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A Manual Of Pathology | by Joseph Coats, Lewis K. Sutherland



Pathology is the scientific study of disease. The term Disease, which strictly means nothing more than Discomfort, has reference primarily to the subjective sensations of the person affected, but as these feelings have an objective basis, and as it is possible to distinguish various groups of phenomena, each with its own mode of divergence from the healthy conditions, these groups of phenomena have come to be designated as diseases.

TitleA Manual Of Pathology
AuthorJoseph Coats, Lewis K. Sutherland
PublisherLongmans, Green, And Co.
Year1900
Copyright1900, Longmans, Green, And Co.
AmazonA Manual Of Pathology

By Joseph Coats, M.D, Late Professor Of Pathology In The University Of Glasgow

Fourth Edition, Revised Throughout By Lewis K. Sutherland, M.B., Professor Of Pathology In The University Of St. Andrews

With Four Hundred And Ninety Illustrations

-Preface To Fourth Edition
A desire has been expressed that this posthumous edition of the late Professor Coats's standard work should contain some brief indication of what he did, and what he was, in a life-time full of activi...
-A Manual Of Pathology
Introduction PATHOLOGY is the scientific study of disease. The term Disease, which strictly means nothing more than Discomfort, has reference primarily to the subjective sensations of the person af...
-Part First - General Diseases. Section I. Nature, Causation, And Terminations Of Disease In General
Nature of Disease. Normal activities of tissues concerned with self-preservation; in disease their efficiency impaired. Causation of Disease. - Action of external forces nearly always present, but pow...
-Causation Of Disease. Aetiology
The actual causation of particular forms of disease is in many cases obscure, because of the limitations of our present knowledge. Looking at disease as a whole and the great groups into which the mor...
-A. Influence Of External Forces In The Causation Of Disease
External influences may have a direct or an indirect influence in the causation of disease. This is to say, they may act directly on the tissues so as to bring about certain phenomena which we term di...
-1. The Physical Forces, Mechanical, Chemical, Thermal, And Electric
The Physical Forces, Mechanical, Chemical, Thermal, And Electric, often directly affect the tissues. Their effect is to damage the parts on which they act. The mechanical forces cause wounds, bruises,...
-2. Poisons
Poisons, in the ordinary sense of the word, can scarcely be said to produce diseases. Some of them, indeed, are chemical agents, such as alkalies and acids, which act locally on the tissues, and produ...
-II. Influence Of External Circumstances In Producing Susceptibility To Disease
External circumstances doubtless produce definite effects on the living body, but these effects are frequently very difficult to determine. Climate, temperature, condition of the atmosphere as regards...
-B. Influence Of Internal Conditions On The Causation Of Disease
From what has gone before it will appear that the condition of the tissues forms frequently a strong predisposing element in the causation of disease. It will also appear, however, that there are cert...
-I. Congenital Diseases And Susceptibilities
A condition is congenital when the person is born with it. There are some diseases which are manifestly present at birth, for the causation of which it is necessary to go back to the period of life in...
-II. Influence Of Inheritance In The Causation Of Disease
At the outset it is necessary to distinguish two very different classes in relation to the inheritance of disease. Hereditary Diseases The term hereditary disease is usually applied to cases in ...
-1. The General Principles Of Inheritance
In order to determine the dormyn of inheritance in the causation of disease, it is necessary first to consider the nature of its influence in the normal anatomical and physiological conditions of our ...
-2. Inheritance Of Structural And Physiological Abnormalities
From what has gone before we have seen that minute differences in local structure are the usual subjects of inheritance. Coming to more considerable differences in structure, such as constitute more o...
-3. Inheritance Of Susceptibilities Or Predispositions To Disease
We have seen that certain forms of disease are due to the action of infective agents, which, obtaining.an entrance into the body, multiply there and give rise to certain phenomena. It is matter of fre...
-4. The Constitution Of The Body The Result Of Inheritance
If we define the Constitution as the inherent structure and powers of the organism, then we shall recognize that the constitution of the individual is made up of an immense number of particulars of st...
-5. Theories Of Inheritance
The facts to be accounted for in any theory of inheritance are that the fertilized ovum at the outset of its career bears in itself the various particulars of the future individual down to the finest ...
-III. Influence Of Age And Sex In The Causation Of Disease
It will be understood from what has gone before that age and sex will affect the causation of disease only by increasing or diminishing the susceptibility to certain diseases. ...
-1. Influence Of Age
The first weeks and months of life are the most fatal, so much so that about a fourth of the children born die within the first year, while in many towns more than half the deaths are of children unde...
-2. Influence Of Sex
Diseases of the generative organs are of course distinctive in the two sexes. The tissues of the male being, as a rule, larger and firmer, they might be expected to offer more resistance to the extern...
-Terminations Of Disease
The termination of disease is in recovery or death. The recovery may be much prolonged and only partial, or death may ensue onlj-after a long struggle. ...
-1. Recovery From Disease
It has been indicated above that disease is due to an interference from without with the normal physiological processes, or to an abnormal construction or tendency of the living tissues. The existence...
-2. Death
This is the unfortunate termination of many diseases, but the tendency to death is frequently more an accidental circumstance than a necessary part of the phenomena of the disease. Life may persist...
-Section II. Teratology. General Malformations. Monstrosities
Introduction - Definition of terms and grouping. Causation of monstrosities. Nomenclature. I. Monstrosities by excess, in size or number. A. By excess in size, giants, local hypertrophies. B. By exces...
-General Malformations
Introduction THE conditions to be considered here are all referable to errors in the development of the embryo. They are to be traced to causes acting on the embryo and causing it to deviate in its...
-I. Monstrosities By Excess. A. Monstrosities By Excess In Size
The excess may be either in size or in number, and these again may affect the body as a whole or individual parts. 1. General Hypertrophy Of The Body: Giants We include here persons who greatly ...
-B. Monstrosities By Excess In Number - Fission Of The Embryo
These form a very important group, and include a large proportion of the more considerable malformations of the body. They present great variety in form and degree. At the one end of the scale we have...
-I. Complete Duplication. Twins
Most twins are developed from two ova, and are just as distinct as children who are born one at a birth. But the so-called homogeneous twins are developed from one ovum, are contained in one chorion, ...
-1. Xiphopagus
( = united, from ) (Union confined to the neighbourhood of the umbilicus and xiphoid). - This is the least degree of union, and is illustrated by the well-known Siamese twins. There is a common umbi...
-2. Sternopagus (Union From Umbilicus Upwards, To Form A Single Thoracic Cavity)
In this case, as the union is very close, some of the adjacent structures may be united or represented by a single common structure. The two intestines may be united at the jejunum, but double above a...
-3. Prosopothoracopagus Or Syncephalus (Union Of Thorax And Head)
The spinal column and base of the cranium are separate, but the faces have come in contact and partly coalesced. There may be two faces, but they are often partially undeveloped (Fig. 2). The union he...
-4. Kraniopagus (Union Of Cranial Vaults)
The twins are complete, and separate except that the cranial vaults have united. The union may be frontal, parietal, or occipital (Kraniopagus frontalis, parietalis, occipitalis). ...
-5. Ischiopagus (Union Pelvic, With One Umbilicus)
This is the con: verse of the preceding form. The two bodies are united below, and diverge from one another so that the heads are at the opposite poles. The two pelves are united, and sometimes the tw...
-6. Pygopagus (Union In Sacral Region)
In this the union is limited to the region of the sacrum and coccyx. There are two individuals who may live many years, as in the case of the Hungarian girls, Judith and Helena, who lived to the age o...
-II. Abcaudal Duplication
The duplication in this case may be more or less extensive, from below upwards, and it may involve the whole vertebral column, but the head is always single. One of the halves may develop ex-cessivety...
-1. Dipygus
( = buttocks) (Head single, bodies double and equally developed). There is here one head and two bodies, but the bodies and arms may be to a variable extent coalesced. There may be the regular four a...
-2. Parasitic Forms (Head Single, One Body Much Larger Than The Other)
We have here a great variety of malformations according to the degree of defect of the smaller portion. The fully-developed foetus is continuous with the head, while the imperfect one seems a mere app...
-3. Supernumerary Legs (Duplication Affecting Pelvis And Appendages)
There is in this case a duplication which affects the inferior part of the embryo; the primordial pelvis, with its appendages, is duplicated. From the observations of Cleland, it appears that the t...
-III. Abcranial Duplication
As in the case of abcaudal duplication the division may be more or less complete, and the lateral halves may be unequally developed, so that in the extreme cases one is parasitic. ...
-1. Diprosopus
( = a face), double-face (Partial duplication of head). - In this there are indications of duplication in the middle line, but the corresponding parts have coalesced more or less, so that while the h...
-2. Dicephalus, Double-Head (Complete Division Of Head)
In this case (Fig. 3) also we have degrees of duplication varying from cases of two heads on one neck to those in which the body is also to a large extent doubled. The condition of the arms indicates ...
-3. Parasitic Forms (One Division Much Larger Than The Other)
As in the case of abcaudal duplication, so here, one of the halves may develop fully, while the other is dwarfed, and remains as an appendage or parasite. (A) Epigastrius (Smaller Part Appended In ...
-4. Supernumerary Arms
As in the case of supernumerary legs in abcaudal duplication, so by a somewhat similar cause we may have supernumerary arms produced in abcranial duplication. In this case the spinal column is single,...
-IV. Duplication Simultaneously Abcranial And Abcaudal
This will present many of the features of complete duplication, but the spinal column will be, in part at least, undivided. There will be two heads or the indication of such a division, and four legs ...
-V. Triple Monsters
A true triple monster in which there has been first a duplication of the one extremity, and then a second duplication of one of the parts, is very rare. In one authentic case there were three heads (T...
-VI. Reduplication Of Parts
The tendency to reduplication does not confine itself to the cerebrospinal axis, but extends to the individual parts of the body, more especially to those accessory parts which, as it were, bud out fr...
-II. Monstrosities By Defect
It will be understood that we have here to do with the more general defects, and that the distinctly local ones fall under their respective special sections. In studying the malformations by defect we...
-1. Causes In The Foetus
Causes In The Foetus itself are mainly of two kinds, namely, want of energy in the formative powers, and disease in the foetus, chiefly dropsy, calculated to interfere with the closure in the middle l...
-2. Influence Of The Amnion
The amnion may be the agent in producing malformations in two ways, namely, by adhesion to the developing parts, or by pressure on the parts so as to hinder their growth. The amnion is formed by a bac...
-I. Extreme Defect In Twin Fcetation. Acardiaci
In cases of two embryoes originating from one ovum, which, as .already described, gives rise to homogeneous twins, separate or united, one of the embryoes may develop normally whilst the other is faul...
-II. Defects Involving The Head And Spinal Column
As already indicated, there are various degrees of this defect. It is important to bear in mind that we may have a more or less complete absence of the bone and cutaneous structures which cover in the...
-1. Anencephalus (Cranioschisis)
This name implies that the brain is absent. It arises by a non-closure of the medullary canal or an early rupture of it. The child is often born at the full time, and the trunk and limbs are usuall...
-2. Encephalocele, Hernia Cerebri
In this case the brain or a portion of it projects outside the skull (see Figs. 7 and 8). There may be distension of the ventricles in the extruded part (Hydrencephalocele) or there may not. It arises...
-3. Cyclopia (Monophthalmia)
In this condition there is a single orbital cavity in the middle line, containing, in some cases, only a rudiment of the eyeball (Fig. 9), in others a fully-developed globe, or it may be two, close to...
-4. Agnathia
This constitutes a still further defect of the face, apparently from a similar cause. In it the lower jaw is deficient and the ears are brought close together so as to touch one another below. This ma...
-5. Spina Bifida
In this condition the arches of the vertebrae are usually more or less incomplete, and there is frequently a tumour projecting whose internal cavity communicates with the spinal canal. But this tumour...
-III. Defective Coalescence Or Closure Of Parts In Front
In the completion of the parts in front, the visceral arches grow forward, and, for the most part, coalesce in the middle line in a fashion similiar to that of the neural arches on the dorsal surface....
-1. Facial Clefts
The face and neck (see Fig. 10), are partly formed by the subcranial and branchial arches, which variously unite with each other and with the frontonasal process. In all these there are possibilities ...
-2. Congenital Fistula In The Neck (Fistula Colli Congenita)
This arises by imperfect closure of the lateral aspects of the branchial arches. There is a small aperture, only sufficient to admit a small probe or bristle, usually situated half an inch to an inch ...
-3. Defective Closure Of Thorax (Fissura Sterni)
There are various degrees of this, and various combinations with defect of the anterior abdominal wall, the highest degree being a complete cleft of thorax and abdomen. In these extensive clefts the o...
-4. Defective Closure Of Abdomen (Fissura Abdominalis)
It is to be remembered that in the early foetus the anterior wall has a great gap to give transit to the umbilical vesicle and the allantois, and that it is by the gradual contraction of these structu...
-IV. Abnormal Closure Or Defect Of Orifices And Canals
Some of these are local and fall under their special sections, but there is one form which has more general results. Imperforate Anus With Persistence Of Cloaca Up to the fifth week of embryonic...
-V. Absence Or Defect Of The Extremities
Defective formation of the extremities may be due to a failure in the inherent powers of the germinal matter which forms these parts, or to mechanical interference. Where there is a symmetrical defect...
-1. Defects Of All The Four Limbs
(a) Amelus ( = a limb), or absence of all the extremities. The body is usually well formed, but at the shoulders and hips there are short rounded or warty projections, at the ends of which there may ...
-2. Defect Of The Arms
(A) Abrachius The upper extremities absent, while the lower are developed. Fig. 13. - Peromelus. The four extremities defective. (Glasgow Hunteriiin preparation). (B) Perobrachius Bo...
-3. Defects Of The Legs
Defects of the lower extremity are similarly classified to those of the upper, and have similar characters. We have Apus, Peropus, Monopns. In the last mentioned the absence of the leg may be associat...
-4. Defects Of The Fingers And Toes
These present themselves as absence or defect of the digits, and as coalescence. These are very frequent malformations, and they may affect all four members, as in Fig. 17, or be limited to two or one...
-III. Aberrant Monstrosities
In this division we include malformations in which there is little or no quantitative defect, but there is a qualitative difference from the normal, an error in the development; they are the forms whi...
-Section III. Alterations Of The Blood And Its Constituents
Constituents of the blood: - (1) Plasma; (2) Red corpuscles; (3) Leucocytes; (4) Bizzozero's third corpuscle. I. General hyperemia, Plethora; produced artificially by Transfusion of blood; Plethora as...
-Constituents Of The Blood
The blood is composed of the fluid part, the blood-plasma, and the solid elements, the blood-corpuscles. ...
-1. The Blood-Plasma
The Blood-Plasma holds in solution two albuminous substances, namely, serum albumen and fibrinoplastin or serum globulin, besides a variety of nitrogenous substances in small quantity, most of which a...
-2. The Red Corpuscles
The Red Corpuscles are disc-shaped bodies whose chief constituent is haemoglobin. The origin of these corpuscles cannot yet be said to have been unequivocally determined. In the early embryo they are ...
-Leucocytes
This term may be properly applied to free colourless corpuscles whether present in the blood (hsemic) or in the lymph, serous spaces and lymphatics. There are several readily distinguishable forms of ...
-4. Blood-Plates. Bizzozero's Third Corpuscle
Hayem and Bizzozero have maed the presence of a third form of corpuscle in the blood. Hayem gives the name hsematoblast, and Bizzozero that of Blutplattchen to this corpuscle. Hayem's name implies the...
-I. General Hyperemia. Plethora
These terms designate a condition in which the total quantity of blood in the body is in excess. The number of red corpuscles is generally set down as normally about 5 million per cubic millimetre in ...
-II. General Anaemia
The term Anaemia would mean literally want of blood, but it is used in a wider sense to indicate defect in any of the essential constituents of the blood As the red corpuscles are, so far as the gener...
-2. Character Of The Changes In The Blood
From what has gone before it will be apparent that in the different forms of anaemia the state of the blood will vary considerably, and it will be proper to refer to each individually. The condition o...
-3. The Condition Of The Bone-Marrow In Anaemias
In almost all forms of anaemia the bone-marrow shows alterations which vary in different cases, and are most extreme in advanced cases of pernicious anaemia. The normal bone-marrow is of two sorts: th...
-4. Secondary Organic Changes In General Anaemias
The altered condition of the blood commonly induces secondary changes, which are not peculiar to any form of anaemia, but are liable to be more pronounced the greater the degree and the longer the dur...
-Leukaemia. Leucocythaemia
These terms mean literally white blood and white-cell blood, and they express a condition in which the blood is light in colour, from the fact that the white corpuscles are in great excess. The excess...
-Leukaemia. Leucocythaemia. Continued
Tissue Changes In Leukaemia The changes in the blood are associated with lesions in the tissues, some of which are generally regarded as primary, and some as secondary, although authors are not. wa...
-Section IV. Affections Of The Circulation And Distribution Of The Blood
Physiology of the Circulation - Innervation of Arteries, etc. Local Hyperemia. - I. Active hyperemia; caused chiefly by dilatation of arteries; phenomena. II. Passive hyperemia; caused chiefly by weak...
-Local Hyperemia
This term is applied to conditions in which the vessels, and especially the capillaries, contain an excess of blood. Two forms are distinguished according as, on the one hand, the blood is too freely ...
-II. Passive Or Venous Hyperemia Or Passive Congestion
This is a condition in which the blood stagnates in the vessels; they are overfilled with blood which, as it remains too long in the vessels, has a venous character, hence passive hyperemia is also ca...
-Local Anaemia Or Ischaemia
These terms designate the condition in which the blood-vessels, and in particular the capillaries, are more or less empty of blood, and the part is correspondingly pale. Causation The vessels, a...
-Thrombosis And Embolism
These two conditions are often associated, but must be carefully distinguished. Thrombosis is the coagulation of blood within the vessels or heart. Embolism is the obstruction of a vessel by a plug br...
-I. Thrombosis
In considering the mode of occurrence of thrombosis, it is necessary to refer to the Coagulation of blood. According to the views which are identified with the name of Alexander Schmidt (although Andr...
-Thrombosis. Part 2
The Process Of Thrombosis If a portion of blood inside a vessel be cut off from the circulation, then it will by and by coagulate just as it does outside the body, a leading factor in the coagulati...
-Thrombosis. Part 3. Causation
In most cases of thrombosis there is either a stagnation of the blood or else some palpable injury to the vessel compromising its endothelium, and the various thrombi may be studied according as they ...
-Thrombosis. Part 4
Changes In Thrombi If a thrombus contains red corpuscles, then their colouring matter is soon dissolved out and stains the coagulum, giving it frequently a deep brown tint. The pigment sometimes de...
-II. Embolism
Causation Any solid material in the circulating blood may obstruct a blood-vessel which it finds too small to give it passage. It may be a foreign body, such as a parasitic animal or vegetable, or ...
-Embolism. Part 2
The phenomena of embolism in the case of end arteries may be included in three processes which manifest themselves separately or in combination, according to the circumstances of the case; these are (...
-Embolism. Part 3
Disposal Of The Infarction In the case of the haemorrhagic infarction of the lung, if necrosis does not occur there may be complete restoration. The circulation may be resumed by organization and v...
-Haemorrhage
Two forms of haemorrhage are to be distinguished, namely, by rapture (per rhexin), and by diapedesis (per diapedesiri). In the latter case the blood escapes through the walls without solution of their...
-2. Stilling Of Haemorrhage
In the case of haemorrhage by diape-desis, and more particularly in haemorrhage due to passive hyperaemia and alterations in the blood, the haemorrhage will cease when the cause is removed. If the ves...
-3. Seat Of The Effused Blood
When bleeding occurs at the free surface of the body, the blood usually passes away and is lost. On the other hand, it may take place into an existing cavity, or the blood may make a cavity for itself...
-4. Disposal Of The Blood
In the case of haemorrhage by diapedesis and in most haemorrhagic infiltrations, the blood, being in the serous spaces and in communication with the lymphatics, is readily carried oft'. Before it is f...
-Oedema And Dropsy
In order to understand these conditions it is necessary to refer to certain points in the normal relations of the lymphatic circulation. The connective tissue throughout the body is as it were permeat...
-Oedema And Dropsy. Continued
It should be added that in the case of passive hypersemia it requires considerable increase of pressure in the capillaries to produce an oedema. It has even been stated that a simple passive hyperemia...
-Section V. Retrograde Changes
I. Necrosis, Gangrene. Mortification. (1) Causes; direct injury, obstruction of arteries, spasm of arteries, obstruction of veins, nervous influences, assisted by weakness of the heart; (2) Forms of n...
-I. Necrosis: Gangrene: Mortification
The term Necrosis is equivalent to local death of tissue, and includes all forms of lesions in which any portion of the body loses its vitality. Gangrene has a more limited significance, being applied...
-1. Causes Of Necrosis
An agent may cause necrosis by acting directly on the tissues, or may do so indirectly by interfering with their blood-supply or innervation. Instances of Direct action are afforded by chemical age...
-2. Forms Of Necrosis, And Changes In The Tissues
The changes which the dead tissues undergo vary considerably according to circumstances, and the resulting appearances are so different that special names are given and forms described according to th...
-3. The Issues Of Necrosis
In many cases the necrosis limits itself at once, the agent which produced it having acted once for all. It only remains to dispose of the dead structures. In other cases the limitation does not take ...
-II. Simple Atrophy
By this term is meant a simple diminution in the nutritive activity of the structures, and a consequent diminution in size without further change. Strictly speaking, we should distinguish from this a ...
-III. Albuminous Infiltration - Cloudy Swelling
The condition designated by these terms was first described by Virchow, and regarded by him as characteristic of Parenchymatous inflammation. The term Parenchymatous degeneration has a similar signifi...
-IV. Fatty Degeneration
In this condition, which affects the cells of tissues, we have a change in the chemical composition of the cell-contents; the albuminous constituents split up and yield fat. Causation Fat may be...
