REPORT ON PATHOLOGY AND PRINCIPLES AND PRACTICE OF MEDICINE.

BY FRANCIS C. WEBB, M.D., F.L.S.,

Member of the Royal College of Physicians, Physician to the Great Northern Hospital.

Pathology of the Blood in Chronic Diseases.-In January of the present year Dr. Adolph Lestorfer announced the discovery of certain corpuscles in the blood of patients the subjects of syphilis. The corpuscles were not to be seen in fresh blood, but in blood which had been kept from twenty-four hours to four days. The corpuscles were discovered by the use of high magnifying powers, Hartnach's eye-piece No. 3 and immersion lens No. 10. The corpuscles were described as minute, bright bodies, some immovable, some in a state of undulation. Some of the bodies exhibited projections. As they were watched from day to day they enlarged in bulk and numbers. The projection appeared to be a kind of sprout; some of the bodies had one projection, some three or four. The projections were sessile or had a minute pedicle. The corpuscles were irregular in shape. After eight or ten days a vacuola was formed in the larger corpuscles, which extended over the whole body and terminated its further development. Dr. Lestorfer stated that he had examined in a similar manner the blood of patients suffering from gonorrhoea, diphtheria, eczema, typhus, elephantiasis, and lupus, but never had found anything to be compared with the appearances he found in syphilitic blood. He gave to the bodies the name of "syphilis-corpuscles." The discussion which has arisen out of Lestorfer's announcement has led Professor Stricker to re-examine the whole subject. Professor Stricker commenced his observations by examining the blood of three syphilitic men; in all three, in the course of a few days, the Lestorfer's corpuscles were found. He found that the temperature at which the blood was kept had a great influence on the production of the corpuscles. In a chamber heated to 22 Cent. he watched the process of the growth and development of these bodies. He writes:-"On the following day I took again a fresh specimen of blood from a syphilitic patient, had my chamber warmed, placed a portion of a specimen under Hartnach's immersion lens No. 10, and watched. About fifteen minutes had passed since the drop of blood was taken, when it seemed to me that I could detect, in the otherwise clear plasma-interspace, a few granules. In the course of ten minutes more these granules had assumed so decided a character that I could clearly define their positions. At the same time it appeared to me as if numerous fresh granules were making their appearance in the same interspace. At the end of half an hour the granules which had first appeared were already so large as to enable me to recognise them as the bodies I was looking for. At the end of an hour and a half the first granules had grown to the size of a nucleus of a pus

corpuscle, and the whole plasma-interspace was scattered over with similar but smaller granules. There was no longer the slightest doubt; I had before me Lestorfer's bodies; they had made their appearance and grown up in a clear plasma-interspace under my own eyes." Stricker finds that whilst it is true that the bodies bear sprouts, some of the sprouts arise, not through a process of growth, but through the apposition of other bodies. He watched the process by which a smaller corpuscle which had been lying in the neighbourhood of a larger one approached the latter, and became attached to it like a button. With regard to Lestorfer's statement that the bodies sometimes grow into sack-shaped bodies or tubes, he states that he only once saw a corpuscle with a long adherent tube, but he saw the tube originate by the arrangement in a row of three small corpuscles. The interspaces and constrictions between them became effaced, and a homogeneous tube projecting from the large corpuscle was completed. The chemical reaction of these bodies was different immediately after their first appearance from what it was when they had been developed to a large size. When fully developed, they are but little affected by alkalies and acids; they shrink a little, but are not destroyed. In an early stage they are destroyed by acids and alkalies, and even by water. Stricker observed the phenomenon of repeated approach and separation between larger and smaller bodies, a phenomenon which he says can only be explained upon the supposition that their bond of union is contractile, and that the bodies themselves are organisms. In answer to the question whether these corpuscles are only to be found in the blood of syphilitic persons, he gives a decided negative. In 13 cases of general syphilis he found the bodies in large number in 9 cases; in 2 they were not to be found; in 2 they were so few that he considered the result negative. He found no trace of the corpuscles in the blood of 10 healthy, well-nourished persons, in 1 case of pneumonia, 1 of heart disease, 4 of typhus abdominalis, 1 of typhus exanthematicus, and in 10 cases of smallpox. They were found in 2 out of 10 cases of lupus. Stricker, however, was led to inquire whether the occurrence of the corpuscles might not be connected with deficient nutrition. He therefore observed the blood in several chronic affections. He found the corpuscles in large numbers in 1 case of carcinoma ventriculi, in 2 cases of tuberculosis, in a case of Bright's disease with disease of the heart, and in a case of anæmia following variola. He concludes that these new elements of the blood are seldom present in sound persons and in persons with acute diseases, but are frequently present in persons suffering from long-continued disturbance of nutrition, and in persons affected with syphilis.

