebral Abscesses.
Dr. J. E. Graham asked if any cause was
known for the pyaemia; the post-mortem report
and the history did not show any.
Dr. W. P. Caven thought the fact that the
abscesses were multiple pointed strongly to their
being of pyaemic origin.
Dr. Graham asked if multiple abscesses occur
oftener in the brain from idiopathic than from
traumatic pyaemia. Multiple abscesses do occur
in the brain when there is but one depot of pus
elsewhere.
Dr. R. A. Reeve wanted to know how the
pus had been transmitted in this case. Had it
been by the lymphatics or by the blood
vessels? In cases of purulent otitis we find
abscesses surrounded by healthy brain tissue
and no traceable connection between the dis-
eased bone and the abscess.
Dr. Graham suggested that the green color of
the pus was due to some peculiar micrococcus.
In the absence of Dr. J. Caven, Dr. James
MacCallum presented the following specimens:
Enlarged Prostate, Hypertrophied Bladder
Obstructive Nephritis, Phleboliths in Prostatic
Veins. The specimens were obtained from a
man of about sixty years of age, who died in the
Toronto jail. The bladder was markedly hy-
pertrophied; there was a very great enlarge-
ment of the middle lobe of the prostate, fibro-
myomatous in character. The lobe had dimin-
ished considerably in size while in spirit, but
was still the size of a walnut. Both ureters
were dilated, and the usual condition of the
kidneys as a consequence of obstruction was
well marked. The heart was enlarged, a uni-
versal hypertrophy, not merely a hypertrophy of
the left side as is usually found in disease of the
kidney. The lungs were pale and emphysema-
tous ; the lower lobes, Oedematous, and pre-
senting an approach to hypostatic pneumonia.
The radial arteries were atheromatous. This
case is interesting not only on account of the
great enlargement of the middle lobe of the
prostate and the size and number of the phle-
boliths, but because of the relation of all the
morbid conditions, which seem directly traceable
to the original bladder condition ; although it
it is quite possible that there may have been
another causative element, as shown in , the
atheromatous radials. When first removed
from the body the enlarged lobe of the pros-
tate seemed almost large enough, in a contracted
state of the bladder, to block up the orifices of
the ureters. - -
Dr. Primrose thought that the urine could
pass up through the mouth of the ureters. He
had seen a dilated and very tortuous ureter fully
three-quarters of an inch in diameter, and he
thought that urine could pass up such an one.
He considered that the sequence of events in
this case probably was: -
I. Obstruction at the bladder orifice of the
urethra, due to enlarged prostate.
2. Distension of bladder and consequent
closure of ureters. •
3. Distention of ureters throughout their
entire course, including enlargement of orifices
into the bladder: subsequently regurgitation
could occur.
Dr. Cameron agreed with Dr. Primrose that if
there was dilatation of the ureter there might be
regurgitation, especially when, as in this case,
there was an enlarged prostate preventing the
urine from passing into the urethra.
Drs. McPhedran and Peters considered that
6
THE PATHological society of toRoNTo.
regurgitation from the bladder into the ureter
was impossible, Dr. Peters advancing as an
argument against such a possibility, the obliquity
of the ureter in its course through the wall of
the bladder; it being about three-quarters of an
inch in length from its entrance at the serous
coat to its orifice in the mucous. When the
bladder was dilated by the urine retained on
account of the enlarged prostate, the pressure
of the retained urine would mechanically tend
to press together the walls of the ureters as they
ran obliquely through the bladder wall, and
thus occluding them, prevent regurgitation.
The same condition was seen in the closing of
the orifice of the common bile duct by dilata-
tion of the duodenum. Experimentally it had
been proven impossible for water to regurgitate
from the bladder. He thought that the dilatation
of the kidney had occurred owing to the kidney
continuing to secrete against the pressure due
to occlusion of the ureteral orifices.
Dr. Cameron said that Dr. Peters’ arguments
were quite true, provided the bladder walls have
not been changed and become thinned, for in
hypertrophy with dilatation the obliquity of the
ureter in its course through the bladder wall is
lost -
SYPHILITIC ARTERITIS.
Dr. J. E. Graham: The patient, a woman
about 35 years of age, was sent from the Tor-
onto Jail to the Toronto General Hospital. She
was then in a semi-comatose condition ; there
was no paralysis of the limbs. At first there
was doubt as to whether the condition was one
of typhoid fever or disease of the brain. There
was dilatation of the right pupil, ptosis of the
right eyelid, congestion of the right conjunctiva.
Syphilitic cicatrices were found on the body.
Post-mortem examination showed endarteritis
of the basilar and also of the middle cerebral
arteries, as well as in the smaller subdivisions of
these vessels. The vessels could easily be seen
to be thickened, beaded in some localities, and
in places even completely occluded. The
meninges of the brain were thickened; two
minute haemorrhages were found, one into the
pons, and the other into the medulla. No
thrombus found. Ventricles dilated.
Dr. Oldright had seen her at the jail, and
thought her to be suffering from syphilitic dis-
ease of the brain. She had had some diarrhoea,
but that was traceable to Epsom salts. Tem-
perature Io.2.2. 'She did not look like a typhoid
patient. She was said to have had a good deal
of headache. Dr. Richardson had seen her at
the jail off and on for years, and knew that she
had syphilis.
Dr. Cameron asked if alcoholism as well as
syphilis might not have caused this arteritis P
Dr. Primrose said that before calling the
arteritis syphilitic, the syphilitic history must be
well established. In syphilis the thickening
occurs first in the coats of the arteries without
there being any thrombus. He referred to a
case under his care in the Temperance Hospital,
London ; this case is now narrated in Erichsen's
Surgery, Vol. II . I 15, 8th ed.
Dr. McPhedran asked whether the other and
larger arteries showed atheroma. The beading
of the arteries he thought almost characteristic.
Are these beadings gummatous in nature?
Dr. Cameron asked why one-sided beading
was present in syphilis rather than in atheroma?
The beadings are not gummatous, because they
do not break down, but are organized.
Dr. A. B. MacCallum thought on closer ex-
amination that the artery seen under the micro-
scope to contain an organized thrombus, was
really occluded by thickening of the walls of
the artery.
Dr. Primrose said that he had thought that
syphilitic arteritis was confined to the small
vessels. In it there were no calcareous plates,
and the arteries became occluded by hyper-
trophy of the intima. Atheroma, on the other
hand, attacks the large vessels, and in it calcare-
ous plates occur.
Dr. Graham, while confessing that the case
was incomplete, still held that there was suffi-
cient evidence of syphilis, in the cicatrices and
the one-sided beading of the arteries. Syphilis
might, he thought, attack the larger vessels,
carotid, vertebral, even the aorta. Syphilitic
arteritis would not be symmetrical.
The discussion on syphilitic arteritis was
adjourned until next meeting.
Dr. Wm. Oldright presented a specimen of
aneurism-involving the transverse and descend-
ing parts of the arch of the aorta. The aneur-
ism posteriorly had eroded the fourth and fifth
dorsal vertabrae, destroying their bodies, and
anteriorly had reduced the second and third ribs
THE PATHOLOGICAL SOCIETY OF TORONTO.
7.
to mere shells. The aneurism had opened into
the left lung, burrowing out a large cavity. This
cavity apparently had existed for some length of
time. The immediate cause of death was rup-
ture of the wall of this cavity in the lung, and
haemorrhage into the pleural cavity.
The patient from whom this specimen was
obtained was a merchant, age 50. He con-
sulted Dr. Oldright for indigestion. Six months
later he came complaining that the pain had
returned, and was higher up, and that he was
slightly swollen. Examination disclosed a well-
developed aneurism pulsating at the second rib
on the left side. No bruit, nor palpitation, or
discomfort. A month later there was no bruit,
but the pain in upper part of right chest was
intense. No change in symptoms for remaining
three months of patient's life. Five days before
death there was haemoptysis,
CHYLOUS PLEURISY.
Dr. Cameron :
Mrs. A. B., aet 22. About five months pre-
vious to pregnancy had severe pain in left
inguinal region, with considerable circumscribed
swelling, which gradually passed away with a
discharge from the vagina. This discharge
continued during gestation, ceasing about two
months after confinement. About seventh
month of gestation she began to suffer from
pains in the left side, and dypsnoea. Physical
examination showed this to be due to fluid in
the pleural cavity. By aspiration fluid was
removed similar in character to the specimen
shown. During the past nine months, at inter-
vals of from one to six weeks, the fluid has been
removed, the quantity ranging from one and a
half to six pints (wine measure). The fluid has
at times coagulated in about three minutes after
removal; at other times it has remained fluid at
the end of two or three weeks.
Condition of patient when seen by Dr.
Cameron: She was pale and anaemic, yet fairly
well, in spite of having passed through a severe
labor. She complained of epigastric pain and
pulsation. Examination showed this to be due
to the aorta. There was a hard, irregular, and ill-
defined mass in front of the aorta, either the
retro-peritoneal glands or the head of the pan-
creas. This mass was said to have been there
from the first. Uterus was anteflexed ; ovaries
slightly enlarged. No signs of an old pelvic
abscess. Heart displaced to the right, and
pleura full of fluid ; nothing found at the root
of the lung.
Dr. Miller, of Cornell University, has twice
analyzed the fluid. The first sample he reported
to be milk; the second was not milk.
Dr. Clark, of Thorold, thought this case
resembled one reported by the younger Flint, of
obstruction of the thoracic duct by the pressure
of the pregnant uterus.
* Dr. Cameron thought that the presence of
the chyle within the pleural cavity was due to
disease of the root of the lung (enlarged bron-
chial glands), causing obstruction of the lymph
channels, consequent dilatation, stasis, and
rupture of the lymph vessels. The physical
signs did not bear this out; still, the general
appearance of the woman, who is of the dark,
coarse, strumous type, permits one to believe
this the case. In the last number of the Ameri-
can Journal of the Medical Sciences, Busey has
collated 64 cases of chylous effusion, Io of
which are of chylo-thorax. Of these the effu-
sion came directly from the duct in five ; three
were due to violence. Dr. Cameron then
exhibited two small samples of the fluid ; they
were both of a thick, white, milky appearance.
One had coãgulated, the other had not.
Dr. McPhedran asked what caused the va-
ginal discharge. Was it also chyle, and due
to the pressure of the uterus P
Dr. Graham had seen the case presented by
Dr. Whitla, at the Belfast meeting of the British
Medical Association. The fluid was the same
in appearance as this. ©
Drs. A. B. MacCallum and Acheson, who
had examined the fluid microscopically, agreed
that it contained fat globules and bacteria, but
no pus corpuscles.
Dr. Cameron thought that the vaginal dis-
charge was probably chylous, due to a chylous
ascites making its way into the retro-peritoneal
tissue.
Discussion adjourned until next meeting.
A special meeting of the Society was held on
the evening of Friday, December 20th. There
were present as the guests of the Society, Pro-
fessors Welch and Osler, of Johns Hopkins
University, Minot, of Harvard University, and ,
Vaughan, of the University of Michigan.
8. ū the pathological society of Toronto.
Diseases of coronARY ARTERIES AND ALTERA- With disease of the coronary arteries the
\
TIONS, IN THE MUSCULAR WALLS OF THE
HEART.
Professor Welch said that since the discovery
of Auscultation by Laennec, our knowledge of
valvular diseaseofthe heart had greatly increased.
Little attention, however, had been paid to the
diseases of the coronary arteries and of the
muscular walls of the heart, because as the
symptoms were not characteristic, there could be
but little precision in diagnosis. Nevertheless
these diseases are of great importance to the
physician as they are very common causes of
sudden death. The cases of sudden death
which we so often see described in the public |
newspapers in which death is said to have
occurred “in a moment,” and to have been due
to apoplexy, or to heart disease, are very often
really due to disease of the coronary arteries.
The general practitioner should have a special
interest in these diseases, for death occurs from
them more often in the middle aged or elderly
and well-to-do than in the poor.
The coronary, like other arteries, may be
affected by arteritisobliterans, arteritis deformans,
thrombi, or emboli. Very commonly a thrombus |
was found just where the anterior coronary artery
gives off its main branch. &
. The question arises, why is death so sudden?
Clinically there are two classes of cases; those
in which there may have been attacks of angina
pectoris, or the signs of cardiac insufficiency,
without any valvular lesion, hypertrophy or
dilatation ; and those in which there had never
been any complaint, people apparently in good
health; in both classeshoweverdeath was sudden.
Post mortem examination shows that the lesion
in the artery is a permanent one, yet the symp-
toms are sudden and paroxysmal in their onset.
We cannot explain why this is. It may possibly be
that the heart does not suffer until certain areas
lose their nutrition. Experiment has shown that
in the dog's heart there is a spot which, if punc-
tured, causes immediate cessation of the heart's
action. It may be that in the heart of man
there are such spots from which nutrition being
shut off, death immediately ensues. Experiment
has also shown that if a limited portion of the
coronary supply is cut off, the heart still goes on,
but if more and more is cut off, the heart
stops. -
muscle walls, the pericardium, endocardium
and valves may be found intact, but in most
cases there are associated muscular lesions,
namely, fibrous myocarditis, fatty degeneration,
white infarction. - -
In fibrous myocarditis, which is also known
as cirrhosis of the heart, and as chronic intersti- f
tial myocarditis, there are found in the muscular
wallsgrey translucentor white patches of irregular
shape and size, in which the muscle has been
replaced by connective tissue. These patches
situate in any part of the wall may be compli-
cated with pericarditis or with endocarditis.
These patches were commonly thought to be
like fibroid patches in other parts of the body,
the resultsof interstitial inflammation. As Hilton
Fagge has pointed out, this cannot be, for we do
not find in them any sign of inflammation, any
granulation tissue, any small cell formation.
These patches are nearly always associated with
disease of the coronary arteries, so that they
may be considered the result, not of genuine
inflammation, but of the death of localized
patches.
Thickening of the walls of the coronary artery
causes the nutrition of the muscle to be cut off,
and degeneration occurs, the muscle fibre drops
out and is replaced by connective tissue. The
fibrous tissue is of slow growth and never pre-
ceded by true granulation tissue. We see the
same process in the liver and the kidney, where,
as a result of malnutrition, the most highly
differentiated parts of the organ degenerate.
These so-called fibroid patches are probably due
to coagulatiºn necrosis of the muscle fibre, as in
fibroids of the uterus. e
An interesting point is the enormous increase
in size, three or four fold, of the nuclei of the
adjacent and normal muscle cells Whilst we
affirm that these patches are not the result of
pre-existing inflammation, we do not deny that
there may be patches of that origin. For you
may see in this specimen of the heart of a
hog, which died of hog cholera, genuine fibroid
patches, along the edges of which genuine
granulation tissue is found, and in which there is
no disease of the coronary arteries. We cannot,
therefore, entirely discard the old view.
Disease of the coronary arteries may produce
genuine white infarctions in the heart walls,
THE PATHOLOGICAL SOCIETY OF TORONTO: - - 9.
resembling those found in the kidney and the
spleen. . * - - . . . .
[A specimen was exhibited in which a throm-
bus had formed in the apex of the left ventricle,
a portion breaking off obstructed the anterior
coronary artery completely, thus causing anaemia
of the wall, coagulation, necrosis, and a white
infarction.] •
A young man of thirty-five, suffering from
transverse myelitis, with paraplegia, paralysis of
the bladder and rectum, bedsores developed
just before death, fever, irregular pulse, dyspnoea,
etc. Post mortem examination showed the
muscle walls to be unusually flabby and yellow.
The microscope shows the entire heart wall to
be diffusely infiltrated with white blood corpus-
cles. This is a pathological curiosity, a genuine
diffuse interstitial myocarditis. Micrococci were
found in the sections, but there were no foci of
pus in the walls, so that it was not a regular
septic suppurative inflammation.
Circumscribed myocarditis is not so rare. In
various acute infectious diseases, diphtheria,
pneumonia, typhoid, and typhus, there are found
in the heart small areas of small celled infiltration.
In many of these cases the muscle fibres do not
show any degeneration, but often careful search
discovers small areas. This circumscribed
myocarditis may be the real cause of the heart
failure in these diseases.
Fatty degeneration of the heart muscle often
occurs in connection with disease of the coron-
ary arteries.
acute infectious diseases, due to high temperature
or other causes. If an animal be put into a box
which is well ventilated, and the air of which is
kept at a high temperature, fatty degeneration
does not occur, but if the box be ill ventilated,
the degeneration is almost constant. Fatty
degeneration alone is of but little importance,
but if associated with disease of the coronary
arteries, the case is altered. Rabbits' hearts had
been made fatty by artificial means, but no
alteration in function could be made out. It
may be, however, that the heart gives way all at
Gnce. . . . .
* The fat is chiefly deposited at the point of
junction of the vertical lines with the anisotropic
lines. . . ſ \ .
The best results were to be had by making
frozen sections of the fresh heart wall, treating
This condition is also found in the
acidulated glycerine.
Ah
4.
them with osmic acid and mounting them in
* Professor Osler related the history of a case
of obliterating arteritis of the anterior coronary
artery. The patient, a physician, was under his
observation for six weeks. He was a large, well-
built man, with no history of syphilis. One day
when getting into his carriage he was suddenly
attacked with slight cardiac distress, but was able
to do his work. From that time there was
cardiac uneasiness, which in three weeks had
increased so as to force him to take to his bed,
with extreme dyspnoea, small, weak, irregular
and rapid pulse, and slight cyanosis of the finger
tips. Death occurred two weeks later.
- The autopsy showed complete obliteration of
the anterior coronary artery. Fibroid degenera-
tion of the apex of the left ventricle, slight
dilatation at that point. *
A similar case was that of an idiot aged thirty-
six, a powerfully built man, docile and quiet,
who, although he had never displayed any heart
or lung symptoms, suddenly dropped dead
Autopsy showed complete obliteration of the
posterior coronary. Only oue branch of the
anterior artery, that passing down the interven-
tricular groove, was pervious.
The classical description given in the text
books of fatty degeneration of the heart was
really that of myocarditis.
SYPHILITIC ARTERITIS.
Dr. Graham briefly narrated the history of
the case, and the histological appearances of the
specimen presented at the November meeting :
of the Society. The point reserved for discus-
sion was whether it was possible to distinguish
histologically the syphilitic from ; the other
varieties of arteritis. • . . .
Prof. Osler said that even Heubner himself
had receded from the view that syphilitic arteritis
had distinctive histological appearances. One
cannot with the microscope distinguish syphilitic
arteritis from the obliterating arteritis in old
people, or that found, within the cavities of
phthisis. He had never seen obliterating arteri-
tis of the cerebral vessels, with beading, that
was not syphilitic. He then exhibited a
specimen of genuine syphilitic arteritis asso-
ciated with a large gummatous growth in the
| cord. -
1 {}
THE PATHOLOGICAL SOCIETY OF TORONTO.
PAT HOGENIC GERMS IN DRINKING WATER.
Prof. Vaughan said that as the State Univer-
sity of Michigan was required to examine all
samples of suspected food and drink sent by the
local health officers, he had from time to time
to analyze many samples of drinking water. At
first he had been in the habit of reporting, say,
that the water was bad chemically, but that it
did not contain any pathogenic germs. The
effect was bad, for the people continued to use
the water, arguing that if there were no patho-
genic germs in it the water was fit to use. Of
late he had adopted the plan of reporting that
the water was chemically bad, and that an injec-
tion of so many drops of a culture of the germs
contained in the water killed arabbit. The effect
was much more satisfactory.
Usually both a chemical and a bacteriological
examination was made of the sample of water.
Plate cultures were made, and a report sent of
the number of bacteria in a given quantity and
of the varieties.
The procedure adopted was to take a cubic
centimetre of sterilized beef tea, add to it one
drop of the water. Place it in an incubator,
where it was kept for 24 hours at the temperature
of the body. The whole was then injected into
the peritoneal cavity of a rabbit, or if a rat 1o to
20 drops were used. In most cases the animals
die within 24 hours. A rat will bear 25 drops
of a sterilized solution, while Io drops of a non- |
sterilized will kill them. Autopsies are made
upon all animals thus killed, and cultures are
made from the spleen, liver, and kidneys.
The germs vary in the rapidity with which they
kill; one kills in 24 hours, another not for twenty
days, producing emaciation, fever, paralysis and
death. This latter germ seems after a while to
die, for cultures made from liver, kidney, and
other organs, remains sterile.
Some of these germs, though killing rabbits,
do not affect man. There is a qualitative as
well as a quantitative element in the action of
these germs. For instance he had received two
samples of water from Grand Rapids, labelled
No. 1 and No. 2. No. 1 contained 30, ooo
germs in a drop ; No. 2 contained 12o. No.
2 killed rabbits; No. 1 did not. No. 1 was
better chemically than No. 2.
The pathological changes produced vary.
The germs which killed the rabbits in 20 days
produced ulceration of the ascending colon,
and of the lower part of the small intestine.
Lower 2 or 3 inches of lower part of small
intestine were denuded of epithelium.
A case of continued fever was cited in which
one after another of the family were taken down
until at last five were ill. The only cause which
could be found was the use of cistern water for
washing the face and teeth, one of the family had
used this same water in a nasal douche. The
whole family used the city water for drinking
purposes. No one was sick in the surrounding
families. The cistern water was vile chemically,
and contained a great number of germs, and
invariably killed the animals. He was not sure
that the fever was typhoid ; all the cases ran 42
days. Temperature ran high at first, some
delirium ; no abdominal eruption.
In another instance seven people in neighbor.
ing families had continued fever from using the
water of a well common to all. The water was
very bad chemically. The test for phenol was
given by it, showing that it had been contamina-
ted by facal matter.
Cultures of the various germs spoken of were
exhibited.
PSEUDO-PATHOLOGICAL CHANGES IN THE
PREGNANT UTERUS.
Prof. Minot described the peculiar large tri-
angular cells which have by some been described
as characteristic of moles, but which are a
normal appearance in the walls of the uterus.
As pregnancy begins the uterine glands are
elongated and widened ; their lining epithelium
is thickened and enlarged. Fissures appear,
separating the cells. The cells continue to
enlarge, separate from each other and from the
uterine wall, and thus are produced the large
triangular cells seen in moles. The history of
these cells has not been elucidated. They dis-
appear after the 5th or 6th month of preg-
nancy. .
Other changes in the uterine wall and in the
foetal portion of the placenta were described,
changes which were normal, but which many
observers have described as pathological. A
knowledge of embryology must precede any
attempt to describe uterine pathological
changes.
‘rhE PATHOLOGICAL SOCIETY OF TORONTO.
1 ;
CHYLO-THORAX.
The adjourned discussion was opened by Dr.
I. H. Cameron, who briefly related the history
of the case.
Prof. Welch said that these cases may be
divided into two classes: oily hydrops pleurae,
and chylo-thorax. From the history given he
thought that the case was one of chylo-
thorax.
There are some eminent authorities who urge
that these cannot be cases of chylous effusion,
for grape sugar is absent in these chylous effu-
sions, while in chyle it should be present. They
also urge that there has never been found any
rupture of the vessels.
In spite of these authorities, eminent as they
are, it may be accepted that there do occur
genuine cases of chylo-thorax. In Whitla's case,
Redfern, of Belfast, a most careful anatomist,
found rupture of the thoracic duct. Strauss
demonstrated in his case, by giving butter, that
there was a rupture. The effusion is most often
due to obstruction by damming back at the
radicles, not of the thoracic duct. It may be
due to actual ulceration into the lymphatic
vessels, by tubercle, cancer, etc., or there may
be lesion of the mediastinal glands.
Reprinted from THE CANADIAN PRActitionER, January 1, 1890.
^}
*
ſ
* &
;
. . . . THE PATHOLOGICAL SOCIETY OF TORONTO . . . .
DECEMBER 28, 1889.
The President, Dr. Reeve, in the chair.
Dr. John Caven presented the following
specimens:
1. Small globular growth in substance of
supra-renal capsule. Size, about 34 inch
diameter. Color, yellowish white. Consistence
firm. The growth is embedded completely in
capsule substance, and is possessed of a slight
‘fibrous capsule of its own. Under microscope
growth it is seen to be mainly made up of poly-
hedral epithelial cells, much resembling those
in the fasciculi of the normal supra-renal.
These peculiar cells are shut up in alveoli,
formed of a very delicate fibro-cellular tissue.
In some cases the alveoli are jammed full of
the cell elements, in others they are arranged
with some show of regularity around the
alveolar wall; . In many of the alveoli-leucocytes
are to be seen, scattered amongst the larger
peculiar cells. “The “peculiar” cells have a
distinct nucleus, single, and much larger than
that of a leucocyte. These cells measure on an
average about rºo of an inch.
º iverticulum on the small intestine g e e
2. A divert . s e common in the child than in the adult.
about 3 feet from the ileo-caecal valve—about
2% inches long—opens into intestine—contains
all the coats of the infestine in its structure—
evidently a specimen of Meckel's diverticulum.
Has no connection with the umbilicus.
3. A curious cyst found in an anencephalous
monster. This cyst, which occupies the position
of the middle cervical ganglion, was about the
size of an ordinary hickory nut. Contained a
mucous fluid which the microscope showed to
contain large quantities of cylindrical and flat
cells, both separate and in masses. The cyst
wall is made up of fibrous and muscular tissue
(sm oth) lined with flattened cells, apparently
epithelial, and showing apparent gland structure
with columnar cells. -
4. A portion of the large intestine, studded
the presence of the muscle.
with small grape-sized diverticula. These
diverticula consisting of mucous coat protruding
through the muscular walls of the intestine.
GROWTH IN THE ANENCEPHALOUS MonstER.
Dr. Cameron thought that the supra-renal
growth could not be cancerous, as it had a
capsule. The cyst might be a relic of the
branchial cleft, which contains muscular tissue.
Dr. A. B. MacCallum was not sure that the
musculature could arrange itself in such a regu-
lar way as in this preparation, if the cyst were
derived from the branchial cleft. Its position
would favor the idea of such an origin. In
these anencephalous, monsters the organs
frequently present these low types.
From the microscopic specimen it is hard to
make out whether the muscle is striated or not.
Not much importance was to be attached to
We can easily
suppose that the muscular tissue would continue
to grow, although slightly changed.
MECKEL's Diverticulum.
Dr. Primrose asked why these were more
Was
it because in the adult they close, shrivel, and
become a mere fibrous cord P
Dr. Cameron had seen several specimens, but
there had always been more than one diverti-
culum. He had always considered them to be
of the same nature as the vermiform appendix.
Dr. McPhedran asked if these diverticula
were subject to the same pathological changes
as the vermiform appendix.
Dr. Caven replied that he thought that there
might be the same pathological changes. We
know that they may become cystic and even
strangulated.
GRAPE-LIKE DIVERTICULA.
Dr. Cameron had seen a number of such
grape-like diverticula but they were usually of
1.
º
4.
larger size. His experience had been that
patients who have these usually die of dilated
stomach. This might be attributed to the fluid
diet which they have in their toothless old age.
One would think that these slender walls of
these diverticula might easily give way and
cause the death of the patient. Probably this
was prevented by closure of the mouths of the
diverticula by the contraction of the intestinal
muscles.
Dr. Nevitt, who had with Dr. Cameron made
several post-mortem examinations on cases of
this kind, said that in all the cases the mouths
of the diverticula were patent and solid faeces
were found in them, while the rest of the bowel
was empty. The faeces might of course get in
during intervals of quietude.
Dr. McPhedran
thought that the
real source of the
patient's safety was
his debility.
TALIPES CAVUS.
Dr. Primrose :
The cast which I
now show you, Mr.
President, was
taken from an ex-
aggerated case of
so-called “hollow
foot,” occurring in
a boy about four-
teen years of age,
apatient under Dr.
Cameron, in To-
ronto General Hospital.
The deformity presented in the specimen is
typical in character although excessive in degree,
and one can with advantage examine such a foot
for the purpose of determining the different
factors which have been at work in producing
the condition. The cast of the inner half of the
foot is perfect; note the marked exaggeration of
the antero-posterior arch of the foot, the ball of
the great toe is unusually prominent, the proxi-
mal phalanx is hyper-extended on the head of
the metatarsal bone and the distal is flexed upon
the proximal phalanx. The condition of the
four outer toes is similar to that of the great toe,
the proximal phalanges are abnormally extended,
and the terminal phalanges flexed, producing
From A Photograph of Cast.
THE PATHOLOGICAL SOCIETY OF TORONTO.
the deformity usually known as “hammer-toe.”
It has been suggested that the cause of the
deformity in hollow-foot is primarily paralysis of
the interossei muscles. The anatomical plan
common to all the interossei is that each muscle
has its origin laterally from one or more meta-
tarsal bones near their proximal extremities, and
runs forward to be attached laterally to the bone
of the proximal phalanx of the toe ; in addition
to this there is an aponeurotic expansion con-
tinued from each muscle which blends with the
tendon of the extensor muscle on the dorsal
aspect of the proximal phalanx. The action of
the interossei is two-fold, they act as adductors
and abductors to and from the second toe ; they
also by their contraction bring about flexion of
the proximal phalanges and extension of the
terminal phalan-
ges; this latter is
the action with
which we are con-
cerned in the de-
formity under con-
sideration. When
the interossei are
paralysed the phy-
siological antago-
nists of these mus-
cles will by their
unopposed action
bring about a con-
dition of things the
reverse of that
which occurs when
theinterosseiarein
action; the reverse condition would be, extension
of the proximal phalanges and flexion of the ter-
minal phalanges ; in fact, the exact condition of
things which we find in this cast. There are no
interossei inserted into the great toe, but the
oblique adductor and the short flexor of the
great toe have insertions similar to that of the
interossei, namely, into the bone of the proximal
phalanx and also into the extensor aponeurosis
on the dorsal aspect of the first phalanx; this 1
have verified by dissection. It is therefore
these two muscles which take on the action
of the interossei in the case of the first
digit ; paralysis of these muscles would bring
about the deformity which we find in the great
toe of the cast. After the deformity has been

THE PATHOLOGICAL SOCIETY OF TORONTO.
15
thus produced, it is rendered permanent by a
contraction of the plantar fascia.
The condition existing in this case may there-
fore be satisfactorily explained by having been
brought about primarily by a paralysis of the
interossei muscles along with that of the oblique
adductor and short flexor of the great toe, a
subsequent contraction of the plantar fascia,
rendering it impossible to correct the deformity
by simple manipulation.
The material of which the cast is made is
printers’ “roll,” very similar in composition to
that suggested by Dr. Cathcart of Edinburgh.