-V. Fatty Infiltration
By this term is meant the infiltration of free fat into the tissues. This condition is only in a restricted sense pathological, especially when it is general. It is necessary to distinguish fatty infi...
-1. Fatty Infiltration In Connective Tissue
Adipose tissue is a form of connective tissue, and is, to a considerable extent, interchangeable with loose connective tissue. Adipose tissue is formed by the infiltration of fat into the connective t...
-2. Patty Infiltration Of The Liver
Fat is often found in large quantities in the liver in cases where, in the subcutaneous tissue or elsewhere, there is an actual deficiency of it. The fat in the liver is in the peripheral parts of the...
-VI. Pathological Pigmentation
The pathological variations in colour in the tissues come under a considerable number of different categories. The endeavour has been frequently made to refer all pigments found in the body to the ...
-1. Alterations Of Physiological Pigmentation
The pigment of the skin varies much in different persons within physiological limits. There is an absence of pigment from congenital defect (albinism), and a congenital excess (negrism). The pigment a...
-2. Pigmentation By Haemoglobin And Its Derivatives
The pigment of the red corpuscles of the blood, the haemoglobin, is an unstable substance, and rapidly passes into other forms. Haemoglobin contains iron, but the latter is so intimately combined that...
-3. Icterus Or Jaundice
Icterus Or Jaundice is a condition in which the blood contains a yellow pigment which stains the tissues of the body generally. The pigment is usually that of bile, namely, bilirubin. This substance i...
-4. Pigmentation In Tumours
In certain sarcomas and cancers a brown pigment is present in the cells of the tumours, giving to the tissue a brown or black colour. The pigment here has the chemical characters rather of melanin tha...
-5. Pigmentation From Without
Pigmented substances introduced may lodge in the tissues and even permanently colour them. Salts of silver, when long administered, or when taken in excess in one dose, may cause a bluish staining of ...
-6. Pigmentary Atrophy
When coloured tissues atrophy there is usually a concentration of their pigment. Thus we have a brown atrophy of muscle, especially of the heart, and a deepened coloration of the fat in emaciated pers...
-VII. Amyloid Degeneration
This name is applied to a condition in which the constituents of the tissues are converted into a substance whose chemical characters are different from those of any normal principle in the body. The ...
-Amyloid Degeneration. Continued
Changes In The Tissues Amyloid degeneration, being due to a condition of the blood, is nearly always present in a number of organs simultaneously, although its degree varies greatly in different or...
-VIII. Mucous, Colloid, And Hyaline Degenerations
There are many pathological conditions in which translucent, glancing substances appear in the tissues, and it is frequently difficult or impossible to determine the chemical and other relations of th...
-1. Mucous Degeneration
This is characterized by the presence in the tissues of Mucin. This is a normal secretion of certain glands, and is a body of definite chemical reactions. It is closely allied to albumen, but it is pr...
-2. Colloid Degeneration
Under this name are included conditions in which the cells of structures secrete or become converted into a clear homogeneous substance, this transformation implying the destruction of the cells. It o...
-3. Hyaline Degeneration
Recklinghausen has introduced this term to designate conditions in which a clear homogeneous substance of a vitreous appearance is present, which does not yield the reactions of amyloid substance or m...
-IX. Calcareous Infiltration And Concretions
By these terms is meant the pathological deposition of lime-salts. In Ossification we have the salts of lime united with an organic matrix, and the tissue has a definite structure in which living, act...
-Section VI. Inflammation
Etiology. Produced by irritants, whose character is to injure the tissues; influences of nervous system, etc.; mode of entrance of irritants. I. Principal phenomena, exhibited in an experiment. II. Th...
-Etiology Of Inflammation
In many cases the causes of inflammation are obscure, and this applies mainly to internal organs whose actions are greatly hidden from our view. Inflammation is producible artificially; and if we stud...
-I. The Principal Phenomena Of Acute Inflammation
Looking to the cardinal signs of inflammation already enumerated, it will appear that two of them, namely redness and heat, are intimately related to the condition of the circulation, while the swelli...
-II. The State Of The Vessels In Acute Inflammation
When an irritant is applied to a transparent vascular tissue, such as the tongue or web of the frog, it produces effects which vary slightly, according to its nature. If croton oil be applied, there i...
-The State Of The Vessels In Acute Inflammation. Continued
Increase Of Temperature In Inflammation Calor is one of the cardinal signs of inflammation, and a feeling of heat is usually experienced when external parts are the seat of acute inflammation. In r...
-III. The Inflammatory Exudation
In the experiment sketched at the outset the inflammatory exudation was the fluid which collected on the surface of the wound. We saw that this fluid contained amoeboid cells, and that it was coagulab...
-1. The Serous Exudation
Nearly all inflammations are accompanied by a transudation of the fluid part of the blood from the blood-vessels, and this passes in the direction of least resistance, wherever it finds room. In the c...
-2. The Fibrinous Exudation
This is seen most typically in acute inflammations of serous cavities such as the pericardium or pleura. (Figs. 57 and 58.) In such cases there is, in addition to the serous exudation occupying the ca...
-3. Exudation Of White And Red Blood-Corpuscles
The resemblance of the cells met with in acute inflammations to the leucocytes in the blood long ago suggested the idea that they are white blood corpuscles. In the year 1846 Waller observed the pavem...
-4. Cells From Other Sources Than The Blood
Still dealing with the inflammatory exudation, the question arises whether all the cells found in it are derived directly from the blood. The origin of leucocytes as a whole is somewhat obscure. The b...
-5. The Purulent Exudation. Suppuration. Pus
Pus consists of a fluid portion, the liquor puris, and of pus corpuscles, which are identical with ordinary leucocytes. It is customary to speak of all the leucocytes found exuded in acute inflamma...
-IV. Changes In The Tissues And The Inflammatory New-Formation
In what has gone before, the changes referred to have mainly concerned the blood-vessels and the various channels and spaces of the lymphatic system in connection with them. Besides these, however, we...
-1. Parenchymatous Changes
In these we include the changes which occur in the proper substance of the tissues, the structures which perform the special functions of the parts. We have the numerous epithelial structures forming ...
-2. New-Formation Of Tissue
In what has gone before the phenomena described have been chiefly those of the earlier periods of inflammation and hence of the acute stage. Some inflammations, however, have no acute stage, and other...
-New-Formation Of Tissue. Continued
The New-formation of epithelium is an essential part of the process of the conversion of a granulating wound into a cicatrix. To some extent the cells at the margins of the granulating wound are deriv...
-V. The Issues Of Inflammation
The manner in which inflammations conduct themselves till their conclusion, and the results which remain, have, to a large extent, been explained in what has gone before. We have here briefly to gathe...
-1. Resolution, Or Restitutio Ad Integrum
These terms are applied to the subsidence of the inflammation and a restoration of the parts to their previous normal condition. This can scarcely take place except in acute and transient inflammation...
-2. Adhesion Of Inflamed Surfaces
Adhesion Of Inflamed Surfaces is a frequent result of new-formation. In the case of the granulating wound, if two granulating surfaces, such as the flaps of a stump, be brought together, they coalesce...
-3. Induration
Induration is a frequent result when the connective tissue of an organ or a considerable portion of tissue is affected by chronic inflammation. The new-formed connective tissue, like that of the cicat...
-4. Necrosis, Or Death Of Tissue
Necrosis, Or Death Of Tissue, is a frequent issue of acute inflammation. The dead tissue may be absorbed in the manner already referred to, or it may be discharged as a slough. ...
-VI. The Forms Of Inflammation
We have had occasion already to notice that the various phenomena of inflammation are not always present in every case, and one or other of them may be so pronounced as to give its character to the in...
-1. Parenchymatous Inflammation
Parenchymatous Inflammation is a term introduced by Virchow to indicate that the inflammation affects mainly the tissue elements. It is characterized chiefly by cloudy swelling and fatty degeneration ...
-2. Interstitial Inflammation
Interstitial Inflammation is almost the converse of that just mentioned. In it the inflammation affects chiefly the connective tissue, which forms the supporting stroma of organs. In acute inflammatio...
-3. Suppurative Inflammation
From what has gone before it will appear that, for the most part, it is in intense inflammations produced by virulent microbes that suppuration occurs. Phlegmonous inflammation is a name given to very...
-4. Infective Inflammations
Infective Inflammations imply the presence of microbes, which by their multiplication produce an extension of the inflammation from its original seat. The infection usually extends locally by means ...
-5. Ulcerative Inflammation, Ulceration
These terms imply necrosis or loss of tissue, generally of a progressive character.' The loss of tissue may be rapid, and involve the formation of visible sloughs, or it may be gradual, a molecular ne...
-Section VII. New-Formation. Hypertrophy, Repair, Regeneration, Transplantation
New-formation of Tissue by Karyomitosis. Genesis of new-formations, from indifferent cells; Metaplasia. I. Hypertrophy, compared with normal growth; Hypertrophy (1) from congenital proclivity; (2) com...
-New-Formation Of Tissue
THE pathological new-formation of tissue occurs by processes analogous to those concerned in the physiological formation of tissue in the process of growth. Karyomitosis ( = nucleus, = a thread or...
-I. Hypertrophy
The term hypertrophy means overgrowth or excessive growth. Looking to the cellular constituents of the tissues, Virchow has drawn a distinction between an increase of tissue due to an enlargement of t...
-1. Hypertrophy From Congenital Proclivity
There may be an excessive growth of the whole body, so that the person becomes a giant; or there may be a localized hypertrophy, as of the fingers, one side of the face, etc. There are also cases in w...
-2. Compensatory Hypertrophy
This form of hypertrophy implies that, as a result of some defect in the organism, some function has been called into unusual exercise. As a result of the continued excessive exercise, the tissue is i...
-3. Hypertrophy From Increased Blood-Supply
In ordinary growth of tissue, whether normal or pathological, the blood-vessels strictly follow the growing tissue, and are formed according to its needs. But if, from some accidental circumstance or ...
-4. Hypertrophy From Direct Stimulation
From the observations of Gies it appears that small doses of arsenic administered to growing rabbits caused increased growth in the bones. When administered to pregnant rabbits the young were born wit...
-5. Hypertrophy From Pressure Or Friction
Thickenings of the epidermis occur in places where the skin is exposed to unusual pressure or friction. Continued pressure, as by a splint or bandage, causes atrophy, but intermittent pressure, by all...
-II. Regeneration Of Tissue
The term Regeneration is applied to the restoration of portions of the body which have been lost by injury or disease. The regeneration of a part is to be carefully distinguished from mere growth or h...
-III. Repair Of Injuries
While the absolute restoration of complete and considerable portions of the body is scarcely possible in man, yet the body is by no means unprovided with powers by which injuries are repaired and loss...
-IV. Transplantation
By this term is meant the removal of parts of the living tissues from their normal position, and their implantation in another situation. This process has been frequently effected by experiment in ...
-Section VIII. Tumours Or Morbid Growths
Introduction Definition Structure, typical or atypical. Causation, Cohnheim's theory of origin; inheritance; effect of injuries, etc.; parasitic microbes; influence of age. Growth and Extension,...
-Tumours Or Morbid Growths. Part 2
Injuries, Irritations, and Chronic inflammations play an important part in determining the occurrence of tumours. Thus, fractures of bones are sometimes the starting points of cartilaginous or bony tu...
-Tumours Or Morbid Growths. Part 3
Occasional Malignancy Of Typical Tumours It has already been stated that sarcomas and cancers are the tumours which regularly present a malignant tendency, but on rare occasions other tumours also ...
-A. Typical Or Histioid Tumours
1. Fibroma, including molluscum fibrosum or neuro-tibroina and hard fibroma; 2. Lipoma, diffuse or encapsuled, pendulous; 3. Myxoma, characters of mucous tissue; hydatid mole: proper tumour, varieties...
-1. The Fibroma Or Connective-Tissue Tumour
AS fibrous tissue is frequently the product of inflammation we may expect that the demarcation between inflammatory new-formations and fibromas is not always easy to make. Elephantiasis arabum is some...
-2. The Lipoma Or Fatty Tumour
This form of tumour consists of adipose tissue exactly like that of the body, as for instance the subcutaneous adipose tissue. Adipose tissue contains bands of fibrous connective tissue which carry th...
-3. The Myxoma Or Mucous-Tissue Tumour
This form of tumour is composed of mucous tissue, and as this is not one of the physiological tissues of the adult, it will be proper to refer more specially to its characters. The blood-vessels of th...
-4. The Chondroma Or Cartilaginous Tumour
This tumour is composed of cartilaginous tissue. The cartilage may be liyaline (see Fig. 75) or fibrous, generally the latter, and the matrix is not infrequently rather soft. The tumour is also inters...
-5. The Osteoma Or Bony Tumour
In this class are included tumours composed of bone, not mere new-formations due to inflammation, nor tumours in which bone exists as a subordinate element with other tissue. The large majority of ...
-6. The Myoma Or Muscular-Tissue Tumour
These are tumours in which muscular tissue is the essential constituent, but just as all muscles have supporting connective tissue so have these, some more, some less. As there are two kinds of muscle...
-7. The Neuroma Or Nervous-Tlssue Tumour
A neuroma is properly a tumour composed of nerve tissue. As there are two kinds of nerve tissue so we may distinguish a ganglionic and a fibrous neuroma. There are some cases of small tumours projecti...
-8. The Angioma Or Vascular Tumour
We have here a tumour composed of blood-vessels or lymphatics. The tumour varies in bulk according to the fulness of the vessels, hence some of them are occasionally designated Erectile tumours. The t...
-9. The Glioma
This is a tumour with the structure of the connective tissue of the central nervous system, the Neuroglia. In examining a section of the brain substance, it is difficult to tell what is really nervous...
-10. The Psammoma Or Brain Sand Tumour
The pineal gland contains calcareous particles like grains of sand, and tumours are met with in which similar particles are present. It is necessary, of course, to distinguish these from tumours in wh...
-11. The Lymphoma Or Lymphatic Gland Tumour
Under this designation are included tumours composed of typical lymphatic gland tissue. Such tumours originating in glands would be scarcely distinguishable from simple hypertrophies of these. It is d...
-12. The Papilloma Or Papillary Tumour
By this name is meant a tumour composed of a congeries of exaggerated papillae like those of the skin, or like the villi of mucous membranes. A papilla or villus consists of a basis of connective tiss...
-13. The Adenoma Or Glandular Tumour
As there are many glands of different structure, so are there various forms of adenoma. The several forms will be more particularly described under their respective organs, and it will only be necessa...
-14. The Cystoma. Cysts
A cyst is a cavity having a defined wall composed of connective tissue lined with epithelium, and containing more or less fluid contents. The modes of formation of cysts are somewhat various, but t...
-15. Teratoma
This name has been applied by Virchow to tumours into the structure of which a number of very different tissues enter. The name is derived from , a monster. The tumour contains various structures of...
-Atypical Tumours
I. Sarcoma. Definition. Structure; cells, intercellular substance, blood-vessels. Place of origin. Mode of growth; local malignancy aud metastasis. Changes in structure; induration, ossification, cyst...
-I. Sarcoma
IN its literal meaning this term simply indicates a fleshy tumour, and it was formerly applied in a very indefinite way. Under the influence of Virchow, however, it has come to include a group of tumo...
-1. The Round-Celled Sarcoma
The Round-Celled Sarcoma (Fig. 97) is also called the granulation sarcoma and the encephaloid sarcoma. It is composed of round or slightly oval cells generally about the size of white blood-corpuscles...
-2. The Spindle-Celled Sarcoma
The Spindle-Celled Sarcoma (Fig. 98) is also called the fibrosarcoma, and corresponds with Paget's class of recurrent fibroids, and Lebert's group of fibro-plastic tumours. The cells are spindle-shape...
-3. Myeloid Or Giant-Celled Sarcoma
Myeloid Or Giant-Celled Sarcoma (Fig. 101) is a tumour in which the giant-cell is characteristic, but never forms the only sarcomatous element, there being generally spindle cells and sometimes round ...
-4. Melanoid Or Pigmented Sarcoma
Melanoid Or Pigmented Sarcoma always originates in a situation where pigment already exists, the eye or skin. The cells of which it is composed are usually spindle-shaped, but may be round, and from t...
-5. Plexiform Sarcoma Or Cylindroma
Plexiform Sarcoma Or Cylindroma is a name applied to a form of tumour whose relations are somewhat obscure, and it probably includes more than one kind. The peculiarity of the tumour is the existence ...
-II. Carcinoma Or Cancer
The term cancer is a clinical one, expressing the malignant characters of the tumour. Like sarcoma it was formerly applied in a general way, and included most sarcomas. The delimitation of the sarcoma...
-Carcinoma Or Cancer. Part 2
Origin And Locality Of Carcinoma In regard to their place of origin it may be said that cancers always arise where epithelium or endothelium is normally present, and there seems no doubt that the e...
-Carcinoma Or Cancer. Part 3
Parasitic Protozoa In Cancers Much attention has been paid lately to the presence in cancers of bodies which by many are interpreted as minute animal parasites belonging to the protozoa, to the cla...
-Carcinoma Or Cancer. Part 4
The cancerous infection may for a time remain confined to the primary seat and the lymphatic glands, but it is liable to extend further and become generalized. This occurs by the material of infection...
-1. Flat-Celled Epithelioma; Epithelioma Proper
In English works the term Epithelioma is chiefly used to designate cancers of the cutaneous surface, tongue, and oesophagus, places where the surface is covered with flat epithelium. Similar tumours o...
-2. Cylinder-Celled Epithelioma
This is a tumour of parts where cylindrical epithelium normally covers the surface, hence it is found chiefly in the stomach and intestines, and more rarely in the uterus. As cancer of the stomach and...
-3. Soft Cancers Or Medullary Cancers
Soft Cancers Or Medullary Cancers are characterized by the existence of a very delicate stroma in which are abundant cells, usually of small size, and loosely packed in the alveoli with a good deal of...
-5. Colloid Or Alveolar Cancer
Colloid Or Alveolar Cancer is a tumour characterized by the occurrence of colloid degeneration of epithelial cells. It is met with chiefly in the stomach and intestines, and in the mamma; more rarely ...
-6. Melanotic Cancer
Melanotic Cancer is a rare form of tumour compared with the melanotic sarcoma. It occurs primarily in similar situations, namely the skin and eyeball. It is really a soft cancer in which pigment is pr...
-7. Mucous Cancer
Mucous Cancer includes tumours in which the stroma of the cancer assumes the characters of mucous tissue. The cells of the cancer may undergo a similar degeneration. The tumour as a whole is very gela...
-8. Endothelioma
Endothelioma is a name sometimes applied to cancers arising from the endothelium of serous membranes and elsewhere. (See above, p. 249.) Cancers of the pleura and peritoneum belong to this class. They...
-Section IX. Intoxications - Diseases Resulting From Changes In Secretion And Excretion
Intoxications A varied assortment of morbid conditions characterized by changes in the blood and other fluids, either from the presence of toxic substances or from alterations in chemical constitut...
-A. Intoxication - Auto-Intoxication
Intoxication means the action on the living elements of the tissues of substances which affect the intimate vital chemistry of these elements. In this sense it has wide relations and is frequently an ...
-B. Diseases From Changes In Secretion And Excretion
As indicated above there may be an auto intoxication from the retention of the excreta, more particularly those eliminated by the kidneys. Whilst the normal metabolism of the tissues produces leucomai...
-1. Uraemia
By this term is meant the poisoning of the body by the urinary constituents, which, by reason of their defective secretion or elimination, accumulate in the blood. As the condition is directly connect...
-2. Gout
In this condition an excess of uric or lithic acid in the form of urate of sodium is present in the blood and fluids of the body, and is deposited in a solid (mostly crystalline) form in the articular...
-3. Diabetes Mellitus
This term is applied to a disease characterized by an excessive excretion of grape sugar or glucose by the urine. The condition of the urine is expressed by the term Glycosuria. In diabetes there is a...
-4. Lipaemia. Piarrhsemia
These names designate a condition in which fat is abnormally present in the blood. There is a certain quantity of free fat in the blood normally, and after a meal it may be somewhat abundant. In li...
-5. Melanaemia
By this name is meant, literally, black blood. It is used to designate a condition in which pigment occurs abnormally in the blood and is deposited in the tissues. The pigment is in the form of solid ...
-6. Myxcedema
This condition was first described by Sir William Gull under the designation Cretinoid state. Dr. Ord recorded further cases, and suggested the term Myxcedema. It is a condition due to falling away o...
-7. Cretinism
This name is applied to a condition in which the body is stunted from deficient growth of the long bones, the nose is sunk from imperfect growth of the base of the skull, the head is proportionally la...
-8. Acromegaly
This condition is in all probability to be included amongst the diseases due to alteration of secretion and excretion. The gland concerned is the Pituitary body, which in all recent post-mmiem examina...
-9. Addison's Disease
The pathology of this disease is still very obscure, but the connection of myxcedema with disease of the thyroid has suggested that the symptoms may be due to defect in the secretion of the supra-rena...
-Section X. Infection And Infective Diseases
I. General facts with regard to Infection, Infective, and Infectious diseases, (a) Local infection. (b) General toxic effects. (r) Infection of the blood. II. Susceptibility to infection. Immunity. (1...
-I. General Facts Of Infection
INFECTION is a general term used to designate the production of disease by agents which, penetrating into the body from without, multiply in the body, spreading either locally, or to the tissues ...
-II. Susceptibility To Infection. Immunity
The introduction of infective agents into animals is by no means followed by the same results in all cases, and we are thus met with the fact of varying susceptibility amongst animals. We are able to ...
-1. Natural Immunity
This subject has been sufficiently illustrated at pp. 17 and 18, where it is pointed out that, as a part of the generic, specific, racial, and individual characters, there are great differences in the...
-2. Acquired Immunity
It is well known that in the case of some of the infective diseases the survival of one attack causes a certain immunity to further attacks. This applies to most of the specific fevers, such as small-...