Lestorfer also has published some observations showing that sarcina, or what closely resemble sarcinæ ventriculi, are found in the blood of healthy men after it has been kept to the third and fourth days.-Archiv. für Dermatologie und Syphilis, IV Jahrgang, erstes Heft, 1872; Medicinische Jahrbücher, 1872; Amer. Journ. Med. Sciences, July, 1872.

On the Injection of Pus into the Medullary Canal of Bones.M. Demarquay has laid before the French Academy of Medicine the account of some experiments in which he injected pus into the medullary canal with the view of determining whether it is absorbed and carried into the circulation. Pus taken from a human subject -pure and putrid-was injected into the medullary canal of the femur of rabbits. Twelve experiments were recorded. The following were the results in each case. All the animals died after presenting during life the following phenomena :-(1) Alteration of the hair, (2) sensible loss of flesh, (3) elevation of temperature from 38 to 39°; it has been noted as high as 41 or 42o, diminishing a little before death. The autopsies showed deep and superficial phlegmon more or less marked on the side operated on. 2. Pulmonary congestions; pneumonic patches more or less marked; once pulmonary gangrene. 3. Congestion and softening of the liver, spleen and kidneys. 4. Metastatic abscesses of the liver in various degrees of development. M. Demarquay is convinced of the importance which is to be attributed to osteomyelitis in the theory of septicemia or purulent infection. The same lesions were produced in these experiments as follow the injection of putrid matters into the jugular or crural veins.-Gaz. Hebd. de Méd. et de Chir., Oct., 1871.

On the Local Action of Pus and Putrid Substances.-According to some experiments by S. Samuel there probably exists a specific toxical agent in putrid matters. Putrid substances injected under the skin of a rabbit's ear, in a state of concentration, and in a quantity of twelve or fifteen drops, produce in the living animal a putrid process, which, developing more or less rapidly, is characterised by swelling, greenish coloration of the tissues, and an intense putrid odour. This physiological reaction is also observed with substances which do not present the putrid odour nor the characteristic chemical reactions. Symptoms of septicemia, due to the absorption of the injected matters, follow the local phenomena. The chemical agents whose presence has been established in putrid matters do not give rise to this reaction. This is the case with leucine, butyric acid, valerianic acid, carbonate of ammonia, sulphurous water, sulphocarbonic acid. Sulphide of ammonium, injected under the skin, produces patches of gangrenous inflammation more resembling those produced by putrid poison, but they differ in not giving off the putrid odour. The physiological reaction of putrid pus is not altered by the quantities of butyric, formic, or valerianic acids it contains.Medic. Central. Zeit., and Gaz. Hebd. de Méd. et de Chir., Oct., 1871.

Hectic Fever.-Dr. Francis D. Condie lays down the proposition that hectic fever, however distinctly developed, is by no means pathognomonic of pulmonary tuberculosis, even when accompanied by impeded or disturbed respiration, cough and expectoration. The symptoms of hectic mark, usually, cases of spurious consumption (chronic bronchitis and pneumonia), while hectic fever is the attendant upon a large number of cases of disease in which no affec

tion of the respiratory organs is present, as is proved by post-mortem examinations. Again, it is not invariably the attendant on pulmonary tubercular phthisis. Louis found it wanting in one case out of ten. According to the author's experience, however, the fever is absent less frequently than this. Neither is it true that hectic is dependent on slow continued suppuration in some internal part or organ, or that it is caused by the reabsorption of pus from internal or deep-seated abscesses. It is found in tubercular phthisis even before tubercular deposit has taken place or any abscess has been formed in the lung. In no case has it direct relation to the extent of the suppuration going on at the time, or which has preceded it. In patients of an eminently strumous diathesis it is one of the first indications of mischief going on in the lungs. It is of common occurrence in cases of debility when the patient has been subjected for a long time to some source of irritation, although it is certain there is no suppuration going on in any part of his organism. This is especially the case in patients of a strongly marked nervolymphatic temperament. On the other hand, it is absent in very many cases of long-continued suppuration when there is an impediment to the escape of the pus, as in cases of abscess under deep fascia. Hence the presence or absence of hectic affords no certain diagnosis as to the presence of pulmonary disease or between tubercular and spurious phthisis.-Amer. Journ. Med. Sciences, April, 1872.