This has been called cathcartine and is made in
the following manner : “Soak glue, or what is
preferable, ordinary French gelatine, in water
until it has been thoroughly softened. Allow it
to lie exposed so that the water may evaporate
to such an extent that the gelatine becomes
pliable but not soft. Melt this in a water bath,
and add to it as much glycerine by measure as
there was dry gelatine by weight. It is also ad-
vantageous to add to the glycerine about one to
forty drops carbolic acid. Mix them thoroughly,
and stir in the finest ground oxide of zinc, sus-
pended in a little glycerine, until the whole mass
assumes an opaque white appearance.”
Dr. Cameron : “I cannot give all the pre-
vious history of the patient, but there is no
record of diphtheria or of scarlatina. The
treatment has been Electricity and Barwell's
Elastic Muscle. To me, Dr. Primroses explana-
tion seems very reasonable. The term Pes
Cavus is misleading. I do not think that there is
any such condition. The case is really one of
talipes equino plantaris varus. Talipes arcuatus
is a better name. Simple division of the fascia
and superficial muscles will cure. It is note-
worthy that the other foot is now getting into
the same condition.”
Dr. Peters pointed out that the tonic contrac-
tion of the long flexors and extensors of the toes
tended not only to maintain, but to aggravate
the condition brought about by the paralysis or
atrophy of the interossei. By such chronic con-
traction the proximal ends of the first phalanges
become subluxated upon the heads of the meta-
tarsal bones. These are in this way thrust down
into the sole of the foot in such a manner as to
increase its arch. The plantar fascia which is
thus relaxed in process of time becomes short-
ened, and changes may also subsequently take
place in the ligaments and articulations. In some
cases of club foot, all the soft parts except the lig-
aments may be cut away without correcting the
deformity of the foot. Hence, in the treatment
of this deformity, it may be necessary to divide
not only the plantar fascia and the contracted
muscles, but also the long calaneo-cuboid and
some other ligaments. -
Dr. Primrose in answer to Dr. Peters said that
the action of the flexor digitorum muscle has
not so much to do with producing the deformity
as his remarks might lead one to infer. It is
the common extensor muscle and the extensor
longus pollicis which have the chief action ; if
the interossei, the adductor hallucis, and the
flexor brevis hallucis be paralysed, then the
extensor muscles are no longer retained against
the dorsal aspect of the proximal phalanges, and
they would act from the proximal extremity of
the distal phalanx as their fixed points below.
The result of their action would be to draw the
terminal phalanx upwards and backwards,
producing thereby extension at the metacarpo-
phalangeal joint and extension at the inter-
phalangeal joints. The flexor tendon, on the
other hand, is firmly bound down on the under
aspect of the proximal phalanx, in a fibrous
sheath, and contraction of this muscle would
tend rather to prevent hyper-extension at the
metatarso-phalangeal joint. There is not neces-
sarily any alteration in the shape of the bones of
the foot, although a partial dislocation may
occur at the metacarpo-phalangeal joint.
--
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REPRINTED FROM
“THE CANADIAN PRACTITIONER,”
FEBRUARY IST, 1890.
ºper
***
wº
\
. . . . THE PATHOLOGICAL SOCIETY OF TORONTO . . . .
JANUARY 25, 1890.
^
* . .
The President, Dr. Reeve, in the chair.
Dr. A. B. Macallum and Dr. John Caven
presented their second report on
CARCINOMATO US GROWTHS.
Malassez and Albarran in the spring of last
year gave to the Biological Society of Paris a
detailed account of the same structures which
were described by Dr. Macallum at the month-
ly meeting of the Pathological Society last
October. Dr. Macallum, when he made that
report, was unaware of this, and of the fact that
any other observations in the same line had
been made on epitheliomata from the human
subject.
The observations conducted since last October
have yielded a full confirmation of the point
then advanced, viz., that all the three classes of
structures, intracellular as well as intercellular,
are modifications of one another, or are differ-
ent stages in the life-history of the same
organism. These stages in the order of de-
velopment of the organism are : (1) the spore;
(2) the plasmodium ; (3) sporulation. The
plasmodium may be homogeneous, sometimes
vacuolated and granular, and sometimes
nucleated with a nucleolar body. Some non-
nucleated forms have been seen to possess
small irregular chromatin masses, which may be
essential parts of its structure, or accidental
elements (as swallowed food material). It has
been seen fixed in the act of entering epithelial
cells, and it has also been very frequently found
with pseudopodial projections stretching fo.
some distance between the epithelial cells.
Their peculiar safranophilous or eosinophilous
protoplasm serves to distinguish them in pre-
parations stained with haematoxylin and either
safranin or eosin The plasmodium, when ready
for sporulation has attained a definite size, forms
a doubly contoured membrane about itself, and
apparently only in this phase of its history
simulate the nuclei
acquires a nucleus. This stage may be passed
within or without the epithelial cell, although by
far most commonly, within. The manner of
the segmentation of plasmodium has not been
observed definitely. The number of spores
formed is greater than that observed by Albarran,
who found only six to eight in two cases of
epithelioma of the jaw. In sporulation the
protoplasm loses its safranophilous and eosino-
philous characters. The spores at first are
spherical, measuring about o.o.o.45 mm., and pro-
vided with a central protoplasmatic mass
(chromatin P) stained more or less with
haematoxylin, and a peripheral unstained zone.
These spores change their form, become bilobed
or trilobed, and in the latter form are oftenest
found between the epithelial cells, where they
of leucocytes. These
spores apparently enter other cells, where
they pass a certain part of their life cyle, during
which they increase in size, and acquire again
their capacity for certain dyes (eosin and
safranin.) After attaining a certain size they
become free, and this appears to be the
condition in which active migration commonly
OCCUlrS. - - -
The plasmodia were present in the nuclei of .
the epithelial cells, in one case abundantly,
where they presented the characters of the so-
called plasmosomata, but they were distinctly
seen fixed in the act of passing into or from the
nucleus. * -
The presence of a plasmodium in an epithelial
cell deranges the metabolism of the latter,
increases its size, and as a consequence of this
increase in size, the adjacent epithelial cells are
pressed upon and become laminated around the
attacked cell, in the form usually known as the
“nest.” .
These bodies, especially the plasmodia, were
found in the affected lymphatic glands from a
*
*
1 S .
case of epithelioma. The structure and micro-
chemical reactions (i.e., staining power) of these
are the same as described for those of the
primary growth. The other stages, i.e., the
spore and that resulting in sporulation (encysted
stage), were not definitely determined in the
sections of the lymphatic gland, probably owing "
to the fact that the preparations were not made
with a view to the study of these organisms.
(A full and complete account of these
structures, with illustrating figures, will be
published shortly).
Discussion.—Dr. Cameron said that the idea
of a specific cancer cell had long ago been given
up. Cancer cells, in the sense of infected cells,
had been detected in their travels along the
course of the lymphatics. Jonathan Hutchin-
‘son has lately given the weight of his authority
against cancerous disease being caused by these
organisms. The plasmodium uses up all the
elements of the cell for its nourishment. It
may be that only in the epithelial cells does it
find its proper food.
If the theory prove correct, it will prove
valuable by simplifying our knowledge of and
aiding in the treatment of the affection.
Dr. J. E. Graham asked what effect this dis-
covery would have on the classification, usually
given, of these growths.
# Dr. Primrose could not find any evidence of
cell division in a slide illustrative of cancer of
the liver. y -
l)r. Macallum said that the absence of evi-
dence of cell division in cancer of the liver
tended to show that the growth is added to by
infection of the healthy cells, and not by pro-
pagation of the infected cells.
Whilst acknowledging the eminence of the
authority of Jonathan Hutchinson in all that
concerned practical surgery, he did not see why
his opinion should in this matter be allowed
special weight.
In reply to “Dr. Graham, he said he thought
that connective tissue escapes, as do all cells
which cannot be converted into phagocytes.
He did not know whether cartilage cells were
attacked. -
\ AN INTRACELLULAR PARASITE IN THE INTES-
* TINE OF NECTURUs LATERALIs.
, Dr. A. B. Macallum : .
While looking over some preparations of the
THE PATHOLOGICAL SOCIETY of toRONTO.
intestinal epithelium of Mecturus lateralis to
determine if a form allied to Steinhaus's
Caryophagus Salamaudrae were present, I
came across a number of intracellular bodies
which were either stained deeply, or not at all,
with the staining reagent (alum cochineal) and
which I at first considered to be similar to the
plasmosomata and nucleo-plasmosomata - of
Lukjanow (Arch. fur Anat, and Phys. 1888)
occurringin theintestine of the European Salam-
ander. I had not continued my observations
long before I came to the conclusion that many
of these forms were parasitic, for the following
rea SOIn S : -
1. They are inter- as well as intra-cellular.
2. They are frequently fixed in the act of
migration, when they are found possessed of
long processes which extend between the cells.
3. They have been seen fixed in the act of
migrating from the nucleus of an epithelial cell
after having absorbed all its 6hromatin.
4. When one cell is found specially affected
by them, careful search shows the immediately
adjacent epithelial cells to have these bodies in
greater or less number. This infection of the
adjacent epithelial cells may extend to a dis-
tance equal to the thickness of half a dozen
epithelial cells. -
It is not to be denied that some of the intra-
cellular elements described by Lutjancw are
due to cell degeneration. I am inclined to be-
lieve that many of them are parasitic elements.
The main peculiarity of this intestinal
parasite in Mecturus is its chromatophagous
character. ...-
of haemoglobin in Mecturus allow room for no
other conclusion than that the chromatin of
the haematoblasts is the mother - substance
(haematogen) of the baemoglobin. I have also
determined, I think definitely, that ºthere is a
transmission from the mother to the ovum
(in Amphibia) or to the foetus (in the cat) of
this chromatin in but a slightly changed con-
dition. What is more natural then, than to infer
that chromatin is an essential constituent of the
food of a growing or adult individual, and that
when it is withheld, or its resorption by the in-
testine prevented, the system is thrown into that
condition which results in anaemia P
as a disease or condition in which only the
~
My own observations on the origin
Ordinary
or simple anaemia is usually regarded clinically
|
*
*
• *
te
g - A THE PATHOLOGICAL SOCIETY OF TORONTO.
133
corpuscles and their haemoglobin contents are :
affected, whereas in my opinion the latter con-
dition is secondary, the primary cause of the
anaemia being the non-absorption of the chroma-
tins, of the food (milk, flesh, etc.) for some
reason or other (intestinal fermentation,
putrefaction, etc.), hence the lessened produc-
tion of that compound derivable from chromatin,
(haemoglobin) as well as the digninished perform-
ance of the functions of the yarious organs of
the system.
On the other hand, it may be that progressive-
pernicious anaemia depends on a greater de-
ragement of the chromatin-absorbing power of
the intestine, and the characters of the chrom-
tophagous parasite in the intestine of AVecturus
point to the possibility of the occurrence of a
similar parasite in the intestinal tract or in the
blood in cases of pernicious anaemia, which
absorbs the chromatin, which should go towards
recruiting the nuclear elements of the body.
The action of arsenic in so-called cases of
pernicious anaemia might therefore be attributed
to a specific effect on such parasites, if they
exist, just as the action of quinine in cases of
malaria is attributed to a specific effect on the
Zaverania malaria If such parasites do not occur
in cases of pernicious anaemia, then we must at-
tribute the action of arsenic in such cases to its
facilitating the absorption of chromatin from the
food in some way or another.
The parasitic nature of the condition known .
as pernicious anaemia is rendered probable from
the fact that in certain localities it is more
frequent than in others. For instance, in the
canton of Zurich, Biermer observed 15 cases in
5 years (1867-72), all of course ending fatally: an
exceptional record, I believe. -
In chlorosis we have probably two factors:
the diminished absorption of chromatin from
the same causes as in ordinary anaemia, and the
more or less abundant constant withdrawal from
the organs of the patient, during the abnormal
condition, of the chromatin to store up in the
ovarian cells and in the developing uterine
IIl UlOOSal. – -
Dr. Graham said that clinical experience had
often caused him to think that some cases of
pernicious anaemia must be of parasitic origin.
. The cases which had especially impressed him
were those coming on suddenly, a few days
º
after a confinement in which there had been no
loss of blood. He used the term in a general
way, for of course some would not consider
anaemia after confinement really a pernicious
anaemia. Can there be any connection between
the large number of white blood-cells and
parasitism P. He had often thought leukaemia,
pseudo-leukaemia and pernicious anaemia were
closely related. *
PECULIAR CASE OF DISEASE OF THE BRAIN.
A. McPhedran : -
A. T. aet. 56; enjoyed good health till March,
1888, when appetite became fitful, with oc-
casional attacks of sudden vomiting. He gradu.
ally lost flesh. Towards the end of May he
noticed some difficulty in walking, objects
“wavered,” as they would on shipboard in a
stormy sea. In June there was slight paralysis
of right side of face, unable to open right eye
alone. Partial anaesthesia of lower part of
cheek, lower lip and chin on right side. Tongue
feels as if scalded, is partially anaesthetic, as is
also inner part of left cheek. Taste sweetish
and disagreeable, lately becoming more bitter.
Frequent pains in occiput, shooting up over
vertex, jolting causes pain across shoulders.
Bowels constipated : need strong purgatives;
formerly easily moved. .
Dr. R. A. Reeve found the eyes normal, ex-
cept slight diplopia, due to paralysis of the
superior oblique muscle.
Paralysis of left face developed early in July,
being complete by the 10th. Some vertigo on
sitting or standing. Diplopia more marked,
now unable to read. Walking more difficnlt.
Watch heard at six inches on left, and
twenty on right side. Hearing on left
side sharpest until last few days, he says.
Tragus of left ear, and neighboring parts feel .
swollen and numb. Sense of taste absent in .
anterior part of tongue; slow perception at
back. Vomiting more freque nt; but without
nausea, sudden and projectile. Constipation
persists. About July 25th, urine suddenly
became very copious, over a gallon in twenty-
four hours, very pale, sp. gr. 1 oos. A few days
later profuse vomiting set in, lasting a couple of
days, during which the urine was reduced to
almost -normal amount. , After the stomach
quieted the polyuria returned ; in this manner
it alternated several times with vomiting, some.
KY 24
THE PATHOLOGICAL SOCIETY OF TORONTO. 2 * *
times fully 300 ounces of urine were passed in
twenty-four hours. There was great thirst and
often a voracious appetite. •
In August, the diplopia became more marked,
so that he constantly saw objects double, except
when they were above the level of the eye.
In September, the hearing in the left ear
seemed to be completely lost.
In October, the paralysis of the right side of
the face, which had been scarcely perceptible
after the left side became paralysed, now in-
creased and became nearly complete. The soft
palate and pharynx became paralysed also, so
that no food could be taken, and very little
drink, for a month before death. During this
time the amount of urine passed diminished,
until very little in excess of normal. Vomiting.
occurred occasionally, emaciation became very
marked. &
Death from asthenia, Oct. 29th, at 5 a.m.
Rigor mortis complete at 7 a.m.
The discussion was postponed until the next
meeting.
Reprinted from THE CANADIAN PRACT Ition ER, March 1; 1890.
o
*
. . . THE PATHOLOGICAL SOCIETY OF TORONTO . . . .
FEBRUARY 22, 1890.
The president, Dr. R. H. Reeve, in the chair.
CASE OF BRAIN DISEASE.
Section of the brain, the clinical history of
which was given by Dr. McPhedran at the last
meeting, showed suppuration of the corpus cal-
losum extending through the lateral lobes into
the posterior lobes. This was more marked on
the left, although present on both sides. There
s was also a small patch of softening in the centre
of the cerebellum. A thrombus was found in
the left cerebral artery.
Dr. I. H. Cameron argued from the symp-
toms that the lesion in the cerebellum was
probably primary. The case was hardly regular,
for the plugging of the left cerebral artery should
have caused complete hemplegia.
Dr. J. E. Graham had seen a case in which
the symptoms were the same, with the excep-
tion of the peculiar gait. In that case there
was softening of one of the hemispheres down
into the crus. Lesions of the corpus callosum
are rare. Irregularity of gait is a symptom of
tumor of the corpus callosum. Thelesion in cere-
brum seemed so much farther advanced than
that in the cerebellum, that the cerebellar dis-
ease could not account for the peculiar gait.
There was no thickening of the arteries to be
found.
Dr. W. P. Caven thought that disease in the
vessels must have caused the embolism.
MORBUS COXAE.
Dr. I. H. Cameron exhibited the left femur
from a case of morbus coxae.
girl of three, was admitted into the Hospital for
Sick Children with hip-joint disease in the third
stage. There were several sinuses opening
above Poupart's ligament. Extension was ap-
plied and every effort made to feed the child
up. An operation was not thought advisable,
because the acetabulum was, to all appearances,
affected. The girl was in the hospital for three
The patient, a
years, during which period aboesses developed
from time to time. -
Post mortem examination showed amyloid
disease of the liver, which was so enormously
enlarged that there was scarcely a half inch of
space between the edge of the liver and the
crest of the ilium. The os innominatum was
greatly thickened, but there was no perforation
of the acetabulum. The cartilage lining the
acetabulum had disappeared, as had the head
and part of the neck of the femur. The pos-
terior surface of the neck was united to the body
of the ischium by fibrous tissue. The medul-
lary cavity of the shaft was much enlarged, so
that only a very thin stratum—two lines in thick-
ness—of compact bone remained. The remains
of the capsule and other fibrous tissue about
the joint was very much thickened, especially
over the upper part of the great trochanter,
where an incision in this region opened into a
somewhat large abscess cavity, about the size of
a sparrow's egg. The fibrous tissue was closely
adherent to the periosteum, which was appar-
ently quite healthy where it still remained.
Microscopic examination showed amyloid dis-
ease of the liver, spleen and kidney.
From the light thrown by the post mortem
upon the condition of the femur and joint; it
was to be regretted that excision had not been
done. - *
Dr. Thistle saw in the fibrous, thick, walled
cyst surrounding the head of the bone, an effort
at reconstruction on the part of the periosteum.
It extended too far down the shaft to be a part
of the capsule. -
ANEURISM OF AORTA.
Dr. Cameron said that this case was interest-
ing, not only on account of the seeming acute
development of the aneurism, but also because
the patient was commonly reported to have died
of la grippe. The patient was a man of 35,
9
*}
5* - *\
THE PATHOLOGICAL SOCIETY OF TORONTO.
banker by occupation, very tall and thin. He
was a great oarsman, one of the Argonaut eight,
and spent most of his leisure time either rowing
or canoeing. He had never had any illness,
save some slight attacks of dyspepsia. Nothing
had ever occurred to indicate any heart lesion.
Dr. Scadding, who had attended the patient
for Dr. Cameron, had found him dressed for
was made.
dinner. Whilst dressing, he had been suddenly
seized with great pain, referred to the pit of the
stomach and abdomen, passing up into the
throat, which he described by saying that he
felt as if he would burst asunder. There was
no heart murmur or noticeable dullness; pulse
5.o. He was put to bed and morphia given
hypodermically, with but little relief of the pain.
Morphia granules, gr. 4, were given, to be taken
every 3 or 4 hours if needed. On the following
day the pulse was 9o, on the third day pulse
was 116. The pain persisted, but was localised
more in the region of the umbilicus. That
evening he had a spasm and died. Post mor-
tem examination showed, at the base of the
aorta, a dissecting aneurism, which had rup-
tured. There was no laminated clot in the sac.
The blood in the pericardium was clotted; on
the visceral pericardium a few milk patches.
Heart was dilated, but not hypertrophied.
It was supposed that on the first night the
internal coat had given way. The pain had
been kept up by the dissecting blood. The an-
eurism was evidently of very recent date, as
shown by the fact that there was no hypertrophy
of the heart, and by the absence of a laminated
clot in the sac.
CEREBRAL HEMORRHAGE, CANCER OF PANCREAS.
Dr. Cameron: The patient, a man of 70, was a
shoemaker by trade. Eight years ago he came for
advice concerning attacks of vomiting blood, and
of pain referred to the stomach. It was thought
that thickening could be detected in the epi-
gastric region, and therefore a diagnosis of cancer
This diagnosis was rather shaken
by the fact that ordinary treatment for dyspepsia
relieved him, and by the duration of life.
I was sent for one afternoon to see him, but
found him so well and jolly that I concluded
there was not much the matter with him. That
evening, at 8 o'clock, he complained of feeling
a little sick and of pain in the head ; no par-
*
alytic symptoms at any time. An hour and a
half later he was dead. I had never known
death to occur from cerebral, haemorrhage in
less than 8 hours. g
Dr. Cameron said that the condition of the
stools could never be ascertained. The patient
was not a drinker. There had not been a
haematenmesis of late. The haematemesis must
have been due to obstruction of the vessels of
the stomach by the growth.
Dr. Peters, who performed the autopsy,
said that there was found an extensive hem-
orrhage into the meninges of four or five
ounces of blood. This came from a rup-
ture in the basilar artery. The arteries at the
base of the brain were markedly atheromatous.
There was no interstitial hemorrhage.
There was a hard, nodular tumor, involving
the whole head of the pancreas, surrounding
the pylorus, but not involving it, for it was still
patent. The stomach was but little dilated.
The growth had surrounded and caused the dis-
appearance of the gall bladder and cystic duct.
The common duct was found. The liver was
slightly shrunken. There were adhesions to
the transverse colon, hepatic flexure, and omen-
tum. There was a cystic condition of the left
suprarenal capsule, while the right was un-
affected. g
CHY LOUS U R IN E.
Dr. Graham exhibited a specimen of chylous
urine, obtained from a patient of Dr. Todd's,
who had typhoid fever complicated by pneu-
monia. * .*
A. B. Macallum :
NORMAL PROCESSES OF DEGENERATION IN THE
UTER IN E MUCOSA OF THE PLACENTAL SITE
IN THE CAT.
The greatly enlarged endothelial elements
and the glandular cells of the placental mu osa
in the cat, present many points of interest in
connection with the studies on the degeneration
of cells in epithelial neoplasms. That they are
of great physiological importance to the embryo,
my studies, I think, have shown unmistakably.
The ordinary endothelial cells of the mater-
nal bloodvessels, increase in size simultaneously
with the widening of the latter till each capillary
appears like a gland tubule lined by large ir-
regular cells, with a tortuous lumen in the
Af
* * * *
<
. Aſ
THE PATHOLOGICAL SOCIETY OF TORONTO, ~ ~ 3A
centre. The edge of the cells next the lumen
have a granular border, and they are separated
from the syncytium of the foetal ectoderm by
thin strands of fibrillar tissue. The latter is seen
with difficulty in some places, where the en-
dothelial cells appear to abut directly on the
syncytium. This is especially the case in the
stage where the embryo measures less than an
inch in length. At this stage, also, the endo-
thelial cells frequently exhibit indirect division,
the amount of chromatin present in such cases
being remarkably small is comparison with the
amount of the cytoplasma. The latter con-
dition recalls a common peculiarity in epithelial
neoplasms. At this stage in the placental his-
tory, the division of the nucleus, apparently,
usually is followed by division of the cell, but
in the placenta at later stages (when e. g. the
embryo is nearly 3 inches in length) the div-
ision of the nucleus is rarely followed by division
of the cell, so that in the latter we frequently
see two or more nuclei, each larger than the
single nucleus of the earlier stages. This con-
dition is accompanied by certain changes in the
cell body, which becomes vacuolated, especially
towards the periphery, and the cytoplasma be-
comes fibrillar, the fibrillae radiating towards
the cell boundaries. These cells are senarated
from the lumen of the bloodvessel by a new
endothelial lining composed of small endo-
thelial cells and a hyaline membrane, the cells and
the membrane appearing perforated by canals
like those in the peripheral border of the epi-
thelial cells of the intestine. The older endothel-
ial cells exhibit plasmolysis either in one of their
nuclei or in the whole cell. The nuclear con-
tents in some cases appear to undergo chromat-
olysis. When a whole cell degenerates, the mass .
acquires an eosinophilous character, fragments,the
pieces are taken up by the protoplasm of the
syncytium of the foetal villi, passed through the
cellular layer and thrown into the lymphatic
spaces of the villi. On their passage the frag-
ments become more numerous and smaller, till
finally they are of granular size. In earlier
stages (when the embryo measured less than one
inch in length), similar yolk-like masses are seen
in the syncytium of the villi, but they appar-
ently come from the absorbed and degenerated
tissues in the path of growth of the villi.
Here we see that the degenerated cells serve
directly
or the nutrition of the embryo. The chromatin
and protoplasm of the endothelial cells pass
into foetal tissues, when they can
readily be detected with staining reagents.
The glands at the base of the placental layer
of the mucosa also degenerate, but the process
is somewhat different. At points in the epi-
thelial wall of the gland the cells increase in num-
ber ; they elongate by pressure, and the mass so
formed projects into the lumen of the gland for
a distance two or three times the height of the
original epithelial layer. The nuclei of some of
these cells become homogeneous or plasmol-
ysed, and both nucleus and cell are set free in .
the lumen. Here further degeneration occurs,
accompanied by gradual diffusion of the chro-
matin through the mass, which now fragments.
Sometimes the protoplasm of degenerated cell
disappears as if through digestion, leaving the
chromatin in small masses, which run together,
forming deeply colored spherules in the centre
of the lumen. The fate of this chromatin was
not observed distinctly, but it was inferred
where a villus had broken through and projected
into the lumen of a gland tubule, that epithelial
cells covering the lower end of the villus were
irregular in shape, with long, pseudopodial pro-
cesses stretching out into the granular debris of
the lumen, and apparently functioning as ab-
sorptive organs.
cess one can see granules, similar in character to
those found amongst the debris. One can,
furthermore, find in the axial part of this
end of the villus, an elongated mass of chro-
matin, apparently derived from the chromatin
of the broken down gland cells. In the later
stages of gestation the greater part of this chro-
matin, which persists, owing to slow assimila-
tion, becomes mucinoid.
Thus, in the placenta of the cat, are to be
seen many processes which find their parallel in
conditions occurring in neoplasms, etc. The
parallel is not surprising, since the embryo is,
In the substance of the pro-
from one point of view, a foreign body, a par-, .
asite, which irritates, though physiologically,
the structures of the uterine mucosa, and calls
forth in its cells changes such as those des-
cribed above. In fact, the growth and changes -
in the placenta belong to the class of phenom-
ena which concerns the border-land between
pathology and physiology. - t
*-
*
g
>\4–
ass=y
f
REPRINTED FROM
“THE CANADIAN PRACTITIONER,”
MAY 16th, 1890.
ºpºs
2
3.
Af
. . . . THE PATHOLOGICAL SOCIETY OF TORONTO . . . .
APRIL 26, 1890.
The President, Dr. R. A. Reeve, in the chair.
- UTERINE FIBROIDS.
Dr. Oldright presented two intra-mural
fibroid tumors, one of which he thought
had undergone osseous degeneration. The
other noticeable point discovered during
the post-mortem examination was the presence
in the stomach of a number of circular depres’
sions, seemingly old ulcers which had healed, the
mucous membrane growing over them.
Dr. Acheson thought that the nodule had un-
dergone calcareous rather than osseous degener-
ation, for under a magnifying glass it presented
a broken crystalline, appearance. Ossification
could not occur in such a place, for where would
the osteoblasts come from ? -
Dr. McPhedran asked if these calcifications
are ever crystalline. He had thought that they
were always amorphous. -
MENINGITIS.
Dr. Oldright presented the brain and cord,
the bladder and ureters of an unmarried woman
of 34.
seen her in consultation, and thought her to be
a masturbator and hysterical. Three weeks
after having la grippe, she complained of loss of
power in the right arm, which was not entirely
imaginary. She then took to her bed. Par-
alysis of the right leg was next noticed. The
catheter was necessitated by paralysis of the
bladder. Pains in the head and in the dorsal
spine were complained of. In the urine there
was an abundance of albumen. On post-mor-
tem examination the meninges were found to
be slightly injected, and there was an unusual
amount of spinal fluid. The left ureter was
very much enlarged, being 1% inches in diam-
eter at its widest point. The wall of the ureter
was thickened. The pelvis of the kidney was
dilated. The bladder walls were slightly thick-
ened. -
Y.
Dr. J. E. Graham had some time ago.
Dr. Thistle presented a
TUMoR of corpora QUADRIGEMINA.
J. S., aet. Io years, admitted to Hospital for
Sick Children, Toronto, Jan. 3rd, 1890. This
patient was brought to the H.S.C. to obtain
treatment for supposed stomach trouble, having
for some time been unable to retain food, vom-
iting coming on at once after eating. For sev-
eral weeks he had been dull and stupid, show-
ing no inclination for his usual games, etc. He
also complained much of frontal headache. Ten .
months before admission to hospital had had.
one or more fits. -
Present condition. The boy is well nourished
and healthy in appearance. He has a blank
expression in his face and pays little attention
to surroundings. Questions have to be repeated
several times before an answer is received.
Answers are correct.
patient staggering sometimes to right, sometimes
to left side. Pupils are slightly dilated, but
equal. Reaction to light is normal. No squint
is present. The boy lies curled up in bed with
his face downwards, and holding his head in his
hands. Patellar reflexes are exaggerated, ab-
dominal reflex present. Testicles are drawn up.
to external rings; abdomen is flat and hard.
The skin is harsh and dry, the papillae standing
out prominently (cutis anserina). Vomiting:
occurs a few minutes after eating, the act of
vomiting being easy. The bowels are constipat-
ed. Heart sounds normal and regular, rate 64
per min. Breath sounds normal, rate 16 per
min. Temperature 97.4. Lymphatic glands -
nowhere enlarged. Sensation is normal.
NOTES TAKEN DURING STAY IN HOSPITAL.
Jan. 4. Retained dinner, bowels moved. Pa.
tellar reflex absent. Abdominal and cremas-
teric reflexes present. Blister applied to nape
of neck, and mixture of maltopepsin, nux vom
ica, and infusion of calumba given,
His gait is peculiar, the
N.
THE PATHOLOGICAL SOCIETY OF TORONTO.
face.
peraesthesia marked, but patient is able to dis-
Jan. 7th. Vomiting continues; cannot find his
... way back from bathroom, although he goes there
by himself. , , -
Jan. 9th." Convulsive seizure, nurse says,
“He became quite stiff and his eyes fixed.”
Jan. 23rd. Food retained ; pupils unequal,
right larger than left; both react to light.