-3. Induced Immunity
By vaccination, immunity to small-pox is induced by the introduction of the virus of a disease which is either an allied condition or a weakened form of the disease against which protection is sought....
-4. Explanation Of Acquired And Induced Immunity
The facts already noted indicate that acquired and induced immunity have a different explanation from natural immunity. It is not here phagocytosis or direct cellular action, but the production of ant...
-5. Duration Of Induced And Acquired Immunity. Inheritance
It is well known that immunity acquired by passing through such a disease as scarlatina or small-pox persists for years, or perhaps during the remainder of life. Immunity induced by vaccination is of ...
-III. Septic Infection
It may be said that the whole of the modern activity in regard to infection has its foundation on septic infection. The terms sepsis and septic ( = I putrefy) designate the contamination of the anima...
-IV. Infective Tumours. Specific Inflammations
The affections in this group show in their structure and general relations considerable analogies to inflammation on the one hand and tumours proper on the other. Hence the conditions are variously ca...
-I. Syphilis
Causation This disease is due to an infective agent, which is asserted to be a bacillus, discovered by Lustgarten. This bacillus has special reactions to staining agents, which will be more fully r...
-Syphilis. Continued
Tertiary Lesions These are chiefly characterized by the formation of tumours to which the name G-ummata is applied. They are composed similarly to the indurated chancre, of granulation tissue, but ...
-II. Tuberculosis
Tuberculosis is an infective disease in which the tissue-changes are due to the action of a specific virus or infective agent. As in the case of syphilis there is always a local or primary lesion, but...
-Tuberculosis. Part 2
The inoculation was effected by making a small incision in the abdominal wall of a guinea-pig with the scissors, inserting the point of the scissors to form a pocket-like subcutaneous wound, about h...
-Tuberculosis. Part 3. Character Of The Lesion
The typical lesion in tuberculosis is the so-called miliary tubercle, and it is this which was referred to above as being the specific product of the action of the virus. The miliary tubercle is a ...
-Tuberculosis. Part 4
Scrofula And Struma These terms are used to designate conditions of the lymphatic glands, which are now generally recognized as tubercular. They will be described in their proper places. The terms ...
-Tuberculosis. Part 5
Effects Of Local Tuberculosis The process of tuberculosis, as already described, involves destruction of tissue, and in many cases ulcers and cavities are the result. The destruction of tissue may ...
-Tuberculosis In Animals
It has been already mentioned that tuberculosis has been communicated to a large number of animals by inoculation, and that probably all warm-blooded animals are susceptible. As a spontaneous disease ...
-III. Leprosy Or Lepra
This disease was at one time spread over the whole of Europe, but is now limited to certain localities in Norway, Russia, Iceland, and the coast of the Mediterranean. It is still somewhat prevalent in...
-IV. Elephantiasis Arabum
This disease, which is called elephantiasis arabum to distinguish it from E. grsecorum, which is true leprosy, is often simply designated. Elephantiasis, sometimes also Pachydermia. Causation Th...
-V. Glanders
This disease is met with chiefly in horses, but is occasionally communicated to man. The name Farcy is sometimes given to the disease when the skin and lymphatic system are specially engaged. Causa...
-VI. Actinomycosis
This disease is prevalent in cattle in whom it was first recognized as parasitic by Bollinger. It has been observed in man in a considerable number of cases. Causation As the name implies, the d...
-VII. Malignant Lymphoma Or Hoogkin's Disease
The exact relations of this disease, or group of diseases, are somewhat obscure. In many respects it presents the characters of the infective tumours, and on the other hand it is related to leukaemia,...
-VIII. Acute Specific Fevers
It may be inferred from what has gone before that the diseases grouped under this designation are due to specific infective agents, but the precise character of these agents remains in many cases as y...
-1. Small-Pox
This disease has two febrile periods, which, it may be inferred, have different relations to the infective agent. There is the primary, fever which is accompanied by severe general symptoms, and is pr...
-2. Scarlet Fever
The relations of the local lesions and general symptoms to the infective agent are, in this disease, obscure and complicated, and are not likely to be cleared up till the infective agent itself is dis...
-3. Measles
In the absence of any knowledge of the infective agent, we are in this disease, as in the case of scarlet fever, left to inference as to the principal seat and mode of action of the infection. The inf...
-4. Typhus Fever
Here also we are, as yet, in the dark as to the form of the infective agent. It is volatile, so that infection occurs through the air, by inhalation. It is to be inferred that the infective agent is p...
-5. Yellow Fever
The general aspects of this disease resemble those of typhus fever. The infective agent is volatile, there is no local lesion, and there is a profound alteration of the blood. The blood-corpuscles are...
-6. Rheumatic Fever
This is a disease whose right to a position amongst the infectious may still be disputed by some, and which has, in the past, been regarded variously as an intoxication arising frofn faults of excreti...
-7. Whooping Cough
The infective agent in this disease is quite unknown, although many attempts have been made to discover it. The indications are that it lodges in the respiratory passages, where its toxine produces ir...
-Section XI. Bacteria And Parasitic Fungi
Bacteriology. I. General Considerations. Definition and classification, structure and mode of growth of microbes; cell, cell-membrane, spores; methods of detection. Conditions of life, as to temperatu...
-Bacteriology
THE relation of minute vegetable organisms to disease has of late years assumed a high degree of importance, so much so that a special science has been created with its chairs and laboratories, and a ...
-Bacteriology. Part 2
Methods Of Detection It will be obvious that these minute organisms are often very difficult of detection, even with high powers of the microscope, especially when they are mixed up with other stru...
-Products Of Bacteria. Toxines, Ptomaines, And Toxalbumins
In their growth bacteria are engaged for the most part in splitting up organic compounds, and in building up others. In this process they frequently eliminate chemical principles of greater or lesser ...
-Bacteriology. Part 4
Cultivation The greatest advances in our knowledge of bacteria nave been made by their artificial cultivation. Following the example of Koch the bacteria are now cultivated not only in fluids, but ...
-1. Saprophytes, Parasites, Pathogenic Microbes
It will be readily understood that the great majority of bacteria present no relation whatever to disease; they have their various functions in the economy of nature, and may never come into relation ...
-III. The Individual Forms Of Bacteria
In what has gone before it has been indicated that there is not as yet a complete and satisfactory classification of the bacteria. Sufficient is known, however, to enable us to identify many of the fo...
-A. Microbes Of Acute Inflammations Tending To Suppuration. Pyogenic Microbes
The majority of the bacteria in this group are micrococci, and on the other hand most of the pathogenic micrococci belong to this group. The group is characterized by the fact that the microbes induce...
-1. Streptococcus Erysipelatis
Streptococcus Erysipelatis, the micrococcus of erysipelas, is composed of perfectly globular cells of small size, which have a peculiar tendency to grow into long chains. It has been cultivated on var...
-2. Staphylococcus Pyogenes Aureus
Micrococci are to be found virtually in all abscesses or suppurations, and the form now under consideration is the most important. It has been studied by many authors, of whom Ogston, who suggested th...
-3. Staphylococcus Pyogenes Albus
Staphylococcus Pyogenes Albus closely resembles, and is probably a variety of, that just described, almost the only difference being that, when growing, it does not produce a yellow pigment, but inste...
-4. Streptococcus Pyogenes
Streptococcus Pyogenes is not infrequently found in pus (Fig. 139), either alone or in conjunction with the Staphylococcus aureus. In all its characters it closely corresponds with the streptococcus o...
-5. Bacillus Pyocyaneus (Bacillus Of Blue Or Green Pus)
Surgeons sometimes find that the dressings suddenly assume a bright green or blue colour, which may occur without disturbing the process of healing. This is due to a small bacillus which has found acc...
-6. Micrococcus Gonorrhoeae, Gonococcus
This form, discovered by Neisser, is now acknowledged to be the active agent in the causation of gonorrhoea. It is a large micrococcus, which is generally found united in twos (diplococcus), the two s...
-7. Bacillus Coli Communis
This bacillus is constantly present in the colon of man and frequently in the faeces. It is also sometimes present in the vagina and uterus, and may be the cause of peritonitis by extension from these...
-8. Bacteria Of Pneumonia
Pneumonia is caused by virulent pathogenic bacteria, but the same microbe is not always the infective agent. In some cases of secondary pneumonia, the ordinary pyogenic micrococci have been found, but...
-9. Bacillus Of Rhino-Scleroma
This bacillus is found in the tubercles of the skin characteristic of the disease named. It closely resembles the bacillus pneumoniae of Friedlander, and like it possesses a capsule. In its appeara...
-1. Bacillus Anthracis
This is one of the best known and most widely diffused pathogenic forms, occurring, as it does, both as a saprophyte and a parasite. As a parasite it gives rise to the conditions variously known as Sp...
-2. Bacillus Of Symptomatic Anthrax (Bacillus Of "Quarter Evil"; Bacillus Of Rauschbrand)
This is found in certain cases of disease in cattle, having a rapid course and nearly always a fatal issue. The disease has several names, such as Black-leg, Quarter evil, and, in Germany, Rausch...
-3. Bacillus Of Malignant Oedema
This is a bacillus somewhat similar in size to the bacillus anthracis, and it is also identical with Pasteur's vibrions septiques which he found in his septicaemie. (See Fig. 146). Malignant o...
-4. Bacillus Of Typhoid Fever
Eberth, and after him several other authors, have, in cases of typhoid fever, observed, in the closed follicles of the intestines, and in the lymphatic glands and spleen, bacilli which were distinguis...
-5. Spirillum Of Relapsing Fever, Spirillum Obermeieri
This form is an active spiral microbe which is found abundantly in the blood of persons affected with relapsing fever. (See Fig. 148.) It is present only during the acute attacks, disappearing in the ...
-6. Bacillus Of Diphtheria, Loeffler's Bacillus
This form is of great importance in view of the fulness of our knowledge regarding it, of its practical consequence as the causative agent in a widely spread disease, and of the recently devised metho...
-7. Bacillus Of Tetanus
Tetanus has been suspected to be an infective disease by many (see former editions of this work). The demonstration and full elucidation of its nature have been effected of late years. The tetanus bac...
-8. Bacillus Of Influenza
In cases of epidemic influenza the microbe is found in the mucus discharged, and it is more pure the further down the bronchial tree the discharge has been produced. In cases of death pure cultupes ha...
-9. Bacillus Of Bubonic Plague
The plague used to occur in gigantic epidemics in Europe, but till lately had been banished for many years. Its recent appearance in Hong-Kong and in India shows that it has lost none of its old virul...
-10. Bacillus Of Asiatic Cholera, Koch's Comma Bacillus
The bacillus is a short, thickish rod, about two-thirds the length of the tubercle bacillus and somewhat broader (see Fig. 150). It is curved on its long axis so as to resemble a comma (but without th...
-1. Bacillus Of Tubercle
The great frequency of tuberculosis both in man and animals lenders the discovery of the bacillus by Koch one of the most important results of science in this century. The merit of this discovery is t...
-2. Bacillus Leprae. Bacillus Of Leprosy
This form of microbe was first observed by Hansen in Norway, and the observation was confirmed by Neisser. It is a rod which closely resembles the tubercle bacillus, and, like it, is motionless. It pr...
-3. Bacillus Of Syphilis
Lustgarten has described a bacillus whose connection with syphilis still stands in need of proof. He has found it in the secretions and in the tissues affected with syphilis. It is a rod lomewhat rese...
-4. Bacillus Mallei, Bacillus Of Glanders
This form is abundantly present in the lesions of glanders, is readily cultivated, and easily communicated to animals. The bacillus is a rod somewhat like the tubercle bacillus, but slightly thicke...
-5. Actinomyces Or Ray Fungus
This, which belongs to the bacteria rather than the fungi, is pathogenic chiefly in cattle, but is readily communicable to man. It grows in the form of little heads composed of radiating threads swoll...
-D. Acute Blood Infections In Animals. Septicemia
A number of pathogenic bacteria have been very thoroughly investigated in animals, and of some of these a brief account may be given. As these microbes propagate in the blood and are found abundantly ...
-1. Micrococcus Tetragenus
This microbe was discovered in the contents of a tubercular cavity in the lungs, and afterwards in normal sputum. It has been investigated by Gaffky. It consists of micrococci, which, when found in th...
-2. Bacillus Of Septicaemia Of Mice
The condition designated septicaemia of mice is a laboratory disease which Koch produced by inoculating the house mouse with one or two drops of putrid fluid. The animal in a certain proportion of cas...
-3. The Bacillus Of Swine-Erysipelas
The Bacillus Of Swine-Erysipelas (Rouge da pore) is apparently identical with the above. It has the same appearances and reactions, and shows the same pathogenic relations to the house mouse and field...
-4. Bacillus Of Septicaemia Haemorrhagica
Evidence accumulates to show that a number of diseases in animals is due to the same bacillus, which is pathogenic in a large number of different species. In all of them it propagates in the blood and...
-1. Sarcina
The sarcina is a micrococcus which in dividing shows lines of fission in three directions at right angles, so that it always divides into fours. The fours often remain adherent, so that we may have gr...
-2. Gas-Forming Bacillus Found Post-Mortem
Gas is frequently formed in the tissues after death, but there are some cases in which the development of gas, especially in the liver, is so marked and extensive that special attention has been attra...
-3. Bacillus Prodigiosus (Micrococcus Prodigiosan)
This is one of the commonest bacteria. It appears as blood-red stains on objects - sometimes on milk, bread, starch, etc., from which the names blood-rain, bleeding host, were derived. As the bloo...
-4. Bacillus Megaterium
Bacillus Megaterium has been fully described by De Bary, who made special observations as to spore-forrnation in it. It was first observed growing on boiled cabbage leaves, and afterwards cultivated o...
-5. Bacillus Subtilis
Bacillus Subtilis, Hay bacillus, is a very common form, and, as its cells are large as compared with those of most bacilli, it is readily seen, and was early discovered. From its name, hay bacillus, i...
-6. Bacillus Acidi Lactici
Bacillus Acidi Lactici is concerned in the souring of milk. When milk is withdrawn from the mammary glands and exposed to the air, it is liable to have several forms of bacteria and fungi developing i...
-7. Bacilli Of Butyric Acid Fermentation
There are two bacilli by whose action starch, milk, sugar, and lactic acid are made to yield butyric acid. They also dissolve coagulated casein. One of them is strictly anaerobic (B. butyricus of Praz...
-8. Bacterium Termo
Bacterium Termo is a name which, in view of the modern position of Bacteriology, can hardly be said to have a proper place. In putrid fluids every drop contains large numbers of bacteria, doubtless of...
-9. Bacteria In The Mouth
A number of varieties have been described, having the three forms of cocci, bacilli, and spirilla. The most constant and readily distinguished is the Leptothrix buccalis, which consists of long thread...
-I. The Sprouting Fungi Or Yeasts
These consist of oval cells which contain granules and frequently vacuoles. They grow by the formation of buds from the cells, which increase in size and then separate from their parents. Great imp...
-II. Filamentous Fungi Or Moulds
The root part or mycelium of these fungi consists, as we have seen, of hyphae or threads, from which may grow up the stems which produce the spores. The common moulds belong, for the most part, to thr...
-1. Saprophytes And Occasional Parasites
In the common moulds there are three genera which are frequently represented, namely, Penicillium, Aspergillus, and Mucor, and of these the aspergillus is the only one which is of importance as an occ...
-2. Pathogenic Fungi
The true pathogenic fungi occur on the surface of the body, usually attacking the epidermic or epithelial structures, but in some cases penetrating more deeply. They mostly cause lesions of the hairs ...
-Section XII. Animal Parasites
A. Entozoa or Internal Parasites, their general characters and effects. I. Protozoa. (1) Amoeba. (2) Coccidia. (3) Haematozoa of malaria. II. Trematoda or Flukes, chiefly Distoma hepaticum, sinense, a...
-I. Protozoa
The unicellular organisms at the lowest position in the animal kingdom are by no means so well known as the corresponding vegetable organisms. Of late years much attention has been paid to them, and t...
-1. Amoeba
This, the lowliest form of animal life, consists of a mass of contractile substance with a nucleus. Many authors have described the Amoeba coli as of constant occurrence in epidemic dysentery. It i...
-2. Coccidia. Psorospermia
These belong to the class of Sporozoa, or unicellular animals with a smooth cuticle. They have little power of movement. These parasites are common in the lower animals, constituting the condition of ...
-3. Hsematozoon Of Malaria, Or Paludism
This parasite, the knowledge of which we owe to Laveran in the first instance, belongs to the protozoa and to the class of sporozoa, being nearly allied to the coccidia. It has been called, by the Ita...
-II. Trematoda. Flukes
We have here an order of flat-worms of a more or less oval shape, and many of them somewhat in the form of a leaf. They possess, on the ventral surface, one or more sucking discs by which they attach ...
-III. Cestoda. Tape-Worms
These are in the mature state long flat worms, without mouth or alimentary canal. Anteriorly there is a head furnished with some apparatus for attaching itself to the host. Behind the head and neck th...
-1. Taenia Solium
This form is of very common occurrence in this country, but that taken next is probably as frequent, if not more so. The strobilus or mature worm occurs in the alimentary canal, and the head is usuall...
-Taenia Solium. Continued
As the proglottides become mature they sever their connection with the worm and drop off from its lower extremity one by one. They pass down the alimentary canal, and are discharged with the faeces, o...
-2. Taenia Mediocanellata Or Saginata
This worm has a strong resemblance to the taenia solium, and in Britain it is probably more common than the latter, this being connected with the beef-eating character of our countrymen. The strobi...
-3. Taenia Echinococcus
In the strobilus form this is a comparatively insignificant worm (Fig. 185). It inhabits the dog, and there are generally several individuals present at the same time. The total length of the worm is ...
-Taenia Echinococcus. Continued
Dead and shrunken hydatids are more frequently met with in this country than active ones. The animal may die spontaneously, or be killed by the fluid which fills the vesicles being drawn off. In that ...
-IV. Nematoda Or Round-Worms
The round-worms have elongated bodies, and possess a well-developed digestive apparatus, with mouth, cesophagus, stomach, intestines, anus. The sexes are separate. Some of them bear living embryoes, w...
-1. Trichina Spiralis
This worm is met with in the muscular tissue of man, and occurs there in immense numbers, producing the disease Trichinosis. We shall see afterwards that this is not the mature form of the worm, but i...
-2. Ascaris Lumbricoides
The common round-worm is probably the commonest entozoon in the human subject. It occurs very frequently in children, and inhabits chiefly the small intestine. In its colour and general appearance it ...
-Ascaris Lumbricoides. Continued
Filaria Medinensis (Dracunculus Medinensis, Or Guinea-Worm) This parasite is of frequent occurrence in tropical lands, where it is met with in the tissues of the foot and leg chiefly. The female is...
-V. Epizoa Or External Parasites
These do not call for extended treatment here, as they are fully described in works on diseases of the skin. Little more than an enumeration of them will be attempted. ...
-1. Arachnida
Parasites belonging to this class occur both in man and animals. In one form the larva inhabits the internal parts, while the adult is external. Acarus Scabiei, Or Sarcoptes Hominis This has an ...
-2. Insecta Or Insects
The parasitic insects occur entirely externally. Some of them are not parasitic at all times. Pediculi Or Lice The head louse (P. capitis) lives among the hairs. It forms a chitinous sheath for ...
-Section XIII. Pyrexia - Fever
Normal temperature, resulting from balance of production and discharge of heat, regulated by a calorific centre in the brain. Limitations of power of regulation when body exposed to excessive cold or ...
-Pyrexia - Fever. Part 2
Regulation Of Temperature The fact that in healthy persons the temperature remains close to a constant normal, indicates that there are arrangements in the body whereby the production and discharge...
-Pyrexia - Fever. Part 3
Pyrexia From Lesions Of The Central Nervous System There are many cases on record in which injuries or diseases of the brain have led to elevation of temperature, sometimes to a high degree. These ...
-Pyrexia - Fever. Part 4
As the fever patient eats less than a healthy person, the excessive production of heat takes place, to a large extent, by the combustion of the tissues. Hence, as the fever progresses, there is great ...
-Pyrexia - Fever. Part 5
The Metabolic Theory Of Pyrexia According to this theory the abnormal production of heat is due to the direct action of the fever-producing agents on the living tissues, while the due regulation of...
-Part Second - Diseases Of The Special Organs And Systems. Section I. Diseases Of The Organs Of Circulation. A. The Heart And Pericardium
1. Congenital malformations, chiefly of the heart and great vessels. Causation. Forms. Cyanosis a common result. II. Coagula in the heart; the various forms of thrombi. III. Occlusion and stenosis of ...
-I. Congenital Malformations Of The Heart
MISPLACEMENTS of the heart are of rare occurrence, and the more important of them are merely part of a general malformation of the body. The heart may be transposed, that is to say, placed in a positi...
-2. Defects Of The Septum Auriculorum
The least degree of defect of this septum is the persistence of the foramen ovale. A certain degree of this is very frequently present in adult hearts, but the aperture is usually so small or so valve...
-3. Congenital Stenosis Of The Pulmonary Artery
This may be to a slight or to an extreme degree. In most cases the ventricular and auricular septa are also defective. (Kussmaul in 192 cases found the ventricular septum complete in only 21.) The mos...
-4. Congenital Stenosis Of The Aorta
The narrowness may be at its origin or at the isthmus aortas. In the former case there is usually defect of the septa as already explained. Stenosis of the aorta, even amounting to atresia, may have l...
-5. Persistence Of The Ductus Arteriosus Botalli
This communication between the pulmonary artery and thoracic aorta is normally completely closed within two, or at most three, weeks after birth. It may, however, remain patent when from any cause the...
-6. Transposition Of The Great Vessels
This consists in a reversal of the relative positions of pulmonary artery and aorta, so that the former takes origin from the left ventricle and the latter from the right. The blood from the systemic ...
-7. Malformations Of The Semilunar Valves
Malformations of the aortic or pulmonary valves may be part of congenital lesions of the main vessels themselves, but are frequently of independent origin. The valve may be in the form of a diaphragm ...