Dengue.-Surgeon Sparrow, of the 89th Regiment, gives an account of the dengue fever as observed in Cannanore amongst officers and troops who had just arrived from Aden, where dengue was prevailing. Isolation proved successful in preventing the extension of the disease. A general uniformity of symptoms characterised all the cases. There was a sudden invasion of the disease by pain of limbs, followed by the hot stage of fever, intense frontal headache, furred tongue, acute pain of joints (the most marked symptom during the progress of the disease), the pain so severe in some cases that the patient was seen to fall to the ground as though paralysed; the stage of pyrexia lasted three days, when, with the exception of continued pain in the joints, all the symptoms were relieved; there was clean tongue, normal pulse, cool and moist skin. On the fifth day a burning pain of the palms of the hands was complained of, on examination they were found to be swollen and covered with redcoloured blotches. The eruption then extended up the arms, and in most cases the entire body became covered with the erythematous eruption, resembling that of scarlatina; fever returned and lasted twentyfour hours after which there was gradual abatement of the symptoms, but soreness of the feet and swelling of the hands, with inability to close them, continued. In many the pains in the joints continued at intervals for a month. No delirium attended any of the cases. Except in one or two cases where there was slight diarrhoea, there were no sequela; relapses, consisting of increase of articular pain, with slight return of fever, were observed in three or four.— Madras Monthly Journal of Med. Science, May, 1872.

Scorbutus.-Dr. A. Porter gives an account of scurvy as observed in fifty cases which occurred during five years in Akola jail; 78 per cent. of the cases occurred during the months of July, August, and September, when fresh vegetables are most scarce; owing to the rains. The coldness and moisture of the season seemed to have little to do with the causation of the disease; the majority of the patients were not exposed. The attacks could not be attributed to deficiency of salt in the diet. In 92 per cent. of the cases weakness and listlessness were present on admission; in 4 cases only was pain in the limbs and back the first symptom noted by the patient; pain in the limbs and back were absent in 14 of the 50 cases, but in 7 of these there was pain in the limbs. Nyctalopia was present in 74 per cent. of the cases, and in 60 per cent. was the first symptom to make its appearance. In one case there was a burning sensation in the conjunctiva. Petechiae and ecchymoses were noted in 24 per cent., but this symptom was not easily recognised on account of the darkness of the skin of the patients. In 88 per cent. the gums were livid and swollen; in 6 cases they were pale and contracted; in 10 cases soreness of the gums, with difficulty of mastication, was the first symptom observed. Bloatedness of the face was absent in 26 per cent. of the cases. Fetid odour of the breath was present in every case except two. Respiration was generally normal; in only 10 cases was it noted above 20 in a minute, in 5 of these there was chest complication. Hard swellings in the flexures of the joints were present in only 60 per cent. The pulse in uncomplicated cases was weak and generally under 80; morning temperature 980-99°, evening temperature a degree higher. The appetite was bad in 14 cases; the tongue furred in 30 cases; livid in one, swollen in none. The bowel swere costive in 4 cases, loose in 3, dysenteric in 1, normal in the remainder. Sleeplessness was noted in 58 per cent. One patient died from syncope. Effusion into the pleura was present in 2 cases, and pulmonary congestion in 3. In 2 cases there was lupoid ulceration near the outer malleolus. The urine was pale of low specific gravity, and contained indican. It was otherwise healthy. The treatment consisted of full diet with fresh vegetables, arrack and lime juice. The gums were sponged with a solution of nitrate of silver. The author records the post-mortem appearances in six fatal cases. In almost every instance there was emaciation, with effusion into some part of the body. Effusion of blood on the pleura, peritoneum, and beneath the mucous membrane of the stomach and intestines, was observed in some of the cases.-Madras Monthly Journal of Med. Science, April, 1872.

Suppuration of one half Lobe of Cerebrum; Consciousness and Ability to Labour Intact; Sudden Death.-Dr. Schwartzenthal relates the case of a day-labourer, æt. 30, who in May, 1871, suffered for two weeks with pain in the head, langour and want of appetite, followed by a severe fever, which lasted a month. He then became apparently convalescent, and resumed his occupation. About four weeks after he left the hospital he received a blow on the head and died