Jan 26th. Convulsion; general tonic spasm
lasting a few minutes, complete opisthotonos;
during spasm eyeballs jerked from side to side ;
unconscious (12.30 p.m.) >
Slight nystagmus present; movement being
lateral (9.30 p.m.) Staggers more to-day;
pupils equal.
Feb. 3rd. Had three fits, two close together,
third an hour and a half later; opisthotonos
with jerking of eyeballs and congestion of the
Right pupil twice as large as left. Hy-
tinguish sensations. Tăches cérèbrales marked.
Urine passed in bed. Can be aroused only
with great difficulty.
Feb. 4th. Internal strabismus of right eye.
Feb. 6th. Evidently blind; very stupid, giving
same answer to all questions.
Feb. 7th. Convulsion, opisthotonos, etc., as
before. -
Feb. 12th. Internal squint of left eye—right
eye normal. *
Feb. 19th. Convulsion to-day, right pupil
. larger than left, unable to stand; if left unsup.
ported, he stands with feet apart, and sways back
and forward, finally falling backwards; is some.
what cataleptic. Muscular power remains good.
Feb. 22nd. Very stupid; squint in left eye,
pupils react to lighl; slight convulsion as before;
double optic neuritis present.
Feb. 25th. Complains if bed is jarred, putting
hand to forehead ; squint in left eye, nystagmus
present, slow and lateral ; urine and faeces
voided in bed.
March Ioth. Fit; spasms both tonic and
clonic, and so differs from previous ones; no
opisthotonos nor frothing at mouth. Respiration
sighing and irregular.
Mar. 21st. Three fits; tonic spasms, very
severe. - :
Mar. 23rd. Breathing irregular, long pauses
between inspirations ; abdomen retracted.
Mar. 29th. Difficulty with food, which accum-
ulates beneath lips. .
Mar. 30th. Tonic spasms for four hours,
frothing at mouth, pupils contracted, pulse 200,
respirations 4o. This condition passed into
coma, and Mar. 31st, death supervened at 9 a.m.
The diagnosis in this case was intra cranial
tumor, probably cerebellar or pressing on the
cerebellum, and in all probability interfering al-
so with the corpora quadrigemina. -
The autopsy showed that the diagnosis was
correct and that the localization had been almost
exactly accurate. The growth, which was as large
as a good sized hen's egg, lay upon the crura
cerebri, and was bounded by the third ventricle
in front, and the middle lobe of the cerebellum
behind. Superiorly it was partly covered by
the velum interpositum. The corpora quadri-
gemina and pineal gland appeared to have been
completely destroyed, the new growth taking
their place. The middle lobe of the cerebel-
lum was also damaged, and perhaps the lateral
lobes also slightly, by pressure. The growth
proved, when examined microscopically, to be an
alveolar sarcoma. The stroma forming the al-
veoli was evenly arranged in fairly broad bands,
which in many places were richly nucleated,
the cells represented by the nuclei not being
distinguishable. The cells contained in the
alveoli were large, spherical, epithelioid cells ;
the nucleus, however, in most of them, was
large, filling out the cell as commonly seen in
round cell sarcomata. Blood-vessels were num-
erous, in some cases running amongst the cells.
Occasionally processes of connective tissue were
to be seen entering the alveoli from the stroma,
and running amongst the intra-alveolar cells. A
considerable quantity of fluid was found in the
ventricles, but not sufficient to cause any ap-
preciable flattening of the convolutions. The other
organs of the body showed littlenoteworthy, except
lack of nutrition. Subpleural ecchymoses were
found in the lungs, accounted for by the condition
of respiration shortly before death. On the free
border of the liver was found a light whitish.
yellow patch, extending back into the liver sub-
stance for about 34 of an inch ; it was perhaps
1% inches long. It was perfectly smooth, caus-
ing no puckering or raising of the surface—the
change in color being the only-peculiarity. This
white wedge on microscopic examination
proved to be fat. Every trace of liver substance
had disappeared, and its lobules had been entirely
, , , - .
\
replaced by fat. The surrounding liver tissue
was not fatty to any extent. The reporters have
noticed such patches in the liver—always on
the free border—in a number of cases, and are at
a loss for an explanation of their causation.
Possibly the cause is some localized interference
with blood supply ; producing a local anaemia
and consequent fatty change.
From a clinical standpoint, this case is inter-
esting, mainly on the account of the fact that the
symptoms allowed of such accurate localization.
The localization was based upon: .
(a) Staggering gait, swaying when standing,
and finally falling backwards. These point to
the cerebellum as seat of lesion.
(b) Character of convulsions, tonic spasms,
pointing to cerebellum.
(c) Irritation of corpora quadrigemina in
monkeys produces similar convulsions.
(d) Sudden supervention of blindness points
to injury of corpora quadrigemina. -
w ATROPHY OF CEREBELLUM.
Dr. McPhedran presented a brain, in which
the right lobe of the cerebellum was greatly at-
rophied, being less than half the size of the left
lobe. The patient was a man of 26, who had
for some eighteen years had epileptic seizures.
He was of a dull, heavy, unintellectual cast of
countenance. He gave a history of nocturnal
attacks. For some two weeks while in the hos-
pital, he was free from seizures and was advised
to go home. Constipation was then marked,
and he was given physic. Some four days before
death there came on excessive diarrhoea and in-
continence of faeces. Suddenly tympanites came
on. For the last two days before death he com-
plained greatly of abdominal pain, there was
excessive tympanites, watery diarrhoea, and
elevation of temperature. Post-mortem exam-
ination showed tubercular ulceration of the
intestine with a small point of perforation.
Dr. McPhedran presented a heart with
MITRAL STENOSIS.
Lizzie D., aet. 39, married. A small spare
woman of most irascible temper. No reliable ac-
count could be obtained as to either her family
or personal history. She gave no account of
a decided attack of rheumatism, but said she
had suffered from pains. There is no certainty
of her having had measles, scarlatina, etc. She
had been in the hospital many times during
THE PATHOLOGICAL society of Toronto.
ºf 5 .
the last few years. During that time she had
more or less cough, some shortness of breath,.
with a “wheezy’ voice. She complained of
pain in the praecordial region—it may have been
feigned. Her complexion was clear with a pink *
hue to the cheeks and lips. The lungs, to ex-
amination, gave negative results. -
The heart, two years ago, presented the fol-
lowing conditions:—On inspection there was
nothing unusual to be seen. On palpation
there was a marked systolic thrill over the apical
region. The apex beat was felt in the normal
position and slightly diffused to the right. To
percussion the area of cardiac dullness was
not altered. On auscultation there was a loud' .
rough presystolic murmur heard over a circular
space in the apical region, loudest in the cen-
tre of the space, which was a little to the right of
the normal seat of the apex beat. The first
sound of the heart was short, resembling the
second sound in character ; both were audible
at the apex. There was accentuation of the
pulmonic second sound heard to left of the
sternum in the second interspace. -
During the following winter (1888-9), she
came under observation again. By this time
the thrill was much less marked, and often ab-
sent. The murmur was not so harsh or loud.
and was now followed by only one sound of the
heart, so that, by some, the murmur was thought
to be regurgitant now, followed by the second
sound. But by carefully auscultating above
the apical region over the fourth costal cartilage,
the two heart sounds became distinct, and by
moving the stethoscope a little downwards the
murmur became audible, and at the same time
the second sound was lost; with care, how-
ever, a point could be found at which both the
murmur and heart sounds could be heard. The
pulmonic sound was still accentuated, while the
aortic was weak; owing to weakness of the lat-
ter it could not be heard at the apex. . .
Her condition otherwise was but little altered.
Last winter she entered the hospital again.
She had married and was pregnant about five
months. She was weaker and the breath short-
er, with more cough and expectoration, but no
blood. There was some oedema of the feet
and legs. Urine was normal.
There was no thrill at the apex. The mur-
mur was much less harsh, but still terminated
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THE PATHOLOGICAL society of Toronto.
abruptly before the heart sound, that followed
it. The two sounds of heart were audible over
the middle and upper parts of the praecordial
region, but only the murmur and one sound at
the apex, and th it sound was short and sharp
like second heart sound. , ,
The pulmonic sound was less accentuated
but still much sharper than the aortic sound,
which was much weaker than normal.
As pregnancy advanced, the dyspnoea, cough,
dropsy, and weakness increased ; the urine be-
came highly albuminous. At times no murmur
was audible, only the first sound being heard at
the apex. By April 15th, being then about
eight months pregnant, her condition became
so critical that it was deemed necessary to in-
duce labor, and she was transferred to the care
of Dr. A. H. Wright for that purpose. Matter
progressed favorably ; she was in fair condition
just before the head was delivered, the pulse be-
ing about as good as usual. Immediately after
delivery of the child no pulse could be felt; she
sank rapidly and died shortly afterwards.
At the post-imortem examination, which was
performed by Dr. J. Caven, the lungs were found
extremely cedematous, greatly fibrosed, and to -
contain many recent haemorrhagic patches. The
heart: the right auricle greatly dilated and filled
with recent clot; the right auriculo-ventricular
orifice narrower than normal, only admitting
the ends of two fingers; the right ventricle
somewhat dilated, with thickened walls ; in its
walls, near the pulmonary orifice, was found a
large sinus extending to the left into the tissue
of the left ventricular wall, and terminating in
two blind cul-de-sacs, the whole lined by smooth
membrane. -
The left auricle was much dilated and its
walls thin. The mitral orifice was much con-
tracted, the valves thickened and adherent,
forming a funnel the apex of which formed a
narrow oval slit about half an inch in length.
The edges of the slit were approximated by
slight pressure, and were doubtless closed with
each systole of the ventricle. The cavity of the
left ventricle was small and its walls thin. The
thickening of the endocardium extended from
the mitral sigment of the aortic valves, which
were slightly affected also, but competent.
The liver was “nutmeg,” and very fatty, but
not enlarged. Kidneys showed little change.
general course of mitral stenosis.
In the uterus the placenta was still adherent.
There was a fairly large clot in the vagina.
The cause of death was probably due to the
sudden emptying of the uterus and the slight
literine hemorrhage, both combining to deprive
the general circulation of more blood than could
in her condition be spared. . . .
Remarks: This case is fairly typical of the
The clearest
conception of the history of a case of mitral
stenosis is obtained by following Broadbent's
plan of dividing the history into three stages, as
given in his Harveian lectures (Brit. Med. Jour.,
vol. 1, 1884, page 449). “In the first stage
there are the presystolic murmur and thrill with
more or less accentuation of the pulmonic sec-
ond sound; its distinguishing mark is the pre-
sence of the second sound at, and to the left
of, the apex.” An apex murmur preceding the
cardial impulse, followed by two heart sounds
is almost pathognomic. At this stage there are
few if any symptoms. “The second stage is
marked by the disappearance of the second
sound from the apex. At the same time, the
first sound has gradually undergone a complete
change in character and has become short,
sharp, and loud, resembling an exaggerated sec-
ond sound. Now, mistakes in diagnosis are,
easily made; the presystolic murmur, followed
by a short, sharp, first sound is taken to be a
systolic murmur followed by a loud second
sound, and the disease is supposed to be mitral
insufficiency.” .
This accurately describes the condition in the
above case. Very few of the works refer to the
disappearance of the second sound at the apex,
yet it is a point of great importance not only in
diagnosis but also in prognosis, which is much
more grave in stenosis than in insufficiency of
the mitral valves.
Normally, the second sound is always to be
heard at the apex and to the left of it, and its
disappearance in mitral stenosis is owing, (1) to
weakness of the aortic second sound on account
of the insufficient distension of the aorta by each
systole of the left ventricle, and (2) to the en-
larged right ventricle overlapping the left and
preventing its coming into contact with the
chest wall, thus the aortic sound is not con-
ducted through to the ear. . -
In Broadbent's third stage the murmur disap-
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THE PATHOLOGICAL SOCIETY OF TORONTO.
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pears, and only the short, sharp, first sound is
heard at the apex. In the case detailed above
this stage was not fully developed. The thrill
disappeared, the murmur lost much of its harsh-
ness, and on one or two occasions was not to be
heard but it did not disappear for long. This
is probably due to the fact that the termination
was hurried by the pregnancy, without which
life would, probably have been prolonged, it
may be, for a year or two at least.
This is to be noted also, that the murmur in
this case, even when softest, always terminated
abruptly, and never had the prolonged character
that characterizes a regurgitant murnur.
^
Dr. D. J. Gibb Wishart presented a heart *
with mitral stenosis and tricuspid incompetence.
from a girl of 14. There had been a history of
tonsillitis and various rheumatic manifestations.
The lungs were greatly fibrosed and absolutely
devoid of any Oedema. The mitral valve was of
the cone form, the chordae tendineae being
agglutinated and presenting an appearance like
a half-opened fan. The musculi papillares were
also agglutinated by small fibrous patches.
Dr. Scadding presented a card specimen of .
PERFORATING ULCER OF THE STOMACH.
# -
THE PRESIDENT, DR. REEVE, IN THE CHAIR.
THE PATHOLOGICAL SOCIETY OF TORONTO.
THE FOLLOWING SPECIMENS, WITH HISTORIES, WERE PRESENTED BY T. K. HOLMES, M.D.,
A. OF CHATHAM.
CANCEROUS UTERUS : REMOVAL By vagiNAL
HYSTERECTOMY—RECOVERY.
.
Mrs. C., aet. 55, the mother of several chil-
dren. About nine months before I saw her
she began to have menorrhagia; this growing
worse, she consulted Dr. Jenner, of Kingsville,
who discovered the nature of the disease and at
whose suggestion I saw her. Dr. McGraw, of
Detroit, who has seen her, coincided with Dr.
Jenner. On Dec. 7th, 1889, assisted by Drs.
Jenner, Campau, and Dewar, and Mr. Pearson,
I removed the uterus through the vagina. The
operation was done in the usual manner, except
that I was unable to draw the uterus down on
account of the fragile nature of the diseased
cervix, and was obliged, therefore, to perform .
the first part of the operation in situ. Clamps
were used, instead of ligatures, to control the
vessels of the broad ligaments. There were no
enlarged lymphatic glands to be felt anywhere.
She made a good recovery under the skilful
attention of Dr. Jenner, and has regained her
former weight and feels and looks well.
VESICAL CALCULI.
S. Y., aet. 48, for about four years an English,
R. R. Station Agent. Has had gradually
increasing vesical irritation. Has been exam-
ined by several surgeons, who, not detecting a
calculus, have variously diagnosed prostatic
abscess, stricture, albuminuria, enlarged pros-
trate, cystitis. When he came under my care
he had lost forty pounds in weight, had a sal-
: low complexion, a wery, pained look, and was
obliged to urinate every ten or fifteen minutes.
The vesical tenesmus at the end of urination
was so great as to cause an involuntary dis-
\
charge from the bowels at intervals. The
urine, strongly ammoniacal, contained much
mucus and pus; the appetite was poor; the
temperature varied from loo" to Io2° F.; the
pulse was never below Ioo (generally 120).
His urine had never contained blood, so far as
he was aware. What seemed to be a greatly
enlarged prostate could be felt per rectum, and
slight pressure there caused intense suffering.
I learned that various means had been tried to
cure the cystitis, and as I was unable to pass a
sound on account of the pain produced by the
attempt, I determined to make an incision into
the bladder and remove any foreign body, if
found, or drain that viscus if none existed. As
soon as complete anaesthesia was produced, the
sound revealed the truth, and as the stones
seemed numerous, I deemed it safer to cut
than to crush, and accordingly made a median
incision, and without difficulty removed the
thirteen calculi here exhibited. The nuclei are
composed of uric acid, and the remainder of
amorphous phosphates. The patient made 3.
good recovery. - - -
CANCER OF THE UTERUS—AMPUTATION OF CER-
VIX—IMPROVEMENT—DEATH FROM -
RECURRENCE OF DISEASE.
Mrs. T. H. N., aet. 39 years, married, and has
had five children and four miscarriages. Had
lead poisoning, and never fully recovered her
former strength. First noticed that menses was
unusually profuse about August, 1887, but did
not consult anyone till June 11th, 1888, when
I saw her and discovered the nature of the dis-
ease. The cervix was large, nodular and hard,
and bled profusely. The organ was not firmly
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The Pathological Society of Toronto.
fixed, but the inguinal lymphatic glands were
enlarged. After amputation of the cervix in
the usual way, she improved very much during
the next seven months, regaining her former
weight and being free from discomfort. The
disease recurred in the stump in March, 1889,
and she gradually ſailed, with the usual symp-
toms of pain, hemorrhage and fetid discharges,
and died September 27th, 1889. -
MALIGNANT TUM(OR OF THE LABIUM.
Mrs R., aet. 55, of good family history, and
no suspicion of specific taint, consulted me on
September 14th, 1889. She has had a large
family of healthy children, and no serious diffi-
culty in any of her labors. She suffers from
asthma and has vesicular emphysema. Four-
teen months ago, she noticed a small indurated
spot on the right labium near the junction of
the skin and mucous membrane, and this
induration has spread until the whole surface
from the anterior commissure to the middle of
the perinaeum is involved, and several spots of
pale ulceration exist on the cutaneous surface,
and also on the mucous surface of the lower
part of the vagina. No enlarged glands could
be detected anywhere, and the patient had a
good appetite, was well nourished and suffered
but little pain. The diseased mass was removed
on October 18th, 1889, and necessitated an
incision six inches long, the wound being of an
elliptical shape, three and a half inches wide in
the widest part. . It extended from a point near
the clitoris to the middle of the perinaeum, and
included the lower part of the vagina on the
right side. The wound healed readily, and the
patient is well. -
DEGENERATE KIDNEY witH SUPPURATING CAvi-
TIES AND CALCULUS,
Mrs. G., aet. 73. Seven years ago she noticed
an enlargement, the size of an orange, on the
right side of the abdomen on a level with the
umbilicus. It grew gradually, but gave little
pain or discomfort until a year ago, when it
began to hurt her to lie on her right side. For
three years she has noticed, at intervals of a
week or two, a discharge of a teaspoonful of
pus from the bladder after urinating and stand-
ing up. During the last ten weeks she has
passed thick pus with her urine every day.
The quantity of urine is about a pint daily, the
specific gravity io2-6, and the reaction acid.
There is no pain about the bladder or urethra,
and she can retain her urine as long as she could
when she was well. The tumor now extends
from the lower border of the ribs to the anterior
superior spinous process of the ilium, and from
the dorsal region to the median line in front.
It is moderately hard, smooth, somewhat ten-
der, and only slightly movable. From the date
of my first visit on the 28th of March, she gra-
dually failed, having pain, fever, and night
sweating until she died on July 1oth, 1888.
About a week before death there was a free dis-
charge of pus from the bowels. The autopsy
showed the kidney to be large, smooth and -
regular in form, and adherent to the under sur-
face of the liver, the ascending colon, and indeed
to all tissues with which it was in contact. The
pelvis was large and suppurating, and contained
an irregular shaped calculus which weighed 18o
grains. There were several pus cavities near.
the surface of the organ, and one of these com-
municated with the ascending colon by an
opening as large as a pencil. The inside of
the bladder presented no gross appearance of
disease, but its walls were very easily torn. She
was opposed to any operative interference, for
which her age and general condition were
unfavorable.
DEGENERATION OF BOTH OVARIES-RAPID GROWTH
• AND SUDDEN DEATH. -
Mrs. C. S., aet. 35, married and has had three
children; good family history. Was well until
six weeks before I saw her, when she noticed an
enlargement in the region of right ovary, but
did not consult any physician until four weeks
later when Dr. Bell, of Merlin, was called. At
his suggestion, I saw the case a few days subse-
quently. I found a well-defined tumor of the
right ovary, which seemed smooth and uniform
in shape, quite soft, and gave a sense of fluctua-
tion. It extended beyond the median line, and
rose two or three inches above the umbilicus.
Her temperature at the time of my visit was
102°F., her pulse 120, and she was weak and
anaemic, so that it was deemed prudent to post-
pone surgical interference until her condition
**
The Pathological Society of Toronto.
33
could be improved by general treatment. At
the end of a week she was free from ſever, her
appetite was better, and her strength somewhat
improved. This was Thursday, and it was
decided that I should see her early the follow-
ing week and perform abdominal section. On
Saturday, however, she became suddenly very
weak, her extremities cold and her heart so
feeble that her family became alarmed, and sent
in haste for Dr. Bell. She died before night.
At the autopsy the right ovary was found to
weigh ten pounds. It was semi-solid, smooth,
had a small pedicle, and on being cut open was
found to contain numerous small cysts in a
soft reddish succulent stroma. The whole
was friable, and even the more solid parts were
infiltrated with a greenish colored serous fluid.
There was about a quart of fluid in the peri-
toneal cavity. The left ovary weighed half a
‘pound, having begun to undergo the same kind
of degeneration. No cause could be discovered
in the abdominal or pelvic cavities for the sud-
den collapse and death.
UNUSUAL ARRANGEMENT OF THE BRANCHES OF
THE AORTIC ARCH.
Dr. Primrose showed a dissection of the great
vessels arising from the arch of the a rta, which
exhibited the following peculiarities: The first
branch arising from the arch was a common
trunk, one-half of an inch in length, which
bifurcated in front of the trachea into the two
common carotid arteries. The two carotid
arteries, after gaining the outer side of the
trachea, on the right and left sides respectively;
continued upwards in normal relation to the
air-tube and the other structures at the root of
the neck. The second branch arising from the
arch was the left subclavian ; arising one-half
inch from the origin of the first branch, it passed
upwards to the outer side of the left common
carotid artery, but lying on a plane posterior to
that vessel. The vertebral artery arose from
the subclavian, one and a quarter inches from
the origin of the latter vessel. The subsequent
course of the subclavian artery and its branches
of distribution were normal ; the left pneumo-
gastric nerve passed in front of the artery to
cross the aortic arch. The third branch from
the aortic arch arose one-half inch from the
origin of the left subclavian. It was the last of
the great vessels arising from the arch. The
two vessels last described arose from the super-
ior portion of the arch, whilst the right sub-.
clavian arose from the posterior aspect of that
vessel. The artery then coursed upwards and
to the right, crossing the spinal column and the
longus colli muscles obliquely, lying behind the
trachea and Oesophagus; the artery then lay on
the right side of the trachea, between it and the
right longus colli muscle; it then passed out-
wards behind the scalenus anticus muscle and
occupied its normal position, crossing over the
first rib. The vertebral artery was the first
branch given off, and the other branches of the
artery were normal in course and origin. The
left vagus nerve crossed over the aortic arch,
and its recurrent laryngeal branch ascended
behind the arch and crossed over the anterior
aspect of the right subclavian artery in its course
to the larynx. The right inferior laryngeal nerve
passed directly from the vagus to the larynx
without running behind the right subclavian
artery, and was therefore not recurrent.
HYDROCELE.
Dr. Cameron presented a specimen of a
hydrocele sac, which he had excised from a
young man who had received an injury in boy.
hood, and who had been the subject of recurrent
effusions into the tunica vaginalis ever since. '
There was no pain so long as the sac was full
of fluid ; great pain when the sac was empty.
There were two distinct portions of the sac ;
the specimen has been dissected by Dr. Prim-
TOS62. :
Dr. Primrose said he had made a partial dis-
section of the sac. The division of the tumor
into two portions, mentioned by Dr. Cameron,
was due to a constriction caused by a firm
fibrous ring. The explanation of the condition
is probably as follows: Originally, the hydrocele
was covered by a complete fibrous tunic, com-
posed of the normal coverings of the testicle; as
the hydrocele increased in size a hernia of the
tunica vaginalis occurred through its fibrous
covering, or, at all events, through a portion of
the fibrous layer. The opening in the fibrous
layer, through which the tunica vaginalis had
passed, enl rged somewhat, and the margins of
the opening thickened and thus formed a con-
stricting band dividing the hydrocele, as it in-
A
2°
& S. 4. .
6 ºz. . . . -
ing.
correct, one, then we can understand the for-
The Pathological
creased in size, into two distinct portions. The
thickened ring of fibrous tissue has been dissected
out and is well seen in the specimen. A very
Y. significant fact supporting this view is, that the
portion of the tumor representing the herniated
part of the tunica vaginalis possesses a very thin
covering, whilst the portion of the hydrocele
above is enveloped still by a firm fibrous cover-
If this explanation of the condition be a
mation of those hydroceles which appear to be
multilocular cysts, but which an introduction of
the cannula prove to be composed of a single
sac constricted in the middle. -
Dr. H. A. Macallum presented a
TU MOR OF THE BRAIN.
J. H., at 16, weight 75 lbs. This history
dates his illness back to June, 1889.
It began
with severe pain in head and vomiting. This
continued more or less severe till a few days
before his entrance into the London Hospital
(Nov. 1st). He then became stupid and dizzy.
When seen in the ward by the attending phy-
sician he appeared dull, and complained of
double vision, pain in the head, dizziness, and
sleeplessness. Temperature normal. Before
January he lost vision in left eye; the loss was
accompanied by paralysis of the sixth cranial
nerve on same side.
facial nerve. No loss of motion or sensation in
lit.1bs occurred. Liver enlarged and tender.
Died March 13th. Post mortem on March I3th.
Liver, lung, and kidneys were very much con-
gested; brain presented a tumor (a round-
celled sarcoma), involving the pons and pressing
upon and obliterating the left half of the cer -
bellum.
Dr. W. J. Burt presented an
, ODONTOME.
*
The patient from whom I removed this speci-
men was a young man, to whom I gave ether in
a dentist's office, for the purpose of removal
of his teeth. The first and second- molars on
the right side were drawn. The wisdom
- After January right eye
became blind, followed by paralysis of the left
Society of Toronto.

tooth on that side had not yet appeared. Two
months after renoval of the teeth an opening
took place in the cheek, opposite where the
second molar had been. The neck was fre-
quently lanced below, and in front of the first
opening. After the opening, a portion of the
jaw from which the molars were removed, pre-
sented a necrosed condition, and it was thought
nature would cast it off in course of time.
However, as the time passed by for a natural
separation, instead of becoming loose, the de-
nuded portion was firmly fixed and increased in
size, présenting the appearance of a small wal-
nut. It was then that I advised its removal.
The patient willingly cónsented, as the fistulous.
opening was a constant source of annoyance to
a rising young man. Ether was given and the
growth, after a couple of taps with a chisel, was
readily turned out with a pair of forceps. The
fistulous opening closed almost immediately...'
Some little time after this the patient again con-
sulted me for what he thought was a return of
the growth at the site of removal, when I dis-
covered a tooth presenting, quite roughened,
and which was most probably the wisdom tooth,
exactly opposite the scar on his cheek. Shortly
after its appearance it began to decay, and
although it is now a number of years since, he:
refuses to have the root removed, as he says the
jaw is quite weak. The body of this tooth has
decayed to the gums and has apparently been
very large. You will observe the portion of the
growth attached to the jaw or tooth presents a
honey-combed appearance, as if removed from
the cusps. To all appearances, it enveloped
the top of the tooth, and whether the margin
was attached to the alveolar process, I am not
prepared to say, but it has the appearance and .
the description that some pathologists give of
an odontome and which is considered a rarity.
PRIMARY SARCOMA of the LEFT KIDNEY.
This specimen was removed from a child 18
months old. The mother first noticed some-
thing wrong with the child when it was a year
old, and shortly afterwards a lump appeared in
the left lumbar region of a hard consistence. It
gradually increased in size, filling the space
between the crest and the lower rib, and eventu-
ally the whole of the left side of the abdominal
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The Pathological Society of Toronto.
35
cavity. Ascites gradually developed, the fluid
being very dark-colored. The urine contains
at times a slight amount of albumen and pus
Corpuscles. *.
all the other organs were normal. The father
had been an invalid for several years, and died
only a few months before the child. He had
suffered from a psoas abscess, Bright's disease,
and pleuro-pneumonia, a large abscess cavity
forming ultimately in one of the lungs.
ACRANIA AND TRIPLETS.
I have attended three cases of acrania, all
very similar; only one of the specimens I will
present. Hydramnios was present in all; in
one case very profuse. All the children lived a
short-time. I have nothing to say in reference
to these cases except that, in addition to the
many causes given for the over-production of
liquor amnii, I cannot help but think that a
portion of the fluid in these cases is cerebro-
spinal. In one case there had evidently
been a large meningeal tumor which shewed
evidence of a recent rupture of the membranes,
which were noticed lying in loose folds on the
head, and then we know how rapidly cerebro-
spinal fluid is produced, e.g., in cases of spina
bifida. It is well known from the history of
these cases that a pint will be reproduced after
tapping in a very short time. Then, again, the
functions of the cerebro-spinal and amniotic
fluids are in some respects, at least, similar. If
rupture of the meninges takes place during preg-
nancy, there will then be an intermingling of the
fluids within the membranes of the liquor amnii.
In these cases, too, when rupture does not take
place, there seems to be nothing to prevent the
intermingling of the fluids by osmosis. The
matter of this kind at rest.
The kidney weighed 44 ounces;
children.
analyst and microscopist will no doubt set a
As a contrast to
this specimen, I beg to present you with a card
of triplets. These children were born Nov.
19th, 1886, and weighed at birth 8, 7%, and 6
lbs., respectively. Although this specimen does
not appear to have a pathological bearing, I be-
lieve most of these cases have a pathological
influence. Even with twins, one is frequently
born dead; and in the case of triplets, I believe
that there can be but few specimens produced,
such as the specimens I now present you. Dr.
Omstein, of Athens, Greece, is at present act-
ively engaged in collecting information regard-
ing the longevity of triplets. In the case of
triplets, quadruplets, quintuplets, etc., multiple
foetation means certain death to one or all the
The children spoken of to-night are
still alive and healthy, and have every appear-
ance of living as long as any single birth.
PAGET's DISEASE.
This specimen was removed from an unmar-
ried woman, aet. 40. Eleven years ago she began
to complain of her left breast becoming swollen
and painful at times. A lump appeared between
the breast and axilla shortly afterwards. This.
enlargement disappeared ; but as it did so, the
breast became harder. About two years ago
the nipple became excoriated; scabs would form
and peel off. All about the nipple became
sore and the excoriation was spreading upwards.
A thick, whitish matter exuded from the nipple,
and continued to do so until its removal. Breast
very painful most of the time since the appear-
ance of the eczematous condition. There has
been no return of the trouble since the removal,
and the patient has improved generally since
the operation. -
PROCEEDINGS AND TRANSACTIONS
OF 'I HE
PATHOLOGICAL SOCIETY
TORONTO
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Publishki, For THE PArnological Society of “Torosto my THE J. E. BRVANT Co. (LTD.)