-8. Congenital Malformation Of The Auriculo-Ventricular Valves
These valves are, like the semilunar valves, occasionally the seat of malformations which usually cause narrowing of the orifice. This may be in the form of coalescence of the curtains, produced, in s...
-II. Coagula In The Heart
Thrombi in the heart are of frequent occurrence; they vary in kind and in significance. Most of the forms of thrombi have been already referred to (see p. 95). Thrombi are frequently designated vegeta...
-III. Occlusion And Stenosis Of The Coronary Arteries
The coronary arteries are frequently affected either at their orifices or in their course by lesions which interfere with the circulation through them. As these arteries are, at the most, possessed of...
-1. Atrophy Of The Heart. Brown Atrophy
This condition is one of comparatively frequent occurrence, but is for the most part merely a part of general atrophy, or emaciation of the body. In emaciating diseases where the muscular system as a ...
-2. Fatty Infiltration Of The Heart
The normal hearth well known to present on its surface a certain amount of adipose tissue (see Fig. 208). This fat is beneath the pericardium, lying between it and the muscular substance of the wall. ...
-3. Fatty Degeneration Of The Muscular Substance
This condition is of exceedingly frequent occurrence in the heart,, especially in its minor degrees. Any disease which causes a serious deterioration of the blood may produce it, and it is seen in its...
-4. Fatty Degeneration Of The Endocardium
The valves of the heart, more particularly the mitral, frequently show opaque white or yellow patches with little or no thickening. These are areas of fatty degeneration; they occur mostly in debilita...
-5. Calcareous Deposition In The Pericardium And Connective Tissue
In connection with pericarditis it is not very uncommon to meet with calcareous infiltration of old fibrine or dried-in pus which may remain on the surface. Again, where, in the pericardium, there has...
-6. Calcareous Infiltration Of The Muscular Substance
The author has met with two cases of calcareous infiltration of the muscular substance of the heart, but they differed somewhat from each other. In one the lime salts were deposited in massive form, c...
-7. Other Forms Of Degeneration
Amyloid degeneration affecting the intermuscular vessels is not uncommon. In extreme cases the endocardium may be involved. Hyaline degeneration occurs in the muscular cylinders in sudden obstruction ...
-8. Injuries And Rupture Of The Heart
Wounds of the heart are not by any means necessarily fatal, although, of course, commonly so. In most cases of penetrating wound of the heart there will be fatal haemorrhage, but such wounds, especial...
-V. Hypertrophy And Dilatation Of The Heart
Hypertrophy and dilatation concern chiefly the muscular substance of the heart, giving rise according to circumstances to enlargement of particular ventricles or auricles, or of the heart as a whole. ...
-VI. Inflammations Of The Heart
The inflammations of the heart are divisible into three forms, according as the myocardium, the endocardium, or the pericardium is the primary seat. As the myocardium is closely in contact with perica...
-1. Myocarditis
This name designates inflammation of the muscular substance of the heart. Several forms are distinguished. Parenchymatous myocarditis is a general inflammation of the proper muscular fibre of the h...
-2. Endocarditis
The various forms of endocarditis are somewhat closely related to each other, but it is possible to distinguish three forms - a simple acute, a simple chronic, and an ulcerative or infective form. Acc...
-Endocarditis. Part 2
Rupture of the chordae tendineas sometimes occurs in the mitral valve when the inflammation happens to extend to these structures. The result will be that during the systole of the ventricle the valvu...
-Endocarditis. Part 3
Causation The disease is due to the implantation of pathogenic microbes on the endocardium. Pyogenic micrococci constitute the form of microbe, but the source of these is sometimes obscure. The dis...
-3. Pericarditis
The pericardium in its anatomical and pathological relations corresponds to the other serous sacs, and, to a certain extent, to the synovial cavities. The pleura, peritoneum, and pericardium are to be...
-VII. Valvular Disease Of The Heart
In studying endocarditis we have seen that the valves are frequently altered in their structure; we have now to consider these alterations more specifically, and their effects on the heart and circula...
-1. Insufficiency Or Incompetency Of The Mitral Valve
This is a condition in which, during the systole of the heart, some portion of the blood passes back into the left auricle instead of the whole being forced into the aorta. The actual physical cond...
-2. Obstruction Of The Mitral Orifice. Mitral Stenosis
This name is applied to the condition in which the mitral orifice is not large enough to allow of the usual quantity of blood passing from the auricle to the ventricle. The normal width of the mitral ...
-3. Insufficiency Of The Aortic Valve
This is the condition in which, after the completion of the ventricular systole, a portion of the blood regurgitates into the left ventricle through the imperfectly closed semilunar valve. It is usual...
-4. Obstruction Of The Aortic Orifice. Aortic Stenosis
In this lesion the passage of blood from the left ventricle into the aorta is interfered with. It is, in the great majority of cases, caused by chronic endocarditis. The conditions already described a...
-5. Valvular Disease Of The Right Heart
We have already seen that, except in the foetus, this form of disease is uncommon as a primary lesion. In cases of acute or chronic endocarditis with well marked lesions on the left side, however, the...
-VIII. Tuberculosis And Syphilis, Etc
1. Tuberculosis This is rare as a lesion of the heart itself, but frequent and important in the pericardium. Tuberculosis of the heart is an occasional accompaniment of acute general tuberculosis, ...
-IX. Tumours Proper And Parasites Of The Heart
Primary tumours are exceedingly rare in the heart. According to Berthenson the structure in 30 published cases of primary tumours of the heart was as follows: - Sarcoma 9 (Pure Sarcoma 5, Fibrosarcoma...
-B. Blood-Vessels
I. Diseases Of The Arteries (1) Thrombosis and Embolism, (2) Obliteration, (3) Acute inflammation, (4) Chronic endarteritis or atheroma; (a) Causation and nature, (b) tissue changes, (c) effects on...
-1. Thrombosis And Embolism
These conditions having been somewhat fully discussed in previous pages, it remains here to refer to the more local changes. Thrombosis occurs as a secondary result of disease of the walls of arter...
-2. Obliteration Of Arteries
In several of the affections to be considered in the succeeding paragraphs, partial or complete occlusion and obliteration of arteries occurs, and the processes, although differing somewhat in detail,...
-3. Acute Inflammation Of Arteries. Acute Arteritis
Arteries often take part in inflammations in their neighbourhood, but an independent acute inflammation of the walls is very rare. An endocarditis affecting the aortic or pulmonary valve sometimes ext...
-4. Atheroma. Chronic Endarteritis. (Arteriosclerosis, Endarteritis Deformans, Endarteritis Nodosa)
These names are applied to a disease of very frequent occurrence in arteries, the nature of which has been differently regarded at different times. (A) Causation And Nature Of The Disease Accord...
-Atheroma. Chronic Endarteritis. (Arteriosclerosis, Endarteritis Deformans, Endarteritis Nodosa). Continued
Calcareous infiltration is a frequent result in the atheromatous patch. The dense tissue of the patch may become infiltrated with lime salts, with or without a preceding fatty degeneration. This is pe...
-5. Endarteritis Obliterans
This is not an independent disease, but is frequently of considerable importance as a part of the phenomena of other conditions. It affects the finer vessels of certain organs, and consists, like athe...
-6. Retrograde Changes In Arteries
We have already referred to retrograde changes in connection with atheroma. Some more independent forms have still to be considered. (A) Fatty Degeneration Of The Intima Of Arteries This conditi...
-7. Aneurysms
An aneurysm is a localized dilatation of an artery. Taking this as the definition, it will follow that in the aneurysm the coats of the artery are stretched, and, to some extent, retained as the cover...
-Aneurysms. Part 2
Another circumstance of importance is the Localization of aneurysms in different arteries. Nearly half the cases of aneurysm occur in the aorta, and the great majority of these in the thoracic portion...
-Aneurysms. Part 3
(E) Effects On The Heart Aneurysms affect the heart somewhat variously. The organ is frequently depressed by the mere presence of the aneurysm at its base. Room must be afforded for the increasing ...
-8. Special Forms Of Aneurysm
There are certain lesions to which the name aneurysm is commonly given, but which do not accord with the description given above. (A) Cirsoid Aneurysm And The Aneurysm By Anastomosis Cirsoid Ane...
-9. Syphilitic And Tubercular Affections Of Arteries
These arise usually by extension of the infective process to the arteries, and are generally part of a larger and more pronounced lesion. Syphilitic affections of the arteries occur in the neighbou...
-1. Thrombosis
This is of very frequent occurrence in veins. The full description of this process in a previous section applies especially to the veins. As the blood in the veins is normally at a lew pressure and fl...
-2. Inflammation Of Veins. Phlebitis
The simplest form of phlebitis is that just referred to in which a thrombus causes a chronic inflammation of the wall of the vein. We may also have an inflammation of the wall from inflammations in th...
-3. Varix Or Phlebectasis
Varix is dilatation of veins just as aneurysm is dilatation of arteries. Causation We saw that some .weakening of the wall is always necessary to the occurrence of aneurysm, but no such conditio...
-4. New-Formations In Veins
Syphilis rarely attacks veins, but a gummatous inflammation has been observed in the portal vein and in the umbilical vein in new-born children. Leprosy may .attack the large veins of the extremity. ...
-C. Diseases Of The Lymphatic System And Spleen
I. The Lymphatic Vessels. - Inflammations. Tuberculosis. Dilatation from obstruction of the thoracic duct and other steins. Tumours, including secondary cancer. II. The Lymphatic Glands. - 1. Their st...
-I. The Lymphatic Vessels
WE have already had occasion to observe that the lymphatic system is intimately related to the blood-vascular system, and may be regarded as a part of it. We have also seen that this system nas close ...
-1. Structure And Relations
All lymphatic vessels connect themselves directly with lymphatic glands, so that no lymph passes into the circulation without first traversing a lymphatic gland. Dissolved substances introduced into t...
-2. Degenerative Changes
These are not of common occurrence apart from tuberculosis and syphilis. Amyloid disease is the commonest form of degeneration, but it does not usually occur in a high degree, and it is only occasiona...
-3. Pigmentation Of The Glands
We have seen how pigment artificially introduced into the lymphatics is arrested at the glands. Similarly, carbonaceous pigment is carried from the lungs and deposited in the bronchial glands. Again, ...
-4. Acute Inflammation Of Lymphatic Glands, Lymphadenitis
As already indicated, this condition is nearly always a result of inflammation in the peripheral parts from which the vessels come to the gland. The enlarged and inflamed gland is called a Bubo. The m...
-5. Chronic Lymphadenitis
This term is used for a simple chronic inflammation in connection with prolonged irritation of the glands. This is most directly produced by the introduction of foreign substances, where the solid par...
-6. Tuberculosis Of The Lymphatic Glands (Scrofula)
Tuberculosis occurs in the lymphatic glands as elsewhere, by the action of the tubercle bacilli. In some cases there is an obvious propagation of these microbes from an existing local tuberculosis at ...
-7. Syphilitic Disease Of Lymphatic Glands
This, as we have seen, is a constant result of the primary syphilitic infection, and constitutes the syphilitic or Indurated bubo. The glands slowly enlarge by new-formation of round cells, and they r...
-8. Tumours Of Lymphatic Glands
We have already described several forms of new-formation of lymphatic tissue, some of which attain to the dignity of actual tumours, and are designated lymphoma or lymphadenoma. There is the leukemic ...
-1. Structure And Formation
The exact nature of the function of this organ is somewhat obscure. In order to understand the various changes which it undergoes, it will be necessary to bear in mind certain facts as to its structur...
-2. Malformations And Malpositions
One or more Supernumerary spleens (splenculi, lienculi) are not infrequently met with, these being in addition to the ordinary normal organ. They are generally round in form, and have the dark red or ...
-3. Active Hyperemia And Acute Inflammation
We have already seen that an active hyperemia of the spleen occurs physiologically during digestion. It is met with as a distinctly pathological condition, and frequently in a very exaggerated form, i...
-4. The Spleen In Malaria
The parasite of malaria seems to exercise a strong local influence on the splenic tissue. There is in acute cases an inflammatory enlargement such as that described above. But in cases where the infla...
-The Spleen In Malaria. Continued
Rupture Of The Spleen This occurs occasionally, as we have seen, in acute enlargements of the organ. But traumatic rupture is much more frequent This is effected by blows or falls on the abdomen, a...
-Section II. Diseases Of The Bones And Joints
A. The Bones. - Introduction as to development and structure. I. Some Affections of the Bone Marrow. II. Malformations. III. Rickets, Cretinism, etc., a disease of growing bones, caused by general ill...
-A. The Bones
Introduction Bone differs materially in structure and function from most of the other tissues of the body, and these peculiarities exercise an important influence on the pathological changes to whi...
-I. Some Affections Of The Bone-Marrow
The bone-marrow as a blood-forming structure is intimately concerned in diseases in which the constitution of the blood is altered. Most of these conditions have been already considered under Pernicio...
-II. Malformations Of Bone
The more important malformations of bone are connected with general malformations, and have been considered in an earlier part. We have defects of the skull in anencephalus, and of the vertebrae in sp...
-III. Diseases Of The Developing Bones, Rickets Or Rachitis, Cretinism
Causation Of Rickets This disease occurs in children during the earlier periods of growth, and so far as the bones are concerned it is a disease of development, the normal process of ossification b...
-Diseases Of The Developing Bones, Rickets Or Rachitis, Cretinism. Part 2
Character Of Lesions The lesions in rickets may be summed up in the statement that the preparatory stages of ossification are exaggerated, while the completion of the process is delayed. At the ...
-Diseases Of The Developing Bones, Rickets Or Rachitis, Cretinism. Part 3
Deformities Of The Long Bones The most obvious change at the outset is swelling of the cartilaginous ends (see Fig. 268) of the long bones, giving a clubbed or knobbed appearance to the limbs. This...
-Diseases Of The Developing Bones, Cretinism. Part 4
Deformities Of The Bones In Cretins Athough the pathology of Cretinism is not fully elucidated, yet much light has been thrown on it by the discovery of the important lesions following on disease o...
-IV. Retrograde Changes
1. Atrophy The bones are liable to various forms of atrophy. One of the commonest forms is that described as Atrophy from pressure, which, however, is not true atrophy, but an absorption of bone. I...
-2. Osteomalacia Or Mollities Ossium
This condition is liable to be confused with rickets on the one hand and simple atrophy on the other. It differs from rickets in being a disease of mature bone, rarely occurring in children. It leads,...
-V. Inflammations Of Bone, Ostitis, Periostitis, Osteomyelitis
Introductory Inflammations of bone are sometimes distinguished according as they affect the periosteum (Periostitis), the bone proper (Ostitis), or the bone-marrow (Osteomyelitis). Such a distincti...
-1. Acute And Suppurative Inflammations Of Bone
The pyogenic microbes may be directly introduced from without or may reach the bone by the blood, and hence two principal forms may be distinguished. (A) Acute Traumatic Ostitis This occurs chie...
-2. Chronic Inflammations Of Bone. Chronic Ostitis
In its Causation, chronic ostitis is very varied. All sorts of irritants acting on the bones lead to it. Traumatic agents causing wounds, and more especially fractures, are a frequent cause. The proce...
-VI. Hypertrophy Of Bone. Hyperostosis, Periostosis
The distinction between hypertrophy of bone and chronic inflammation is sometimes a difficult one to draw. In the former there is a new-formation, as in the latter, and it may be only the absence of a...
-VII. Necrosis Of Bone
Death of bone is of frequent occurrence, and it leads to such obvious phenomena that the term necrosis has been almost monopolized by mrgeons for this condition. Causation Necrosis in bone is ne...
-VIII. Regenerative Processes. Healing Of Fractures. Transplantation
In the various regenerative processes the structures above referred to as having to do with the growth of bone are concerned. The structures become cellular, their existing cells multiplying by karyo-...
-1. The Healing Of Fractures
In the case of simple fractures or of those which are protected from septic contamination, the process of healing generally begins soon after the infliction of the injury. According to Ogston, in c...
-2. Transplantation Of Bone
It has usually been stated that, when pieces of the periosteum are transplanted, they proceed to the formation of bone. This is only true in regard to the deep layer of the periosteum, or more properl...
-1. Tuberculosis Of Bone
This is an exceedingly frequent affection, and one attended usually by very serious results. The lesions to be here described are not universally recognized as tubercular in character, although, as ob...
-2. Syphilitic Affections Of Bone
The Lesions of tertiary syphilis have usually their seat of origin in the periosteum, although the subjacent bone may be simultaneously involved. The condition may be briefly described by stating that...
-3. Actinomycosis In Bone
This affection occurs in the bones of the face, and sometimes, by extension, in the vertebrae, sternum, etc. The lesions somewhat resemble those of tuberculosis, the new-formed granulation tissue open...
-X. Spinal Curvatures
Introductory The spinal column is composed of vertebrae whose bodies are separated by elastic fibro-cartilages. The vertebrae articulate with each other at four other points, two on the upper and t...
-1. Antero-Posterior Curvature
There are two quite distinct forms of anteroposterior curvature, the curve in the one form being rounded^ and mainly an exaggeration of the natural curvature, and in the other sharp or angular. (A)...
-2. Lateral Curvature, Rotatory Curvature, Scoliosis
In the introduction to this subject we have seen that the mechanism of the spine allows of exceedingly limited lateral deviation. But it often happens that from habitual faulty positions at work or ot...
-XI. Tumours Of Bone
The tumours of bone spring from the active tissue which enters into the composition of bone, and this has been shown to be, on the one hand, the medulla, forming not only the marrow of the long bones,...
-Tumours Of Bone. Continued
Myxoma This form of tumour is very rare, but cases have been observed of both central and peripheral origin. The tissue is usually mixed with cartilage or other tissue. The growing tumour, whether ...
-1. Congenital Dislocations
Children are sometimes born with certain joints in faulty positions, some of these being really traumatic and others of more obscure origin. The traumatic cases arise for the most part during parturit...
-2. Talipes Or Club-Foot And Club-Hand
These names are applied to distortions of the feet, or more rarely of the hands; the bones assume certain abnormal positions in which they are retained by the contraction of muscle. Causation A ...
-3. Flat-Foot
In this condition the internal arch of the foot is flattened so as to be in some cases abolished; at the same time the foot is rotated outwards and the astragalus is pushed downwards and inwards, the ...
-4. Traumatic Dislocations
We have here to do with cases in which the bone is pushed out of its place by some external force acting on it. The bones are kept in their places mainly by the ligaments of the joints, but no inco...
-5. Spontaneous Dislocations
This name is applied to dislocations which occur without any considerable violence, and they usually imply a previously diseased state of the joints. The disease is generally inflammation or tuberculo...
-II. Anchylosis
By this name is meant fixation of a joint by union of the opposing bones by means of firm adhesions. The expression false anchylosis is sometimes used to designate the condition in which the joint i...
-III. Inflammation Of Joints - Arthritis
In most cases of arthritis the inflammation affects, more or less, all the structures which enter into the construction of the joint. The irritant is usually present in the joint itself, and is distri...
-1. Simple Arthritis
This condition is produced most directly by the opening of joints and the occurrence of septic decomposition in their fluids. But it also occurs sometimes by exposure to cold, from injuries, and from ...
-2. Pyemic Arthritis
In this disease septic microbes are deposited in the joint and spread over the surface by the synovial fluid. The result is an acute inflammation with fibrinous exudation, but generally going rapidly ...
-3. Gonorrheal Arthritis
An acute arthritis sometimes develops in gonorrhoea, but the connection between the two diseases is disputed by some. The inflammation is usually slight, like that in Acute rheumatic arthritis, or it ...
-4. Acute Rheumatic Arthritis
Like pyaemic arthritis this is due to an irritant which is present primarily in the blood and affects the structures of the joints like other connective tissue structures. The result is an acute infla...
-5. Gouty Arthritis
In this disease uric acid, in the form of urate of sodium, is deposited in the tissues of the joints. It is first deposited in the cartilage, and, according to Charcot, always, to begin with, at the m...
-6. Chronic Rheumatic Arthritis
As a rule this disease affects many joints. The condition is sometimes designated Rheumatic gout. As the changes are virtually the same as in Arthritis deformans, and the two conditions run into one a...
-IV. Syphilis And Tuberculosis Of The Joints
Syphilis does not frequently attack the joints, but rheumatic attacks in syphilitic persons may have some relation to the specific virus. According to Lancereaux, there may be, in the secondary stage,...
-V. Loose Bodies In Joints
These occur most frequently in the knee joints, but also in the hip, shoulder, maxillary, and other joints. They consist generally of mora or less rounded pieces of tissue, and we may have fibrous tis...
-Section III. Diseases Of The Nervous System
Introduction. The plan of the nervous system in general. A. - The Peripheral Nerves. Anatomical introduction. 1. Effects of injury and division of nerve stems. 2. Neuritis; (1) Toxic neuritis - (a)...
-Introduction. Plan Of The Nervous System
RECENT observations regarding the connections and relations of nerve cells and nerve fibres, with which the names of Ehrlich, Golgi, Ramon y Cajal, and Retzius are chiefly connected, are interesting a...
-A. The Peripheral Nerves
Anatomical Introduction A nerve stem, whether met with embedded in the tissues of an organ or lying free, is composed of one or more bundles of nerve fibres united together by connective tissue. Th...
-1. Injury And Division Of Nerve Stems
When a mixed nerve is divided there occur motor and sensory paralyses in the peripheral parts dependent on it. It sometimes happens that conduction is re-established within a few days, and this must t...
-2. Neuritis
Nerves are liable to inflammations from the action of irritants of various sorts. In the causation of such inflammations two distinct categories may be distinguished. We have, in the first place, a gr...
-3. Tumours Of Nerves
The term Neuroma is applied to almost all forms of tumours in the course of nerves, and as the majority of these do not consist of nervous tissue, they are to be regarded as false neuromata. In the tr...
