« ZurückWeiter »
Thus bone becomes cartilaginous; cartilage is made to resemble fibro-cartilage; cartilage, fibrous membrane ; and this, as well as the serous and mucous membranes, to assume some of the qualities of the cellular. It is obvious, that deposites of coagulable lymph would retard, rather than promote this series of changes. Softening is sometimes the only test of pre-existent inflammation in the brain and gastro-enteric mucous membrane, and hence it is of great importance for the pathological anatomist to have an accurate knowledge of the variations of normal density exhibited by those tissues.
Softening, as we have already said, does not always depend on inflammation. Whatever impairs the nutrition of a tissue, will tend to produce its decomposition.
Induration is in some degree the opposite of mollescence, ramollisement or softening, and often shows itself as governed by the same law. Thus cellular may be converted into fibrous membrane, cartilage into bone, &c. But in other cases the tissues are consolidated with each other by deposits among them of plastic lymph. In speaking of the causes of this pathological state Prof. Gross remarks:
“ These are referable, for the most part, to inflammation, followed by an effusion of coagulating lymph into the insterstitial substance of the affected organ. In the lungs there is frequently, in addition to this, more or less blood poured out, which, combining with the natural structures, gives them a red color. It is thus that red hepatization is established. In chronic cases, on the other hand, the induration is commonly effected by the lymph alone; and hence it is that the organ is usually of a much lighter hue. In the hardening of the subcutaneous cellular' tissue of infants, a disease of pretty frequent occurrence in certain districts of Europe, the effused matter is generally impregnated with two coloring principles, the one of an orange red, the other of a bluish shade, both of which are stated by M. Chevreul to exist in the blood.”
The chapter on hæmorrhage is full of interest, but we have not space for its analysis. Professor Gross is of opinion, that in most cases not dependent on a mechanical lesion of the vessels, the hæmorrhagic action is more or less inflammatory. In evidence, among other facts, he cites the constitutional and local symptoms attendant on menstruation, especially when painful. We are aware, that many cases of the latter are inflammatory, but in these the discharge is generally sparing, whereas it ought to be copious, if caused by an inflammatory action. It is impossible to believe, moreover, that inflammation attends the profuse hæmorrhages connected with the final cessation of the menses, inasmuch as none the ordinary symptoms of inflammation, either pelvic or constitutional, are present; and the discharge is best restrained by a treatment, the reverse of that which is adapted to the cure of inflammation. Hæmorrhages from the other mucous membranes are often mere exhalations; but in hæmoptysis the discharge is not always from the bronchial membrane. We recollect a case in which it came from an artery of considerable size, divided by ulceration, and remaining pervious. We are quite convinced that many hæmorrhages depend on a morbid state of the blood-perhaps on a diminution of its albuminous ingredients, whereby it passes through tissues, which were only competent to its confinement while it remained in a normal state.
Hypertrophy and atrophy are the subjects of separate chapters. We can but glance at them. Hypertrophy may be either general or topical. The last by far the most interesting to the physician and surgeon, generally arises from too great a determination of blood to the part. This may be the result of an irritation maintained within it for some time, raising more or less of inflammatory action; or of its being thrown into excessive action. The heart may furnish an example of both. Under the influence of certain passions, that organ becomes hypertrophied; and again, when the valves, seated at the outlet of any of its great cavities, become impaired in their structure, the parietes, from the increased labor they are called upon to perform, acquire abnormal dimensions. We lately saw a heart in the possession of Dr. Enders, in which this was beautifully illustrated by the valvular vegetations, which obstructed the passage of the blood through the organ.
Atrophy, the opposite of hypertrophy, often coexists with it in the same compound organ. Thus while one tissue is reduced below its proper size, another may be increased beyond—and vice-versa. More commonly, however, all the tissues of an organ are equally reduced. Atrophy implies de ficient nutrition, or excessive absorption. Pressure external or internal frequently leads to it, and is said, in the common parlance of the profession, to do so by promoting absorption. In these cases, however, the supply of blood is limited by the compression of the nutrient arteries. In this manner portions of the lung and liver are occasionally greatly reduced in size-contracting coagulable lymph having been effused about and within them. The causes of atrophy are, however, extremely various. Thus the disuse or rather nonuse of an organ or a limb rapidly reduces its size ; and a lesion of its innervation, impairing its function of nutrition, may have the same effect. In old age nearly all the parts of the body pass into a state of atrophy; on the other hand, the whole never rise into hypertrophy. The great bulk which some aged persons exhibit, arises from hypertrophy of the adipose tissue alone.
Our author next arrives at transformations-the conversion of one texture into another. He regards the whole as
“ effected under the influence of inflammatory irritation." To this sweeping generalization we are not quite prepared to give our assent. Nevertheless, many transformations take place almost under our eyes, and can be seen to depend on inflammatory action. Thus when the skin is transformed into mucous membranes, it is under circumstances of irritation, and with the appearance of inflammation; when a deep seated abscess does not fill up with granulation and a fistula remains, this artificial efferent duct comes to be lined with a mucous membrane, analagous to that of the excretory vessels of certain glands,--which may be regarded as the transformation of cellular into mucous membrane. A few months since we saw an extensive adipous transformation of the gas- . trocnemii and other muscles of the leg, in connexion with chronic inflammation and articular ulceration of the ankle, rendering amputation necessary. The skin of the same limb was changed into a tissue nearly resembling cartilage.
Many transformations, however, are not preceded by symptoms of inflammation. Such are ossifications of the cartilages of the ribs, the valves of the heart, and the parietes of the vessels
on the other hand, bones occasionally pass into the state of cartilage, without the signs of inflammation being present. Transformation is, in fact, a lesion of nutrition and may take place with or without inflammation.
The following are the analagous transformations admitted by our author: 1. the cellular-2. the mucous—3. the cutaneous—4. the fibrous-5. the cartilaginous—6. the osseous 7. the adipous. These cannot be formed in or out of any other tissue of the body, indiscriminately. The law which governs their production, is nearly the same that presides over the softening of the tissues. The cellular may pass into the mucous, and this into the dermoid or into the fibrous
which may then become fibro-cartilaginous, cartilaginous and osseous.
Under no other aspect does the science of general anatomy appear more attractive and useful, than when administering to the study of these transformations; the contemplation of which fills the mind with cheering anticipations of the future condition of pathological science.
ART. III.-Guy's Hospital Reports. No. viii, April, 1839.
Edited by George H. Barlow, M. A. &c., and James P. Barrington, M. A. 8vo. pp. 263. London, 1839.
THE present number of this most excellent and highly practical work contains the following articles :
On the Disorders of the Brain, connected with diseased Kidneys. By Thomas Addison, M. D.-On Perforations of the Stomach, from Poisoning and Disease. By Alfred T. Taylor.-On the Diurnal Variations of the Pulse. By William Augustus Guy, M. B., &c.—Observations on Poisoning by the Vapours of Burning Charcoal and Coals. By Golding Bird, M. D., &c.—Two cases of Poisoning by the Inhalation of Carburetted Hydrogen. By Thomas Pridgin Teale, F. L. S.-Case of Imperforate Uterus, with Remarks. By Alexander Tweedie.-On Incision in Cases of Occlusion and Rigidity of the Uterus. By Samuel Ashwell, M. D. Observations on Fibrinous Concretions in the Heart. By Dr. Hughes, M. D., &c.-Analysis of Bones affected with Mollities Ossium. By G. O. Rees, M. D., &c.- Case of Division of the Tibia, for the Cure of Deformity occasioned by a Gun-shot Wound. By Charles Aston Key. Case of Spermatocele, or Varico