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OFFICERS AND COUNCIL
PATHOLOGICAL SOCIETY OF TORONTO.
SESSION 1890-91.
President : - . Vice-Presidentſ : 7?'easurer and Curator :
J. E. GRAHAM, M.D. A. McPheprAN, M.D. e. A. B. MacALLUM, , M.B.
Council :
J. E. GRAHAM, M. D. A. H. MACAI.I.U.M., M. B.
A. MC12H EI) RAN, M. D. J. M. MACCALLUM, M.B.
A. I’RIM Rose, M. B.
A'ecording Secretary: 1890, J. M. MACCALLUM, M.B.; 1891, GEO. Achesos, M.B.
* . Corresponding Secretary : A. PRIM Rose, M.B. ar
Microscopical Committee :
GEO. Achesos, M. B. - John CAvf N, M.I).
A. B. MACAI.I.U.M., M. B.
/.../S 7 OF ..]/E.1/A/EA'S OF 7'HE SOC/E 7"V.
| , - f Złonorary A/embers :
DR. Cou NCILMAN, Baltimore. - PROFEssor W.M. Osler, Baltimore.
PROFESSOR W. H. ELLIS, M.A., M. B. DR. A. R. Robinson, New York.
DR. WYATT G. Joli Nson, Montreal. PROFESSOR WEI.sh, Baltimore.
z PROFESSOR R. RAMSAY WRIGHT, M.A., B.Sc.
n i
- * * --- Corresponding ..}/embers : -
DR. BURT, Paris, Ont. - I)R. H. A. MacAllisi, London, Ont.
n Eccl.ES, London, Ont. n W. A. Ross, Barrie, Ont. -
GRIFFIN, Hamilton, Ont. , SHAw, I Iamilton, Ont.
n GUNN, Clinton, Ont. * TYE, Chatham, Ont.
in HENDERSON, Kingston, Ont. - - it WARDLAW, Galt, Ont.
, Hoi.MEs, Chatham, Ont. n Joh N WEBSTER, Kingston, Ont.
n IIow it"r, Guelph, Ont. - - a Wii ITE, IIamilton, Ont.
1)R. Wilson, Richmond Hill.
- Ordinary Members : •
ACHESON (GEORGE), M.A., M. B. MACALLUM (A. B.), B.A., M. B., PH.D.
AikiNs (H. Wilbek FORCE), M.D. - MACCALLUM (J. M.), B.A., M.D.
, AikiNs (W. H. B.), M.B. - * * NEvitt (R. B.), M.D. *
BARKER (L. F.), M. B. OLD RIGHT (WM.), M.A., \ ..
CAMERON (I. II.), M.B. - te OLMSTED (I.), M. B.
CAven (Jon N), B.A., M.D. { - PETERs (G. A.), M. B.
s, CAvºn (W. P.), M.B. - PRIM ROSE (A.), M. B., C. M. *-*.
' - FERGUsos (Jolis), B.A., M. D. . REEve (R. A.), B.A., M.D. - * ,
- Foster (C. M.), M.D. *- SCADDING (H. C.), M. D.
GRAHAM (J. E.), M. O. THISTLE (W. B.), M.D.
McKENziE (B. E.), B.A., M. D. WILSON (R. J.), M.D. -
McKeNziE (Thos.), B.A., M.B. WishART (D.J. G.), B.A., M.D.
McPheid RAN (A.), M.D. • WRIGHT (A. H.), B.A., M.B.
THE PATHOLOGICAL SOCIETY OF TORONTO.
Meeting held Oct. 25, 1896. The President, Dr. J. E. Graham, in the chair.
PRESIDENTIAL ADDRESS.
GENTLEMEN: I desire to express my thanks
for the honor you have conferred by elect-
ing me president of this young and vigorous
society. Had I been aware during the summer
of the honor conferred upon me, and that an
opening address would have been expected, I
would have taken some subject in pathology
which is at present uppermost and endeavored
to make observations upon it. Under the cir-
cumstances, I will not attempt anything of that
kind, but rather confine my remarks to some
general topics in connection with the study of
pathology in this city.
We are now entering upon the second full
year in our history, and we have every reason to
feel encouraged on account of the progress
already made. The number and variety of the
specimens presented at our monthly meetings
would compare favorably with older societies
in much larger cities.
It is also a subject for congratulation that
some of our members have had the time and
energy to devote thmselves to original research,
and that they have freely given us the result of
their labors. It is felt, however, that in this
department only a beginning has been made,
and that nothing short of a continuous rate of
progress will satisfy us. In this comparatively
young country, and in a city which only a few
years ago completed the fiftieth year of its
existence, we must naturally expect many ob-
stacles and discouragements in prosecuting the
study of pathology, a science which cannot be
regarded as popular. I wish very briefly to
take into consideration some of these difficulties,
and make a few suggestions as to their removal.
It will be impossible for us to mak meuch
progress as a society, especially in the domain
of original investigation, unless we can in some
way or other have two or three professional
men in our membership who can devote their
whole time to this branch.
So far we are indebted to two of our members,
Dr. A. B. McCallum and Dr. Caven. Dr. Mc-
Callum has been kind enough to examine
specimens and make reports when the work re-
quired was not quite in his line. We sincerely
hope that he will continue to give us this advan-
tage of his rare gifts and attainments. If, how-
ever, at any time he should engage in a course
of study more intimately associated with his
work as a lecturer, we might be to a great extent
deprived of his valuable assistance.
Dr. Caven has not yet received a reward
commensurate with his work, and we cannot
expect to always continue under such disad-
vantages.
Some members of our society who have
recently commenced practice have done excel-
lent work—with them, however, as with others
before them, when patients become more
numerous, their time will be so taken up with
clinical work that they will not have much
leisure to devote to original investigation.
It is, therefore, in my opinion, necessary in
order to advance the science of pathology that
we should have at least two men who are suffi-
ciently well paid to devote their whole time and
energy to this subject–one to take up general
pathology, including pathological histology, and
the other to confine himself to bacteriology.
I do not think it would be difficult to con-
vince our Provincial Government of the great
necessity of establishing a bacteriological labora-
tory in connection with the Provincial Board of
Health, which should be superintended by a
thoroughly competent man, whose salary should
be paid out of provincial funds. -
Really, a board of health is very much
cramped in its operations without such a labora-
tory. The testing of drinking-water cannot now
be properly made without examination for germs.
Enquiries into the origin and progress of
epidemics cannot be properly made without the
aid of a competent bacteriologist. Then, it
2 p - THE PATHOLOGICAL SocIETY OF Toronto.
must be remembered that these minute beings
attack and destroy the lives of domestic animals,
trees, and plants, and that their discovery might
lead to the adoption of measures which would
result in the saving of thousands of dollars to
our country.
If these and similar arguments were used, our
legislators would see the great advantage to the
country of such an institution. They would
only have to refer to countries in Europe to find
out that every large health board has such a
laboratory connected with it.
lf these views should meet with your approval,
it might be well for us as a society, or as indi-
vidual members, to lend our assistance to the
Provincial Board of Health in their endeavors
to carry on this work. -
The presence in this city of a thoroughly
Competent bacteriologist, who could devote his
whole time to that science, would be of immense
benefit to us. So many pathological processes
are in some way connected with the presence of
bacteria that we ought always to have some
authority to whom we could refer.
I propose to separate it from pathology, as
there is in it sufficient scope for the abilities, ener-
gies, and the whole time of any one engaged in it.
There are two or three different ways in which
we can assist the professor of pathology in his
work.
The medical college which properly endows
a chair in pathology will, other things being
equal, be the most successful in securing stu-
dents. We are inclined to put too much money
in buildings. It would be better, in my opinion,
to retain a first-rate man, by paying him a proper
salary, than at once to build a pathological
laboratory. A really good man will be sure to
find room and apparatus for his work.
In reading the accounts of coroners' inquests,
we are often astonished that general practitioners
are required to give opinions on post mortem
appearances, sometimes of a very obscure char-
acter. How can it be expected that one who
does not perhaps see more than two or three
post mortems a year can make a proper repôrt in
any case for a coroner's jury P Under present
circumstances, post mortems cannot be made in
any other way. If a pathologist were appointed
for each district, whose business it would be to
make such examinations, the result of coroners'
inquests would be more valuable than is at pre-
sent the case. We would then have a class of
men who would have an excellent practical
knowledge, and who would become good mem-
bers of our society. The specialist in pathology
might be better supported than he is at present
by the general profession. How frequently
some of us send specimens without enclosing
any fee. It is true that, in many cases, no
money is obtainable, but in others a fee could
be secured if asked for. -
These are matters which may perhaps seem
scarcely what might be expected in an address
before such a society as this, but they are of a
practical character, and of great importance to
the development in this city of the science in
which we take so much interest. -
The majority of our members are not patho-
logical histologists, but rather students of clinical
work. We must not forget that the study of
pathological processes, as they take place in the
living subject, are really more important than the
study of the results as they are found on our
post mortem tables, and that the careful observa-
tion of these processes are equally the work of
members of this society. It is probable that
enquiry for the future will be made in the direc-
tion of the chemical and microscopical examina-
tion of the fluid secretion and excretion of the
human body when the subject of disease, rather
than into the microscopical examination of dead
tissue. -
It is therefore pleasing to know that we have
all work to do, whether in the microscopical,
chemical, or purely clinical field. During the ,
past year our indefatigable secretary undertook
to receive descriptions of specimens to be pre-
sented, had a number of copies printed, and
distributed to the members. In this way each
one obtained beforehand a good idea of the
programme, and was able to direct his reading
accordingly. It is to be hoped this year, when
the secretary takes so much trouble to provide
us with the programme, we shall not only hand.
in reports of specimens, but also to some extent
read the literature, so as to enter into the dis-
cussion with more profit.
MALIGNANT GROWTH OF THE PERITONEUM.
Dr. H. C. Scadding presented a specimen
from a book-keeper,' aged 68, a ruddy, stout,
THE PATHOLOGICAL SOCIETY OF TORONTO. 3
healthy man, who was, in January last, seized
with acute pain of a “bursting” nature, referred to
the region of the left nipple. This, which was
thought to be angina pectoris, was relieved by
the use of nitro-glycerine. In May he again
sought advice, complaining of pain in the same
region, and in the stomach, no ha-matemesis or
melaena ; for this pepsin was given. He again
appeared during August, and was found to have
rapidly run down and to have lost a great deal
of flesh. There was now found a tumor in the
left anterior axillary line. Death ensued after
two weeks of severe pain. Post mortem examin-
ation revealed the fact that the omentum, the
surface of the liver, under surface of the dia-
phragm, and the mesentery, were studded with
nodules of new growth The tumor found in
the axillary line had involved the fourth, fifth,
and sixth ribs, and projected, pushing the pleura
before it. This tumor, which was found only
two weeks before death, was no doubt secondary.
Dr. McPhedran regarded the case as one of
primary malignant growth of the peritoneum, for
the peritoneal surface of the liver and of the
diaphragm were covered by innumerable small
growths, like a lot of cherries scattered over it.
These growths did not in any way implicate the
substance of the liver or of the diaphragm.
Drs. A. B. Macallum, J. Caven, and Acheson,
took part in the discussion.
The specimen was referred to the microscop-
icar committee for further examination, to re-
port at the next meeting.
- cAleULI IN URETER.
Dr. John Caven presented a kidney, in the
ureter of which were lodged, about half an inch
apart, two calculi, the nearer being an inch from
the pelvis of the kidney. The specimen had
been obtained from a child eight years of age,
who had hip-joint disease. The liver, spleen,
and kidneys had, to the naked eye, the amyloid
appearance, but no reaction could be obtained
from the use of iodine in either alcoholic or
aqueous solution. The kidney was really of the
large white variety. There was no hydrone-
phrosis, so that the ureter had not been occluded. |
It had been suggested that during the examina-
tion of the kidney the calculi had been forced
into the ureter. The fact that there was not
any destruction of the kidney substance showed
this to be impossible. Urine was seen to pass
from the end of the cut ureter, making its way
past the calculi, which were angular. This ex-
plained the escape of the kidney. The bladder
was normal.
Dr. Thistle said that on four occasions dur-
ing the life of this patient there had been
almost complete suppression of urine, with
symptoms of uraemia, followed in a few days
by the passage of blood in the urine and the re-
lief of the symptoms. There had, however,
never been any complaint of pain such as occurs
in renal colic. -
Dr. McPhedran was of the opinion that the
uraemic attacks, which had been occurring for
the last three or four years, were dependent not
upon the calculi, but rather upon the kidney
condition. There had never been any pain
complained of which would give rise to a sus-
picion of renal calculus.
INTESTINE OF CHRONIC DYSENTERY.
Dr. W. P. Caven presented the intestine of a
woman, aged 48, who had been twelve weeks in
bed with symptoms showing great irritation of
the bowel. When the patient was seen by him
she was in a moribund condition, having, during
the night, some twenty-four profuse watery
evacuations—foul Smelling, and containing pus
cells. Palpation discovered some tumor of the
transverse and descending colon, painful on
pressure. Pulse, 14o; temperature, subnormal.
Post mortem examination showed all the organs
anaemic, especially the lungs, but otherwise nor-
mal. The large intestine was found greatly
thickened throughout, studded with numerous
small ulcers, which extended into the muscular
coat. Just above the sigmoid flexure was a
stricture. He regarded the case as one of
chronic dysentery. Is the stricture the result of
this or of previous attacks? He did not think
it malignant. Dr. Cameron had seen the patient
in consultation with another physician, who told
him that she had had typhoid fever. At the
time of consultation defervescence had existed
for a month or more. At that time she was evi-
dently suffering from ulceration of the intestine.
Dr. Ferguson suggested that the stricture was
an old one. . gy
Dr. Graham thought that the ulceration was
not due to the stricture.
ULCER OF PYLORUS.
Dr. H. W. Aikins presented a specimen of :
4 THE PATHOLOGICAL SOCIETY OF TORONTO.
ulcer of the pylorus from a middle-aged man,
who had been seized with sudden, intense pain
in the stomach, and had died twenty-four hours
later. There was no history of previous illness,
burn, or trauma. The pylorus was not stenosed.
There had not been found any extravasation of
blood, nor any ecchymosis in the stomach around
the ulcer.
Dr. McPhedran thought that the peculiar
position of the ulcer in the pylorus indicated
that the ulcer was of malignant origin, yet there
was nothing in the appearance of the specimen
to corroborate the idea.
Dr. Cameron thought the position of the ulcer
pointed to a foreign body as the cause.
Dr. John Caven exhibited a number of micro-
scopic specimens.
The first was from the small intestine of a
horse, and had been sent to the exhibitor as
showing the enteric lesions of typhoid fever.
The history was said to be that of typhoid. Ex-
amination showed dense small cell infiltration
of all coats of the gut, in minute spherical-shaped
patches, visible to the naked eye. In most of
these patches a mass of micrococci were to be
seen, centrally located. There was no ulcera
tion nor abscess formation, although the appear-
ances were those of pyaemia. No cultivation or
inoculation experiments were possible, since the
material was received in alcohol.
The second exhibit was of specimens showing
a supposed phagocytic operation of giant cells.
The exhibitor has come to the conclusion that
there are two distinct forms of giant cell, both
of which can be seen in tuberculosis. There
appears to be (1) a giant cell which fills the office
of a phagocyte. This cell has no processes con-
necting it with the surrounding connective
tissue. It is multi-nuclear, and frequently con-
tains pigment in large quantities. The general
tendency of this cell is to roundness in shape;
this was illustrated by a specimen of an epithe-
lium in one of the cell masses, of which a num-
ber of giant cells were found which had appar-
ently removed a considerable part of the mass,
and were engaged on the corneous tissue in its
Centre.
Another illustration of the phagocytic type
was shown in specimens of tubercle in which
were giant cells laden with pigment.
In connection with the phagocytic role of
giant cells in cancer, the experiments of Pod-
wisotsky's on hepatophagues are interesting.
He induced necrosis of liver tissue by injec-
tions of pure alcohol, and found that the
necrosed mass was removed by giant cells.
These giant cells he has named hepatophagues.
The second form of giant cells is one which
is fibro-blastic in its function. This form has
distinct and numerous processes connecting it
with the surrounding connective tissues. It
carries no pigment. It has a tendency to
become oblong or oval in shape, is frequently
found on the outskirts of a tubercle nodule, and
appears, in some cases at least, to spring from
the wall of an alveolus in the lung. No bacilli
have been seen in this form. tº
Dr. Acheson exhibited microscopic speci-
mens of pus containing gonococci from the
vaginal discharge of a young girl, 7 years of age,
and from a case of ophthalmia monatorum.
Dr. Graham asked if the case was to be
regarded as one of gonorrhoea, because the
gonococci were found. Such discharges were
often found in children. *
Dr. Acheson replied that for a diagnosis of
gonorrhoea it was necessary. that the cocci
should be found in pairs and chains in pus
cells, and surrounded by a capsule. In this
specimen the clear spaces surrounding the pairs
could be easily made out.
Dr. Primrose presented a card specimen of
necrosis of tibia, which had been prepared by
standing for five months in a weak solution of
liquor potassae. -
The society then adjourned.
THE PATHOLOGICAL SOCIETY OF TORONTO. 5
Meeting held Mov. 29, 1890. The President, Dr. J. E. Graham, in the chair.
NEPHRITIS, PROBABLY DEPENDENT UPON
- PERNICIOUS ANAEMIA.
Dr. J. E. Graham presented the kidney, spleen
and liver, and read the following history, taken
on admission to the hospital : W.F., aet. 25;
occupation, overseer of a saw-mill; admitted
October 13th, 1890. No trace of any heredi-
tary disease, habits temperate, never was over-
worked; had usual diseases of childhood, except
scarlatina; five years ago had pneumonia of the
right lower lobe. About six months ago he be-
gan to feel out of sorts, having pains throughout
his body, with considerable weakness and pro-
fuse epistaxis every day. These symptoms have
continued to the present. His father said he
had been anaemic for more than six months
before he complained of his present trouble.
A short time before his first feeling unwell he
had been rafting logs and received a thorough
yvetting, followed by a chill and severe cold.
He is 5 ft. 9% in. in height, and weighs 1.68
pounds; well-developed, and muscular. Face
has a slightly yellow tinge, and shows marked
anaemia. There is some oedema of the ankles
and lower part of the legs. t
Alimentary System.—Lips pale, teeth dark in
color, but sound, gums pile, tongue coated with
a whitish fur and soft, appetite very good. No
marked thirst. During the last six months he
has been subject about once in three weeks to
attacks of sick stomach, which terminate in vomit-
ing. Bowels are fairly regular, has never suffered
from continuous diarrhoea, but has had short
attacks of it. Liver situated lower than normal,
abdominal walls fleshy, abdomen full, no pain or
tenderness, no fluctuation. - “e
Circulatory System.—Inspection : A forcible
heart impulse can be seen. On palpation a
heaving sensation can be made out at the apex,
which is displaced to the left in a line with the
nipple. Percussion : the area of dullness is in-
creased. Auscultation: the heart sounds are loud
and clear, and can be heard over a considerable
area. The second sound is accentuated. Pulse,
74, strong, full, and tense. -
A'espiratory System.—Breathing, twenty-one
per minute, natural in type, no cough or ex-
pectoration. Inspection reveals nothing abnor-
mal. Palpation shows diminished vocal fremi-
tus over the lower lobe of the right lung before
and behind. Percussion: a light dullness over
lower lobe of right lung. Auscultation: over the
chest generally the breath sounds can be dis-
tinctly heard, and the expiration is more plainly
heard than usual. The sounds are weaker over
the lower part of the right lung.
Orinary System.—No pain in loins, bladder,
or urethra, until this last week; from the begin-
ning of his illness, he has had to rise twice in
the night to urinate ; for the past week he has
not had to do so. He generally passes his urine
four or five times a day. In quantity it is less.
than formerly, being now about five or six cup-
fulls in a day. It is pale, acid, contains no
sugar, but considerable albumen. On micro-
scopic examination, abundant granular casts
are Seen, *
Mervous System.—Sometimes experiences con-
siderable itching of the skin. Patellar tendon
reflex well marked. His sight is not as good as
it was once. However, on having his eyes ex-
amined by Dr. Burnham, his sight was found to
be normal. Dr. Burnham said that his retinae
were typical of albuminuric neuro-retinitis, with
brilliant shining radiating lines of exudation. w
Progress of Case.—Oct. 29th. For a week
past he has been drowsy at times. He has
vomited considerably and had frequent epistaxis.
Examination of his blood showed that the red
corpuscles were 8oo, ooo to the cubic millimeter;
there are a number of microcytes, darker in
color than red corpuscles usually are. There
are a few megalocytes which are paler in color.
There is no poikilocytosis to speak of. White
corpuscles relatively, but not absolutely, in-
creased. Size of corpuscles as follows:
Red 6% mikrons in diameter.
Microcytes 2-4 | | | | ! {
Megalocytes 8-Io in | |
Urine : as far as could be ascertained, the
amount is small. No sample for examination
has been obtained for a week.
Remarks. At first Bright's Disease was sus-
pected. From the examination of the blood, how-
ever, pernicious anaemia was diagnosed for the
following reasons: (1) the history; (2) the ap-
pearance of the blood; of course in nephritis we
have changes in the blood, but not so marked
6 THE PATHOLOGICAL SOCIETY OF TORONTO.
as in pernicious anaemia; (3) the condition of the
liver post mortem; it was chocolate colored. The
kidney showed tubal nephritis with some inter-
stitial infiltration also, and marked fatty degener-
ation. Retinal hemorrhages might be found in
either Bright's Disease or pernicious anaemia
The view of the case entertained is that the
nephritis followed on pernicious anaemia.
Dr. Acheson asked if there were any patho-
logical changes in the peptic or intestinal glands,
such as are frequently found in cases of
pernicious anaemia. He thought the condition
of the kidney might be accounted for as a result
of pernicious anaemia. A haematogenous tubal
nephritis was to be expected. -
Dr. A. B. Macallum said some observers
diagnosed pernicious anaemia by the presence
of megalocytes; and as none were reported over
ten mikrons, it would be concluded that this was
not a case of that disease. Rossibly, however,
in this instance the few megalocytes, which are
of diagnostic value, were overlooked. He finds
that there is a peculiar change in the endothelial
lining of the capillaries of the liver, in acute
yellow atrophy of that organ ; the result of
albumose poisoning; and he thinks the same
change may be brought about in the liver of
pernicious anaemia, and the sections shown sup-
port this view. ſº
Dr. McPhedran thinks the examination of th
blood will not bear out the diagnosis of perni-
cious anaemia in this case ; nor was the condi-
tion of the urine suggestive of that. The urine
in Dr. Graham's patient was pale, he (Dr. Mc-
Phedran) finds the urine dark in color, while of
a low specific gravity, especially after the febrile
exacerbations. He asked whether gross speci-
mens of the liver had been tested for free iron.
Dr. Oldright referred to a case of kidney
disease where the condition of the organs was
very similar to this case.
Dr. McPhedran in answer to a question by
Dr. Acheson, said he believed the condition in
pernicious anaemia to be one of haemolysis.
Dr. Acheson agreed that the condition was in
all probability a true haemolysis due to the
absorption of albumoses from the intestinal
canal. t
Dr. Graham, in reply, said the post mortem
in this case was unfortunately very imperfect.
In regard to the color of the urine he was of
opinion that in most cases of pernicious anaemia
it was high colored and of fairly low specific
gravity. There was no examination of the liver
for iron. The diagnosis of the case was diffcult,
and he could not be certain about it. The
general appearance of the patient and his mode
of death were those of pernicious anaemia; while
the epistaxis, retinal hemorrhages, and Oedema,
are found in both diseases.
MAMMARY TU MOR.
Dr. Oldright presented the specimen, and gave
the following history: Miss D., aged 40, un-
married, has suffered for some years with pain
in the left mammary gland, and latterly it has
extended to the shoulder and arm. The breast
has been enlarged, the lobes being somewhat
hard and tender. Dr. Oldright ordered ano-
dyne applications and alteratives. About seven
or eight months ago it was observed that one
of the axillary glands was somewhat enlarged,
and in concert with Dr. W. T. Aikins, removal
(of breast and gland) without further delay was
advised. From various causes this advice was
not acted upon until ten days ago. A few
weeks ago one of the glands in the upper part
of the posterior triangular space of the neck
was found to be enlarged and tender, but this
condition ceased after the removal of an aching
tooth. The case was a somewhat peculiar one,
The specimen was referred to the Microscopical
Committee for examination and report at the
next meeting.
DIAPHRAGMATIC HERMIA.
Dr. Olmsted, of Hamilton, presented a speci-
men, and read the following history :
Arevious history : In June, 1881, the patient,
George J–, was marking at Victoria Rifle
Ranges. By some mistake he went out to
examine the target without putting up the dan-
ger flag, the result being that one of the marks-
men shot from a point, nine hundred yards
distant, piercing the body of J., and scored
a bullseye. J. said he felt a stinging sensation
in left side followed by a feeling of warmth,
but did not know that he was shot until he
saw blood on the target. He then turned and
ran towards the shooters, shouting like a mad-
man. Ater he had gone about three hundred
yards he fell. When assistance arrived, patient
was very much frightened and vomited a small
THE PATHOLOGICAL SOCIETY OF TORONTO. 7
quantity of blood. There was an opening in left
side of thorax posteriorly about two inches to left
side of spine, and between the seventh and eighth
ribs, where the bullet (44 cal. Remington) en-
tered, and another anteriorly between the fifth
and sixth ribs, in mammary line, caused by its
exit. Surgeon Griffin, of 13th Battalion, informs
me that the patient had an attack of pneumonia
after the accident, but was quite well in about
two weeks. Nothing more was heard of J.
until March 14, 1890, when he walked into the
hospital and said he was suffering from consti-
pation. He was very reticent, and hence little
or no history of his case was taken. After he
had been in the hospital a few days, I am told
he developed peritonitis, which caused death in
two days, viz., 21st March, 1890.
The following is a condensed report of the
Aost mortem notes taken nine hours after death,
viz.: George J., aet. 45; powerfully built, rather
Corpulent man.
Abdomen. On opening abdomen, intestines
were found very much distended and glued to
the upper and left side of the abdominal wall
with recent lymph. About 500 cc. of reddish
fluid in abdominal cavity. That portion of
the small intestine which is bound to the wall
was of a dark-greenish color and semi-gangren-
ous. The ascending and transverse colon were
very much distended. On tracing this bowel
up it was found to pass through an opening in
the left leaflet of the central tendon of the dia-
phragm. The descending colon emerged from
this opening and was very much contracted ;
stomach was displaced to right.
Thorax. On raising sternum, the anterior
border of the right lung was emphysematous
and pleura adherent. Left pleural cavity con-
tained 150 cc. of a reddish fluid ; lung pushed
up and contracted, not descending lower than
third rib. The lower part of cavity was filled
with a mass of colon, covered by the great
omentum, the whole mass measured 9.5 cm.
wide, 12 cm. in antero-posterior, and projected
Io cm. into pleural cavity. The opening in
the diaphragm corresponded to the interval
between the fifth and sixth ribs, and 7 cm. to
left of median line. At the anterior and pos-
terior part of the hernia were two condensed
: masses of fat and omental tissue, while a thin
ſlayer of omentum covered the surface of gut.
Around the opening in the diaphragm was astrong
constricting band formed from old inflammatory
deposits, also some recent lymph. The omentum
was bound to the upper surface of diaphragm,
and the walls of the intestine to the under sur-
face. The pleura was thickened. The hernia
contained hardened masses of faeces. Water
could be injected from the ascending colon into
the hernia, but not from descending, thus show-
ing complete obstruction. On attempting to re-
move the specimen, the posterior surface of gut
was found to be greenish-black in appearance,
and so soft that a small rent was made into it,
notwithstanding the great care taken.
From the appearance of the 'hernia it was
judged that it had existed for years, although
there was no history of his having suffered,
except occasionally, from shortness of breath.
The heart was displaced somewhat to the right.
All other parts normal:
HIP DISEASE.
Dr. B. E. McKenzie presented a specimen
and made the following remarks on the case,
and on the pathology of hip disease :
The notes of the history of the disease in
the case from which this specimen was taken
are incomplete. M. H., female, aet. 8 years,
was one of a family of three children, one of
whom died of convulsions in infancy, and one
is now in the Hospital for Sick Children under
treatment for caries of the spine. The child
was admitted to the hospital suffering from hip
disease, in Oct., 1886, under the care of Dr.
McPhedran. There is no note to show the
condition at time of admission, but her tempera-
ture varied at that time between the normal and
101°F., and an abscess was opened shortly after
admission. Occasionally, for a few weeks at a
time during her continuance in hospital, the
evening temperature did not go much above 99°F.
Generally, however, the evening temperature
ran up to Ioo” or Io I°F., and occasionally
reached 1 oA"F. During all this period there
were suppurating cavities, and for the latter part
of the time numerous sinuses, which could be
found to connect with intrapelvic sources of
suppuration. No operation was at any time
performed other than that necessary to drain
abscess cavities.
At examination post mortem firm ankylosis of
the right hip was noted, also adduction of the
8 - THE PATHOLOGICAL SOCIETY OF TORONTO.
limb to about 30°. There was no shortening,
measurement being made from the ant. sup.
spines of the ilium. There was slight lordosis,
showing a slight amount of flexion. Upon thesur-
face there were noted six sinuses, two ant. to and
lower than the ant. Sup. sp. process, two behind
and below the gr. trochanter, and two about the
crest of ilium. The viscera were characterized by
marked amyloid degeneration. No tubercles
were noted in the lungs; but several bronchial
glands were found in a condition of calcareous
degeneration, and the mesenteric glands were
slightly enlarged. The kidneys were firmly
bound down and imbedded in inflammatory
tissue. In the right ureter were found two
angular calculi which readily permitted th
passage of urine. º
The right os innominatum and upper half of
the femur were removed. The inside of the
pelvic bone was thickly covered by inflammatory
exudate, which was traversed in all directions by
sinuses; and some small pockets of pus were
found. One sinus passed through the ischium
and is indicated in the specimen. The section
through the femur and the pelvic bone permit
the osseous union between the two to be well
seen. The fact that the head of the femur and
the acetabulum have not “travelled upward,” as
they so frequently do in old hip disease, is prob-
ably due to the treatment adopted—by traction
upon the limb by the weight and pulley, thus pre-
venting the head of the femur from being pulled
up against the upper portion of the acetabulum.