-B. The Spinal Cord And Medulla Oblongata
Anatomical Introduction The cord is made up of grey substance, forming the ganglionic centres and consisting of ganglion cells in the midst of a fine network, and of white substance consisting of m...
-I. Secondary Degenerations In The Cord
Causation Secondary degenerations occur in the brain and spinal cord as a result of interruption of nerve fibres, and they are to be understood on similar principles to the degeneration of peripher...
-1. Descending Grey Degeneration (Descending Sclerosis)
As we have just seen, this lesion affects centrifugal or motor fibres, including the fibres of the anterior root-zone and the pyramidal tract. The former are short fibres, and when they are interrupte...
-2. Ascending Grey Degeneration (Ascending Sclerosis)
This condition occurs as a result of any cause which interrupts the ascending or sensory fibres of the cord. The degeneration affects the centripetal fibres, and these we have already seen to be of tw...
-3. Degeneration In The Cord After Amputations
The removal of a limb abolishes the function of the nervous structures concerned in the movements and other actions of the limb, and so these structures undergo atrophy from disuse. The posterior root...
-II. Inflammations Of The Spinal Cord
In its widest acceptation, inflammation of the spinal cord, or myelitis, includes a large number of widely-different conditions, each of which will be considered separately. The cases may for convenie...
-1. Acute Transverse Myelitis (Softening Of The Cord) - Causation
Cases occasionally occur of a limited transverse myelitis, manifested in a softening of the cord, without any sufficient cause being apparent. These cases, which are usually designated spontaneous or ...
-2. Chronic Transverse Myelitis
We have just seen that this condition may follow oil an acute myelitis, but the inflammation may be chronic from the first, when it is produced by an irritant which acts gradually. It is most frequent...
-3. Diver's Paralysis. Caisson Disease
Persons who have been working for considerable periods under a greatly increased atmospheric pressure, such as divers, or workers in caissons at the foundations of bridges or underground railways, som...
-B. Systematic Myelitis And Degeneration
As already indicated, in the diseases included here the affection follows certain physiological systems, and we have, in the first place, to inquire whether any explanation of this can be suggested. ...
-1. Sclerosis Of The Posterior Columns (Locomotor Ataxia, Tabes Dorsalis). Causation
Syphilis is assigned as the cause of this disease in a large proportion of cases (according to Gowers in about two-thirds, and according to Erb even a larger proportion). Syphilis does not act by mean...
-Sclerosis Of The Posterior Columns (Locomotor Ataxia, Tabes Dorsalis). Continued
Relation Of Lesion To Function The lesion in the cord and nerves affects the sensory tracts, and yet the most prominent symptom is inco-ordination of motion. Violent pains are indeed commonly prese...
-2. Spontaneous Or Primary Lateral Sclerosis (Erb's Spastic Paralysis)
In 1875 Erb described a condition characterized clinically by paresis and spasm or rigidity in the inferior extremities, and without loss or impairment of sensation, and expressed the opinion that thi...
-3. Postero-Lateral Sclerosis (Ataxic Paraplegia)
Clinically cases incur which present a combination of paraplegic weakness with spasm and ataxy, and in which the pathological findings are a combined sclerosis of the lateral and posterior columns of ...
-4. Acute Ascending Paralysis (Landry's Paralysis)
In this disease there is a rapidly extending paralysis, commencing in the legs, extending to the trunk and arms, and usually causing death in a few days, but not always fatal. The pathological finding...
-5. Poliomyelitis Anterior Acuta (Infantile Paralysis, Acute Atropine Spinal Paralysis).Causation
The features of this disease at the outset are those of an acute inflammation accompanied by marked general disturbance of health. These suggest a morbid poison acting on the body generally but select...
-6. Poliomyelitis Anterior Subacuta
This disease is a rare one, and, as the symptoms closely resemble those of multiple neuritis, the discrimination of cases is not easy. The principal feature is the occurrence, with little or no distur...
-7. Poliomyelitis Anterior Chronica. Progressive Muscular Atrophy
In its clinical aspects the main feature is a gradually progressive atrophy and consequent paralysis of the muscles. It very commonly begins in the muscles of the hand, but progresses from one muscle ...
-8. Bulbar Paralysis, Or Glosso-Labio-Laryngeal Paralysis
This condition is called bulbar paralysis from the fact that the part affected is the medulla oblongata, which is frequently designated the bulb. There is progressive atrophy and paralysis of muscl...
-9. Pseudo-Bulbar Paralysis
Perhaps it may be well to mention in this place a condition known by the above name, which, although belonging rather to diseases of the brain, clinically presents features so closely allied to the or...
-10. Pseudo-Hypertrophic Paralysis
The resemblance of this disease to progressive muscular atrophy strongly suggests that it is primarily due to a lesion in the spinal cord. But repeated examinations of the cord have shown no constant ...
-III. Tumours, Specific Inflammations, And Parasites Of The Cord
Tumours of the cord and medulla proper are very rare, but it is not uncommon to find tumours of the meninges, and even of the bones, affecting the cord by pressure. The tumours of the meninges fall to...
-C. The Encephalon
C. The Encephalon. - Anatomical Introduction, arrangement of fibres and centres. Functions of convolutions. Arteries of brain. I. Malformations. 1. Congenital smallness, microcephalus. 2. Hypertrophy....
-The Encephalon. Part 2
It is to be remembered that the three nuclei we have referred to, the nucleus caudatus, nucleus lenticularis, and thalamus opticus, receive fibres from and give fibres to the internal capsule. There a...
-The Encephalon. Part 3
The temporo-sphenoidal lobe presents on its lateral surface again three transverse convolutions, superior, middle, and inferior (c, c', c, Fig. 322); the superior, bounding the fissure of Sylvius and...
-I. Malformations Of The Brain
The more considerable of these have been considered in the section on general malformations. The principal forms are anencephalus accompanied by acrania or cranioschisis, encephalocele and cyclopia. T...
-1. Cong-Enital Smallness Or Aplasia Of The Brain
This may affect the brain as a whole or parts of it. Micrencephalus signifies a general smallness of the brain, which is usually associated with Microcephalus or smallness of the head, the latter t...
-2. Hypertrophy Of The Brain
This is a condition rarely observed; but occasionally, without any hydrocephalus, a child is born with an unusually large encephalon. There are also cases in which, in later life, a hypertrophy of the...
-3. Heterotopia Of The Brain Substance
Besides the extreme form of Encephalocele (see p. 49) certain cases of Hernia cerebri, in which there is no hydrocephalus, are regarded as belonging to this class. Sometimes also masses of grey substa...
-II. Traumatic Lesions Of The Brain
Laceration Of The Brain The brain may be injured directly or indirectly. In injuries involving fracture of the skull the brain is often simultaneously wounded, or the bone may be carried inwards an...
-III. Lesions Affecting The Circulation In The Brain
These conditions are somewhat variously associated with each other and with lesions of other kinds. They mostly imply local or general alterations in the volume of the blood and lymphatic fluid in the...
-1. Hyperaemia, Anaemia, And (Edema
Hyperaemia in the brain, as elsewhere, is divisible into active and passive. Active hyperaemia occurs generally or locally in consequence of hypertrophy or over-action of the heart, especially when th...
-2. Occlusion Of Arteries
This is a frequent and serious lesion, occurring mostly as a result of embolism or thrombosis. Embolism occurs in the great majority of cases in connection with old standing valvular disease of the...
-Occlusion Of Arteries. Continued
Effects Of Occlusion Of Arteries Here, as in other parts, the effects of occlusion depend chiefly on whether the arteries concerned have sufficient anastomosing communications or not. The arteries ...
-3. Thrombosis Of The Cerebral Sinuses And Veins
These venous channels are somewhat frequently the seat of thrombosis. The coagulation may have its starting point in an inflammation propagated from a neighbouring structure, in which case it is usual...
-IV. Cerebral Haemorrhage
By this term is meant bleeding in the substance of the brain. The blood, which may be large or small in quantity, pushes aside the brain substance, tearing for itself a cavity where it coagulates. Wit...
-1. Haemorrhage From The Larger Cerebral Arteries
We have seen that these vessels run in the sulci and fissures of the brain, involved in the meshes of the pia-arachnoid, and it might be supposed that their rupture would give rise to meningeal rather...
-2. Haemorrhage From The Nutrient Arteries
As these vessels run in the substance of the brain the haemorrhage is always cerebral and rarely extends to the meninges. It might be supposed that as the nutrient vessels are small the haemorrhage fr...
-3. Haemorrhage From The Capillaries
A certain amount of capillary haemorrhage generally accompanies all larger bleedings. The explanation of this seems to be that the pressure of blood produces such obstruction of the vessels around, th...
-V. Inflammations Of The Brain
These embrace a very extensive and varied set of conditions, some of which have little in common. Thus there are localized inflammations of an acute kind, going on sometimes to the formation of absces...
-1. Acute Localized Non-Septic Encephalitis
We have already seen that, around and in the midst of haemorrhagic foci and cerebral softenings, there are inflammatory manifestations, evidenced by the presence of leucocytes containing fat granules....
-2. Abscess Of The Brain
Abscess of the brain being, like abscess elsewhere, a septic process, it arises by the implantation of pyogenic microbes in the brain substance. The disease is a somewhat frequent. The abscess is u...
-3. Chronic Localized Encephalitis
The processes of chronic inflammation are similar to those in the spinal cord, and the result here, as there, is Sclerosis. In the case of the brain there is hardly anything of the systematic sclerosi...
-4. Diffused Encephalitis
This term may be applied to conditions in which there is a general irritation of the brain, presumably by an irritant circulating in the blood. It may be held to include a considerable number of varie...
-Diffused Encephalitis. Continued
(C) Hydrophobia In this disease the symptoms indicate irritation of certain nerve centres, and a greatly increased reflex irritability. The centres irritated are chiefly those of the medulla oblong...
-VI. Atrophy And Degenerations Of The Brain
Under the congenital malformations of the brain we have already described several conditions which might be included in the designation congenital atrophy or aplasia. We have also seen that in Dementi...
-VII. Tuberculosis And Syphilis Of The Brain
Both of these conditions present themselves in the form of tumours, but more especially tuberculosis. In its clinical aspects, indeed, tuberculosis of the brain substance has all the characters of a t...
-1. Tubercular Tumour Of The Brain (Scrofulous Tubercle Of The Brain)
As already indicated, this is a very common lesion, being the most frequent form of tumour of the brain. It is a pure local tuberculosis, and may occur without any other tubercular manifestation. The ...
-2. Syphilis Of The Brain And Its Membranes
Syphilis attacks the brain chiefly in conjunction with the membranes. It is very rare to meet with a syphilitic tumour in the brain substance without some connection with the surface, and probably the...
-VIII. Tumours And Parasites Of The Brain
General Effects On The Brain Tumours are of frequent occurrence in the brain, and produce secondary consequences of great importance. These secondary results are mostly related to the fact that the...
-D. The Membranes And Cavities Of The Brain And Spinal Cord
Introduction. I. Accumulation of cerebro-spinal fluid. 1. (Edema of membranes. 2. Hydrocephalus, acquired and congenital. 3. Dropsies of central canal and meninges of cord, (a) Hydrorrhachis interna, ...
-I. Accumulation Of The Cerebro-Spinal Fluid In The Membranes And Cavities
It has been already pointed out that the subarachnoid space, with the ventricles and central canal of the spinal cord, forms a single system of lymph spaces which intercommunicate. The lymph or cerebr...
-1. Oedema Of The Membranes
There may be General CBdema of the membranes and spaces, perhaps including the perivascular spaces in the brain substance. This sometimes takes place in Bright's disease, and may occur along with an o...
-2. Hydrocephalus
This term expresses a massive accumulation of fluid inside the skull. The fluid is, in the great majority of cases, in the ventricles, more especially the lateral ventricles, but in certain congenital...
-3. Hydrorrhachis Interna, Hydromyelia, Syringomyelia, Cysts Of The Cord
The affections to be here considered are almost all congenital, at least in their origin. They are related to the central canal of the cord and its origin. The central canal of the cord presents no...
-4. Spina Bifida
In the section on General Malformations, this con-dition has already been considered. Rhachischisis, or spina bifida without tumour, has been sufficiently described (see p. 50), but the form associate...
-1. Hematoma Of The Dura Mater. Pachymeningitis Hsemorrhagica
Haemorrhage on the internal surface of the dura mater, a lesion of considerable frequency, is found associated with thickening and new-formation, characters indicative of chronic inflammation. There a...
-2. Haemorrhages In The Soft Membranes
Most of these are secondary to some other lesion and they are usually of minor consequence. We have seen that aneurysms, although situated in the meninges, give rise, when they rupture, to cerebral ha...
-1. Pachymeningitis. Inflammation Of The Dura Mater
Excluding the condition already described as connected with haematoma, the inflammations of the dura mater are, for the most part, secondary to affections of the bones or sinuses. In compound fracture...
-2. Leptomeningitis. Inflammation Of The Pia-Arachnoid
As the arachnoid and pia mater are closely connected and form virtually one membrane, they are always associated in their inflammations. The term Meningitis is commonly used without qualification to e...
-3. Tubercular Meningitis (Basal Meningitis, Hydrocephalus Acutus)
This disease, as the name implies, depends on the presence in the meninges of the bacillus of tubercle. The tubercle bacillus is readily detected in the affected structures, lying in the membranes but...
-4. Syphilitic Meningitis
This has been described in a previous-page along with Syphilitic lesions of the brain (p. 679). ...
-IV. Tumours And Parasites Of The Meninges
Tumours of the membranes of the brain are of importance especially when they press on the brain or on the nerves as they issue from the skull. They are of considerable variety. Fibromas have been f...
-1. Pineal Gland
The pineal body is a small reddish structure, which is adherent to the under surface of the velum interpositum, so that it is often torn away in removing the choroid plexus and velum interpositum. It ...
-2. Pituitary Body. Hypophysis Cerebri
The pituitary body or hypophysis cerebri is a small body situated in the sella turcica. It is elongated from side to side, and is connected with the brain by a stalk which is continuous with the infun...
-Section IV. Diseases Of The Organs Of Respiration
General Introduction. The function of respiration implies access of air to the blood and of blood to the air, a double mechanism. Respiratory movements-effected by nerve centres. Pulmonary circulation...
-Diseases Of The Organs Of Respiration. Dyspnoea
This condition, which means difficulty of breathing, is popularly called shortness of breath. In its physiological aspects it means an exaggeration of the respiratory movements. The affected person ha...
-Diseases Of The Organs Of Respiration. Asphyxia. Suffocation
These terms imply a more or less sudden and complete interference with the process of respiration, whether by interruption to the entrance of air into the lungs or to the passage of blood through them...
-A. The Nasal Passages
1. Congenital Malformations Such deformities as absence of the nose and its cavities, and stenosis, are usually parts of a general malformation, chiefly Cyclopia (see p. 49). In Clefts of the lip a...
-2. Haemorrhage. Epistaxis
Haemorrhage from the nares is of frequent occurrence. There are persons who have a special proclivity to it, in whom it occurs at intervals without apparent cause. It also occurs in consequence of tum...
-3. Acute Catarrh. Acute Rhinitis. Coryza
Acute inflammation of the nares occurs most frequently as a catarrh, constituting the ordinary cold in the head, but there may be a more intense and specific inflammation in diphtheria and scarlet fev...
-4. Chronic Nasal Catarrh
This may supervene upon acute catarrh, or it may be of more independent origin. The presence of foreign bodies not infrequently leads to an inveterate discharge from the nares, more especially...
-5. Syphilitic And Tubercular Lesions Of The Nares
Syphilis not infrequently affects the nares in the tertiary stage. There is the formation of gummatous tissue with inflammation, beginning either in the mucous membrane or in the deeper parts. As the ...
-6. Tumours
Amongst the lesions just bordering on tumours may be mentioned the so-called Post-nasal adenoid growths. This name is a somewhat unfortunate one, and it should be remembered that the glands concerned ...
-7. Foreign Bodies
Different kinds of foreign bodies are not in frequently found in the nares. They may be introduced into the nostrils accidentally or designedly by children. These may become coated with lime salts so ...
-B. The Larynx And Trachea. I. Malformations
The lesions of the larynx and trachea are frequently associated with those of the bronchi, more especially the inflammations. Their separation here is consequently somewhat artificial. Entire Absen...
-II. Spasm Of The Glottis. Laryngismus Stridulus
The larynx being exceedingly sensitive, is somewhat readily brought into a state of spasm. Thus the mere introduction of a brush with a stimulating solution into the larynx usually produces a spasm wh...
-III. Inflammations Of The Larynx And Trachea
The larynx and trachea are liable to inflammations of very varying forms and degrees of intensity. ...
-1. Diphtheria
This disease, as already seen, depends on the action of a specific microbe, the bacillus of diphtheria (p. 354). The local action of the microbe is not limited to the larynx and trachea, but usualty a...
-2. Acute Catarrh Of The Larynx And Trachea
We have seen that Acute catarrh forms the first stage in diphtheria; it is the result of the action of the specific poison. Similarly we have acute catarrh in measles and small-pox, there being here a...
-3. Chronic Catarrh
This is a common result of repeated attacks of acute catarrh, but may occur spontaneously. It is chiefly characterized, like other chronic inflammations, by new-formation of tissue; the mucous membran...
-4. Subglottic Inflammation
This disease, which is not of very frequent occurrence, is an inflammation of the mucous membrane beneath the glottis. It may be acute at its onset, but it generally passes into a chronic stage. It ha...
-5. Inflammation Of The Perichondrium. Perichondritis
This disease is rarely a primary one, being induced chiefly by syphilitic and tubercular inflammations, especially when there is deep ulceration extending down to the perichondrium. It occurs occasion...
-IV. Syphilis And Tuberculosis Of Larynx And Trachea
1. Syphilis In the secondary period of syphilis the larynx is frequently the seat of catarrhs which are to be classified along with the various inflammations of that stage. There may be in this per...
-2. Tuberculosis. Laryngeal And Tracheal Phthisis
Tuberculosis of the larynx is usually secondary to pulmonary phthisis, the mucous membrane being infected by the sputum from the lungs; it occurs in about 30 per cent, of the cases of tuberculosis of ...
-V. Tumours Of Larynx And Trachea
The most frequent form of tumour of the larynx is the Papilloma. This tumour is often preceded by catarrhal conditions, and is particularly common in persons who, from the nature of their profession, ...
-C. The Bronchial Tubes
Introduction In order to appreciate the changes which occur in affections of the bronchi, it is necessary to refer to some points in the structure of the tubes. The mucous membrane is covered with ...
-I. Inflammation Of The Bronchi. Bronchitis
Various forms are distinguishable. This is an inflammation of the larger and middle-sized tubes, but not involving to any considerable degree the finer ones. In the slighter forms of bronchitis the la...
-1. Bronchial Catarrh. Ordinary Bronchitis. Causation
The bronchial mucous membrane exposed to the inspired air presents varying degrees of sensitiveness to variations in temperature and otherwise. Much that has been said under nasal catarrh is again app...
-2. Septic Bronchitis. Foetid Bronchitis
Where highly irritating decomposing fluids are present in the bronchi, they produce acute inflammation of a suppurative character. This occurs chiefly under three conditions. In the first place local ...
-3. Fibrinous Bronchitis
This name, as well as that of Plastic bronchitis or Bronchial croup, is given to a condition of very rare occurrence and of rather obscure pathology, but yet of great interest. We have seen that in la...
-1. Narrowing Or Obstruction Of The Bronchi
Narrowing Or Obstruction Of The Bronchi occurs under a considerable variety of different circumstances. It may be the result of inflammation in the bronchial wall itself. There is some swelling of the...
-2. Dilatation Of Bronchi. Bronchiectasis
This is a condition of considerable frequency, and it arises under a variety of different circumstances. (A) Causation In most cases the main agent in causing dilatation of the bronchi is the ai...
-III. Tumours Of The Bronchi And Foreign Bodies
Simple tumours originating in the bronchi are exceedingly rare. Cancer not infrequently occurs, originating in the mucous glands of the bronchi, although the resulting tumour has rather the characters...
-Continued. IX. The Lungs
D. - Of the Lungs. Introduction, as to structure. I. Malformations. II. Atelectasis and Collapse. III. Hypertrophy. IV. Pulmonary Emphysema, 1. Interlobular; 2. Vesicular; causation, either substantiv...
-The Lungs
Introduction In examining the lungs after death we seldom meet with them in a perfectly normal condition. They may be abnormally adherent to the wall of the thorax, or unduly pigmented, or there ma...
-I. Malformations Of The Lung
These are not infrequent, but are mostly of minor importance. Apart from absence and exceeding smallness of one or both lungs, which occur as parts of general malformations, there are cases where sing...
-II. Atelectasis And Collapse Of The Lung
These names designate conditions in which the lung alveoli and finer bronchi contain no air, but are in a condition similar to that of the ftal lung before inflation, the internal surfaces of th...
-III. Hypertrophy Of The Lung
This occurs as a Compensatory process perhaps more frequently than is usually supposed. There is evidence to show that in persons who go to reside in high altitudes, the chest increases in size, the g...
-IV. Pulmonary Emphysema
This nanre includes two distinct lesions, in one of which air escapes into the connective tissue of the lung and distends the connective-tissue spaces, while in the other the alveoli are over-distende...
-1. Interlobular Or Interstitial Emphysema
This form, which is rare, occurs when the air vesicles or bronchi are ruptured and the air escapes into the interstitial tissue. The air vesicles may be actually torn open by a broken rib coming again...
-2. Vesicular Emphysema
In this condition the air vesicles are over-distended, and, by partial atrophy of their walls, to some extent coalesced, but without any actual tearing of them. Causation Of Emphysema There have...
-Vesicular Emphysema. Continued
Anatomical Changes In Emphysema We have to do with air spaces of irregular shape and separated by partial partitions, and as the dis-tensile force acts from within, its tendency is to distend equal...
-V. Disorders Of The Circulation In The Lungs
The pulmonary circulation differs in certain important respects from the systemit circulation. The pulmonary arteries are comparatively thin-walled and the muscular coat, even in the finer branches, i...