It is now very generally held that “hip dis-
ease " is an ostitis of tubercular origin, in nearly
all cases, and that it generally begins about the
femoral epiphysical junction.” Occasionally,
however, the disease begins in the acetabulum,
and extends afterward to the joint and involves
the femur. Gibney records a case of double
hip disease, which, upon post mortem examina-
tion, showed the tuberculous focus to have
originated in the acetabulum on one side and
in the head of the femur on the other.f
The various centres of Ossification, because
of their physiological activity, form fertile soil for
the development of tubercle. The tuberculous
process having begun in the bone, a long time
*Wright: Hip Disease in Childhood, p. 17. Bradford & Lovett:
Orth. Surg., pp. 214 and 255. Gibney : Diseases of the Hig, pp.
17o et sqq. Macnamara : Diseases of the Joints, 1887, pp. 419
and 437. #Cibney : Diseases of Hip, p. 181.
may elapse before the intra-articular structures
become involved. Macnamara, Wright, of Man-
chester, Emmet Holt, Cheyne, and others, show
specimens that reveal the articular surfaces
normal in appearance, longitudinal section of
which shows tubercular faci centrally situated in
the bone. Though the contiguous joint sur-
faces may not reveal anything abnormal, yet
symptoms probably due to reflex nervous action
may be present, giving clinical evidence of the
disease.
In adults it is claimed that the disease origi-
nates more commonly as a synovitis.
In the specimen here presented it is probable
that the disease began in the acetabulum, and
at an early date perforated its floor. While there
is evidence of extensive destruction here, the loss.
of tissue in the femoral portion of the articula-
tion is not great.
The specimen is interesting in several particu-
lars: (1) It shows the effort on the part of nature
to bring about a cure by ankylosis. (2) The
natural tendency to produce adduction, thus
leaving a shortened limb on the diseased side,
and curvature of the spine. (3) Marked
atrophy of the shaft of the femur, probably
greater than can be accounted for by disuse.
(4) The inutility of operative measures when the
disease has attacked the acetabulum and made
much progress. * *
The exudate about the sinuses has been ex-
amined for bacilli—with negative results up to
the present:
Dr. McPhedran said when the patient was
admitted to the hospital there was flexion. This
was gradually overcome and the prospects were
good for a time, but abscesses and sinuses.
formed, and the patient went down hill.
Dr. Acheson asked if bacilli have ever been
found in the discharges from hip disease.
I)r. McKenzie replied that bacilli have been
found in the diseased tissues, but not in the
discharges. g
Dr. Graham presented a specimen of malig- .
nant disease of the pylorus.
Dr. Cameron presented a specimen showing
stricture of the rectum, multiple ulcers in the
colon, and perforation of the transverse colon.
Drs. McPhedran and Graham took part in the
discussion, and Dr. Cameron replied.
}
THE PATHoLogical sociETY of Toronto, ,-- 9
º,
REPORT of MICRoscopical committee.
. The Microscopical Committee reported on
the specimens submitted to them as follows:
1. The tumor from the peritoneum in Dr.
Scadding's case (see page 2) was a myeloid
Sarcoma, showing in some places a structure
strongly resembling carcinoma. Being derived
from the peritoneal endothelium, there was a
possibility that there might be a transition from
a connective tissue tumor to a true epithelioma.
2. The ulcer of the pylorus presented by Dr.
H. W. Aikins (see page 3) was a simple ulcer.
3. The rectum from the case of chronic
dysentery, presented by Dr. W. P. Caven (see
page 3), showed thickening of all the coats of
the bowel, especially of the submucosa, and the
endothelial cells of blood-vessels were in many
places greatly enlarged ar.d proliferating, prob-
ably the result of albumose poisoning. There .
were also foci of inflammatory infiltration here
and there. , - -
The Society then adjourned.
-- Meeting held Dec. 18, 1890. The Aresident, Dr. J. E. Graham, in the chair.
The Society met in the Biological Depart-
ment. Dr. A. R. Robinson, of New York, read
a paper on
PSOROSPERMOSE FOLLICULAIRE végéTANTE.
Under the name of psorospermose folliculaire
végétante, M. M. Darier and Thibault, in 1889,
described a peculiar condition of the skin
which had probably been previously con-
founded by dermatological writers with other
cutaneous affections, and which was already
separately described by Dr. J. C. White, of
Boston, under the name of keratosis follicularis.
According to Darier, there exists in man a
group of cutaneous diseases which merit the
name of pserospermoses, being due to the
presence in the epidermis of parasites of the
order sporozaires, of the group psorosperms or
coccidia. In one of these diseases the coccidia
of a particular species invade the follicular
orifices of a greater portion of the cutaneous
surface, where they appear in the form of
round bodies, generally encysted and contained
in the epithelial cells, or as refracting granules,
the accumulation of which forms a plug which
projects from the orifice of the follicle. “The
presence of these bodies enables one to make a
diagnosis of the disease, as they are not met
The
with in any analogous clinical affection.
neck of the follicles invaded become second-
arily the seat of papillomatous vegetations,
which can develop to a great degree and form
real tumors. The affection, from an etiological
point of view, should be placed with Paget's
disease of the nipple, and probably with mol-
luscum contagiosum.” *
The disease called molluscum contagiosum,
according to Neisser of Breslau, is caused by
psorosperms, but this view has not yet secured
anything like general acceptance, many patholo-
gists, including myself, regarding the molluscum
bodies as chemically changed epithelial cells
and not organisms, although believing the di-
sease to be a communicable one and parasitic in
nature. In epithelioma, especially that clinical
form known as Paget's disease of the nipple,
which was generally considered to commence
as an eczematous process, Wickham has en-
deavored to show that psorosperms are very
abundant, and argues with much force and
plausibility that they are the essential factors of
the disease, and the cause of the anatomical
changes which occur.
Returning to the subject of my paper, Darier
showed a case of psorospermosis follicularis at
a meeting of the International Congress of Der-
matology and Syphilis held in Paris in 1889,
occurring in a man forty-two years. of age, in .
whom the disease had lasted seven or eight
years, commencing insidiously and later assum.
ing an aggravated form, especially during the
last two years. The following is an account of
the eruption as taken from the transactions of
the Congress:
4
tremity, with a sebaceous aspect.
and there is no oozing of blood.
IO THE PATHOLOGICAL SOCIETY OF TORONTO.
“The isolated lesions had the appearance of
papules surmounted by a crust; but if the
latter be removed it is seen to be not a crust,
but a small, obtuse horn plunged into a
dilated follicle orifice, and having a softer ex-
The margins
of the orifice are somewhat elevated and papu-
lar in character. In the axillary and especially
inguinal regions the lesions are larger, con-
glomerated, and forming by their union true
tumors, which become excoriated on their sur-
face. Where the eruption was confluent, as on
the sternum, scalp, axil'aé, and back, there
were brownish crusts, more or less fatty to the
touch, and formed by a series of irregular hard
formations rather adherent to the skin.” *
In an article in the Annales de Dermatologie
et de Syphiligraphie, he summarizes the clinical
aspects of the cases studied as follows:—“The
lesions are almost always spread over the greater
part of the cutaneous surface, but have points
of election where they attain a maximum of
development, or at least of confluence; they
are, the scalp, face, presternal region, flanks,
and especially the inguinal regions. In the
first stage the elementary lesion is a small
papule surmounted by a dark brownish or
grayish crust, which is dry and hard to the
touch, adheres firmly to the integument, and is
a true horn, imbedded in an infundibuliform
depression by a conical or cylindrical extremity,
dirty white in color, of semi-solid consistence,
and somewhat fatty to the touch. The de-
pression of the skin which receives this horn is
slightly entormé at the margins, a little ele-
vated, and manifestly corresponds to a dilated:
orifice of a hair-sebaceous follicle. Where the
lesions are confluent there is a brownish or
earthy-like layer in the skin more or less fatty
to the touch ; there is a series of irregular com-
pact elevations giving a rasp-like feeling to the
hand. Removal of this layer shows the skin
irregular and rough, riddled with small, funnel-
shaped orifices; the epidermis is not destroyed,
In a more
advanced stage the lesions are larger; in certain
parts the elevated margin is deprived of epider-
mis and appears ulcerated, whilst sebaceous
matter, either pure or mixed with pus, can be
pressed out of the follicle orifice.”
The disease commences as small papules the
size of a pin-head and almost of the color of .
normal skin; as they increase in size they be-
come somewhat hyperaemic, and in an advanced
stage they are hemispherical or flattish in form.
The summit of some is excoriated by scratch-
ing, and carry a hemorrhagic crust. When the
lesions become confluent they form elevated
patches covered with flattened, yellowish or
brownish corneous or fatty concretions; or the
corneous mass may form marked elevated col-
lections, or even papillomatous growths.
Microscopical examination of the lesions in
the cases observed by Darier showed the ac-
cumulation of special matter in the neck of the
follicle, changes in the epidermis, especially in
the rete, and some circulatory disturbance in
the corium. The secreting portion of the
glands was unaffected. Sections showed that
the neck of the hair and sebaceous gland follicle
was the principal seat of the lesions, but not
exclusively. “The neck of the follicle is di-
lated, cone-shaped, and filled with a coherent
mass of corneous-like material, which extends
from the base of the cone to above the general
surface, and corresponds to the adherent crust
already described. The rete is hypertrophied,
as shown by the presence of abnormal projec-
tions of this layer into the corium, both on the
general surface and along the hair follicle.
There is also a papillomatous growth of the , ,
corium towards the epidermis. These changes :
Darier believes are due to a special organism
appearing under the form of round bodies,
nucleated and surrounded by a thick membrane,
N
and situated in the interior of the epithelial
cells, displacing or pushing aside its nucleus.
They are present in great numbers in the base
of the cup, whilst the horny plug is composed
in great part of these same bodies, which here
have become transformed into refracting gran-
ules. They are also present in all portions of
the rete layer. In old lesions the projection of
the rete into the corium and the papilloma-like
new formation of connective tissue was very
marked, and resembled closely the condition
present in epithelioma.”
Dr. J. C. White, of Boston, has described
under the condition keratosis follicularis two
cases with very similar clinical conditions to ,
those present in Darier's cases. Sections were
studied by Dr. Bowen from these cases and he
THE PATHOLOGICAL SOCIETY OF TORONTO. ,
i I
N g - tº te º º
found similar histological changes to those above
described. There was dilatation of the mouths
of the follicles, the enlarged space was filled
with a horny mass, there were prolongations of
the rete into the corium, the glandular
structures were not implicated in the process,
and the so-called psorosperms were present.
These peculiar bodies escaped Dr. Bowen's
special notice until after Darier's description,
just as they escaped, much to my regret, my
notice in a case observed by me about eight
years ago, although they were plentiful in some
of the sections. Dr. Bowen was not satisfied,
however, that the psorosperms were ever intra-
epithelial in his sections, and furthermore he
found that the horny plugs were not made up,
as Darier states, of simply refracting granules
but of corneous cells, the result of a hyper-
keratosis. “Microscopically, sections cut paral-
lel with the long axis of the horny plug showed
the round psorosperm-like cells at the base of
the concretion, and they could be traced up-
ward some distance, gradually becoming flat-
tened and fused together, until in the firm,
hard, upper portion the mass is composed
almost entirely of lamillae having much the ap-
pearance of broad bands of fibrous tissue, ar.
ranged in bundles running vertically and ob-
liquely and containing small elongated nuclei.”
As the bodies in question are said, when situ-
ated in the granular layer, to contain granules
V
characteristic of this layer of the epidermis, and
show the same reaction to staining agents when
in the stratum corneum as do the tissue cells.
of the part, Dr. Bowen thinks they must un-
dergo at least a partial keratosis, a change not
to be expected of an animal parasite.
In the Journal of Cutaneous and Venereal
JDiseases for 1886, Dr. Morrow, of New York,
described a rare case of cutaneous disease
under the title of keratosis follicularis, and this
case has been referred to by Dr. White
in his article as presenting many features in
common with his cases. As I made a most
careful microscopical examination of some of
the-lesions in this case and failed to find any
psorosperms or signs of special activity of the
present.
rete or of inflammation of the corium, I will
briefly refer to the clinical characters that were
The eruption occupied the entire fol-
licular apparatus of the skin, with the exception
of the face, palms, and soles. The ducts of the
sebaceous glands projected above the general sur-
face and filled with a comedo-like substance,
which in some cases formed projecting plugs from
one-quarter to half an inch in length. This mater-
ial, when pressed out, was hard and dry in the
outer portion and softer within the follicle.
Removal of the plug left the duct dilated and
projecting. None of the follicles showed evi-
dence of irritative action or signs of inflamma-
tion, differing in this respect very greatly from
the cases described by Darier. Microscopical
examination showed a hyperkeratosis of the
follicular orifice and a comedo-like collection
of material in the central part of the lesions.
I have had one case of this condition under
treatment or observation during the last seven
years. He was first a patient of Dr. Ludwig
Weiss, of New York, and has been seen by all
the New York dermatologists, who regarded the
case as an example of lichen ruber of Hebra
when shown before the Dermatological Society
about seven years ago. That was before Darier
described his cases. Last year Dr. Lustgarten
saw him and recognized the affection as analo-
gous to those described by Darier and White,
and hence if there is such an entity as psoro-
spermosis follicularis cutis, this case should be
regarded as Dr. Lustgarten's case of that disease.
With this statement I will now give a short history
of the eruption as observed during a severe stage
of the disease. M. L., male, aet. 49 years, was
in good health until he entered the United
States army during the civil war. The eruption
appeared after he had been about one year in
the service, the lesions forming upon the fore-
head and sternum and consisting of small dark-
red papules. Since that time the eruption has
never disappeared, although varying greatly as
regards objective and subjective symptoms at .
different periods. The eruption gradually ex-
tended, so that at present it occupies the greater
portion of the body. As already stated, the
eruption commenced as dark-red, elevated
papules, which after a time, owing to increase
in the number of lesions within a given area,
gave a rough, rasp-like feel to the fingers, and
presented many of the characters of lichen
ruber of Hebra, and was diagnosed as such by
all the dermatologists who observed the case.
Whether any of Hebra’s cases would be diag-
12 , , , THE PATHologigal society of Toronto. . . . . . -
nosed to-day as examples of psorospermosis fol-
licularis cutis or not, must remain a question.
At present the patient has an outbreak of the
eruption, that is the eruption is in its severest
form, and the present description refers to this
stage. •
Head : Partial alopecia of the scalp, thinning
of the hair, most marked upon the upper and
frontal parts. The entire scalp is thickened,
less movable than normal, and covered with
crusts of varying thickness, dirty yellowish in
color, and fatty to the feel. Upon removal of the
crusts the dilated orifice of the excretory duct
of the sebaceous glands is very distinct; but no
plugs are present, that is, there is a condition
very similar to that of the crusty form of a
'seborrhoeal eczema. Left ear : Thickened, in-
flamed, and at junction with the head there is a
papillomatous condition like in eczema vuru-
cosum, whilst at the free margin the surface is
red and moist, like an eczema rubrum. The
skin of the external auditory canal is thickened
and covered with a thin layer of fatty scales, as
in seborrhoeal eczema. The right ear is normal
except at junction with head, where the condition
is similar to that on left ear. Face: The skin is
thickened and muddy-like in appearance from
hypertrophy of the corneous layer, with marked
dilated sebaceous duct orifices over the entire
surface, but most marked upon the nose. Upon
the back of the neck the condition is similar to
that upon the face, except that the follicular
orifices are not so distinct. A few lesions pin-
point sized or somewhat larger, reddish in color,
and having a hair in the centre; others pinhead-
sized, and reddish and slightly flattened, without
a hair, are present. On both shoulders there is
a large number of isolated or grouped pinhead
to pea-sized yellowish-brown or dirty brownish-
red elevated lesions, covered with a few scales.
The orifice of a sebaceous duct can be seen in
the central part of many, but no plugs like those
described as existing in Darier's cases were
present. If the scales or crusts were removed
the skin was found to be slightly red, and some-
times oozing of blood followed their removal.
The scales could be removed in a lamellar form.
The pea-sized lesions showed the same charac-
ters as the smaller ones, except there was more
scaling, and upon removal a shining epidermis
was left. In some places grouping of the lesions
was marked and coalescence was observed in
some places. Where lesions have existed and
disappeared, the part is pigmented and shows
slight atrophy. Upon the back, from scapular
to lower part of the lumbar region, the eruption
is very general, symmetrical in distribution, and
somewhat pyramidal in form. The lesions
number perhaps 300 to 4oo in number, and at
the lower part of this field are isolated, and of .
somewhat similar character as that of the large
lesions already described, i.e., are dark-red,
elevated, sharply limited, and covered with dirty-
white or brownish scales, not easily detached.
There are no follicular orifices to be seen and
no plugs. In the central part of this area the
lesions are not so elevated, are of a brighter red
color, and not scaly. They are firm and the
skin is infiltrated. Where lesions had existed
pigmentation was left behind. In some places
lesions much like those in some chronic diffuse
patches of lichen planus were present, and could
not be diagnosed from this eruption in some
areas as large as two inches in diameter.
Front of thorax: Upper part to second rib,
like eruption on shoulders; below second rib to .
a line below nipples part-covered with hair. On
right half of this area there is much pigmentation
and a few lesions the size of a large pinhead.
Over the sternum and beyond for some distance
there was a moist red skin covered with crusts
composed of serum and fatty degenerated
epithelial cells, the whole aspect being similar to
that of moist seborrhoeal eczema in the central
portion of an ordinary papular eczema toward
the periphery. The itching is intense in this
region. The whole of the right side of thorax
and abdomen between the line of the nipple
and that of the axilla is studded with lesions of
all sizes, from pin-point to pea-sized, but the
majority are large pinhead sized, and over large
areas they have coalesced. They have similar
characters to those upon the shoulders, i.e.,
elevated, sharply limited, covered with scales or
crusts, but nothing like plugs are present, nor
are the follicular orifices distinct. In the um-
bilical region the condition is exactly similar
to a moist eczema seborrhoicum of this part.
The lower part of the abdomen is similar to the
parts just described. The penis and scrotum.
are free ; the legs are also free. . . .
Arms: Inner side from axilla to two inches.
i
r
THE PATHOLOGICAL SOCIETY OF
TORONTO. I3
above the elbow from fifty to one hundred pin-
head-sized or larger lesions of similar character
to those of shoulders. Forearm : Left side, ex-
tensor surface, elbow to wrist, an infiltrated
patch with isolated lesions at centre; the rest
infiltrated and scaly, like an eczema in chil-
dren more than a lichen planus. At the lower
part near wrist there is serous exudation with
yellowish crusts like in impetigmoris eczema—a
suppurative catarrhal dermatitis and red surface
beneath. The inner surface of the forearms is
free except upon the lower half; there are a few
isolated lesions. Right forearm same as left,
but the extensor surface is now free. The
palms were never af-
All the corneous cells are larger and more poly-
gonal in shape than normal, especially in the
lower strata. The rete is hypertrophied in some
places and normal in others. There is growth
downward of the interpapillary portion also.
The granular layer and the stratum lucidum are
less distinct than usual. The papillae are larger
from the interpapillary growth of the rete ; the
blood-vessels are dilated, and there is some
exudation and emigration present. The sweat
glands are normal except the duct in the corne-
ous layer, the walls of which are formed with
large cells, some of which have vesicular nuclei.
The hair follicles are unaffected except at the
orifice, where there is
fected. Back of hands
and fingers: Isolated,
closely seated, small
pinhead-sized, slight-
ly red lesions, with
hair in centre, in many
making a picture very
similar to that in pity-
riasis pilaris Devergie.
Nails: Thick, broken,
deformed, like in ec.
zema, but there is no
eczematous condition
of fingers. Nails of
feet similar to those
of the hands.
It will be seen from
the above description
that this case evident-
ly belongs to the same
FIG. I.
a large collection of
corneous cells. The
muscle bundles are .
much hypertrophied.
In old papules there
is a continuation of
the same process, and
after a timeretrograde
changes leading to
atrophy of the part ;
or there is a return to
a normalcondition by
cessation of theabnor-
malkeratosis process.
The corneous layer is
much thicker than in
a recent papule, but
the character of the
corneous elements as
regards size, shape,
class as those describ-
ed by Darier and White as far as objective
characters are concerned, although there were
no plugs, properly speaking, in this case, but
rather collections of sebaceous matter and epi-
thelial cells upon the general surface.
Microscopical examination : I removed seven
years ago several pieces from the patient and
found the following changes: A recent papula
showed the corneous layer to be greatly hyper-
trophied from an increase in the number and
size of the corneous elements. There was also
an aberration from the normal process of corni-
fication, as many of the cells contained nuclei.
The nuclei are particularly abundant at the
orifices of the sweat glands and hair follicles.
etc., are the same.
The rete is hypertrophied and its upper surface
uneven. The cells are not larger than normal,
and in many places are no smaller from pressure
by the corneous layer. The cutis papillae are
but slightly enlarged, the papillary blood-vessels
somewhat dilated, and there are a few round
cells, emigrated, outside the blood-vessels. The
muscles are hypertrophied. In the centre of old
papules a retrograde process often occurs, con-
sisting in a degeneration of the rete and de-
struction of a portion of the underlying corium,
The process, therefore, is a para-typical keratosis.
In fig. 1 is shown a drawing from a section of
the earliest papule I could find upon the body.
It was very small, pinhead in size, slightly ele


sº
*
14 THE PATHOLOGICAL SOCIETY of Toronto. . . . . . . . .
wated, firm, whitish in appearance, and without
a scale or crust. When excised I was in doubt
as to whether it represented a lesion of the di-
sease or not. The drawing is intended to show
the epidermis and the peculiar bodies present in
it. The corneous layer is slightly thickened,
the rete hypertrophied, and at the mouth of the
follicle is a collection of the so-called psoro.
sperm bodies. Similar bodies were found in
sections from every lesion, although some sec-
tions would not contain them although the
epidermis changes were present. I need not
enter into any detailed description of them at
present, as they are similar to those described
by Darier, and also because I intend discussing
their nature in a future paper, as I have a con-
siderable amount of recent material in my pos.
session which, I think, will enable me to obtain
an insight into their nature and significance
as concerns this particular cutaneous condition.
I will only state that no psorosperms were ever
found near the general surface, so that the argu-
ment of Dr. Bowen is supported by my speci-
mens. I might further state that although I saw
these bodies seven years ago, I regarded them at
that time as merely peculiarly changed epithelial
cells without any special significance.
In considering the significance of these bodies,
the following questions require our consideration
and study : (1) Are they found in every well-
marked case of the cutaneous condition above
described? (2) Are they present in every lesion
in the earliest stage of formation? (3) Are they
present in other dermatoses P (4) Are they
organisms ? (5) Are they the cause of th
cutaneous lesions? -
(1) Are they found in every well-marked case
of the cutaneous condition described by Darier P
With the exception of Morrow's case, they have
been present in all the cases. They were not pres-
ent in the case of Dr. Morrow, for I examined
lately many sections from this patient and none
were to be found; but an analysis of the symp-
toms shows, I think that apart from the pres-
ence of epithelial plugs, the case bore no
resemblance to the conditions existing in the
other described cases. We may therefore con-
sider that, in all the cases so far reported, these
each other.
swered at present as I am not aware that the
point has been studied, as the drawings from
Darier's cases and White's are from sections of
lesions of some duration, as shown by the pres-
ence of plugs and the rete proliferation. I
have examined one lesion in the earliest stage
of recognition, before it showed signs of crust or
plug formation or changes in the corium, and
found large numbers of these bodies as shown.
in fig. 1. It is fair, therefore, to presume that
they are present in all lesions at the earliest
stage until the contrary is shown. & -
(3) Are they present in other dermatoses P
I have examined sections from cases of eczema
squamosum, eczema veruccosum, psoriasis,
lichen planus, pityriasis pilaris Divergie, naevus
sinus lateris, rodent ulcer, squamous epitheli-
oma, and molluscum contagiosum. In none
except rodent ulcer and squamous epithelioma
were these bodies to be found. In lichen planus
an occasional cell, not to be distinguished per-
haps from a psorosperm, was found, but they
were probably only vacuolated epithelial cells of
the rete. I will not enter into a description of
the bodies present in epithelioma, as Dr. Mac-
Callum will discuss that subject. I wish only
to draw attention to the great difference in the
clinical course of psorospermosis follicularis cutis
and epithelioma, and to state my conviction that,
if both depend upon psorosperms these bodies
cannot be identical ones but only related to
* (4) Are they organisms ? As already stated,
I will postpone a discussion of this subject
for a subsequent paper upon the subject, merely
stating at present that the existence of such a
group of peculiar bodies as exists in fig. 1.
cannot be traced to the invasion of the epi-
dermis by leucocytes, as they evidently existed
before circulatory changes began in the corium.
(5) Are they the cause of the cutaneous
lesions P If it is proven that these bodies
are organisms, that they are present in the
very earliest stage of the cutaneous disease, that
they are present in every lesion at its commence-
ment and that they are not present in other
dermatoses, that their presence by analogy
drawn from the known action of psorosperms
peculiar bodies have been present.
... (2) Are they present in the earliest stage of
all the lesions? This question cannot be an-
upon other tissues, either in man or the lower
animals, would explain satisfactorily the ana-
tomical changes occurring in the part, then I
THE PATHoLOGICAL SOCIETY of Toronto. . 15.
|
ſ : ſº - . : - - s * * - - -
^ = -
think we must conclude that these bodies are
the cause of the disease, and that the condition
described by Darier as psorospermosis follicu-
laris végtanté represents an entity—a special
cutaneous disease. . .
In the case of the patient whose eruption I
have described, there is one peculiarity as regards
the spread of the lesions that apparently at
least is opposed to the disease depending upon
psorosperms. He informs me, and I have been
able to substantiate his statements, that he has
at indefinite intervals acute outbreaks of the erup-
tion, that is, the disease is kept up by successive
acute outbreaks of new lesions, which gradually
subside and finally disappear, to be followed by
formations of new lesions whilst the old ones
are undergoing retrograde changes, or after
many have entirely disappeared. During these
acute attacks he feels very ill for several days,
as the tissues in which they are found are path-
ological, it is not surprising that the latter pro-
duce abnormal elements. One observer con: .
siders them to be endogenously formed cells.
In regard to the latter theory, it may be stated
that there is no well authenticated observation
of the occurrence of endogenous cell-formation,
as pathologists understand the phrase, in the
animal and vegetable kingdom. The conditions
under which life has existed and does exist on
the globe are so varied that, if cell life is cap-
able of reproduction in this fashion, numerous
instances would be at hand for exemplification.
If we grant that in neoplasms there is but an
exaggeration of the elements of the normal
tissue growths, and if we admit that in normal
cells and tissues there are no endogenously
formed cells, we must be prepared to reject this
explanation of the origin of the structures found
“every part of his body hurts him "; he is con-
fined to his bed or room; then hundreds of
lesions appear, after which there is an interval
of comparative relief. This has been supposed
by one writer to depend probably in this case
- upon malaria, but I find no ground for such a
diagnosis; neither do I think the general con-
ditions can depend upon the presence of psor-
osperms, or it would be a more continuous one.
It is the one point in the history of the case that
seems incompatible with the view that the lesions
depend upon such bodies as psorosperms; but
as this condition was not observed in the other
cases described, it is possible that the general
condition has no relation to the cutaneous dis-
order.
The whole subject is one of great interest, and
well worthy of further study; and its importance
is, I trust, a sufficient excuse for my bringing
the subject before the members of the Patho-
logical Society.
. In the discussion which followed, Dr. A. B.
Macallum said: -
In Paget's disease of the nipple, as well as in
. . . epitheliomata, there are structures which are of
great interest in the settlement of the problem
of the pathology of the disease. Similar struct-
ures are, as Dr. Robinson has just demon-
strated, present in keratosis follicularis. The
nature of these structures has now become a
matter of discussion amongst pathologists, some
maintaining that they are parasitic; others, that
in epitheliomata, Paget's disease of the nipple, .
and in keratosis follicularis. My own view as
to the origin of these structures is divided be-
tween the two explanations: -
(1) That they are parasitic (sporozoa).
(2) That they are leucocytes. -
Against the first explanation, it has been
urged again and again that the structures can-
not be sporozoa because they do not manifest
the mode of reproduction and other points in.
the sporozoon best known, viz., Coccidium oviforme
of the rabbit. This objection indicates, I think,
a rather inexact acquaintance with the characters
of the sporozoa; the occurrence of sickle-shaped
spores, which one objector urged as the test in
this case, being only found in some forms,
while our present knowledge of the characters
of the class demonstrates that there is a great
diversity in the form of the reproductive
elements, and even in the mode of repro-
duction. At present the characters of this
division of the protozoa are too little known,
and therefore we are not in a position to deter-
mine the exclusion from it of forms which may
after all be only aberrant examples of the class.
It seems to me that definite decision cannot be
given between the two-views. Whether they
are leucocytes or not, one may say with some
certainty that they are parasitic. In the nipple .
in Paget's disease the organisms are large, often
greatly exceeding in size the original epithelial,
cell, and they frequently present all the details.
16
THE PATHOLOGICAL SOCIETY OF Toronto.
of structure found in a vigorous cell. If they -
are leucocytes, then they are out of place in the
interior of the epithelial cell; and as they must
thrive at the expense of the cell and irritate the
latter, they are parasitic. When an epithelial
cell is so irritated, its disturbed metabolism
must affect the neighboring epithelial cells.
An inflammation of a chronic character arises,
and if the endocytes are of leucocytic origin,
examples of them are multiplied and the area
of their distribution increased. That leuco-
cytes penetrate other cells is shown by observa-
tions on the livers of patients affected with
acute yellow atrophy or pernicious anaemia, etc.,
and in acute atrophy they give rise, apparently,
to structures which are as large as they are in
the nipple in Paget's disease. One can readily
imagine that in a struggle between a vigorous
epithelial cell and a vigorous leucocyte con-_
tained within it the victory is not always
on one side, and yet there is one con-
stant result: the nutrition of the part is dis-
turbed. This, of course, touches on the ques-
tion why epithelial cells become so pathologic-
ally vigorous as to give rise to neoplasms, but
I do not intend to deal with this just now.
Why, on the other hand, vigorous epithelial
cells should permit the entrance of leucocytes,
and under what conditions, is a question which
I cannot answer ; but vigorous cells do permit
the penetration of parasitic elements, as shown
by observations on the life history of various
sporozoa.
Dr. John Caven said that he had not had an
opportunity of studying cases of keratosis such
as were spoken of by Dr. Robinson, and could
therefore offer no opinion with regard to the
psorosperm origin of that disease. He had,
however, during the last two years, been mak-
ing a special study of cancers of all varieties,
and particularly squamous epitheliomata, for
the purpose of satisfying himself as to their
causation. The conclusion he had reached
was that so far there is nothing like definite or
even probable proof of the presence of such
organisms in carcinomata. That there are
bodies present, particularly in epitheliomata,
which differ greatly from ordinary epithelial
cells, both in appearance and in reaction with
staining reagents, of course cannot be denied.
fied epithelial cells. Certain other elements
have been pointed out which, to a certain ex-
tent, resemble the so-called psorosperms of
Darier. These, the speaker thinks, to be leuco-
cytes. Their position in the centre of the
masses of epithelial cells shows that they are not
the cause of irritation and proliferation. Their
absence from the neighborhood of blood or
lymph vessels is readily explained by their
power of amoeboid movement and the fact that
minute channels can be seen, in which they are
sometimes lodged, between the periphery of
the cell masses and the central corneous nest
of cells in relation to which the organisms are
most commonly collected. The fact that when
these so-called organisms are most abundantly
present the corneous central masses are always
more or less destroyed, points to a phagocytic
action rather than parasitic. Then it is to be
noted that very often these cells are multi-
nucleated, just as the supposed destructive
leucocytes should be. Lastly, that leucocytes
enter and destroy epithelial cells in new growths,
the speaker can demonstrate from his prepara-
tions.
Dr. Robinson replied.
CIRRHOTIC LIVER,
Dr. J. E. Graham presented a specimen from
a patient in the Toronto General Hospital. A
barber, aet. 38; no previous history of disease
before his admission, but no satisfactory history
could be obtained. As far as could be made
out, he was fairly well until ten days before
coming to the Hospital. Then he had pain in
the head and back, chills and fever, and had
been in bed for some days. On his admission
he presented the typical appearance of a ty-
phoid fever patient: tongue coated, temperature
Io2” F., pulse 90, respirations 20. Marked
tympanites, tenderness in the right iliac fossa,
and very much enlarged spleen. On the back
there were two or three typical typhoid spots
near the spine. On the second or third day
after his admission he had an intestinal hemor-
rhage, which, strange to say, did not reduce
his temperature. After five days he had a
hemorrhage from the stomach, and died in an
hour or so. The haematemesis was suggestive
of something besides typhoid. At the autopsy
These, the speaker at present thinks, to be modi- there was found no evidence of typhoid fever
s THE PATHoLOGICAL Society of Toronto. . . 17
in Peyer's patches, but there was marked cir-
rhosis of the liver. - -
Dr. John Caven reported further that the
spleen on fresh section was typical of cirrhotic
induration, and weighed 19 oz. There were no
bacilli found. A small abscess was found in
the-mesentery, close to the caecum, which was
at first thought to be due to appendicitis, but
the appendix was healthy, and further investi-
gation showed the abscess to be due to a sup-
purating mesenteric gland. The gall bladder
was of the size of an ordinary kidney, and con.
tained pus. The fever in this case was proba-
bly the result of the suppurative process in the
gall bladder.
Dr. McPhedran remarked that these profuse
hemorrhages were often due to a varicose con-
dition of the veins of the oesophagus. -
Dr. Nevitt said that he had seen a specimen
of the kind referred to by Dr. McPhedran.
The exhibitor of the specimen stated that a
blow-pipe was necessary to demonstrate the
dilated veins post mortem.
Dr. Caven had not examined the veins of
the Oesophagus.
NECROSIS OF THE FEMU R.
Dr. Ferguson exhibited a specimen of necrosis
of about two inches of the entire diameter of
the shaft of the femur. The dead bone was
removed, and perfect recovery took place with-
out deformity.
SARCOMA OF THE ORBIT.
Dr. R. A. Reeve presented a specimen from
a man, aet. 48, who had suffered from symptoms
of blindness of the right eye for three months.
Three months later there was detachment of
the retina and intense pain. The eye was
enucleated because he was sure of the existence
of a tumor, and he thought the detachment of
the retina was due to sarcoma of the choroid.
The enucleation was as complete as possible,
and the wound healed. The specimen was .
not kept, but was examined at the time, and a
melanotic tumor was found occupying one-third
of the vitreous chamber. - f
In October, 1890, he saw the same patient,
who had then a pigmented tumor of the orbit,
the contents of which were eviscerated and zinc
chloride applied. The case was of interest
from the length of time between the appearance
of the first and second tumors. He did not
consider it a case of melanotic sarcoma. Mel-
anotic sarcomas are the most malignant of
tumors. Sometimes the tumor is encapsuled
and can be removed in the early stage in its
entirety. If in the first instance he had failed
to remove all the growth, it would have recurred
earlier. This, however, did not return for
fifteen years, and therefore it was not a true
case of recurrence. Possibly the elements of
the disease lay quiescent in the deep part of the
orbit, apart from the original tumor. He sug-
gested that possibly the artificial eye that had
been worn constantly for fifteen years had
acted as an irritant and produced the second .
tun) Or. - -
Photographs were exhibited showing the dif.
ferent stages of the disease. - -
Dr. John Caven stated that the second tumor
was a mixed, round, and spindle-cell sarcoma.
The meeting then adjourned.
Meeting held Jan: 31, 1891. The President, Dr. J. E. Graham, in the chair.
The Society met in the Biological Building.
Dr. Oldright presented -
(1) PATENT DUCTUS ARTERIOSUS
-- from a girl, aet. 20. Seen last September, was
somewhat anaemic, with Oedema of the feet, and
albumin in the urine ; no heart murmur. After
four weeks in bed she had a right hemiplegic |
- seizure; no facial paralysis. This passed off
and she died the week after. Towards the end
hands. The autopsy showed a patent ductus
arteriosus, with vegetations on the pulmonary .
side of the opening of the duct; also some
atheroma of the pulmonary valves. The liver .
was slightly fatty, the spleen fully six times the
normal size, and the vermiform appendix con-
tained some hard faecal concretions. .
Dr. McPhedran, who saw the case, had
thought it was hysterical from the symptoms
manifested. The heart was fairly normal as far .
'... there were some purpuric spots on the face and |
as he could remember, and the liver was some-
I8 THE PATHOLOGICAL SOCIETY OF TORONTO.
what enlarged. He could not say what was the
cause of death. - - •º
Dr. Peters thought it peculiar that the only
abnormality should have been the patent ductus
arteriosus; there was no other deformity. The
prevailing current had been in the direction of
the pulmonary artery. He thought, however,
that no murmur was heard in connection with
the second sound because of the vegetations on
the aortic valves. He had a case under his
care in which he had diagnosed five separate
murmurs, one of which he thought to be due to
a patent arterial duct. He would say the aorta
in this case of Dr. Oldright's was fatty rather
than atheromatous. -
Dr. McPhedran asked what was the general
experience as to the occurrence of aorticlesions
in children.
Dr. Peters remarked further, in reference to
the hemiplegia, that it was probably from an
embolus derived from the vegetations on the
aortic valves, rather than from the pulmonary,
and the hemiplegia would be on the opposite
side if from the pulmonary artery.
Dr. Oldright replied.
(2) TRAUMATIC PERFORATION OF THE
INTESTINE. g
The man was said to have been kicked on
the belly; he walked home after the injury, and
subsequently developed symptoms of peritonitis.
An operation was thought advisable, but he
suddenly became collapsed and died thirty-six
hours after receiving the injury. A post mortem
examination revealed injection of the peri-
toneum, intestines glued together, deposits. of
lymph and a large quantity of pus in the peri-
toneal cavity. On the ileum, six or seven
inches from the caecum, was found a rupture
seven-eighths of an inch in length on the
anterior aspect of the gut. He asked how soon
pus could form in such a case.
Dr. Peters said that depended on the defini-
tion of pus; if it means leucocytes in a serous
fluid, then it might form immediately after an
injury. -
Aº (3) EPULIS.
From a woman who presented herself with a
slight tumor just posterior to the left lower
canine. The trouble began last spring with
aching of the teeth. She had some teeth
drawn, but the growth increased in size. He
removed the growth with part of the alveolar
margin of the jaw, cutting well clear of the
growth.
Dr. J. Caven found it to be a mycloid sar-
COma, giant cells in a spindle-cell matrix, and
containing processes of bone. -
Dr. Peters said that the practice now is to
thoroughly remove the growth, but not neces-
sarily any of the bone from which it grows.
(4) MILKY-LOOKING FLUID FROM A CYST OVER
THE OLECRAN ON. .
This was removed from a man, aet. 63, who
had been suffering from rheumatism. Over
the olecranon there was a flat ovoid body which
felt like a flat exostosis, or fibrous tumor. The
nature of the fluid had not been determined,
except that it was not pus. He thought the
crystals it contained were probably lime salts.
Several of the members, on examining it
microscopically, decided that the crystals wer
leucin and tyrosin. -
ULCERATIVE ENDOCARDITIS.
Dr. L. F. Barker presented a specimen and
read the history of a case of ulcerative endocar-
ditis :
Kate G., aet. 35, unºmarried, entered Toronto
General Hospital Aug. 16th, 1890, under care
of Dr. A. McPhedran. Only history of previous
illness is that of anaemia, nine months ago, when
she suffered from palpitation of the heart and
noticed oedema of ankles. These symptoms
disappeared under treatment. Very ill with la
grippe last winter. Family history shows a pre-
disposition to tuberculosis, mother dying at
forty, and one brother at twenty-six, of con-
sumption. Patient has herself complained of
cough every winter for last three years. Two
weeks before entering Toronto General Hospi-
tal she commenced feeling weak and languid ;
noticed slight, hacking cough. One night she
perspired profusely. On August 12th she
“gave out” entirely, going to bed with vomiting,
headache, and chilly sensations. On admission
to ward 24, her temperature was Io.3; ; respira-
tion, 20 ; pulse, Ioo - - .
States that she had capricious appetite, occa-
sionally ravenous before going to bed. Face
shows wearied expression, with some cyanosis ;
THE PATHOLOGICAL SOCIETY OF Toronto. 19
\
patient breathing through widely opened mouth.
Skin, a dirty-brownish hue, dry and hot. Veins
of hands show a magentatinge.
Circulatory system.—Pulse, 1oo, small, low
tension. Heart, apex-beat, 2% in. below left
nipple and in a line with it.
forcible, tumultuous; loud blowing murmurs
replacing first sound at apex and over xiphister-
num ; pulsation in veins of neck.
A'espiratory system.—Respirations labored, 32
per minute ; slight cough, no expectoration ;
dyspnoea, particularly on exertion ; full breath
causes pain in left side. Percussion reveals
dulness over left lower lobe; bronchial break-
ing over same area. . -
Zhe urine.—Pale yellow, slightly acid ; sp.
- gr. IOI8, cloudy, trace of albumen (picric acid
test); no sugar; nothing abnormal seen on micro-
scopical examination. -
AVervous sys/em.—Severe fronto-vertical head-
ache ; delirious at night
Digestive system.—Tongue, dry, brown and
fissured; sordes on lips; some carious teeth;
great thirst ; complete anorexia; constipation;
some abdominal tenderness; liver slightly en-
larged; spleen, markedly enlarged.
The blood.-An examination showed diminu-
tion in the number of red blood corpuscles,
about three million to 1 c.m.m. There was a
considerable degree of leucocytosis. The w.b.c.
were large, and some of them contained two or
three nuclei. Dr. McPhedran found as many
as seventy leucocytes in one field (Leitz syst. 7,
ocular 4). The specimens which I examined
were not so rich in leucocytes.
The case was diagnosed by Dr. McPhedran
as one of acute ulcerative endocarditis and the
prognosis pronounced unfavorable.
The bowels were opened by enema, and Io
grains of antipyrin given to relieve the severe
headache; sponging when temperature above
Io.2%. Thirty minims of tincture digitalis with
five minims of liquor strychninae were given every
four hours, together with liberal doses of brandy.
The patient gradually grew worse, delirium
becoming constant. On August 21st great
abdominal distension came on. This was re-
lieved by passing long rectal tube. She had
dysphagia the next day, gradually grew weaker;
dyspnoea became more marked ; there were in-
voluntary evacuations of faeces and urine ;
patient died at 6 p.m.
Beat, diffuse,
infarctions, as well
Aost mortem.—August 23rd : Ante mortem
clots found in aorta and pulmonary artery.
Sixty c.c. of fluid in pericardial sac, non-inflam-
matory. Endocardium stained bright red.
Mitral valve showed shallow ulcerations along
“line of contact.” Both sides of heart dilated;
dilatation of left auricle particularly noticeable.
Wall of left ventricle hypertrophied. Evidences
of dry pleuritis over left lower lobe. Lower
lobe of left lung consolidated in state of gray
hepatization ; same condition in lower portion
of upper lobe on same side. Spleen weighed
370 grammes; very friable; hemorrhagic in-
farcts present. Kidneys showed cloudy swelling
and infarctions. In the liver one noticed some
as pigmentary and fatty
degenerations. The uterus proved to be a
most beautiful specimen. There were a large
number of small fibroids connected with it, sub-
peritoneal and interstitial. Section through
these showed the typical “whorling” of the
leio-myomatous fibres. The ovaries were both
diseased, containing hemorrhagic cysts. -
Remarks on the case.—A careful study of the
history of the case and the clinical phenomena
leads us to accept the following view : -
The patient had been profoundly anaemic for
some time, as shown by above history of dysp-
noea, pallor, palpitation and Oedema. Possibly
she was leucocythaemic, though the size.of the
spleen did not exceed what one might expect
from a general septic infection. Moreover,
microscopical examination failed to discover
any increase in the lymphoid tissue of kidney
or liver. The debilitated system formed a
favorable nidus for the development of certain
bacterial forms, and on Aug. 12th the complete
prostration was due to either the onset of acute
pneumonia in the left lower lobe or the cardiac
ulcerative process. One would be rash to
make any positive statement regarding the re-
lation of heart lesion to lung lesion. Were the
heart lesion primary and the pneumonitis.
secondary, we would expect, (1) that the ulcer-
ative process on the valves might be extensive,
(2) that the pneumonitis would be catarrhal in
its nature (inhalation pneumonia), and (3) that
the right side of the heart might just as well be
affected as the left. Again, were the pneu-
monia primary, and the pathological changes
in the endocardium secondary, we might expect
2O . THE PATHoLogical SOCIETY OF TORONTO.
(1) the pneumonic changes to be well advanced,
(2) on account of the circulatory mechanism,
the left side of the heart more likely to be
affected than the right, and (3) the pneumonitis
to be croupous. The points in the latter view
are supported by the records of the autopsy.
Perhaps one might be nearly correct if he re-
gard the process as a general primary septi-
caemia, with severe local changes in left lung
and mitral valve.
Acute ulcerative endocarditis is so frequently
associated with pneumonia and pleurisy, that the
complication can scarcely be regarded as accident-
al. In fact the connection has been noted by
many observers, and the term “pneumonic endo-
carditis” is now used by some pathologists.”
Osler has studied a large number of these
cases and described them in his exhaustive
analysis of the different forms of malignant
endocarditis, given in the Gulstonian lectures,
1885. Speaking of pneumonic endocarditis, he
says that “it certainly is a seductive view to
take of its pathology, to regard the local pul-
monary lesion as excited by the growth of
micrococci in the air-cells, and the various con-
secutive inflammations—the endo- and peri-
carditis, the pleurisy, the meningitis, the mem-
braneous gastritis and colitis, as due to the
penetration of the organisms to deeper parts,
and their local development under certain con-
ditions dependent on the state of the tissues.
The processes are all of the character described
as Croupous, and have as common features the
presence of micrococci in a coagulable exuda-
tion. We have still to settle the identity of
the organisms of the air cells with those of the
consecutive inflammations ; but we may reason-
ably hope ere long to have some positive data
from investigations in this disease, which, more
than any other, offers favorable opportunities
for the solution of these problems.”f
Unfortunately our present arrangements did
not permit of a careful bacteriological examina-
tion of the affected organs, and consequently
there are no reports of culture and inoculation
experiments.
Dr. Ferguson narrated the case of a man, aet.
23, apparently in good health, who in playing
foot-ball got greatly overheated. Two days
* Hamilton's Pathology, Vol. I., p. 607.
f British Medical Journal, 1885.
––a–
afterwards there was swelling in the right knee,
and, in two days more, pulmonary consolida-
tion with pleuritic effusion. The knee suppur-
ated; and patient died. The autopsy showed
marked ulcerative endocarditis. Probably the
origin of the condition was the over-exertion.
Dr. J. Caven said, if recent researches are to
be borne out, it would appear that all the con-
ditions might be secondary to leukaemia, as
bacteria can be found in that disease, and Dr.
Cameron, of Montreal, has shown that leu-
kaemia is transmissible.
Dr. McPhedran, referring to the condition of
the blood, said it was typically leucocythaemic,
the proportion being 5 to 1. Yet the spleen
did not present the amount of enlargement we
would have expected. We may take the view
that the lung lesion was the primary one and
the endocarditis secondary, but the other view re-
garding the heart lesion was supported by the
fact that it appeared older than it would have
been had Dr. Barker's view been the correct
one. He thought Dr. Ferguson's case was .
peculiar in that there was such an amount of
pus in the pleura so early ; he had never met
with such a condition. The existence of leu-
kaemia could not be determined in a single
examination of the blood.
Dr. Graham thought Dr. Ferguson's case
might be explained as septic trouble in a case
of old heart lesion.
Dr. J. Caven said the theory had been ad-
vanced that in malignant endocarditis some
heart lesion must always have preceded.
Dr. Acheson asked if it was not a general
fact that in diseases due to micro-organisms
there must always be some lesion of the surface
to enable the organisms to effect an entrance;
otherwise there will be no infection, as in the
case of diphtheria, where some abrasion of the
mucous membrane of the pharynx was always
antecedent to the development of the disease.
Dr. Barker replied, and said that the case
might be explained as one of general infection
resulting in a simultaneous endocarditis, pneu-
monia, etc. -
HEAD of A FEMUR REMOVED FOR TUBERCULAR
DISEASE.
Dr. Cameron presented this specimen. The
patient suffered from hip-joint disease for some
THE PATHOLOGICAL SOCIETY OF ToRONTO. - 2 I
years. The head of the bone was excised
through an anterior incision between the sartori-
ous and the tensor fossae femoris. There is
seen to be disease in the cancellous tissue of
the bone, and some erosion of the cartilage.
CARD SPECIMENS ExHIBITED.
Dr. Cameron —Three ovarian cysts.
Dr. Scadding—Ovaries removed for oophor-
algia. gº -
MICROSCOPIC SPECIMENS.
Dr. Acheson — Epithelioma (rodent ulcer)
from the skin of the temple, removed by Dr.
Nevitt.
Dr. Barker—Liver and kidney from his case
of ulcerative endocarditis.
Dr. J. Caven—Mycloid, sarcoma.
right's case. º
The Society then adjourned.
Dr. Old-
Meeting held Feb. 28, 1897. The Vice-President, Dr. A. McPhedran, in the chair.
The Society met in the Biological Department
of the University of Toronto.
PAGET's DISEASE OF THE SKULL.
Dr. Thomas McKenzie presented a gross
specimen and microscopic sections from a
woman who died of pneumonia, aet. 70. The
following outline of her history had been received
from Dr. Varden, of Galt : “Mrs. M. Father
died at 79, mother at 94. No hereditary disease
in any of the families. She married at 22, and
had three daughters and two sons, two of which
died in infancy ; the others are still living and
well. Her brothers and sisters were healthy and
all lived to be old. She came to Canada forty-
nine years ago, and was then healthy, erect
strong, and active. During her first winter here
she took a severe cold and lost the sense of
smell. Four years after she had a miscarriage
and was confined to bed for six months, and to
the house for one year. The doctor in attend-
ance said that a portion of the placenta had
been retained, and kept up a constant flooding
for six months. She never got strong after this,
but was subject to frequent fainting spells and
headaches. She also complained of pain in the
eyes, and was prone to be very irritable. Her
appetite was good. Her head commenced to
enlarge and her back to become deformed about
twenty-five years ago; about this time she passed
through the menopause. Dr. McKenzie has at-
tended her on three or four occasions during the
past four years; she had repeated attacks of bron-
chitis, and one severe attack of dysentery shortly
before she went to the Home for Incurables in
Toronto. Her memory was always good. The
increase in the size of her head was steady and
almost imperceptible in its evenness of develop-
ment for 22–25 years.”
Dr. McKenzie stated further that there was
angular curvature in the lumbar region and an ,
exaggerated dorsal curvature. She had chronic
bronchitis, but this did not much inconvenience
her. Her memory was very fair, though defec-
tive for recent events, and she was quite intelli-
gent up to the last. When fresh, the calvarium
weighed 36% ounces. The brain was small and
weighed only 36 ounces. The floor of the brain
case appeared as though it had been pressed
upward; no depression, however, existed on the
base of the skull, and the apparent elevation was
evidently due to overgrowth of bone. There
was marked curvature of both the dorsal and
lumbar regions. There were no changes in the
long bones or in the bones of the face. The
case had been diagnosed as hydrocephalus, and
this was favored by the external appearances
during life. Sections through the fresh apd
decalcified bone show marked increase of fibrous
tissue, the bone is rarefied to the periosteum,
Osteoclasts are very numerous, and the haversian
canals are almost wholly destroyed, only a few
retaining circular laminae about them.
Dr. G. A. Peters said he had seen four speci-
mens of this disease in the College of Surgeons
Museum, England. Associated with the skull
specimens were the long bones, which showed
similar thickening and deformity. The compact
tissue of the bones is rarefied. The fact that
this patient showed no symptoms of compres.
Sion agrees with what Paget observed in his five
cases. Three out of the five died either of
carcinoma or sarcoma. An increase in the cur-
vatures of the spine was present in some cases.
Butlin's microscopical report showed that the
whole structure of the bone had been absorbed,
and it was all laid down again on a larger scale,
22 - THE PATHOLOGICAL Society of Toronto.
the haversian canals being much enlarged.
This was shown better in the long bones than in
the skull. He thought Dr. McKenzie's speci-
men showed evidently a condition of rarefying
osteitis. The round cells in the fibrous tissue
he regarded as those of the red marrow.
Dr. A. B. Macallum said the disease should
not be called rarefying osteitis, for the specimen
shows that development of bone has gone on
to a certain point. Haversian spaces are present,
but no haversian canals. The number of osteo-
clasts is probably not greater than in normal
bone. The osteoblasts apparently have not
their normal power of bone deposition. The
aggregations of round cells he regarded as
inflammatory, not as marrow cells.
Dr. I. H. Cameron said the bone was cer-
tainly rarefied. The cause might be a neoplastic
or an inflammatory one. The fact that in other
cases neoplasms had been common might lend
Support to the former view.
Dr. John Caven asked why are the osteoclasts
present? They are usually present in inflamma-
tory conditions, but there is really little inflam-
mation here. Possibly the condition, is neo-
plastic and the osteoclasts are taking on a
phagocytic action.
Dr. McKenzie replied, in regard to the osteo-
clasts, that they are evidently producing a
condition normal in the long bone, but abnor-
mal in the skull ; namely, taking out the centre
while the periphery increases in thickness.
There is no evidence of a general inflammatory
condition.
Dr. A. B. Macallum read the following com-
munication :
QUERY: what IS A PATHOLOGICAL CELLP
It is customary on the part of pathologists to
speak of cells in certain conditions as being
pathological, or to explain certain cellular phe-
nomena and types of structure as due to patho-
logical conditions. This, of course, assumes
that there is a common understanding on the
part of pathologists as to the meaning of the
term “pathological.” There is, however, no
such accepted definition, and the absence of it
renders inevitable a large amount of confusion.
An instance, to illustrate this, was furnished by
the statement made recently by a prominent
pathological condition (e.g., in carcinomata) it is
not surprising that structures are found in their
interior such as some, within the last two years,
have described as parasitic, and that the struc-
tures in question are the result and not the
cause of the pathological condition of the cells.
Here it is taken for granted that the words
“pathological condition” carry a precise and
definite meaning; whereas if we substitute for
“pathological" the word “abnormal,” we see
that the given statement carries no more reason-
ing weight than does the following: These non-
normal, intracellular structures are present be-
cause the cell is abnormal instructure or function.
Here is seen an example of play on words, and
the necessity for determining what we mean
by the word “pathological” is demonstrated.
Perhaps I ought not to be so bold as to at-
tempt a definition of the term “pathological
cell.” I know, furthermore, that a true defini-
tion must be broad enough to cover all conditions
of the cell which vary from the normal, and such
an essential point leads at first sight to the belief
that any such broad definition must be of little
value in the close application to individual cases;
nevertheless I think we can seize on one princi-
ple, that of nutrition, and employ it in elabora-,
ting a definition which will be easy of application.
This principle is made use of hereafter with
special regard to the occurrence of neoplasms,
but I believe it has as great a bearing on all
abnormal conditions, although, owing to our
lack of knowledge of cell metabolism, we may
not now be able to extend its application.
All conditions, physical or chemical, which di-
rectly affect a cell, influence those processes on
which the vital phenomena of the cell are de-
pendent; in other words, influence its nutrition.
The latter may thereby be enhanced or dimin-
ished, in the case of unicellular organisms, with
no further result than that their vitality is in-
creased or diminished ; but in multicellular or-
ganisms, enhanced nutrition of one cell or of a
group of cells out of the whole means the pre-
dominance of that cell or group of cells and the
consequent overthrow of the nutritional equilib-
rium, while a diminished nutrition means, other
things being equal, as regards a similar group
of cells, the nutritional predominance of the re-
* maining cells of the organism.
pathologist, that when epithelial cells are in a |
Before trying to apply this principle in the
&
THE PATHoLOGICAL SOCIETY OF Toronto. - 23
explanation of the occurrence of neoplasms,
we may glance at some of the characters of
their cells, and examine some of the expla-
nations offered therefor. As in other cases, the
application of the word “ pathological" to the
condition of the neoplastic cells gives to many
pathologists a satisfactory explanation of their
occurrence, while others again have been con-
tent to refer their vigorous growth to the embry-
onic character of the cells, or to the supposed
persistence of portions of embryonic tissue.
The latter explanation is no more reasonable
than the former, since no generally understood
character is supposed to belong to embryonic
tissue except its vitality. Lately, however, Mi-
not has pointed out that the embryonic cell is
richer in nuclear material and poorer in cell
protoplasm than that of the adult organism. It
is now generally recognized that the vitality of a
cell depends in large measure, if not wholly, on
its nucleus. Putting these facts together, it
might be assumed that neoplastic cells are, like
embryonic cells, rich in nuclear material and
poor in cell protoplasm. My own observations
lead me to conclude that in neoplastic cells
(of, e.g., carcinomata and sarcomata) the special
nuclear material, “chromatin,” is abundant, but
here the parallel between neoplastic and em-
bryonic cells ceases, for the former are, as a rule,
rich in cell protoplasm. The only common
point between the two classes of cells is the fact
that they have both an abundance of chromatin.
Cytologists are also, in the main, now agreed
that the vital activity, in short, the vitality of a
cell depends on the amount of chromatin pres-
ent in it. That the chromatin of neoplastic
cells is abundant, is readily proven by the fact
that cell division, which is dependent for its oc-
currence on the amount of chromatin present,
is very frequent, and the divisions are (in sarco-
mata) frequently so hastened that several stages
and divisions are “telescoped,” that is, e.g., in-
stead of a cell dividing into two others, four, six,
or eight cells are simultaneously formed from it.
Nothing can more clearly indicate than this latter
fact the correctness of the conclusion that we
must refer the vitality of a neoplastic cell to its
chromatin, for when a cell instead of forming
two daughter cells, as almost always is the case,
gives simultaneously rise to four, six, or eight
cells, the only inference possible is that in such
a cell there is enough chromatin to supply, not
two, but four, six, or eight daughter cells at once.
It may be mentioned that it is almost wholly in
neoplasms (sarcomata) that one finds such mul-
tiple divisions. In carcinomata the division is
very rarely multiple, but that it is extraordinarily
frequent is enough to show that the chromatin
is abundant. *
Having then determined that in neoplastic
cells there is abundance of chromatin, the ab-
normal condition of such may be referred to
this abundance. What is the cause of this P
Have these neoplastic cells inherited or retained
from the embryonic condition this abundance
of chromatin, as would appear to be postulated
by the theory of Cohnheim P. As we have
just seen, an embryonic cell is rich in nuclear
material, i.e., chromatin, and poor in cell pro-
toplasm. Abundance of chromatin in a cell
means a capacity for division and multiplica-
tion, which immediately manifests itself. Why
should an embryonic cell with this capacity per-
sist with its powers dormant—as is supposed to
be the case in the carcinomata—till past mid-
life of the individual P It might be said that
the chromatin in a carcinomatous cell is chemi-
cally different from what it is in an embryonic
cell, but to assert that is to admit that carcin-
omatous cells are not embryonic in character.
Any other answer to the objection is equally
destructive of the theory of the Cohnheim school.
Rejecting, then, Cohnheim's explanation mainly
on the ground that neoplastic cells are not em-
bryonic in character, and because of the credo
involved in the application of it, we must look
for some other which can be built on the basis
of observed fact. We need not go farther, for
such than the acceptance of the principle above
stated, viz., that a cell or a group of cells in an
organism is pathological only when the nutrition
of such cell or cells is enhanced or diminished
beyond that of the surrounding cells, and be-
yond that usually found in the cells of such,
localities. I have already frequently referred, in
the meetings of this society, to the elements in
carcinomatous cells, which are considered by
some to be parasitic, by others to be secretions
or productions of the cell substance; I propose
now to show how the principle just enunciated
is exemplified in the case of epithelial cells pos-
sessing these intracellular elements. These
*
24 THE PATHOLOGICAL SOCIETY OF Toronto.
intracellular elements are sometimes merely
masses of chromatin, at other times they are
simply leucocytes. It is possible to trace a con-
nected history between these chromatin masses
and the enclosed leucocytes; in other words,
the latter may, in the interior of an epithelial
cell, degenerate and break down, and form
chromatin-holding bodies. What effect this has
on the cell can be seen when the nucleus of the
latter is examined, but I found the clearest evi-
dence on this point furnished by my studies on
the pancreas of amphibia. In nearly every case
where a pancreatic cell had swallowed the chro
matin of a neighboring disintegrated cell, the
nucleus was more or less enlarged and its chro-
matin increased; the amount of enlargement
and of the increase of chromatin varying appar-
ently with the amount of the chromatin assimi-
lated. I have already described this in a pub-
lished paper* and will not, therefore, refer more
fully to it. In carcinomatous cells we find a
similar enlargement of the nucleus and an in-
crease of the chromatin when chromatin masses
are present in the cell protoplasm ; and just as
in the pancreatic cells the nuclear chromatin
is reinforced from the assimilated chromatin,
so here the abundant chromatin is derived from
the contained disintegrated leucocytic elements.