-1. Active Hyperaemia
This is not frequently met with except as an accompaniment of inflammation or other affection of the lung. It may be produced by the inhalation of irritating vapours. A Collateral hyperaemia occurs wh...
-2. Passive Hyperemia And Oedema Of The Lungs
In the lungs as elsewhere these two conditions are often associated. Passive hyperaemia in the lungs is nearly always connected with functional disturbance in the heart, and there are two principal fo...
-3. Embolism Of The Pulmonary Artery
The pulmonary artery is. probably more liable to embolism than any other vessel. The embolus, may be derived from thrombi in the right side of the heart or in the veins: it may consist of fat, or it m...
-4. Pulmonary Haemorrhage
Haemorrhage occurs in the lungs under a considerable variety of circumstances and presents many different appearances. The Haemorrhagic infarction is the form most frequently met with after death. ...
-VI. Inflammations Of The Lung
The inflammations of the lung vary considerably according to cause, distribution, and the structures specially affected. The irritant which leads to the inflammation may have its seats primarily in th...
-1. Acute Lobar Pneumonia (Croupous Pneumonia)
This is essentially a disease of the lung alveoli, and the most prominent feature is an exudation of fibrine, from which the name croupous pneumonia is derived. The Causation of pneumonia has been ...
-Acute Lobar Pneumonia (Croupous Pneumonia). Continued
The appearance of the lung in this stage is somewhat different from that in the first. It retains its red colour, both from the continuanceof the congestion of the capillaries and from the red ...
-2. Acute Broncho-Pneumonia (Catarrhal Pneumonia, Capillary Bronchitis)
This disease occurs most frequently in children, and is in them, as in adults, associated with catarrh of the finer bronchi. The bronchi are first affected, and so it may be said that the pneumonia sp...
-3. Septic Broncho-Pneumonia
This name is applied to conditions in which the bronchial tubes contain decomposing matters, which irritate the bronchial wall and the corresponding lung parenchyma. There is, as in the preceding form...
-4. Diphtheritic Pneumonia
In many cases of diphtheria the exudation extends down the bronchi even to their finest ramifications, and sometimes also to the lung alveoli. The bronchi contain casts which do not generally obstruct...
-5. Embolic Pneumonia (Pycemia Or Metastatic Abscesses)
In cases of septic thrombosis of veins (thrombo-phlebitis) in connection with wounds or abscesses, a septic embolism is liable to occur, in which the lungs are most directly involved. Pieces of the th...
-6. Chronic Pneumonia (Interstitial Pneumonia, Simple Cirrhosis Of The Lung)
We include here those conditions in which the lung tissue is the seat of a simple chronic inflammation, without anything of a tubercular or other specific nature. The simplest cases are those in which...
-VII. Gangrene Of The Lungs
In this condition necrosis of a definite piece of lung tissue occurs. Necrosis of the lung is of frequent occurrence without gangrene, the latter implying that putrid decomposition has taken place and...
-1. Definition
The term phthisis pulmonalis was originally used to designate a wasting of the body associated with disease of the lung. In its modern use it is applied to cases in which the lungs are affected by a p...
-2. Causation
In what has been said above it has been implied that the causation of phthisis pulmonalis is connected with the tubercle bacillus. All that has been said in regard to the causation of tuberculosis at ...
-3. Anatomical Changes In Phthisis
In studying the changes in the lung it will be necessary to give descriptions of the various processes separately, and to a certain extent these processes are separable, but at the same time it is to ...
-Anatomical Changes In Phthisis. Part 2
Another feature which distinguishes the process is the occurrence of Caseous necrosis. This consists, as we have seen, in the death of the structures, accompanied by the production of finely granular ...
-Anatomical Changes In Phthisis. Part 3
(B) The Fibroid Form On post-mortem examination in typical cases of this form the lung is found very firmly adherent over the affected part, which nearly always includes the apex. One often has to ...
-Anatomical Changes In Phthisis. Part 4
The Bronchiectatic cavity is lined with a distinct membrane, and is usually directly continuous with a bronchus (see Fig. 369). It may exist in the midst of crepitating lung tissue, the complementary ...
-4. Extension Of The Tuberculosis In Phthisis Pulmonalis
In both of the forms already described it has been shown that the tuberculosis, beginning in the finer bronchi, extends, on the one hand, to the lung alveoli, and, on the other, to the connective tiss...
-5. Healing Of Phthisis
It is to be remembered that tuberculosis is due to an infective material, which usually goes on reproducing itself. In the healing of tubercular lesions generally there are two methods which may be fo...
-6. Haemorrhage In Phthisis
Haemoptysis is one of the most common manifestations in phthisis. It is necessary to distinguish between an early and a late haemorrhage. (A) Early Haemorrhage In examining the initial lesion in...
-7. Affections Of The Pleura In Phthisis
From the intimate connection of the pleura with the lung it may be expected that it will frequently be affected in phthisis. The lymphatic system of the lung does not apparently communicate directl...
-8. General Effects Of Phthisis
In its general influence on the body phthisis pulmonalis is of great importance. Its most constant effects are Emaciation and Anaemia,. the former of which, as we have seen, was the main element in...
-IX. Diseases From Inhalation Of Dust. Pneumoconiosis
Carbonaceous Pigment In The Lungs The lungs of all adults have mOre or less of a grey colour from the existence of a black pigment in the lung tissue. This pigment is absent from the lungs of child...
-X. Acute Miliary Tuberculosis, Syphilis, Actinomycosis, Glanders
Acute Miliary Tuberculosis This condition has been discussed at page 313. The tubercular virus, being present abundantly in the blood, produces very marked lesions in the lungs. As the virus is bro...
-XI. Tumours And Parasites Of The Lungs
Primary tumours of the lungs are infrequent. Hebbing relates a case of primary tumour replacing the left lung and which he calls a Rhabdomyoma, but which contained cartilage, gland-elements, etc., as ...
-1. Affections Of The Circulation
There can scarcely be any independent circulatory disturbances in the pleura. Hyperemia exists in cases of severe dyspnoea, and this may result even .in subpleural haemorrhages, producing Petechiae, w...
-2. Inflammations Of The Pleura. Acute Pleurisy
We have seen that whenever any form of inflammation comes to the. surface of the lung it causes inflammatory changes in the pleura; there is acute pleurisy in acute pneumonia and in caseous phthisis, ...
-3. Chronic Pleurisy And Pleural Adhesions
We have already seen that an acute pleurisy may result in adhesion of the sac, the process of adhesion resulting from coalescence of the surfaces which have become like granulation tissue from the inf...
-4. Tuberculosis Of The Pleura
This manifests itself chiefly as an inflammation of the pleura, and hence is identical with Tubercular pleurisy. The tubercle bacillus does not usually reach the pleura directly from the lung in phthi...
-5. Pneumothorax
This has been referred to in connection with phthisis pulmonalis, and the mode of origin there indicated is that in the great majority of cases. Of the remainder there are some in which it is due to e...
-6. Tumours Of The Pleura
Primary tumours are rare, but cases of osteoma and of lipoma have been recorded. Primary cancer occurs in the pleura, forming, according to some, Endothelial cancer. In most of the recorded cases t...
-Section V. Diseases Of The Thyroid And Thymus Glands And Of The Suprarenal Bodies
A. - The Thyroid Gland. - 1. Inflammation; tuberculosis; syphilis. 2. Exophthalmic goitre; Graves' or Basedow's disease. 3. Simple goitre or Broncho-cele; consists of hypertrophy and adenoma; colloid ...
-A. The Thyroid Gland
THE thyroid gland consists of saccules of various shapes lined with epithelium. In these saccules there is often a little clump of colloid matter, the amount of which varies within normal limits. The...
-1. Inflammation Of The Thyroid Gland
Inflammation Of The Thyroid Gland (Thyroiditis), resulting sometimes in suppuration, may arise from injury, from septic infection, or from other less obvious causes. Its occurrence has been noted ...
-2. Exophthalmic Goitre (Graves' Disease, Basedow's Disease)
In this the condition of the thyroid gland is only part of the morbid phenomena. The eyeballs are prominent, the heart liable to excited action, and the thyroid gland is enlarged and vascular. The dis...
-3. Simple Goitre. Bronchocele (Also Called In German Struma And Kropf)
His disease consists in an enlargement of the thyroid gland, which, occurring as it does chiefly in certain specific localities, has been ascribed to some Miasma. Within recent times a hsema-tozoon ha...
-4. Tumours Of The Thyroid
Cancer is not very uncommon. It occurs chiefly as an ordinary glandular carcinoma, but also as a cylindercelled tumour. Sarcoma also occurs. Wolfler has observed, besides the ordinary round-celled tum...
-B. The Thymus Gland
The thymus gland is situated in the upper part of the anterior mediastinum, extending up in front of the trachea nearly as high as the thyroid. It attains its largest size about the second year of lif...
-C. The Suprarenal Bodies
The function of these bodies is quite obscure, but some writers, on presumed analogy with the thyroid gland, have supposed that they secrete some substance necessary for the economy. With one exceptio...
-Section VI. Diseases Of The Alimentary Canal
A. - The Mouth. - I. Malformations and retrograde changes. II. Inflammations. I. Catarrh, 2. Thrush, 3. Special inflammations, 4. Cancrutn oris, 5. Glossitis. III. Infective and other Tumours - Syphil...
-Diseases Of The Alimentary Canal
Introduction The alimentary canal is lined throughout by a mucous membrane, which consists of loose connective tissue covered with epithelium in one or several layers. In the mucous membrane, and t...
-A. The Mouth
As the mouth is exposed in a special manner to external influences, its mucous membrane possesses an epithelium in many layers, and it is not nearly so liable to inflammations as are most other parts ...
-II. Inflammations Of The Mouth. Stomatitis
1. Catarrh If we leave out of view the catarrhs of the fauces and pharynx, which we consider afterwards, Simple catarrh of the mouth is exceedingly rare as a primary disease. It is not infrequent, ...
-2. Thrush, Or Aphthous Stomatitis (The Soor Of The Germans)
This has already been mentioned as connected with the presence of a fungus. It occurs chiefly in the mouths of young unhealthy children, but is also occasionally seen in emaciated adults, as in diabet...
-3. Special Forms Of Inflammation
In Small-pox, besides the general catarrh of the mouth already mentioned, there are vesicles or pustules analogous to those on the skin. We have first whitish patches consisting of raised and desquama...
-4. Cancrum Oris, Noma, Or Gangrenous Stomatitis
This disease, which is fortunately a rare one, occurs in badly nourished children, particularly when reduced by severe illness such as scarlet fever or measles. It presents itself first as a diffuse s...
-5. Inflammation Of The Tongue
Inflammation Of The Tongue deserves a brief special notice. We have seen that the tongue takes part in most of the inflammations of the mucous membrane, but sometimes it becomes the seat of a special ...
-6. Leucoplakia (Leucoma, Psoriasis, Tylosis, Keratosis)
A not infrequent result of chronic glossitis is the occurrence of bluish-white or pearly patches or plaques on the surface of the tongue. As a rule they are smooth, but sometimes their surface is wart...
-III. Infective Tumours And Tumours Proper Of The Mouth
Syphilis Various syphilitic lesions are met with in the mouth, ranging from slight inflammation to deep ulceration. It is not uncommon to meet with a Primary chancre on the lip. In that case the...
-IV. Affections Of The Teeth
The hard part of the tooth consists of enamel, dentine, and cement. The Enamel, containing very little organic matter (only about 2 or 3 per cent.), is for the most part passive, and presents great me...
-1. Caries
This name is applied to a condition which is not analogous to caries of bone, except in so far as in both there is destruction of the dense calcified structure. Caries of bone is related to inflammato...
-2. Inflammation
Inflammation frequently follows on caries, and the pulp is usually involved. It is almost certainly attacked if the caries causes penetration into the pulp, but before this takes place there is ...
-3. Conditions Resulting From Hereditary Syphilis
In children who are the subjects of hereditary syphilis, the teeth show malformations first pointed out by Hutchinson. The teeth are narrow and pointed; the most obvious lesion being in the permanent ...
-4. Tumours Connected With The Teeth
The cement, which, it must be remembered, is composed of bony tissue, sometimes undergoes a hypertrophy to which the name Exostosis or Osteoma is often given. This is scarcely a true bony tumour, but ...
-B. The Soft Palate, Pharynx, And Tonsils
Introduction The mucous membrane here differs from that of the mouth proper, chiefly in respect that in addition to the ordinary mucous glands there are numerous Lymphatic follicles. The distinctio...
-2. Catarrhal Angina
In its acute form this constitutes the most ordinary sore throat, and occurs either from cold especially at seasons of the year when sudden changes of temperature are prevalent, or as a local sympto...
-3. Acute Phlegmonous Inflammation Of The Fauces
This frequently results in the formation of Abscesses. It is a condition of somewhat common occurrence. There is not merely a surface catarrh, but the mucous membrane and submucous tissue are involved...
-4. Diphtheria
The changes which occur in this disease have already been referred to in considering its manifestations in the air passages (see p. 725). It usually begins in the fauces and has its centre there. Ther...
-5. Acute Tonsillitis. Quinsy
This inflammation of the tonsils is, as we have seen, occasionally a part of a general phlegmonous inflammation of the fauces. Occurring more independently it is accompanied by considerable swelling, ...
-6. Chronic Tonsillitis. Hypertrophy Of The Tonsils
Certain persons, especially in childhood or youth, are prone to repeated subacute inflammations of the tonsils, and as these recur the tonsils acquire a permanent enlargement. This consists anatomical...
-7. Syphilitic Disease Of The Fauces
Here, as in the mouth, syphilis manifests itself in multifarious ways. A persistent Catarrh having the ordinary characters of subacute simple catarrh is very common. Mucous patches or Condylomata are ...
-8. Tubercular Ulcers
These are of comparatively rare occurrence. The disease is associated with phthisis pulmonalis, and is really due to an extension upwards of tubercular ulceration of the larynx. It occurs in the form ...
-9. The Tumours Of The Fauces
The Tumours Of The Fauces are not so different from those of the mouth as to call for special remark, and they are altogether of much less frequent occurrence. We meet with papillary excrescences, cys...
-C. The Esophagus
The diseases of this part of the alimentary canal are important from a practical point of view, chiefly because of the natural narrowness of the tube. The mucous membrane of the oesophagus is covered ...
-1. Dilatation Of The Oesophagus
Of this somewhat frequent condition two forms may be distinguished. (a) General dilatation of the tube is a result of obstruction at any part of its course. The obstruction is mostly low down in th...
-2. Obstruction Of The Oesophagus
This is sometimes Congenital. There may be a congenital deficiency in the middle part of the tube, a fibrous cord representing the occluded tube. In some cases the oesophagus below the occlusion opens...
-3. Inflammations Of The Oesophagus
The mucous membrane of the oesophagus is formed so as to resist the action of irritants, and unless the action be peculiarly strong we have not considerable inflammation. When strong acids, or alkalie...
-4. Rupture And Perforation Of The Oesophagus
The oesophagus may be directly ruptured by hard or sharp bodies being swallowed with the food. The author observed a case in which a fish-bone cut through the oesophagus and on into the aorta. A mo...
-5. Tumours Of The Oesophagus
Simple tissue tumours are rare. We meet with Lipomas and Fibromas, and the author has described a case of Myoma (Fig. 388) in which a tumour, 4 3/4 inches long and 2 inches in thickness, was attached ...
-D. The Stomach
Introduction In considering the diseases of the stomach, it is necessary to bear in mind certain points in regard to the structure and functions of the organ. The innumerable glands which exist in ...
-I. Malformations And Contractions Of The Stomach
1. Congenital Malformations There may be abnormal smallness-either with or without other more general malformations. Sometimes an Hour-glass form is presented on account of the middle part of the s...
-2. Contractions Of The Stomach
Contractions Of The Stomach may be general or local. A General contraction is produced when the stomach is long deprived of food. This is most directly produced by obstruction of the oesophagus or car...
-II. Dilatation And Hypertrophy Of The Stomach
These conditions mostly result from obstruction to the passage of food through the pylorus from contraction of that orifice. A simple weakness of the muscular coat may also allow of passive distension...
-III. Inflammations Of The Stomach. Gastritis
Acute inflammations may be produced by the action of irritant poisons which have been swallowed, the inflammation here being accompanied by sloughing. Phlegmonous inflammation is rare in the stomach a...
-IV. The Simple Perforating Ulcer
This peculiar form of ulcer is met with only in the stomach, first part of the duodenum, and lower part of (esophagus. The duodenum is not an infrequent seat, the oesophagus a more unusual one. It is ...
-V. Hyperemia And Haemorrhage
Passive hyperemia of the stomach is of very frequent occurrence, being brought about not only in that large class of cases in which there is a general venous engorgement, but also in those in which a ...
-VI. Tuberculosis And Syphilis Of The Stomach
Tubercular ulcers are rare in the stomach, although very frequent in the intestine. They sometimes occur in cases of advanced phthisis pulmonalis. The ulcers are more superficial than those in the int...
-VII. Tumours Of The Stomach
Cancer This is the only form of tumour which is of much practical importance, and it is of exceedingly frequent occurrence. From the statistics of a considerable number of observers it appears that...
-1. Cylinder-Celled Epithelioma (Adenoid Cancer, Malignant Adenoma)
In this form there is a tolerably definite gland-like new-formation, as we have in other cases of cylinder-celled epithelioma (see Fig. 112, p. 263). There are spaces lined with cylindrical ep...
-2. Medullary Or Soft Cancer
This form is closely allied to the preceding, but the cell masses are larger and less arranged in definite gland-like spaces, while there is a sparse and delicate stroma. The tissue is soft, and it is...
-3. Scirrhus
In this form the new-formation of epithelial cells is not very rapid or vigorous, and it is accompanied by an excessive formation of connective tissue in the form of stroma. Originating in the...
-4. Colloid Cancer
The forms already described, and especially the epithelioma, occasionally undergo a partial colloid degeneration, but in colloid cancer the cells have a special tendency from the first to undergo coll...
-E. The Intestines
Introduction The diseases of the intestines resemble in many-respects those of the stomach, but there are important differences. In structure the intestine differs from the stomach in several respe...
-I. Malformations Of The Intestine
Congenital malformations of the intestine are of considerable frequency. The most important are those in which, from a fault of development, a part of the intestine is wanting. These may be part of a ...
-1. Embolism Of The Mesenteric Arteries
Although the mesenteric arteries are not end arteries, yet embolism of the larger stems sometimes produces haemorrhage and necrosis, the process being similar to that in the haemorrhagic infarction. T...
-2. Haemorrhage
Besides the rare form just mentioned, we have haemorrhage resulting from various causes. Ulcers of various sorts lead to it, especially cancerous and typhoid. Passive hyperaemia is also not infrequent...
-III. Hernia Or Rupture
True hernia consists in a protrusion of the intestine, omentum, or other abdominal organ into a sac formed by a prolongation of the peritoneum. The sac may project externally, or it may bo contained w...
-1. Diaphragmatic Hernia
Diaphragmatic Hernia is perhaps the commonest. There is a congenital form in which a sac is protruded through one of the normal apertures, or through a part of the diaphragm which by reason of defecti...
-2. Retroperitoneal Hernia
Retroperitoneal Hernia includes cases in which the intestine passes into a pre-existing pouch in the peritoneum, greatly enlarging and filling it. The hernial sac hence lies behind the peritoneum of w...
-IV. Twisting Of The Intestine. Volvulus
This is a condition of frequent occurrence, but one which is perhaps too little borne in mind as a cause of obstruction. It occurs in the great majority of cases at the Sigmoid flexure of the colon. ...
-1. Intussusception Or Invagination
In this condition one portion of the intestine passes into another. In order that one piece may slip inside another, the one must present active peristaltic contractions, while the other is relaxed. T...
-2. Prolapse Of The Intestine
This condition is the protrusion of the intestine outside the body through the anus or through an artificial anus. The commonest form is the ordinary Prolapsus ani. This only occurs when the sphincter...
-VI. Inflammation In And Around The Intestine. Enteritis
We have already seen that the mucous membrane is frequently irritated by the contents being of an obnoxious nature by reason of decomposition or otherwise. In.addition to that, inflammation may be pro...
-2. Phlegmonous And Diphtheritic Inflammations
Some cases of catarrh have a more acute character, and assume the characters of suppurative or phlegmonous inflammation, the conditions approximating to those in severe dysentery (see further on). Suc...
-3. Localized Inflammations
It has already been indicated that certain localities are more liable to inflammation than others, and as the inflammations of certain of these regions present special points of importance they have r...
-1. Dysentery
In this disease we have a violent inflammation determined by the presence of an intense irritant. The disease occurs in a sporadic and an endemic form. As already mentioned, the infective agent is bel...
-2. Cholera
In addition to the epidemic disease known as Asiatic cholera, there is a condition known as Cholera nostras. The researches of Koch have demonstrated the connection between Asiatic cholera and the com...
-3. Typhoid Fever
This disease is also due to the action of a specific microbe (see p. 353), and is characterized by a lesion in the intestine. The morbid poison finds entrance by the intestine, and produces irritation...
-4. Anthrax (Mycosis Of The Intestine)
The wall of the intestine is sometimes attacked by the anthrax bacillus. Several cases described as mycosis intestinalis belong to this group, although the name has also been used for other affections...
-5. Actinomycosis
The intestine is rarely the primary seat of actinomycosis, but a case has been recorded by Chiari. The mucous membrane of the large intestine was the seat of raised whitish patches, in which the yello...
-VIII. Tuberculosis And Syphilis Of The Intestine
1. Tuberculosis In the great majority of cases this condition is secondary to pulmonary phthisis, and it occurs in about two thirds of the cases of that disease examined after death. It is to be ac...
-IX. Retrograde Changes And Abnormal Contents
Atrophy of the mucous membrane of the intestine is an occasional consequence of inflammations, catarrhal, dysenteric, and other. There have also been described atrophic and degenerative changes in the...