The latter point was shown very clearly in pre-
parations from a carcinoma of the prepuce.
Now, whether the chromatin of an epithelial
cell is to be increased in quantity will depend
on its capacity for overcoming the contained
leucocyte. I have already touched on this point
in a communication to the Society. I am un-
able to say why a leucocyte enters the interior of
another cell; that they do is a demonstrable fact;
that they break down in the interior of epithelial
cells is as readily demonstrable. It is a reason-
able inference, from all the facts at our disposal,
that the chromatin of the disintegrated elements
is assimilated by the nucleus of the containing
cell—providing that the latter retains its original
vitality. Such epithelial cells thus acquire a
vigor beyond that of their neighbors; the nutri-
tion of the surrounding cells is deranged, more
leucocytes wander into the part, some of which
contribute in like manner to increase the vitality
of some of the cells; in the end the cells become
* Contributions to the Morphology and Physiology of the Cel
Transactions of the Canadian Institute, vol. 1, part 2.
so vigorous that they merit the name malignant,
and thus form the primary neoplastic cells.
Klebs has stated that there is a direct transfer-
ence of nuclear material from the leucocytes to
the neoplastic cells. I have never seen any in-
stance of such, although I am prepared to admit
that it is possible. - - -
What has been said here of the carcinomatous
cell is equally true of the other neoplastic ele-
ments; of this I have satisfied myself by obser-
vations on the cytology of round, spindle, and
giant-celled sarcomata. -
Given, then, in a tissue any condition compar-
able to a minor state of inflammation which lasts
for some time, we may expect that some of the
cells may become—in the manner described
above—neoplastic. It does not matter what is
the cause of this inflammatory condition so long
as it is more or less chronic ; the cause may be
parasitic, or it may be a projecting tooth, the
pressure of a clay pipe, the presence of soot
particles, etc. The inflammation is never very
marked, but it is sufficient to bring about in the
tissue affected the presence of leucocytes, which
contribute to the origin of the neoplastic cells.
I cannot take up here all the points, which
this aspect of the question presents, but I hope
to have again an opportunity to develop these
views at fuller length.
As already stated, the nutrition of a cell may
be diminished, and when a number of cells, as,
for example, those forming an organ, are so
affected, atrophy may result. Sometimes this
lessened nutrition becomes normal, as in the
case of the superficial epidermal cells of the skin.
On the other hand, the nutrition of every cell
in an organism may be diminished, as in starva-
tion. A similar condition is present in every
cell of the body in anaemia, chlorosis, etc., a
condition the reverse of that in which the neo-
plastic cell occurs. In the latter chromatin is
abundant, but in the former it is manifestly de-
ficient; I say manifestly, because the haemoglobin
of the blood is diminished; and as it is derived
from the chromatin, it is evident that there is not - -
by any means as much chromatin in the cells of
anaemic subjects as there is in the normal cells;
hence the hypoplasia of chlorosis.
Just as there is an increased supply of chro- .
matin to neoplastic cells, so there may be an
excess of cellular or protoplasmic material in
*.
THE PATHOLOGICAL SOCIETY OF Toronto.
25
neoplastic as well as in other cells. The history
of the chromatin supply is, however, more clearly
traceable, and its effects directly on the cell more
* | Mr. John Marshall, and Dr Macallum.
readily demonstrable.
Why leucocytes so contribute to the formation
of neoplastic epithelium past mid-life, and to the
production of connective tissue tumors before
that period, is difficult to say. We may put such
problems on the same plane with the question
why an individual is liable to diseases in early
life to which afterwards he is completely immune.
I have developed here, so far as the limits
allow, what I consider as the proper meaning of
the term “pathological cell.” The view here
taken accords well with the generally received
opinion that there is no marked line of separa-
tion between the physiological and the patho-
logical states; for if the physiological depends
on proper nutrition of cells and organisms, then
the pathological condition must depend on a
deviation from the normal nutrition, and this
deviation may at times barely pass beyond the
neutral line.
I do not claim that I am advancing a new
principle. I think the question of nutrition in
pathology has before this been discussed fairly
and fully, but its importance has not, I believe,
been dwelt on. I claim only that it affords a
satisfactory explanation of the occurrence of
neoplasms, and that its application to other
abnormal cellular conditions will be made when
our knowledge of the nutrition of the cell as a
whole is much more extended than it is now.
Dr. John Caven spoke of the pathological cell
in neoplasms. Why should the karyokinetic cells
here be asymmetric? In Zeigler’s “Beitrage”
the fact is mentioned, and he had verified it in
his own study, that a considerable number of
cells show asymmetrical forms in nuclear
division. Must there not be some other
element to account for this besides the Supply
of chromatin P *
Dr. I. H. Cameron remarked that if Dr.
Caven's observation applied to a simple path-
ological cell, the asymmetry would mean anaemia
of the cell or absence of sufficient pabulum.
Dr. G. A. Peters said that Dr. Macallum's
theory gave a very good explanation of the
activity of sarcomata and carcinomata where
there is mere overgrowth, but it did not explain
adenomata, for instance, where there is some
, sº
definite plan to the growth. Here one would
think there must be some nervous control.
This theory has been advocated by Dr. Parsons,
Dr. Macallum, in reply, said that in regard
to the unequal division of the nuclear chromatin,
the results of his own studies agreed with those
referred to by Dr. Caven. The asymmetry, he
thought, was due to the abundance of the
chromatin not yet assimilated and the necessity
for the cell to divide to make room for it.
Chromatin granules were to be seen among the
loops of the filament. In the testes of amphibia
one sees different varieties of cell division ; at
certain times of the year chromatin is abundant,
and then there is asymmetry of the nuclear
division. The same phenomenon has also been
observed in keratitis. He held this theory only
tentatively.
Dr. John Caven presented the following
specimens. (I) Remnant of patent urachus.
A small sac at the upper surface of the bladder,
lined with a mucous membrane identical with
that of the bladder, the muscular coat having
not closed in. (2) Double ureter on both sides.
The ureters all enter the bladder separately.
(3) Intestinal diverticula in the rectum, sigmoid
flexture, and descending colon. They are thin-
walled and contained faecal matter. .
Drs. Cameron, Nevitt, and Olmstead reported
having seen cases similar to the last in old
people with constipation. -
KIDNEY, URETER, AND BLADDER, witH CALCULI.
Dr. John Caven showed these specimens for
Dr. H. C. Scadding. The substance of the
kidney, pelvis, ureter, and bladder contained a
large number of calculi, varying in size from that
of a small pea to a hazelnut. • -
Dr. Cameron, who had been present at the
autopsy, reported further that the vermiform
appendix was wrapped up in the great omentum,
to which it had become adherent. Its lower
portion was hard and firm, and on removal it
was found to contain an oval mass of impacted
faecal matter.
MICROSCOPICAL SPECIMENS.
(1) Paget's disease of the skull; sections
stained with haematoxylin and eosin, by Dr. T.
McKenzie. (2) Encephaloid cancer of the
breast, and (3) miliary tubercle of the lung, by
Dr. John Caven.
26 THE PATHOLOGICAL SOCIETY OF TORONTO.
Meeting held March 28th, 1891. The President, Dr. J. E. Graham, in the chair.
The Society met in the Biological Department.
The following specimens, with remarks, were
presented for Dr. T. K. Holmes, of Chatham :
(1) UTERUS AND APPENDAGES FROM A CASE
OF RUPTURED TU BAL PREGNANCY.
The uterus is from a married woman who
had been delivered of a child about a year be-
fore her death, and after weaning the child had
menstruated once. She then missed the next
period, but had a slight discharge of blood a
few days later. About four weeks after the
regular period she was seized at night with
severe pain in the lower part of the abdomen,
and rapidly became very weak. A doctor was
sent for and found her almost pulseless and
very pale. He prescribed for her and went
home three miles, but was sent for almost as
soon as he got home, and this time he took Dr.
Langford, of Blenheim, with him. She was in
articulo mortis when they arrived, and died a
few minutes after, and before morning. The
autopsy made next forenoon revealed a large
quantity of blood in the abdominal cavity, and
a minute opening in the Fallopian tube, quite
close to the uterus. It was thought to be rup-
ture of a small abscess, but the symptoms led
one to think it was a ruptured tubal pregnancy
and on examining the specimen one discovered
what appeared to be placental tissue.
(2) HYPERTROPHIED TISSUE REMOVED FROM A
LACERATED CERVIX UTERI.
This was removed from the anterior lip of a
cervix lacerated bilaterally. The lip was so
broad and thick that it would have been im-
possible to cure the lacerations without first re-
moving this tissue, which was done by denud-
ing the posterior lip in the usual way and then
dissecting the hard tissue out entirely across the
anterior lip, depending upon the undenuded
central strip of tissue on the posterior lip to
form the restored cervical canal. The opera-
tion turned out most satisfactorily, and the parts
now present a normal appearance, and the ner-
vous symptoms are entirely relieved."
(3) CARCINOMA UTERI.
This small bit of tissue was from a patient
sent me by Dr. Lake, of Ridgetown. The di.
healed in less than two weeks.
had a large family of healthy children.
several times.
sease involved the vagina, and of course offered
no hope of cure by any radical operation.
Scraping and the thermic cautery gave tempor-
ary relief from hemorrhage, but she sank and
died about five months afterwards.
(4) TUMoR OF THE TESTICLE.
The tumor was removed from a man 56 years
old, about two months ago. It had been grow-
ing about eleven months. A hydrocele had .
existed in connection with it, and had been
cured last summer by tapping and injecting
pure carbolic acid. The tumor occupied the
right side of the scrotum, extending up to the
external ring. . It was hard and painless, and
was removed without difficulty, the wound being
He gained in
strength and felt much better, but about a
month after the wound had healed a rapidly
growing tumor appeared in the abdominal
cavity, near the umbilicus, and his health failed
very soon. He is still living, but offers no
hope of recovery. There is no history of tuber-
cular or of syphilitic disease in his ancestors,
but his daughter recently died after hysterec-
tomy for cancer. -
(5) STRICTURE OF THE CESOPHAGUS.
The oesophagus was removed from a woman, .
aet. 64, who had a good family history and who
She
was never seriously ill until about eight months.
before her death, when there came on gradual
and progressive difficulty in swallowing. She
was under the care of Dr. Samson, of Blenheim,
with whom Dr. Holmes saw her in consultation
From almost the beginning of
her sickness she could not swallow solids, and
even liquids were taken with great diffi-
culty. A medium-sized stomach tube could
always be passed easily, and the autopsy showed
patency of the diseased part of the oesophagus. .
The tissue at the point of disease was pretty
hard and somewhat thickened. She became
greatly emaciated, and died eight months after
the first symptoms were noticed. t
MyxoMA REMOVED FROM THE GREAT PECTORAL
f MUSCLE.
Dr. Primrose presented a specimen with
THE PATHOLOGICAL SOCIETY OF TORONTO.
27
1
microscopic sections, and gave the following
account of the case: ,
"...”
but on exposing the growth at the operation it
looking material.
with the muscle; some of the muscle fibres
The patient from whom this tumor was re-
moved came under my care on Aug. 12th, 1890,
when the following condition existed: On the
right side of the chest anteriorly there was a
swelling, presenting a circular outline, with a
diameter of 2% to 3 inches.
was one inch from the centre of the sternum,
and the upper edge a little more than one inch
below the clavicle. It lay apparently in the
line of division of the clavicular and sternal
portions of the pectoralis major muscle. When
this muscle was thrown into action the tumor
became much more prominent, but the circum-
ference diminished. With the muscles relaxed
the tumor projected three-quarters of an inch
beyond the general surface of the chest wall.
On palpation the tumor felt soft but did not
fluctuate. It presented elevations and indenta-
tions on the surface, and it slipped from under
the finger on pressure in a curious fashion.
The patient suffered no discomfort, with the
exception of a gnawing sensation at the seat of
the tumor after working hard.
The patient had first noticed the tumor nine .
months before coming under my care. He
had a fall three years previously, and received
an injury in the region of the tumor. He knows
of no other apparent cause. The rate of growth
had been very gradual. It was about half the
size of a hen's egg when first noticed. The
condition was thought to be that of fatty tumor,
was found to be composed of a gray gelatinous-
It was intimately connected
passed over the surface. The mass was, how-
ever, detached readily from the muscle by the
aid of the finger-nail; it passed between the
muscle fibres, and a considerable mass of growth
was found on the under aspect of the muscle;
this portion was removed after drawing the
muscle aside by retractors. The whole mass,
when removed, was found to be composed
chiefly of a cluster of small lobules, each lobule
being about the size of a grape, and consisting
of a clear jelly-like material. On section a
ropy fluid could be squeezed out of it. At the
operation it was thought that there was some
enlargement at the junction of the third rib
-
The inner edge
with its cartilage. Under the microscope the
tumor presents the appearance of myxomatous
tissue; branching cells are observed lying in
the midst of clear, transparent material ; fibrous
tissue is observed running here and there, and
blood vessels also. Fat globules are seen scat-
tered throughout the section. There is a
delicate capsule surrounding the growth. At
no point could one discover any evidence of
sarcomatous growth ; nor, indeed, was anything
discovered save the characteristic structure of
a pure myxoma. In looking up the literature
of the subject I find that the only reference
Hamilton” makes to myxomatous growths
which have been described under the name of
“myxoma" are in connection with the sarco-
mata. In these, and in the one figured in his
book, there is a portion of the tumor presenting
myxomatous structure, and a portion that of a
typical round-celled sarcoma. In referring to
mucoid or myxomatous degeneration, Hamilton'
states that “in the foetus at an early period of
life, the whole of the subcutaneous areolar tis-
sues consist of a texture highly loaded with this
substance, the Wharton's jelly of the umbilical.
cord and the vitreous humor are both of a
mucoid character.”f ,
Cohnheim, while advancing his embryonic
theory in discussing the etiology of tumors, in-
stances the occurrence of large subcutaneous
myxomata as met with in the thigh of the adult,
for instance. He rejects the hypothesis that
the subcutaneous and adipose tissues have re-
verted in such cases, not simply to juvenile, but
to intra-uterine habits, and have transformed
the albuminous material conveyed them by the
blood stream, not, as is usual, into collagen and
fat, but into mucin. He supposes rather that
the rudiment of the tumor has risen in embry-
onic life, and it will, under such circumstances,
be precisely the physiological function of its
cells to produce mucous tissue. In the embryo,
he states, myxomatous tissue is extensively de-
veloped, and regularly constitutes the first stage.
in the formation of collagenous and fatty
tissues. ; -
In whatever way the etiology of the tumor
may be explained, I think we must look upon
*Text-book of Pathology. D. J. Hamilton. Page 369.
+ A Text-book of Pathology. D. J. Hamilton. Page 176.
t Cohnheim's Lectures on General Pathology. New Sydenham
Society's Publication. Vol. II., p. 777. • .
28 - . THE PATHologICAL SOCIETY OF Toronto.
the specimen presented as that of a pure myx-
oma developed in connection with the areolar
tissue which exists between the clavicular and
sternal portions of the great pectoral muscle.
Dr. Acheson asked if Dr. Primrose regarded
this myxoma as a neoplasm distinct from sar-
coma, and not the result of a degeneration of a
tumor primarily sarcomatous. -
Dr. A. B. Macallum said that mucigen is not
relatively more abundant in the embryo than it
is in the adult.
Dr. Oldright spoke of the extreme liability to
recurrence of the myxomata, and related a case
which had recurred three times.
Dr. Primrose, in reply, said that, he thought
, there was no appearance in this tumor of sar-
coma, and that if Dr. Macallum is right then
Cohnheim's theory of the embryonic origin of
tumors is destroyed.
Acute NECROSIS OF THE FEMUR.
Dr. Peters presented a specimen and gave
the following history: The patient, a female
nine or ten years of age, died after a week’s ill-
ness. There was some swelling near the right
knee. On incision over the lower end of the
femur, post mortem, thick creamy pus escaped.
The periosteum was raised and separated over
nearly the whole of the lower part of the femur,
but the disease stopped short at the epiphysis.
There was commencing separation of the dia-
physis from the epiphysis. In the fresh pus
stained were found staphylococcus pyogenes
aureus, and other bacteria. Cultures were made
from the pus thirty-six hours afterwards, and
colonies of staphylococcus pyogenes aureus and
bacillus putrescens were obtained. Two mice
were injected with some of the pure culture.
One died in thirty-six hours with all the symp-
toms of acute septicaemia. This disease has
also been called acute osteo-myelitis, bone
typhus, septic osteitis, or acute epiphysitis.
Senn says it is very frequent in children, but
this has not been his experience. The etiologi-
cal factor is in all probability staphylococcus
pyogenes aureus, or albus, the same that gives
rise to furuncle, acute mammary abscess, etc.
The virulence of the disease when in bone is to
be accounted for by the peculiarity of the tissue
near the epiphysis, and its special septicity is
due to the nature of the circulation in bone.
Death results in various ways ; sometimes in a
few hours from septic, intoxication ; most com-
monly, however, from metastatic abscesses.
The progress of the disease is rapid, and the
extent of the bone affected usually much greater
than in this case. . .
Dr. W. P. Caven, who had been associated
with Dr. Peters in the case, gave the following
clinical history : -
Emma R., aet. 9 ; father and mother alive
and healthy; one brothé died, at 10, from
caries of spine ; one brother and one sister died
from heart disease, both having suffered with
rheumatic fever. Patient thin and always deli-
cate. Saw patient first on Feb. 21st. She com-
plained of pain in right knee; it had prevented
her going to school the day previous. The
joint was red and tender, but not swollen.
Pulse, Ioo ; temperature, Io.2°F.
Feb. 22: Pain still in right knee ; not swol-
len ; also in right elbow. Pain also complained
of in right thigh, but not swollen, measurements
being the same for both thighs. Urine normal.
Temperature and pulse same as day previous.
No chills. *.
Feb. 23: Pain in same parts, also in left
shoulder; the right thigh a little larger than the
left, and very tender, especially just above the
knee. No chills, but copious perspirations.
Temperature, Io 3 ; pulse, I2O. No fluctuations
detected. Condition remained about same for º
two days. -
Feb. 26th; Consultation with Dr. Graham. . .
No fluctuation present. Right thigh, above
knee, 1% inches more than left. No pitting or
oedema. Decided to call in surgeon. -
Feb. 27th : Dr. Peters saw patient, and
thought it advisable to operate, but before con-
sent obtained patient had developed pericarditis
and double pleurisy.
Obit. March 2nd: Day before death a swell-
ing presented in right submaxillary region. g
Dr. McPhedran asked if the urine or the con-
dition of the spleen had given any aid in the
diagnosis. - \
Dr. Caven replied that the urine gave no in-
dications, but there was a slight enlargement of
the spleen. . s
Dr. Osler said such cases were not uncom-
mon, and related one which he saw in Montreal,
and which was thought at first to be acute
rheumatism, but the real nature of which soon
THE PATHological SOCIETY OF TORONTO. , 29
-
became evident; post mortem there was found
also ulcerative endocarditis.
difficulties of diagnosis. The local symptoms
were often slight, while the constitutional ones
were grave. - \ -
Dr. Graham related a case of this disease in
the tarsus, where the patient recovered.
Dr. Peters, in reply, said the interesting
point was where did the disease commence, in
the medulla or in the periosteum, as this would
greatly influence the treatment; for, if in the
medulla, there would be no use in opening the
periosteum merely, but one should drill through
the bone into the medulla. This might have
been a case of multiple necrosis, for the autopsy
was only a partial one. If multiple, it might
explain why these cases are so often mistaken
for rheumatism.
A NEW MICRO-CHEMICAL REACTION OF
LARDACEIN, OR “AMYLOID.”
Dr. A. B. Macallum read a paper on the fore-
going subject, of which the following is a pre-
liminary note:
In a communication recently made to the
Royal Society of London, I pointed out that
the occurrence of iron can be demonstrated in
the chromatin of a very large number of cells,
animal and vegetable, and that the firmness of
its combination with the chromatin is compar-
able to that obtaining in haematin and the ferro-
cyanides. Concurrently with this investigation
I carried on another which may be of not less
interest. I had during the past two years sus-
pected lardacein, or “amyloid,” to be a chro-
matin. Since I discovered the method of de-
monstrating, micro-chemically, the presence of
iron in nuclear chromatin, it occurred to me to
put my suspicions as to the nature of lardacein
to the test. For example, if it belongs to the
chromatin class of compounds it ought to con-
tain iron, not as an albuminate, but in a condi-
tion somewhat similar to that present in true
chromatin. By a method to a certain extent
different from what I used in the case of nuclear
chromatin, I have succeeded in demonstrating,
micro-chemically, the presence of iron in the
deposit of all the specimens of lardaceous organs
accessible to me, and in showing that the metal
is combined in the lardacein in a manner simi-
lar to what it is in chromatin. This indicates
He spoke of the
green.
that there is some chemical relationship between
chromatin and lardacein, and a series of experi-
ments with the latter substance seems to corrob-
orate this opinion. That the iron present is not
due to infiltration of the deposit with haematin,
or similar compounds, is shown by the experi-
ments. Whether lardacein is an altered chro-
matin (or nuclein) is a question upon which I
reserve an expression of opinion. -
When a number of other experiments on lar-
dacein, which I am carrying on just now, are
completed, I hope to publish fuller details of
this investigation. - -
Dr. Osler asked whether the iron is seen in
the same granular form as it ordinarily is in the
ammonium sulphide reaction.
Dr. Macallum replied that there was no
granular appearance, but that under the micro-
scope it gave a diffuse stain like that of iodine-
TUM OR OF THE CEREBELLUM
Dr. W. P. Caven read the following history:
The specimen presented was a tumor of the
under surface of the left lateral hemisphere of
the cerebellum. The tumor pressed forward
on the pons, also toward the middle line, dis-
placing the cerebellar substance not infiltrating
it. Where the tumor rested upon the base of
the skull, the bone was slightly eroded. The
tumor sprang from the dura mater, and micro-
scopic examination proved it to belong to the
sarcomatous group.
Clinical history: Miss R., aet, 58. Family
and personal history good. Her paternal grand.
father died, aet. 92, from some form of fungating
tumor, which presented itself in the region of
the frontal bone.
First saw patient on July I Ith, 1890, when
the only complaint was partial loss of sensation
throughout the whole distribution of the fifth
nerve. No interference with motor branches
of fifth, or with sixth or seventh. Taste un-
affected ; motion and sensation normal ; no
“alteration in superficial or deep reflexes; no
optic neuritis; no headache ; no vomiting.
Next saw patient in December, when in ad-
dition to above symptoms patient complained
of attacks of dizziness, with a tendency to face
toward the left side ; these attacks most marked
on rising from sitting posture, although some-,
times felt while in recumbent position ; on one
\
30
**
THE PATHOLOGICAL SOCIETY OF Toronto.
occasion patient was seized with an attack and
fell out of bed. At this time patient also com-
plained of pain in the occipital region and down
the neck; head would become retracted and
neck stiff. Double optic neuritis now present;
pupils dilated and sluggish. About the middle
of January vomiting began ; it never was a
marked feature of the case, occurring at inter-
vals of two or three days and ceasing altogether
a couple of weeks before death.
Feb. 1st, 1891 : Slight facial palsy now noticed
for first time, and some difficulty in swallowing
now manifested, this increasing till death on
Feb. 18th. During the last week of life patient
had frequent general convulsive twitchings,
senses became dulled and she sank into a coma-
tose state. Pulse and temperature remained
normal as far as observed. -
The interesting point in this case is the
presence of a local symptom for a long time
previous to the general symptoms of tumor of
the brain. No general symptoms were mani-
fested until December, 1890; whereas the local
symptom, anaesthesia in distribution of the fifth,
was observed first in May, 1889, the patient
maintaining that it came on suddenly, never
having experienced any neuralgic pain in the
region of the fifth.
Dr. Osler asked if it were not more likely to
be a fibro-sarcoma than a glioma from its situ-
ation. -
Drs. Graham, Acheson and McPhedran
thought that from its microscopical characters
it was undoubtedly a fibro-sarcoma.
SARCOMA TIBIAE.
Dr. Thistle presented a specimen and gave
the following history : - /
Sarcoma of tibia removed from a young man
aet. 23 years. Duration of growth, about Io.
months. The young man first experienced dis-
comfort about 1o months prior to operation,
complaining of aching and tired feeling in limb.
This condition passed into more decided pain
after a time, and the head of tibia became en-
larged. The enlargement became prominent in
the lower part of the popliteal space. A per-
foration occurred on anterior surface of tibia
about region of tibial tubercle. From this
opening there was discharge of dark watery,
grumous fluid. After several months general
health began to fail noticeably, and operation
was decided upon. At this time there was no
evidence of affection of the organs. The leg
was removed by amputation through the lower
ninth of femur. Recovery was rapid and com-
plete, patient being out three weeks from date
of operation. General health improved rapidly
and up to date there has been no evidence of
recurrence. The growth proved to be as diag-
nosed, a sarcoma which began on head of tibia,
which was completely hollowed, and leaving
simply a shell. The growth had extended pos-
teriorly, involving soft parts behind the knee.
Meeting held April 25th, 1891.
The President, Dr. J. E. Graham, in the chair.
The society met in the Biological Department -
of the University of Toronto.
NECROSIS OF THE CALVARIUM.
Dr. Peters presented a specimen from the
head of a child ten months ol ', who fell off a
chair on a piece of coal, causing a scalp wound
and laying bare the bone. Three weeks later
the patient came to the extern department of
the Toronto Generai Hospital, and was seen by
Dr. Peters. At that time there was a large
amount of swelling. Three openings were made
but very little pus exuded ; the bone was bare.
After some weeks the bone appeared to be
Asºº
loose ; so an operation was performed, and the
sequestrum removed. A portion of the dura
mater about two square inches in extent was ex-
posed, covered by a gelatinous tissue, which was
scraped away. Healing took place slowly. At
intervals during convalesence there were some
symptoms of cerebral irritation, and later there
were fifteen fits in one day. The child was
teething, and he thought the fits were due to
that. Since the wound has completely healed
there has been one fit. The part from which
the sequestrum was removed is quite firm, and ap-
parently new bone has formed. It is interesting
to observe how much the dura mater will bear.
{
THE PATHOLOGICAL SOCIETY of Toronto. - º 31
Dr. McPhedran read the following history :
/ PERNICIOUS ANAEMIA.
R.P.E., aet. 36. Barrister. Had always been
a hard-working student, and had met with many
reverses. Had always been healthy until two
years ago, when he had diarrhoea with jaundice.
Recovered in about two weeks. About six
months later he noticed that he was losing color,
but paid no attention to his condition. He at-
tended to his professional work regularly until
about a month before his entrance into the To-
ronto General Hospital, March 8th, 1891.
There he was extremely pallid, with a lemon-
yellow tint. The conjunctivae yellow from fat
and Oedematous; eyes quite protuberant. There
was abundant subcutaneous fat. He was very
weak, and his mental condition was not clear.
He had diarrhoea, with frequent light yellow
stools. Pulse small and weak; apex beat
of heart diffuse ; haemic murmurs at base.
The veins, especially on the backs of the
hands, of a magenta color. The liver and
spleen did not seem enlarged, but could not be
accurately delineated. The urine was at first
scanty; later, more abundant; fairly high-colored;
.sp. gr. IoI2, no albumen. Blood contained
about 7oo,ooor.c. per cmm.; no rouleau; cor-
puscles small, large, and irregular; the largest
1.2m. Temperature varied between 99° and
IoI*; there were no paroxysms. There was
considerable pain in the abdomen and diar-
rhöea persisted; there was also occasional vomit
ing. On March. 16th there was profuse epistaxis
On the 17th he died.
At the autopsy, an abundance of subcutaneous
fat was found, and there was marked fatty con-
dition of all the organs.
The condition found post mortem was then
further described by Dr. John Caven.
Dr. John Caven presented specimens from a
case of pernicious anaemia, and read report of
Aost mortem examination. -
Post mortem examination of the body of R.E.,
T.G.H., March 18th, 1891.
Inspection : Shows body of a male ; apparent
age, 35 ; general nutrition fair ; rigor mortis
fairly marked; post mortem staining almost nil;
waxy-yellow color of skin; blood, crusted in ant.
nares and mouth; eyes, very prominent, scler-
otic yellowish, medium dilation of pupils, small
subconjunctival hemorrhage on left eyeball,
external orifices all right. . . .
Section : Shows a large quantity of very yellow
subcutaneous and subperitoneal fat; muscle
very pale.
Pericardium and Heart. Three fluid ounces
serous fluid in sac ; no ecchymoses; one small
milk spot over right ventricle, peri- and epicardia
otherwise normal. Heart weighs fourteen and
a half ounces; covered deeply over right ven-
tricle with at Right ventricle hypertrophied
to one-quarter inch average thickness; also di-
lated. Left ventricle hypertrophied to three-
quarters inch average thickness; dilated also ;
very beautifully marked fatty degeneration of
muscle of internal surface of left ventricle and of
papillary muscles; this condition not visible in
right ventricle; malformation of aortic valves ;
two cusps continuous with low septum behind
middle; edges and bases, thickened ; valves,
quite competent; mitrals, all right; auricles,
foramen ovale, closed ; walls, thin and dilated.
Aorta : Reddish staining of intima, as in Sep-
ticaemia; vessel, very thin, and of small calibre.
Pleurae and Zungs : Pleurae of left side.com-
pletely adherent, showing very distinct parallel
fatty bars; slight calcareous deposit in adhesions
to diaphragm. Left lung, very pale and Oedem-
atous. Pleurae of right side, no adhesions;
two and a half ounces of reddish serous fluid in
cavity. Right lung, upper lobe shows marginal
and apical vesical emphysema; hypostasis and
oedema in lower lobe. .
Omentum and Peritoneum: Very pale; much
fat in omentum. ~ * . n
Spleen. Large, fourteen ounces; tarry black;
soft, almost diffluent. -
Aidneys. Each five ounces; large, very fatty; de-
marcation betweencortex and medulla almostlost.
Ureters, Bladder, and Prostate: Healthy.
Supra-renals : Healthy, --
Intestines, small and large : Very pale, dis-
tended with gas; slight catarrh ; muscular coat
thin; a few small hemorrhages into mucous
membrane of jejunum. -
Appendix Vermiformis : Four and a half
inches long; lumen contracted till it appears
like a fibrous cord, white and dense. . -
Duodenum and Stomach. Bile ducts, patent;
*
catarrh of stomach; a digested patch in mucous . .
membrane on posterior surface, close to cardia,
N'-
32 THE PATHological society of Toronto.
size of a ten-eent piece; a few small petechiae
in mucous membrane.
CEsophagus : Healthy.
Liver : Four and a half pounds; pale, yellow-
ish-red color; fatty; no lobules distinguishable ;
anaemic gall-bladder contains a small quantity
of thick yellowish bile and mucus; ducts and
veins, healthy. -
Pancreas: Large, healthy.
Brain : Membranes, pachymeningitis interna
plastica over frontal regions and vertex; firm
plastic exudate firmly adherent to inner surface
of dura mater; a few small points of hemori hage
into dura mater ; considerable serous fluid in
subarachnoid space. Brain, pale, firm ; puncta
vasculosa, poorly marked ; nothing else visible
noteworthy. - -
Orbit opened, and bulging of eyes found to
depend upon a very large deposit of fat behind
eyeball. Retina, very red, but no hemorrhages
visible. y -
Microscopic Examination : . -
A'eart: Muscle, extreme fatty degeneration.
Aizer: Cells, swollen and smooth- looking,
most containing finely granular, yellowish-brown
pigment nuclei, often very large and vacuolated ;
cells, occasionally vacuolated also ; interlobular
connective tissue infiltrated with small round
cells; capillaries much narrowed in places, and
containing many nucleated cells, mostly uni-
nuclear ; sometimes three to five nuclei, occa-
sionally large cells, with seven or more nuclei.
Endothelial cells of capillaries swollen very
greatly in places, and rarely containing within
them small round cells, apparently leucocytes ;
large roundish cells in capillaries, containing
brownish granules in large quantities.
Aidney : Cells, granular and fatty.’
Dr. Macallum asked if sections of the kidney
and other glands showed like endothelial hyper-
trophy. The alcohol is apt to extract the iron.
Dr. Caven had not found any enlarged endo-
thelial cells in the kidney, but the cells lining
the tubules were, in some places, reduced to a
granular debris, and pigment was visible.
Dr. Graham asked if there was any striking
want of blood in the vessels post mortem.
Dr. Macallum said the liver sections show
very strikingly cell hypertrophy; this seems to
point to the fact that, pernicious anaemia is
occasioned by absorption of a poison affecting
the cells. It has been found that the poisonous
extract of the germs of diphtheria and scarlatina
injected hypodermically produced hypertrophy
of the cells in the liver, and a certain amount of
leucocytosis. An endothelial hypertrophy of the
kidney occurred after injecting scarlet fever
poison. It looks as if the poisons are capable
of producing these results; they have also given
rise to abscesses. -
Dr. Graham referred to a case occurring five
weeks after pregnancy, where the temperature
was Io 1.2° F. The patient had done well after
confinement, but then became weak. He
thought it might be pernicious anaemia; but he
found in one breast a mass of fluid, and evacu-
ated a pint and a half of pus. There had never,
been any pain, rigors, etc. A few days after,
the other breast went the same way, and in a
day or two the patient died. It did not seem
like an ordinary case of pyaemia. He wondered
if the case had anything to do with extreme
leucocytosis. The blood was examined, and
the red cells were irregular in shape, and the
white cells seemed to be dividing.
Dr. Caven said the leucocytosis in these liver
cases was not to be compared to abscess forma-
tion." The mononucleated leucocyte is found
in leucocytosis without pus formation. Pus
cells are dead white corpuscles.
Dr. McPhedran asked whether pernicious
anaemia is a specific disease or symptomatic
merely. The question as to whether free iron is
present or not is not settled. Is the poison
referred to by Dr. Macallum as producing per
nicious anaemia of a special variety, or is the
anaemia simply symptomatic of the action of a
variety of poisons? He referred to a case in
point in which there was a doubt as to the diag-
In OS1S.
Dr. Macallum did not wish to be understood
as holding that pernicious anaemia was due to
absorption of a particular poison. Pernicious
anaemia is a term used to describe a disease due
to a variety of causes, having been found to re-
sult from syphilis, tuberculosis, etc. There may
also be anatomical causes which produce per-
nicious anaemia.
conjunctival TUMoRs.
Dr. R. A. Reeve presented two specimens.
(1) The first was a recurrent growth in a
man past middle life. He was seen five years
THE PATHological society of Toronto. 33
ago, and a growth from the conjunctiva and
cornea was removed. It recurred two years
- later, and again, a few months ago, a third
growth was removed. It was pale red, covering
the superficial area of the Cornea, implanted on
the sclerotic conjunctiva and part of the outer
part of the cornea. It was not firmly attached
to the surface of the cornea, but could be under.
mined at the edges. The tumor looked like a
compromise between a granuloma and a papil-
loma. Dr. John Caven had found it to be
composed of a mass of cells with little or no
connective tissue. This would point to granu-
loma. He would expect from the history of
the tumor to find it a sarcoma, but apparently
lt Was not.
(2) The second case was one which looked
sarcomatous—a growth extending from the
conjunctiva and outer half of the cornea, thus
damaging the sight, a serious matter for the
patient, as it was the only eye that was func-
tionally active. The tumor was dissected off
and the cornea scraped perfectly clean, all the
affected surface being removed. The cornea
was quite vascular at one place, and bled freely.,
The wound healed readily without inflamma-
tory reaction. He hoped this tumor was not
really sarcomatous, but chiefly fibrous in cha-
racter. -
Formerly it was thought that these growths
sprang from the cornea, but now they are all
thought to grow from the limbus, and therefore
are properly called conjunctival tumors.
Dr. Caven described Dr. Reeve's sections.
(1) In gross appearance looked like a minute
papilloma. On section nothing but polyhedral
epithelial-looking cells could be found, with no
fibrous tissue.
(2) This tumor seems to be sarcoma. There
are spherules of hyaline-looking material charac-
teristic of cylindroma. The nuclei stain evenly
* throughout, and have not the vesicular appear.
ance of epithelium. . . .
PYOSALPINX.
Dr. Barker presented a specimen and read
the following history: - -
M. H., female, aet. 24; admitted to Toronto
General Hospital on April 11th, 1891, with fol-
lowing history: Always fairly healthy until one
year ago, when she was in Toronto General
Hospital suffering from some form of pelvic in-
flammation, said to have been “metritis.” She
was unmarried, but had been living a fast life
at intervals ; history of syphilis About two
weeks before admission she felt severe pain in
abdomen; consulted a physician and improved
under treatment; some days later a gentleman
friend spent the evening with her, and as a re-
sult there was a recurrence of the severe ab-
dominal pain, together with elevation of tem-
perature and general prostration, On admis-
sion her temperature was Io.3%", respiration 26,
pulse IoS, complained of great pain in lower part
of abdomen, paricularly in right groin ; vagina
hot and tender, uterus fixed ; foetid discharge
from vagina ; boggy mass at right of uterus; too
much tenderness to examine carefully, no anaes-
thetic being used. - -
Morphine and hot applications ordered,
vaginal carbolic douches, together with milk diet.
Temperature next few days, 1 oo-Ioz"; pulse,
Ioo-12o. On third day became delirious at
times. On the evening of April 15th she com-
plained of great increase in pain ; abdomen
distended; temperature I oA#, pulse 120 ; quin-
ine in large doses ordered every two hours.
Next morning temperature 97%, respiration 3o,
pulse 98. At 1 1 a.m., she vomited and suffered,
marked rigor, lasting some twenty minutes, the
pulse going to 134, perspiration profuse. At
2 p.m., temperature Iogº, respiration 5o, pulse
140. Next morning temperature I ozº, respira-
tion 6o, pulse fluttering ; died at I 1 a.m. * .
Post mortem.—Examination of pelvic organs.
alone allowed. Uterus, tubes and ovaries bound
down in a mass of inflammatory tissue. Right
ovary indistinguishable ; large pus sac com-
municating with right Fallopian tube, running
also into large sac behind uterus; would con-
tain 6 to 8 ozs. Perforation of sac, contents
escaped into peritoneal cavity; septic peritoni-
tis; uterus adherent to bladder in front and
rectum behind.
AND FIBROID REMOVED BY VAGINAL
UTER US
- HySTEREero MY.
Dr. Cameron presented a specimen from a
patient who, some months ago, was suffering
from a small fibroid with inverted uterus. For
some time she had phlebitis in the legs, which "
delayed the operation for some inonths. The
34 . . . . . . . . THE PATHological, society of Toronto. -
• . . " .”
. . . . . .”
º
ecrajeur was used to remove the tumor. It ||
was doubtful whether or not the body of the
uterus was removed along with the growth.
The patient did uninterruptedly well.
tu MoR, OF THE PONs varoLII.
Dr. John Caven presented a specimen and
said there had been bulbar paralysis followed
by slight hemiplegia. On post mortem exam. |
ination a tumor was found in the pons; there
was symmetrical enlargement, the medulla be-
ing broader than normal. The anterior part of
the pons for a quarter of an inch was normal,
the tumor occupying the posterior portion.
The basilar artery divided it equally into two.
parts. Microscopically it was found to be a
small round-celled sarcoma.
Dr. McPhedran had seen the case some
months ago. The history was that the child .
had had a fright, and there was a slight choreic
attack followed by paralysis affecting the left
side. The child did not speak distinctly, and
there was a slight squint. The general appear-
ance was that of diphtheritic paralysis, but
against this there was the presence of the knee-
jerk. The diagnosis lay between choreic paraly-
sis, diphtheritic paralysis, and tumor at the
base of the brain. . . - -
CARD SPECIMEN.
Dr. Nevitt presented a ligature removed fróm
the scrotum after lying in the tissues twelve
months. -
Annual Meeting held May 30th, 1891.
The society met in the Biological Department.
CARCINOMA OF THE STOMACH.
Dr. W. J. Greig presented a specimen and
read the following history :
D.S., aet. 39 years. Occupation, dentist.
Height, 5 feet, 6 inches; probable weight, 125
pounds. -
Family History.—Mother alive, and in good
health. Father died of heart disease, but suffered
from indigestion. All the brothers are alive and
well. One sister not in good health, but no
cancer is suspected. No history of cancer in
any branch of the family. Y
Previous History. —Had suffered from indi-
gestion at intervals the most of his life. Be.
s tween the ages of twenty and twenty-five years
had frequent vomiting spells, but after marriage,
owing to plainer food, this symptom was re-
lieved. But he very frequently suffered from
attacks of what was supposed to be purely
functional indigestion.
Present Illness.--This began in October or
November, 1890, with an increase of the dys-
peptic symptoms, due, it was supposed, to a
closer application to business. He suffered
from pain and distention after eating, vomiting,
foul eructations, and tenderness in the epigas-
trium, but had a good appetite.
7%e President, Dr. J. J. Graham, in the chair. -
--- - - - - - - - ... - -- ~ -->
Condition when first seen, April 24th, 1891 : .
Increased liver dullness in right side. In the
mid line, dullness normal, reaching a point
half way between the base of the sternum and
the umbilicus. No dullness in left side. Epi-
gastric tenderness; a small nodule, the size of a
marble, was felt in epigastrium, with three or
four smaller ones surrounding it. No elevated
temperature; pulse 90 ; tongue, furred; bowels
normal; lungs and heart normal; urine loaded
with lithates. After filtration, albumen was
found, but no casts. Vomited matter was very
acid, but had no characteristic appearances.
Complexion sallow; and while suggestive of the
cancerous cachexia, was by no means typical.
At this time the stomach digestion appears to
have been almost nil, the patient stating that a.
raw oyster would be returned twenty-four hours
after ingestion unaltered. His great complaint
was that food would not pass on from the
stomach, but would lie there for hours, causing
him distress.
Condition before Death.-May 28th, 1891:
Liver dullness had increased, especially in the
mid line of the body, reaching two inches below
the umbilicus, also extending to the left side.
Epigastric nodules had increased in size, and
new ones had made their appearance. No ele-
vation of temperature. Pulse varying from 10of
---
Slightly jaundiced.
full of a blood-stained serum.
THE PATHOLOGICAL SOCIETY of Toronto.
ser-----
to róo. Bowels acting very well considering
the amount of food he was able to take. Lungs
and heart still normal, excepting the weaker
cardiac action.
only two occasions was there any blood, and
Vomited matter the same. On
then simply a trace. Once my attention was
called to a piece of flesh the size of a bean, and
resembling organized lymph, in the vomit.
Very emaciated.
Patient died on the morning of the 29th.
Post Mortem.—Emaciation very great. All the
subcutaneous fat had disappeared. Abdomen
Liver enor-
mously enlarged, and fully three-quarters of the
liver structure was supplanted by cancer tissue,
much
which broke down easily under the finger.
The nodules felt in the epigastrium before death
supplanted by a huge ulcer.
from the cardiac end through the cancerous
\
were in the left lobe of liver, and were small
round cancer growths. Gall bladder was full,
but apparently no obstruction to the flow of
bile. Stomach : The pyloric end of this organ
was a mass of scirrhus cancer. It completely
encircled the stomach, and extended to, if it
did not include, the pylorus. The mass was
thicker on the lesser curvature, where apparently
it had originated, and extended in a circular di-
rection, until it completely surrounded the
viscus. The cardiac end was free from disease,
and the space there would have held half a pint
of fluid. The mucous membrane of this part
was congested, while that of the pyloric end was
The passage
mass to the duodenum must have been very
small. Spleen was atrophied, and kidneys
small and congested. No further examination
was made of the body. One abdominal gland
was found enlarged and cancerous.
Interesting Points.--—No family history of can-
cer. Notwithstanding the extensive distension
of the liver present, there was no jaundice until
two or three days before déath. Although the
cancerous portion of the stomach was a mass of
ulceration, there was no coffee-ground vomiting,
properly so-called. On only two occasions was
there any trace of blood. It would be interest-
ing to know the relation of the cancer to the
attacks of indigestion for the last fifteen years :
whether these continually recurring attacks of
functional indigestion were sufficient to cause
;
y
|
A
e
claim ; or whether it is necessary to fall back on
Cohnheim's hypothesis of misplaced embryonic
cells acted on by an irritant; but we feel safe
in stating that, granting the presence of the
eumbryonic cells, yet, if the irritation had been
absent, the cancer would not have developed. Dr.
Fenwick, of the London Hospital, states that can-
cer may and does occur in men hitherto perfectly
healthy, and who have never suffered from indiges-
tion. This, however, we believe to be contrary to .
the experience of most medical men, and is con-
trary to the accepted opinions of the day, unless
we grant that normal digestion produces irrita-
tion, or that an indigestion not sufficient to cause
trouble had been present for some time before
the occurrence of symptoms pointing to cancer.
Dr. McPhedran said the unaffected part of
the stomach would likely show atrophy of the
gastric tubules, and so one would expect apepsia.
He thinks that dyspepsia has nothing to do
|
the cancer by irritation, as some authorities
with the etiology of cancer of the stonnach, for
there are as many cases of cancer without a his-
tory of indigestion as with it. The condition of
the gastric glands shows the difference between
simple and malignant ulceration. Some cases
have been reported of very long duration—one
of fifteen years. In chronic cases, where there
is a good deal of fibrosis, one would expect but
little hemorrhage. *
Dr. Ferguson related the history of a casc
with continuous dyspeptic symptoms for ten
years, becoming progressively worse, but with no
hemorrhage, and dying of cancer of the stomach.
Dr. Graham suggested that these slow cases
might be of a nature similar to rodent ulcer of
the skin.
IDr. Oldright thought the cancer might not exist
from the first, but might be developed towards
the end in a course of long dyspeptic symptoms.
CER A FTER A PPLICATION OF A RSENICAL
PASTE, FOLLOWED BY POULTICING.
This specimen was presented by Dr. Oldright.
The patient said she had been using a cancer
paste and then a poultice, and that this large
slough had separated. -.
MICROSCO PIC.A I, SPECI MENS.
IDr. Acheson presented (1) slides of diphtheri-
tic membrane from a case of pharyngeal diph-
theria, stained with an alkaline solution of
35
As"
36
methylene-blue, and showing the Klebs-Loeffler
bacillus, together with the other micro-organisms
usually found in such membranes; also plate
cultures on glycerine agar, and tube cultures on
solidified blood serum. He considered the only
positive test for diphtheria was finding the
probably of the nature of melanin.
THE PATHoLOGICAL SOCIETY of Toronto.
-w
and removed. The tumor proved to be com-
posed of fibrous tissue, containing numerous di-
lated blood channels, and, in places, a dark
pigment, composed of variously sized granules,
The
growth might be designated an angeio-fibroma.
Klebs-Loeffler bacillus in the pseudo-membrane.
It could be readily distinguished by its bent
club-shaped end, especially after staining.
Sections of a tumor of the spinal cord, from
a case where there had been paraplegia for four
years. The diagnosis of tumor, probably a
fibroma, had been made by Dr. Graham ; and
the vertebral canal had been opened by Dr. Came-
ron, with the result that a tumor was found
growing from the inner surface of the dura mater,
(2)
After the transaction of some routine busi-
ness, and the reception of various annual re-
ports, the following Council for the next year
was elected : —- *
1)r. J. E. Graham, President; Dr. A. Mc-
Phedran, Vice-President; with Drs. A. B. Mac-
allum, G. A. Peters, and George Acheson,
|
|
*
Councillors.
The society then adjourned till Sept. 26th,
1891. e
- * - PAGE
Acheson (Geo.), Diphthoritic Menllyrano, showing Klebs-
Loeffler Bacillus............ ................. - * * * * * * * * * * * * * g e 3')
& a Pus containing Gonococci.................................. 4
“ Rodent Ulcer...................................................... 21
fi tº Tumor of the Spinal Cord.................................. 3.5
Aikins (H. Wilberforce), Ulcer of the Pylorus ................ 3
Almyloid or Lardacein, A new micro-chemical reaction
of (A. B. Macallum).................... ~~~~ 29
Anaemia, Pernicious (A. McPhedran)............................... 31
Barker (L. F.), Pyosalpinx.................. - - - - - - - - - - - - . . . . . . . . . . . . . . . . . . :33
“ Ulcerative Endocarditis.............................. ~ 18-21
Breast, Encephaloid Cancer of (J. Caven)....................... 25
Bursa over Olecranon, milky fluid from (W. Oldright).... 18
Calculi in Ureter (J. Caven).................................... ........ !}
Calculi in Kidney. Ureter, and Bladder (J. Caven).......... 25
Calvarium, Necrosis of (G. A. Peters).............................. 30
Cameron (I. H.), Head of the Femur removed for I'ulber-
cular Disease................................................... 20
& & Ovarian Cysts..................................................... 21
4 & Stricture of the Rectum..........‘. . . . . . . . . . . . . . . . . . . . . . . . . . 8
“ Uterus and Fibroid Removed by Vaginal Hys-
- terectomy....... ~~~~… 33
Cancer of the Breast, Encephaloid (J. Caven).............. ... 25
Carcinoma of the Stomach (W. J. Greig)......................... 34
Carcinoma Uteri (T. K. Holmes)...................................... 26
Caven (John), Calculi in Ureter........................ … 3
6 & Calculi in Kidney, Ureter, and Bladder............ 25
- “ Double Ureter on both sides.............................. 2
4 & Enteric lesions of Typhoid lº'ever in the Horse
& 4 Encephaloid Cancer of the Breast.................. .. 2.
“ Intestimal diverticula in the Itectum................. 25
“, Miliary tubercle of the Lung............................. 2.j
“ Myeloid Sarcoma................................................ 21
§ 4 Phagocytic action of Giant Cells............ . . . . . . . - - - - - - 4
“ Remnant of patent Urachus............... … ... 25
“ Tumor of the Polls Varolii................... … 34
Caven (W. P.), Intestine of Chronic Dysentery................ 3
6 & Tumor of the Cerebellum.................................. 29
Cell, Pathological (A. B. Macallum).......................... ...... 22
Cell, giant, Phagocytic action of (J. Caven)........ • * * * * * * * * * * * * 4
Cèrebellunu, Tumor of (W. P. Caven).................. ............ 2:)
Cervix Uteri, Hypertrophied tissue from (T. K. Holines) 26
Cirrhotic Liver (J. E. Graham)........................... ~~~~ 16
Conjunctival Tuniors (R. A. leeve).................................. 32
Cysts, Ovarian (L. H. Cameron)......................................... 21
Diaphragmatic Hermia (I. Olmsted)............ ................... 6
Diphtheritic Membrane, slowing Klebs-lucutlier IBacilius
(G. Acheson).…. … 35
Ductus Arteriosus, l’atent (W. Old right) ......................... 17
Dysentery, Chronic, Intestine in (W. P. Caven)............. ... 3
Encephaloid Cancer of the Breast (J. Caven).................. 25
Endocarditis, Ulcerative (L. F. Barker).......................... 19-21
Enteric Lesions of Typhoid Fever in the Horse (J. Caven) 4
Epulis (W. Oldright)..................~~~~ S. 1S
Femur, Acute Necrosis of (G. A. Peters).......................... 28
Femur, Head of, removed for Tubercular Disease (I. H.
& Cameron)......... F - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - : . . . . . . . . . . . . . 20
Femur, Necrosis of (J. Ferguson)....................... sº w w a s , , s e ... 17
. Fergusou (John), Necrosis of the Femur......................... 17
:
INDEX,
/ . PAGE .
Fil)roid and Uterus removed lºy Vaginal Hystercetomy
(I. H. Cameron)........................................................... $
Giant Cells, Phagocytic action of (). Caven)................... 4
Gonococci in Pus (G. Acheson .... ... .............................. 4
Graham (J. E.), Cirrhotic Liver... ... ............................... 16
& & Malignant Disease of the Pylorus...................... 8
tº gº Nephritis, probably dependent upon Pernicious .."
Antemia..................................... . ................... s 5
“ Presidential Address........................................... 1
Greig (W. J.), Carcinoma of the Stomach......................... 34
Hernia, Diaphragmatic (I. Olmsted) .................. ............ 6
Hip Disease, Tubercular (B. E. McKenzie) ..................... 7.
Holmes (T. ſ.), Carcinoma Uteri............................... • * - - - - 26
& & Hypertrophied Tissue removed from a Ducer-
ated Cervix Uteri.... ..........… ... . . . .......... 26
& 4 Stricture of the CEsophagus.... ................ ......... 26
“ Tumor of the Testicle......................... .............. 26
4 & Uterus and Appendages removed from a case
of Ruptured Tubal Pregnancy.......... .… . 26
Hypertrophied Tissue removed from a Lacerated Cervix
Uteri (T. K. Holmes) ................................................ 26
Intestine of Chronic Dysentery (W. P. Caven)................. 3
Intestinal Diverticula in the Rectum (J. Caven).............. 25
Intestine, Traumatic Perforation of (W. Oldright).......... 18
Kidney, Ureter, and Bladder containing Calculi(J. Caven) 25 -
Klebs-Loeffler Bacillus in Diphtheritic Membrane (G.
Acheson)............................................................. . . . . . . . .
Lardacein or Amyloid, A new micro-chemical reaction
of (A. B. Macallum)................................…. 29
Ligature relimoved from the Scrotumn after having re-
mained in the tissues twelve months (R. B. Nevitt.)... 34
Liver, Cirrhotic (J. E. Grahann),............................* * * g a g is g º a s lſ;
Malignant Growth of the l’eritoneum (H. C. Scadding)... 2-9
Malignant Disease of the Pylorus (J. E. Graham)............ 8
Mammary Tuinor (W. Oldright)...... ................................ 6
. Macallum (A. B.), A new micro-chemical reaction of
Lardacein or Amyloid.................................... 29.
Query: What is a Pathological Cell?.................. 22
McKenzie (B.E.), Tuloercular Hip Disease............. ........ 7
McKenzie (T.), Paget's Disease of the Skull............... .....21-25°
McPhedran (A.), Pernicious Aniemia................................ 31
Microscopical Committee, Ikeport of malignant growth
of Peritoneum................................…...... 9
“ Ulcer of the Pylorus................................ 2 e s • * * * * * * * ‘9
“ Rectum of Chronic Dysentery........................ ... 9
Myeloid Sarconia (J. Caven)............................................. 21
Myxoma removed from the Great l’ectoral Muscle (A. -
Primrose).................................................................... 26 -
Necrosis of the Calvarium (G. A. Peters)......................... 30
Necrosis, Acute, of the Femur (J. Caven)......................... * 28
Necrosis of the Femur (J. Ferguson)............... . * * * * * * "....... 17
Necrosis of the Tibia (A. Primrose)......................... • e º & e º ºs ... 4
Nephritis, probably dependent upon Pernicious Amaemia
(J. B. Graham).......….........…............…. 5
Nevitt (R. B.), Ligature removed from the Scrotum afte
lying in the tissues twelve months........~~~~ ... 34
GEsophagus, Stricture of (T. K. Holmes).................... ...... 26
Oldright (Win.), Epulis.......................... . . . . . . ..................... 18
“ - Malmmary Abscess...................... ....................... ti
* * *
*
Aº
INDEX. •, • - -
. ** - . . PAGE 4 * , - - PAGE
Oldright (Wim.), Milky Fluid from a 13ursa over the Ole- Sarcoma of Tibia (W. B. Thistle)...... •tº a g º º ºs é º º ºs ..'............... 30
ºranou..…..…......…............ 18 Sarcoma, Myeloid (J. Caven)................................ ......…. 21
“ Patent Ductus Arteriosus......................... ......... 17 | Sarcoma of the Orbit (R. A. Reeve).................................. 17
“ Slough separated from a Mammary Cancer by
the application of Arsenical Paste....... ........ $5
“ Traumatic Perforation of the Intestine...... ...... 18
Olmsted (Ingersoll) Diaphragmatic Hernia.......... ~~~~ 6
Orbit, Sarcoma of (R. A. Reeve)........................................ 17
Ovarian Cysts (I. H. Cameron).......................................... 21
Ovaries removed for Oophoralgia (H. C. Séadding).......... *
Paget's Disease of the Skull (T. McKenzie)..................... 21-25
Pathological Cell ? Query: What is a (A. B. Macallumi)... 22
l’erforation, Traumatic, of the Intestine (W. Oldright)... 18
Peritoneum, Malignant growth of (H. C. Scadding)......... 2
Pernicious Anaemia, Nephritis probably dependent upon
(J. E. Graham)............................................................ 5
Pernicious Anaemia (A. McPhedran) .................... ...... ... 31
Pectoral Muscle, Myxoma of the (A. Primrose)................ 26
l’eters (G. A.), Acute Necrosis of the Fennur..................... 2S
“ Necrosis of the Calvarium.................................. 30
Phagocytic action of Giant Cells (J. Caven)..................... 4
Pons Varolii, Tunnor of (J. Caven) .......................... ........ 34
Presidential Address (J. E. Graham)............................... l
Prinurose (A.), Necrosis of the Tibia................................. 4
“ Myxoma relmoved frolin Great Pectoral Muscle 26
l’sorospermosis Folliculaire Végétante (A. R. Rollins 11) 9
Pylorus, Malignant Disease of (J. E. Graham).......... ..... 8
I’ylorus, Ulcer of (H. W. Aik’ns)....................................... 3-9
Pyosalpinx (L. F. Barker) ............................................... 3.3
, l’us containing Gonococci (G. Acheson)........................... 4
Roctum in Chronic Dysentery......................................... 9
Rectuum, Iutestinal Diverticula in (J. Caven)................... - 25
Reeve (R.A.), Conjunctival Tuumors.............. … 32
“ Sarcoma of the Orbit............ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Robinson (A. R.), Psorospermosis Folliculaire Végétante 9
Rodent Ulcer (G. Acheson)....... ......................................... 21
Scadding (H. C.), Malignant growth of the Peritoneum. 2
$6 Ovaries removed for Oophoralgia...................... 21
Skull, Paget's Disease of (T. McKenzie)........ • . . . . . . . . . . . . . . . ...21-25
Slough separated from a Mammary Cancer by the appli-
cation of Arsenical Paste (W. Oldright) ..................... 35
Spinal Cord, Tumor of (G. Acheson)........... ‘...…. ..... 35
Stolnach, Carcinoma of (W. J. Greig)........................... ... 34
Stricture of the CEsophagus (T. K. Holmes)................... 26
Stricture of the Rectum (I. H. Camerou)................. “...... 8
Thistle (W. 13.), Sarcoma of the Tibia............................ ... 30.
Tibia, Necrosis of (A. Primrose)....................................... 4
Tibia, Sarconna of (W. H. Thistle)...................... ............... 30
Tubal Pregnaney, Ruptured Uterus and Appendages
from a case of (T. K. Holmes).................................. .26
Tubercular Disease of the Hip (B. E. McKenzie)............. 7
Tubercular Disease of the Head of the Femur (I. H. -
Calmeron)..........................** a g º e g g : « º e s ∈ e º s v e s a … . . . . . . . . . 20
Tumor of the Cerebellum (W. P. Caven)......". . . . . . . . . . . ~~~ 20
Tumors of the Conjunctiviſt (R. A. Reeve)........................ 32
Tumor, Mammary (W. Oldright) ..................................... 6
Tumor of the Pons Varolii (J. Caven)............................... 34
Tuumor of the Spinal Cord (G. Acheson)................. • * * * * * * * ~ * 85.
Typhoid Fever in the Horse, Euteric Lesions of (J. Caven), 4
Ulcer of Pylorus (H. W. Aikins).......... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '3 s.
Ulcerative Endocarditis (L. E. Harker)........................... 19-21
Ulcer, Rodent (G. Acheson).......................................* * * * * * * * “21
Urachus, Remnant of a Patent (J. Caven)........................ 25
Ureter, Calculi in (J. Caven)..................................…..... 3.
Uterus and Fibroid removed by Vaginal Hysterectomy
(L. H. Cameron)...............'........... ................................. 39
U terus, Cancer of (T. K. Holmes)................................ sº 26
Uterus and Appendages removed from a case of lup-
tured Tubal l’regnancy (T. K. Holmes)...................... 26