-X. Tumours Of The Intestine
Primary Cancer This is by far the most frequent and important form of tumour. Cancers are almost confined to the Large intestine; we have already connected this with the fact that this portion is m...
-XI. Obstruction To The Calibre Of The Intestine
This condition has been incidentally mentioned as occasioned by several of the lesions already described. It may be well here to sum up the various forms of intestinal obstruction and to describe the ...
-Section VII. Diseases Of The Liver, Pancreas, And Peritoneum
A. - The Liver. Introduction. Post-mortem changes. I. Malformations and Deformities. II. Disorders of Circulation. 1. Passive hyperaemia (nutmeg liver), 2. Thrombosis and Embolism. III. Retrograde cha...
-A. The Liver
Introductory The liver is the largest gland in the body, its weight being on an average from 48 to 58 ounces in the adult male and 40 to 50 ounces in the female. In its Function the liver is rel...
-I. Malformations And Deformities Of The Liver
Congenital malformations of the liver are not common. There are cases' of absence of the liver, and of defect of one of the lobes or irregularity in the lobes. What may be called supernumerary livers ...
-1. Passive Hypersemia
This is perhaps the commonest of all affections of the liver. The names Nutmeg liver and Red atrophy ue sometimes given in cases of prolonged passive hyperemia, these names indicating certain appearan...
-2. Thrombosis And Embolism
Thrombosis of the Portal vein is of somewhat frequent occurrence, especially as a result of cirrhosis. It also occurs sometimes by propagation of thrombosis from the radicles of the vein, or by emboli...
-1. Necrosis
On account of the double blood-supply in the liver necrosis seldom occurs. In a case of rupture of the liver, however, in which fissures cut off the blood-supply from a wedge-shaped piece, the author ...
-3. Parenchymatous Infiltration
This occurs, as we have previously seen, in connection with many acute diseases. It is this which causes the enlargement of the liver in the acute fevers, pneumonia, erysipelas, etc. The hepatic cells...
-4. Tatty Degeneration
This is frequently seen as a further stage of the condition just mentioned, and is a special feature in acute yellow atrophy to be presently described. It is also usually present in pernicious anaemia...
-5. Fatty Infiltration
The pathology of this condition has been referred to in a former part of this work (see p. 141). It is most typically seen in phthisis pulmonalis and in some other wasting diseases. It also occurs, al...
-6. Amyloid Degeneration
The liver is usually affected when amyloid disease exists in the body, but the affection shows great differences in degree. It may be very slight in the liver while very advanced in the spleen and kid...
-7. Pigmentary Infiltration
The hepatic tissue is liable to a considerable number of different forms of pigmentation. Icterus is the most frequent and obvious cause of pigmentary infiltration of the liver. We have here to do ...
-IV. Acute Yellow Atrophy Of The Liver
This disease, although by its name it is connected with a definite lesion in the liver, is really a general one, due to a morbid poison in the blood. In some cases the poison seems to be septic in its...
-V. Hypertrophy And Regeneration Of The Liver
Experiments in animals have shown that removal of portions of the liver is followed by a regenerative growth of the various structures of the organ, this growth being by the usual process of Karyomito...
-1. Suppurative Hepatitis
Acute suppurative inflammation occurs in connection with septic processes, which have been propagated to the liver. (a) The Tropical abscess is scarcely ever met with in this country, except in per...
-2. Chronic Interstitial Hepatitis. Cirrhosis
We have to do here with a chronic inflammation of the interstitial connective tissue of the organ. Causation As the disease occurs for the most part homogeneously throughout the organ, the irrit...
-3. Perihepatitis
This condition is an inflammation of the capsule of the liver, and it is always secondary to some other lesion. A chronic pleurisy of the right side often extends through the diaphragm, and causes inf...
-VII. Syphilis And Tuberculosis Of The Liver
1. Syphilis The changes in the liver in syphilis are very marked, and somewhat frequent. It manifests itself for the most part as an indurative interstitial inflammation, with or without the format...
-VIII. Tumours And Parasites Of The Liver
Cavernous angioma of the liver is the commonest form of primary tumour. Its structure has already been described (see p. 229 and Fig. 86). It develops apparently by dilatation of the existing capillar...
-Tumours And Parasites Of The Liver. Continued
Secondary Cancer This is of very frequent occurrence in the liver. There may be a direct extension of a cancer from the gall-bladder or the stomach. In the latter case the organ becomes adheren...
-1. Gall-Stones
These are of very frequent occurrence, especially in people past middle life, and they are often found in the gall-bladder after death without their existence having been suspected during life. The...
-2. Obstruction Of The Bile-Ducts
Obstruction occurs from various causes, of which one of the commonest is Gall-stones as described above. Inflammation of the ducts sometimes produces obstruction, the inflammation being nearly always ...
-3. Rupture And Perforation
Rupture of the gall-bladder or of the ducts outside the liver may occur from over-distension, or it may be the result of injury. The rupture takes place into the peritoneum and the bile causes periton...
-4. Tumours Of The Bile-Ducts And Gall-Bladder
Of these the most important are the Cancers. We sometimes meet with primary cancer in the gall-bladder resembling in structure cancer of the stomach and intestine. By extension it may largely involve ...
-C. The Pancreas
The pancreas has the structure of a salivary gland, consisting of glandular acini whose ducts communicate with a main duct lying in the centre of the gland (Wirsung's duct) and opening into the duoden...
-D. The Peritoneum
Introduction The peritoneum, which is stretched over many organs and possesses many recesses and pouches, has a superficies said to be equal to the surface of the body. It is a large lymphatic sac ...
-2. Disorders Of The Circulation In The Peritoneum
(A) Active Hyperemia Active Hyperemia is produced when from any cause a general relaxation of the arteries in the sac occurs. Leaving inflammation out of account, this will hardly occur except as a...
-3. Inflammations Of The Peritoneum. Peritonitis
Inflammation of the peritoneum is very seldom spontaneous in its origin. It seems remarkable that, compared with the pleura or pericardium, this membrane is so seldom the seat of independent ...
-4. Tuberculosis Of The Peritoneum. Tubercular Peritonitis
This disease is due to the existence of the tubercular virus in the peritoneal cavity. The virus seldom gets into the sac from tubercular ulcers of the intestine, apparently because the intestinal lym...
-5. Tumours Of The Peritoneum
These are rarely primary. Lipomas of small size originating from the appendices epiploicae are not uncommon. They are usually pedunculated and of small size. The tumour may become detached by narrowin...
-E. The Secondary Extension Of Cancers Of The Abdominal Organs
We have seen in the study of the diseases of the stomach and intestine that the cancers of these organs very often lead to secondary tumours in the liver and peritoneum, and it may be well to consider...
-Section VIII. Diseases Of The Urinary Organs
A. The Kidneys and Ureters. - Introduction. 1. Structure, 2. Normal function, 3. Pathological variations in function, (a) diminution in urea, (b) uraemia, (c) albuminuria. I. Malformations and Misplac...
-A. The Kidneys And Ureters
Introduction In studying the diseases of the, kidneys, it is necessary to bear constantly in mind the general facts as to their structure, otherwise the examination of the organs will lead to confu...
-1. Normal Structure
When a microscopic section of the kidney, made so as to include both cortical and pyramidal substance, is examined, the contrast between these two regions is sufficiently stliking in respect that in t...
-2. Function
In studying the functions of the kidneys we have to remember in the first place the course of each uriniferous tubule, which may be followed In the annexed diagram (Fig. 418). It begins in the Malpigh...
-3. Pathological Variations In Function
In considering the various forms of disease of the kidneys it is proper to consider their influence on the functions of these organs. There are two principal pathological changes in function which mer...
-I. Malformations And Misplacements Of The Kidney
1. Congenital Malformations These are frequently such as to produce comparatively little interference with the function of the organs. This does not apply to the extreme cases where both organs are...
-2. Variations Of Position
These may be congenital or acquired. In the former case and in some of the latter the kidney is fixed in its unusual situation. In Congenital malposition it is generally the left kidney which is conce...
-3. Malformations Of The Ureters And Pelvis
These are, in general, of little importance. The ureter may be double either in its whole course or in its upper part. The pelvis may also be double or in several divisions, each of which has a separa...
-II. Disorders Of The Circulation In The Kidneys
Active hyperemia is caused by dilatation of the renal arteries. This may be from traumatic injury to the vasomotor centre in the medulla oblongata. In a case of this kind observed by the author there ...
-III. Hypertrophy Of The Kidney
Compensatory hypertrophy of the kidney readily develops when one kidney is lost or congenitally defective. In the case of congenital absence of one kidney the other will be found homogeneously enlarge...
-IV. Hydronephrosis
Hydronephrosis In this condition there is a dilatation of the pelvis and calices of the kidney, as a result of obstruction of the ureter or urethra. Obstruction of the urethra may be congenital ...
-V. Bright's Disease. Nephritis
The term Bright's disease is here limited to Simple inflammations of the Kidneys, whether acute or chronic, which are bi-lateral, and hence due to conditions of the blood. The inflammation does not oc...
-2. Forms Of Bright's Disease. Parenchymatous Nephritis
Various subdivisions of Bright's disease have been made both from the clinical and the pathological points of view. The most generally accepted division is into parenchymatous and interstitial nephrit...
-Forms Of Bright's Disease. Part 2
In addition to this there is very commonly in acute nephritis Haemorrhage from the Glomeruli. The blood which is usually present in the convoluted tubules comes from the glomeruli, and it is often pos...
-Forms Of Bright's Disease. Part 3. (B) Interstitial Nephritis (Granular Contracted Kidney, Cirrhosis Of The Kidney)
This form of nephritis is for the most part chronic throughout, although sometimes an acute nephritis may pass into it, and it may even ensue on a scarlatinal nephritis. It is chiefly characterized by...
-3. Character And Origin Of Tube Casts
It has been pointed out that tube casts are usually present in Bright's disease, whatever the form or stage, and they are known to afford important indications in the urine passed by patients affected...
-4. Functional Changes And Other Phenomena In Bright's Disease
In this place will be considered the alterations in the functions of the kidney effected by the different forms of Bright's disease, and certain other more general consequences which are liable to fol...
-VI. Embolic Inflammation. Metastatic Abscesses
In Pyaemia and Ulcerative endocarditis pieces of fibrine or other material may be carried to the kidneys and produce embolism there. In this way arise Metastatic abscesses. For the most part the embol...
-VII. Inflammations Of The Pelvis (Pyelitis, Pyonephrosis) And Of The Kidney In Association With The Pelvis (Pyelonephritis)
The various terms mentioned in the heading refer to inflammations which generally arise by extension from the bladder up the ureter to the pelvis and kidney. Pyelitis is an inflammation of the pelvis ...
-1. Pyelitis
Inflammation of the pelvis of the kidney is not always suppurative, as it may be produced by other causes besides the septic agents. A catarrhal pyelitis occurs in the course of some fevers, or it ...
-2. Pyelonephritis, Suppurative Nephritis
By the term pyelonephritis is meant a combined inflammation of pelvis and kidney. As this inflammation is mostly septic the usual result is a suppurative nephritis. The disease mostly connects itself ...
-3. Pyonephrosis
This term is used when, along with or following a hydronephrosis, suppuration occurs in the dilated structures. This is usually the result of an extension upwards of decomposition and inflammation fro...
-VIII. Retrograde Changes In The Kidneys
Retrograde changes are of frequent occurrence in the various forms of Bright's disease, but we have also to do with such as are met with more independently. ...
-1. Amyloid Degeneration Of The Kidneys
Amyloid disease is of more importance in the kidneys than in other organs, both because of itself it leads to albuminuria and because its presence probably induces further structural changes in the or...
-3. Parenchymatous Infiltration, Or Cloudy Swelling
Besides forming one of the lesions in acute Bright's disease, this is liable to occur in acute febrile diseases. There is a general enlargement of the renal epithelium with infiltration of fine granul...
-4. Fatty Degeneration Of The Renal Epithelium
Fatty Degeneration Of The Renal Epithelium is not infrequently present in cachectic conditions such as advanced phthisis pulmonalis, in which, however, it is often associated with amyloid disease or i...
-IX. Concretions And Calculi In The Kidney
Two very interesting forms of Deposition in the tubules are met with in new-born children. In the common icterus of the new-born the Biliary colouring matter (bilirubin) is excreted, as in the adult, ...
-X. Syphilis And Tuberculosis Of Kidney
1. Syphilis Syphilis is sometimes the cause of diffuse Interstitial nephritis. It is undoubtedly a frequent cause of Amyloid disease, and may by this means lead on to chronic nephritis. It is proba...
-2. Local Tuberculosis Or Renal Phthisis
This condition is usually associated with tuberculosis elsewhere. Thus there is commonly tuberculosis of the ureter and bladder, and also, in the male, of the vesiculse seminales, vas deferens, and te...
-3. General Tuberculosis
A Chronic general tuberculosis is not uncommon in children, in the form of yellow masses, usually softened in the central parts. This is associated with tuberculosis in other parts, usually in the lun...
-XI. Tumours Of The Kidney
Fibromas are frequently met with in the kidneys in the form of small white tumours of no practical significance, but they have also been found of large size. Lipomas are very rare in the kidney, but t...
-XII. Parasites In The Kidney
The Echinococcus is of occasional occurrence, sometimes along with a simultaneous hydatid cyst of the liver. There is here, as in the liver, a large mother cyst surrounded by a distinct connective-tis...
-B. The Urinary Bladder
1. Congenital Malformations These are chiefly represented by Extroversion of the bladder, already described at page 55, and Persistence of the urachus, which is a minor degree of a similar malforma...
-2. Perforation And Rupture Of The Bladder
Rupture may be produced in various ways. It may be by a direct wound, by fracture of the pelvis, by injuries during parturition. Then ulceration not infrequently produces perforation, ulceration from ...
-3. Dilatation And Hypertrophy Of The Bladder
A simple dilatation may occur from a sudden obstruction to the urethra, or from paralysis of the muscles concerned in emptying the bladder. In this way a very extreme general dilatation may result. ...
-4. Disturbances Of The Circulation In The Bladder
Passive hyperemia occurs in consequence of obstruction of the veins by tumours in the abdomen or otherwise. Sometimes in such cases the veins of the mucous membrane undergo great dilatation and become...
-5. Inflammation Of The Bladder. Cystitis
This occurs as a consequence of various kinds of irritation. Stone may produce it, and the extension of gonorrhoea, but by far the most frequent cause of it is alkaline decomposition of the urine. ...
-6. Tuberculosis Of The Bladder
This condition is usually only a part of much more extensive tuberculosis. There is often a coincident tuberculosis of the kidney and ureter (see above). The vesiculae seminales, vas deferens, and tes...
-7. Tumours Of The Bladder
A few cases of Fibroma and Myoma have been described, but they are rare. Papilloma is a much commoner tumour. This is met with for the most part in the inferior parts of the bladder, and ,forms eit...
-8. Parasites
If we except the microbes already referred to, parasites in the bladder are of secondary importance. The echino-coccus may burst into the pelvis of the kidney, and portions of the parasite pass into t...
-9. Concretions And Calculi In The Bladder
The most frequent constituents of urinary calculi are phosphates, uric acid and oxalate of lime. Phosphates are precipitated from alkaline urine, uric acid and oxalate of lime from acid urine. Phospha...
-1. The Uric Acid Calculus
This is usually a small oval stone, with rounded prominences regularly distributed over the surface. The colour varies from a light fawn to a deep brick red. It is heavy for its size, and of hard cons...
-2. The Oxalate Of Lime Or Mulberry Calculus
Sometimes small stones are discharged as gravel, forming smooth, round, greyish balls like hemp seeds. The calculus proper is mostly of an irregularly spherical shape, tuberculated on the surface like...
-3. The Basic Phosphate Of Lime Calculus
This form is very rare. It occurs as comparatively small yellowish or greyish white stones, rather hard and smooth on the surface. ...
-4. The Mixed Or Tribasic Phosphatic Calculus
The Mixed Or Tribasic Phosphatic Calculus is very common, at least many calculi are partly formed of phosphates, although few are so entirely. The phosphates are deposited from alkaline urine as a lig...
-5. The Carbonate Of Lime Calculus
The Carbonate Of Lime Calculus is rare. It forms small, round, soft stones. The salt dissolves with effervescence on adding an acid, leaving an organic matrix of the shape of the stone. ...
-6. The Cystine Calculus
This occurs only in persons who are subjects of Cystinuria. It appears as if, by a congenital derangement of the nutritive processes, such persons form cystine, to a certain extent probably in place o...
-7. Xanthine Calculi
Xanthine Calculi are exceedingly rare. The substance is allied to uric acid, and the stones are like those of uric acid but of a redder colour. On applying the murexid test to a fragment of such a sto...
-Diseases Of The Urethra
Injuries to the urethra are chiefly important on account of their tendency to lead to stricture. Falls on the perinaeum when sufficiently severe to fracture the pelvis, usually cause rupture of the ur...
-Section IX. Diseases Of The Generative Organs
Hermaphroditism, implying co-existence of both sexes, chiefly a Pseudo-herma-phroditism in various forms. Subsection I Diseases of Female Organs. A. Uterus, Vagina, Fallopian Tubes, and Ovari...
-Hermaphroditism
THIS name implies the union of the two sexes in the same individual. So far as the internal organs are concerned such a condition is rendered possible by the fact that in every foetus the embryonic st...
-Subsection I - Diseases Of The Female Generative Organs
Introductory The female organs are specially liable to disease from their functional relations. At the times of menstruation and pregnancy changes occur, some of which, although strictly physiologi...
-A. Uterus, Vagina, Fallopian Tubes, And Ovaries. I. Malformations
In treating of this subject it is necessary to bear in mind that the internal and external organs have separate developmental origins, and that the malformations of the one may have no connection with...
-1. Defective Formation Of The Female Organs
Defects of various kinds are met with both in the. internal and external parts. The ovaries may be wanting or may remain rudimentary. The uterus may be wanting, and with it the Fallopian tubes; or it ...
-2. Duplicity Of Uterus And Vagina
The ducts of Muller in the embryo are destined to form vagina, uterus, and Fallopian tubes, and they are at first double from end to end. The fusion of the ducts occurs soon at their lower extremities...
-II. Displacements Of The Uterus
The arrangements by which the uterus is supported are of importance to the understanding of the displacements of the organ. In the virgin the vagina forms a tolerably solid column, on the summit of wh...
-1. Descent And Prolapse Of The Uterus
The position of the uterus is lowered for the most part as a result, of the loosening of the attachments of the organ, combined frequently with increased weight from chronic inflammation. The term Des...
-2. Prolapse Of The Vagina
This occurs mostly in consequence of pregnancy, and seems to be caused by the walls remaining hvper-trophied when they ought to undergo the regular involution. The thickened and loose vagina is thrown...
-3. Inversion Of The Uterus
This is of very rare occurrence. The uterus, which is generally somewhat enlarged, is turned inside out, either by its own contraction or by the exercise of traction on its fundus. These conditions ar...
-4. Flexions And Versions Of The Uterus
Flexion is the bending of the uterus on itself, while version is the displacement of the entire organ forwards or backwards. In flexions the bend takes place at a level corresponding with the os in...
-5. Other Displacements
The uterus is liable to various other displacements, which, however, mostly stand in a different position to those given above. There is elevation or displacement upwards by the dragging of structures...
-1. Thrombosis Of The Uterine Veins
This is an occasional result of the puerperal state, but sometimes it occurs as a result of tumours of the uterus, and even in affections of the neighbouring parts. The resulting condition is expresse...
-2. Haemorrhages In And Around The Uterus
Haemorrhage is a normal occurrence in menstruation and parturition, but it may assume pathological characters when in excess or when the blood is unduly retained. (A) Menorrhagia Menorrhagia is ...
-IV. Atrophy, Hypertrophy, And Dilatation Of The Uterus
1. Atrophy The uterus may retain in adult life the undeveloped condition of that of the child. There may be, on the other hand, a premature atrophy, in some cases ascribed to long-continued catarrh...
-2. Hypertrophy
This sometimes occurs as a result of imperfect involution after the physiological enlargement of pregnancy, and in this case the increase in size is from excess in the muscular substance mainly. Hyper...
-3. Dilatation Of The Cavity
This occurs in consequence of the retention and accumulation of material in the utems. It results, therefore, from Obstruction of the vagina or of one of the orifices of the uterus. There may be imper...
-V. Inflammations Of The Uterus And Its Appendages
These are somewhat various, and they are differently named according to the locality specially affected. In this way we have to consider Endometritis, Metritis, Salpingitis, Perimetritis, Parametritis...
-1. Inflammations Of The Uterus
These are divided into inflammations of the mucous membrane and of the muscular substance. (A) Endometritis This is an inflammation of the mucous lining of the uterus. We may have an Acute infla...
-2. Inflammations Around The Uterus
The structures in the neighbourhood of the uterus are very frequently the seat of inflammation. This occurs by extension of inflammation from the uterus itself, chiefly in cases of Gonorrhoeal or Puer...
-VI. Extra-Uterine Or Ectopic Pregnancy
By these terms is meant the development of the foetus in any other situation than the normal one in the uterus. The causation is somewhat obscure, but if we accept the views of Lawson Tait it usual...
-VII. Syphilis And Tuberculosis
Syphilis manifests itself in the vagina and vulva in the form of the hard chancre, which may even occur at the os uteri. It does not present in these situations any peculiarities distinguishing it fro...
-1. Mucous Polypi And Adenomata Of The Uterus
These are met with mainly as the result of chronic inflammation of the mucous membrane, and may spring from the body of the uterus or from the cervix. Sometimes there is a general irregular prominence...
-2. Myoma
The myoma is very infrequent in the vagina and in the cervix of the uterus, but is extremely frequent in the body of the uterus. It occurs in from 10 to 20 per cent, of women beyond 20 years of age, a...
-3. Cancers Of The Uterus And Vagina
In the great majority of cases the cancer begins just about the junction of the uterus and vagina, and involves both as it extends. The disease scarcely occurs before the age of thirty, and is most pr...
-4. Sarcoma Of The Uterus And Vagina
This form of tumour is Very rare. It originates mostly in the substance of the uterus, and may form an extensive infiltration or a limited tumour. The commonest form is the spindle-celled sarcoma, but...
-IX. Tumours Of The Ovary, Parovarium And Broad Ligament
Introduction The ovary and broad ligament are very frequently the seats of cystic tumours, which sometimes attain vast dimensions. The origin and mutual relations of the various forms are not co...
-1. Simple Cysts Of The Ovary
Simple Cysts Of The Ovary occur which are in many respects comparable with the simple cysts which.are so frequent in the kidney, and like them have no very special significance (see Kidney). They are ...
-2. Colloid Ovarian Cystoma
This form is of much more frequent occurrence and vastly more important. To this class of cysts the name Cystoma is properly applied, because they arise by a distinct new-formation, there being first ...
-3. Papillomatous Cysts Of The Ovary
Cysts of this kind are regarded by Doran and others as originating in the hilum of the ovary, and therefore as springing from the remains of the Wolftian body. They form large multilocular tumours wit...
-4. Cysts Of The Broad Ligament. Parovarian Cysts
The cysts included here form a marked contrast to the proper ovarian ones. They have no solid secreting tissue, and their contents are not colloid. They are unilocular, and they show relations to the ...
-5. Dermoid Cysts Of The Ovary
These are sometimes regarded as belonging to the class of Teratoma. They are of comparatively frequent occurrence in the ovary, and may be bilateral. In some cases they coexist with the commoner cysti...
-6. Cancer Of The Ovary
Cancer Of The Ovary occurs mostly as a Cyst with cancerous growths in its walls. There may be a combination of the colloid or papillomatous cyst with cancer, or a partial transformation of the former ...
-7. Sarcoma
Sarcoma is a rare tumour in the ovary. Spindle-celled sarcoma is the more usual form, but round-celled sarcomas also occur. These tumours may also assume very large proportions, reaching the size of t...
-B. The Decidua, Chorion And Placenta
The pathological changes in these structures have been very imperfectly investigated, and there are many of the lesions whose nature is not clearly understood. The decidua is formed, under the infl...
-1. Affections Of The Decidua
It is generally believed that diseases of the decidua are common causes of premature discharge of the ovum, but little is known as to their nature. Atrophy and hypertrophy are stated to occur, the lat...
-2. Hydatid Mole
This is an affection of the chorion, arising by a transformation of the villi. The villi are branching offshoots consisting of mucous tissue, covered by a layer of epithelium. By increase of the mucou...
-3. Diseases Of The Placenta
The placenta, being rapidly formed and being composed of a tissue intended for temporary purposes, is specially liable to various degenerations and to disorders of the circulation. Haemorrhage occu...
-C. The Mammary Gland. I. Malformations, Inflammations, Etc
The mammary gland is very frequently the seat of tumours. It is also very liable to inflammations, especially during lactation. ...
-1. Malformations Of The Breast
One or both mammae may be absent. It is more frequent, however, to have supernumerary breasts or nipples, sometimes three, four, or even five, instead of two. The supernumerary breasts are usually sit...
-2. Inflammation Of The Mamma
This occurs not infrequently about the period of puberty or in connection with menstruation, but in the majority of cases it is related to lactation. In connection with lactation, and especially at it...
-3. Hypertrophy Of The Mamma
In some cases the mammae undergo a progressive enlargement from the new-formation of proper mammary tissue. In this way the gland may come to weigh as much as thirteen pounds. It is to be remembered t...
-4. Tuberculosis Of The Mamma
This, although probably rather frequent, has only recently been fully recognized although conditions of the breast designated scrofulous have been long known. There may be isolated caseous masses or t...
-5. Syphilis Of The Mamma
This is very uncommon, but cases of gumma in the breast have been recorded. Literature Malformations - Scanzoni, Krankh. der weibl. Briiste, 1855; Velpeau, Traite des malad. du sein, 1858; Masch...
-II. Tumours Of The Mamma
The female breast is one of the most frequent seats of tumours, and they present considerable variety in form. As the two constituents of the breast are the proper glandular structures and the conn...
-1. Adenoma And Fibroma. Adeno-Flbroma
The boundaries between the adenoma and fibroma are not well marked. They are both slow-growing, non-malignant tumours, generally of hard consistence, distinctly encapsuled, and not infrequently multip...
-2. Myxoma
In this rare form of mammary tumour, the mucous tissue develops from the stroma of the gland, and it may involve one or more lobules, or the whole gland, which is then converted into a bulky tumour. S...
-3. Sarcoma. Adeno-Sarcoma. Cysto-Sarcoma
The two last-mentioned names imply that the glandular structures take an important part in giving character to sarcomas of the mamma, although the connective-tissue structures are those essentially en...
-4. Cancer Of The Mamma
According to what has been stated in the general sectionof this work, we have, in cancer, an aberrant growth of epithelium as the foundation process. In the more usual or ordinary cancers the process ...
-5. Cysts Of The Mamma
It has been already pointed out that cysts frequently complicate other tumours, especially adeno-fibromas or sarcomas, but sometimes cancers. Cysts also occur independently, and they too most frequent...
-Subsection II. Diseases Of The Male Generative Organs. A. The Testicle And Tunica Vaginalis
I. Malformations And Misplacements Of The Testicle The testicle may be absent on one or both sides, while the vesiculse seminales and vasa deferentia are perfect. Or the vas deferens may be deficie...
-2. Inflammation Of Testicle And Epididymis. Epididymitis. Orchitis
Most inflammations begin in the epididymis, and may remain limited to it or extend to the testicle. In the causation two groups of cases are recognizable, one in which an affection of the urethra has ...
-3. Syphilitic Disease Of The Testicle
This occurs in two forms, namely, as a late manifestation of the secondary stage or as a tertiary lesion. In the former case there is a generalized inflammation leading to induration like a chronic or...
-4. Tuberculosis Of The Testicle
This is a somewhat frequent disease, occurring not uncommonly in childhood and youth. The path by which the tubercle bacillus reaches the organ has not been unequivocally determined. The fact that the...
-5. Tumours Of The Testicle
These are mostly somewhat malignant in their characters, and there is a peculiar tendency to a mixed structure. Enchondroma is not infrequent in the testicle. It is usually mixed with other forms, ...
-6. Hydrocele
By this name is meant the accumulation of fluid in the tunica vaginalis. The fluid is serous and the cause of its accumulation is believed by some to be inflammation. On the other hand the absence of ...
-7. Spermatocele. Encysted Hydrocele
In this affection there is a cyst having in many cases much the external appearance of hydrocele, but containing a fluid in which spermatozoa are abundantly present. In other respects also the conditi...
-8. Some Other Affections Of Tunica Vaginalis
Free bodies are not infrequently met with in the sac. The bodies are somewhat similar to those found in the sheaths of tendons and elsewhere. Their numbers vary in the individual cases, but they have ...
-1. The Penis
Ulcers or Chancres are the commonest forms of disease. The soft chancre is an ulcer which has its usual seat on the glans or frsenum. See further under Skin diseases. The hard chancre is the primary s...
-2. The Scrotum
Cancer is somewhat common, and the disease is so frequent amongst chimney-sweepers that it is often called chimneysweepers' cancer. In Glasgow it has been found that workers in paraffin refineries are...
-3. The Prostate
A very important lesion of this structure is Hypertrophy. The common enlargement of old age is due chiefly to increase of the muscular substance. This enlargement exists in about 30 per cent, of men a...
-4. Spermatic Cord And Vesicula Seminales
The spermatic cord, in the part of its course outside the inguinal canal, is liable to varicose dilatation of its veins constituting Varicocele (see under Affections of Veins). There is also an occasi...
-Section X. Diseases Of The Skin And Its Appendages
Introduction, as to normal structure. I. Hyperemia. Haemorrhage, and (Edema, including Angioneuroses. II. Retrograde changes. 1. Atrophies of skin, hair, and Pigment; 2. pigmentations; 3. Necrosis, in...
-Diseases Of The Skin And Its Appendages
Introduction THE diseases of the skin are exceedingly manifold, and the names applied to them somewhat complicated. In this section an endeavour is made to summarize the pathological conditions and...
-I. Hyperemia, Haemorrhage, Oedema Of The Skin
The skin is very liable to variations of its blood supply. An active Hyperaemia hardly occurs as a pathological condition except as part of an inflammation. Passive hyperaemia, on the other hand, is e...
-1. Atrophies
Simple atrophy is not uncommon in the skin. The most frequent example of it is afforded by Senile atrophy, resulting in the wrinkled skin of old people. In this ease the connective tissue of the cutis...
-2. Pigmentations
Two fundamentally different forms of pigmentation of the skin are distinguishable, according as the pigment arises by intracellular metabolism or is directly derived from the blood-pigment. The latter...
-3. Necrosis
Death of portions of the skin occurs under various circumstances. Perhaps the commonest case is that of Bedsores (Decubitus), in which a piece of skin which has been exposed to pressure whilst lying, ...
-III. Inflammations Of The Skin
These include a very great variety of diseases, and the nomenclature is exceedingly complicated. In the skin, as elsewhere, inflammation is produced by the action of irritants, and the form of the inf...
-1. Inflammatory Skin Eruptions
The affections included under this designation consist in various inflammatory affections of the skin due in some cases to local irritation, and in others to general irritation from conditions of the ...
-Inflammatory Skin Eruptions. Continued
(D) Psoriasis The nature of the irritant is in this case quite unknown, but it is probably to be found in some special condition of the blood. We know, at least, that remedies introduced into the b...
-2. Symptomatic Inflammations
This class embraces the inflammations occurring in the acute fevers. In some the cutaneous affection is very trivial. Thus the eruptions in measles, scarlatina, typhoid and typhus fevers, consist of l...
-3. Inflammations From Heat, Cold, And Injury. (A) Burns And Scalds
We include here the lesions produced by the application of excessive heat to the skin, whether the heated substance applied be in the solid, liquid, or gaseous form. The heat acting as an irritant dam...
-4. Septic And Infective Inflammations
We include here those forms of inflammation of the skin which can be traced to the action of microbes, but leaving over those which have the characters of the specific new-formations. (A) Boil And ...
-1. Syphilitic Lesions Of The Skin
The various manifestations in the skin are the results of the action of the syphilitic vims. The lesions, like those elsewhere, are either simply inflammatory, or they have the characters of the gumma...
-2. Tuberculosis Of The Skin. Lupus. Scrofuloderma
The skin from its position is much exposed to tubercular infection. The cutaneous surface, however, cannot be regarded as very susceptible to this infection. Tuberculosis varies somewhat according to ...
-3. Leprosy
Leprosy in its cutaneous or so-called tubercular form has been already described. ...
-4. Elephantiasis
Elephantiasis has also been considered at page 320. ...
-5. Framboesia. Yaws. Pian
The disease called by these names, of which the two last are the local designations, presents many analogies with syphilis. Some European observers have believed it to be syphilis, but those who have ...
-V. Trophoneuroses Of The Skin
We include under this heading lesions of the skin in which, by reason of disease of the nervous system, such changes occur in the nutritive processes as to lead to definite anatomical results. The exi...
-1. Cutaneous Lesions In Nerve-Leprosy
These have been already referred to. They consist chiefly in alterations in colour, with ulcerations, the latter probably to be ascribed to the anaesthesia. ...
-2. Cutaneous Lesions Due To Nerve-Syphilis
When syphilis attacks the peripheral nerves there are cutaneous eruptions, often characterised by long-continued pigmentation. These are distinguished from ordinary syphilides by their persistent loca...
-3. Herpes
The two principal divisions of herpes are to be distinguished in their general causation, although similar in their ana tomical characters. On the one hand, Herpes facialis and Herpes genitalis occur ...
-4. Glossy Skin
This name was applied by Paget to a condition which he observed in connection with injuries or wounds of the nerves. There is here again indication of irritation of the nerves, as there is always neur...
-5. Scleroderma And Morphoea
The name scleroderma adultorum is given to a rare form of skin disease which affects considerable areas and is usually symmetrical. Morphoea or Addison's keloid has similar anatomical characters, but ...
-1. Ichthyosis
This is a disease which apparently owes its origin to a congenital defect in the constitution of the skin. The disease itself is sometimes manifest at birth, but if not it begins in the earlier years ...
-2. Callosity And Corn
This is an exaggeration of the horny epidermis occurring where the parts are exposed to unusual friction. It is a true hypertrophy, being a direct provision of nature to protect the true skin from the...
-3. Common Or Hard Wart (Verruca Dura)
This may be variously regarded either as a tumour or a hypertrophy of the skin. The frequently multiple character of the common wart and its grouping suggest an infective origin It consists of a local...
-4. Soft Wart (Verruca Mollis) And Pigmented Mole (Noerus Pigmentosus)
Soft Wart (Verruca Mollis) And Pigmented Mole (Noerus Pigmentosus) are closely allied conditions. They are very often congenital, or they occur very early in life, and usually remain stationary throug...
-5. Angioma. Vascular Nsevus
In. the skin we meet with all the three forms of vascular tumour already referred to - the venous, capillary, and cavernous. The ordinary naevus, which is in the form of a flat, more or less extensive...
-6. True Keloid
This is an elevation of the skin which has in its marginal parts branching processes extending out. There is evidently considerable contraction and dragging produced by the central tumour and the radi...
-7. Molluscum Contagiosum (Epithelioma Mollusaim)
This name is applied to small multiple growths of the skin, occurring chiefly on the face and showing a preference for the eyelids, but sometimes extending so as to be almost universal over the body. ...
-8. Fibroma Molluscum
This condition is to be carefully distinguished from that just mentioned. In it there are large numbers of tumours over the surface of the body, these being composed of fibrous tissue. The annexed fig...
-9. Xanthoma Or Xanthelasma
This name is applied to slight elevations of the skin of a yellowish colour. They occur mostly on the eyelids, where they appear as firm yellow patches, which are usually quite flat, but may be slight...
-10. Lipoma
Of the remaining simple-tissue tumours, the Lipoma is common, originating in the subcutaneous tissue. The Myxoma is not infrequent, and the Enchondroma and Osteoma very unusual. ...
-11. Xeroderma Pigmentosum
This disease, with its prolonged course and its final tendency to cancerous development, forms one of the most curious and most difficult problems of pathology. It seems to have as a predisposing caus...
-12. Sarcoma
This form of tumour is of somewhat frequent occurrence, and we may have round-celled or spindle-celled growths, which sometimes assume considerable dimensions. Sarcomas sometimes originate from soft w...
-13. Canoers
The Epithelioma of the skin forms the majority of the flat-celled epitheliomas, and it has been already considered. The two most interesting forms are the ordinary flat-celled epithe lioma and the ...
-VII. Parasitic Diseases Of The Skin
We have already seen that certain forms of inflammation are associated with the presence of microbes, especially the infective inflammations. We saw also that leprosy depends on a specific bacillus. T...
-1. Tinea Favosa Or Favus
This is a disease chiefly of the hairy scalp, although it occurs on other parts of the skin and also in the nails. On the scalp it forms crusts about the size of split peas, which. when removed, are u...
-2. Tinea Tonsurans Or Ringworm
This is also a disease chiefly of the scalp, but the same fungus attacks the beard and the parts of the body devoid of hair. The disease is therefore divisible into three forms, Tinea tonsurans proper...
-3. Pityriasis Versicolor
In this disease there are patches of a yellowish or dark brown colour with a scaly surface, and occurring chiefly on the trunk in adults. If the surface be scraped* and the scaly products examined und...
-Section XI. Diseases Of The Eye And Ear
A. - The Eye. I. The Conjunctiva, chiefly Inflammations, catarrhal, purulent, and infective (granular conjunctivitis). II. The Cornea. 1. Retrograde changes (arcus senilis, conical cornea); 2. Inflamm...
-A. The Eye
THE eye, with its appendages, composed of a number of separate tissues delicately adjusted to the requirements of vision, is liable to the usual pathological changes. From the facility with which it i...
-I. Affections Of The Conjunctiva
The conjunctiva is liable to the various lesions of mucous membranes, the chief being inflammation. ...
-1. Conjunctivitis
The irritant exciting inflammation of the conjunctiva may be a very simple one, such as dust or cold, and in such cases the inflammation is usually slight and evanescent, being characterized by little...
-II. Affections Of The Cornea
The corneal epithelium is usually affected in the various inflammations of the conjunctiva, being exposed to the same irritations. Its peculiar structure, and especially the absence of vessels, render...
-1. Retrograde Changes In The Cornea
A very common lesion is Arcus senilis, which sometimes comes on in middle life rather than in old age. It consists in a fatty degeneration of the cells and fibres of the cornea along a defined line ne...
-2. Inflammations Of The Cornea
The cornea, although non-vascular, is subject to inflammations even of an acute suppurative character. The inflammatory exudation passes into the canals and spaces with which the cornea abounds, and b...
-III. Affections Of The Sclerotic
The sclerotic is a dense con-teotnre tissue membrane, which, on account of the paucity of vessels and nerves, and from its well-protected position, is little liable to primary disease. Inflammation ex...
-IV. Affections Of The Iris
The iris is a very vascular body which lies in a closed cavity occupied by the aqueous humour. The cavity is lined by a serous membrane, and the diseases are like those of serous cavities. Inflamma...
-V. Affections Of The Ciliary Body And Choroid. Cyclitis. Choroiditis
The ciliary body is highly vascular, and is engaged in the secretion of the humours of the eye. Being very active it is peculiarly liable to acute inflammations, more especially as it is related anato...
-VI. Glaucoma
This is an important disease in which the ciliary body and iris seem specially concerned. It consists in an increase of the pressure of the fluids inside the eyeball, with consequent injury to the str...
-VII. Affections Of The Lens
The only affection of the lens requiring special notice is Cataract. This consists in an opacity of the lens or its capsule, such as to interfere with vision. It sometimes occurs as a congenital affec...
-VIII. Affections Of The Optic Nerve And Retina
These parts form really a prolongation outwards of the cerebrum, and are surrounded by processes from the membranes of the brain. The dura mater forms a sheath around the nerve as it passes to the eye...
-1. Edema And Inflammation Of The Optic Nerve (Optic Neuritis, Chain Disc)
A series of lesions is included here, concerning whose pathology some questions still remain unanswered. Affections of the optic nerve are frequent in consequence of tumours of the brain, and these ha...
-2. Inflammation Of The Retina (Retinitis)
This affection occurs in various forms, the most familiar of which is Albuminuric retinitis This affection consists of a chronic inflammation, apparently commencing in the arteries and accompanied by ...
-3. Embolism Of The Retinal Artery
The central artery of the retina enters the eyeball in the middle of the optic nerve and then divides into branches which radiate from this centre. The artery is a branch of the anterior cerebral, and...
-4. Detachment Of The Retina
In this condition the. retina is separated from the choroid over a larger or smaller area, and the separation is usually permanent. It may be caused by shrinking of the vitreous and by effusion of flu...
-IX. Affections Of The Eye As A Whole
Some of the diseases already mentioned affect the eyeball generally, and there are some affections which do so primarily. ...
-1. Sympathetic Ophthalmitis
In wounds of the eye there is occa sionally an extension of the inflammation to the opposite eye, and this is commonly spoken of as by sympathy. Inflammation, especially in the severe forms which some...
-2. Errors Of Accommodation
Vision is brought about by the images of objects being focussed on the retina. The focussing is effected by the refracting media of the eye, chiefly the lens arid the cornea. In order to accurate visi...
-3. Tumours Of The Eyeball
There are two common forms of tumour, sarcoma and glioma. Sarcoma springs in the majority of cases from the choroid, but may take origin in the ciliary body or iris. It is usually a spindle-celled ...
-4. Parasites Of The Eye
Cysticercus cellulosae (the scolex of taenia solium) is not very uncommon in the eye. Its usual seat is beneath the retina, which may become detached by its growth. Sometimes the parasite perforates t...
-B. The Ear
The ear has intimate anatomical relations with various other parts, and in its diseases it is frequently associated with these parts. It is continuous externally with the skin; it is in communication ...
-I. Affections Of The External Ear
The external ear consists of the auricle, external auditory canal, and tympanic membrane. ...
-1. The Auricle
The Auricle is liable to various congenital malformations, ranging from almost entire absence to simple alterations in the usual outline. Supernumerary organs, generally rudimentary, are also met with...
-2. The External Auditory Canal
Congenital contraction and closure of the canal have been observed in various degree. Inflammations are similar to those of the skin, and may be either in the form of boils, which are somewhat freq...
-3. The Tympanic Membrane
The Tympanic Membrane is liable to Inflammations in common with the meatus on the one hand and the middle ear on the other. Hence arise various thickenings and adhesions, sometimes with calcareous dep...
-II. Affections Of The Middle Ear
The middle ear is a cavity containing air, of a very complicated outline (see Fig. 487). The central part is that immediately within the tympanic membrane, forming the tympanic cavity, which is traver...
-1. Inflammations Of The Middle Ear
These have in their elements, the characters of inflammation elsewhere, but modified by the relation of parts. Catarrh is somewhat common, and may be acute or more chronic. The exudation varies accord...
-2. Syphilis And Tuberculosis Of The Middle Ear
Syphilis is stated to cause in some cases a chronic inflammation with sclerosis as already described. Tuberculosis has been suspected in some cases of chronic otorrhoea, and the tubercle bacillus is s...
-3. Sebaceous Tumours Of The Ear, Cholesteatoma
Under these names are included two very different conditions, one of them a true tumour such as occurs in the brain. This is excessively rare, and most cases of so-called sebaceous tumour are due to n...
-III. Affections Of The Internal Ear
The internal ear, consisting of the labyrinth and the auditory nerve, is rarely the primary seat of disease, but is liable to be involved in affections of the middle ear on the one hand, and of the br...







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