irregular in distribution, there apparently being no attempt to affect any particular column. We may also note here the functional changes to which the author calls attention. He points out that tachycardia is frequent, the pulse varying from 100 to 140. Cerebral troubles consist in either a mild form of delirium, which precedes death by a few days, or in delirium with hallucinations, followed by apathy. Coma is also an occasional symptom, and presents many analogies with the diabetic form; and acetone may even be found in the urine. The author quotes Klemperer as showing that in this condition there is a diminution of albuminoids, and that probably cancerous coma is merely a manifestation of intense autointoxication. J. V. Kelly and John H. Teacher' report a case of deciduoma malignum, and conclude that this tumor originated from the epithelium covering the chorionic villi, and that both layers of the epithelium were concerned. Eberth and Spude report the occurrence of endothelioma in 3 white mice, all descendants of the same pair, but possibly of different generations, although born in the same year. Mouse No. 1 had a tumor in the region of the neck and another in the groin, both being subcutaneous; No. 2 had 1 on the thorax and 1 in each groin; No. 3 had 1 in the neck. The tumors varied in size from that of a pea to that of a cherry. Pieces of the different tumors were transplanted subcutaneously and intraperitoneally in other white mice, but without result. Ludvig Hektoen,3 in a case of blastomycetic dermatitis, found that the organisms were not so numerous in the tissues as in cases previously reported. All the mature organisms seen occurred in the miliary abscess in the epithelial proliferations, usually singly, sometimes in groups of 2 to 4, invariably situated outside the cells. Not even the giant cells in this case contained any parasites. The parasites, when not budding, are round or oval, about 10 to 12 μ in diameter; they are surrounded by a homogeneous capsule, from which the finely granular protoplasm is separated by a clear zone of varying width; in some the protoplasm contains a vacuole of varying size, which in a few instances occupies the larger part of the cell, crowding the granules closely together inside the clear zone, which becomes indistinct; in a few organisms the outer capsule contains oblong thickenings. Budding bodies in different stages are present; the granular protoplasm pushes the capsule and clear zone before it, forming an oval bud, which grows larger, and eventually separates from the mother-organism. Methylene-blue gives the best stain of the parasite, the capsule assuming a deep blue, and the protoplasm a lighter blue tint, when stained in this way. There were no red granules in the parasites, as described by Gilchrist. The morphology, cultural characteristics, and results of animal inoculation are considered. The organism here observed grew rapidly, and the formation of mycelium was not marked. Hektoen's organism was pathogenic for rabbits, guineapigs, white rats, and gray mice. It corresponded very closely to those varieties of pathogenic blastomycetes which, according to Casagrandi, produce local necrotic or suppurating foci, or permanent nodules and a fatal marasmus. Jour. Path. and Bact., vol. v., p. 370. Knauss1 reports a case of true neuroma in a child of 8 years. The tumors-the growths were multiple-were situated under the skin of the buttocks, neck, back, thigh, chest, and abdomen. They looked like lipomas, and could be peeled out like them; but microscopically showed nervefibers and ganglion-cells. None of the tumors was connected by pedicle with nerves, as in the case reported by von Recklinghausen. Durante writes on the histologic types and on the nature of hydatiform moles: 1. Of all the alterations which characterize the development of the mole, the first and most constant are the budding of the syncytium and the appearance of mucus in its interior. The mucous change of the mesoderm is secondary, and the proliferation of the layer of Langhans, though customary, may not occur. The condition of the syncytium decides the ultimate fate of the tumor, and its exuberance, its penetration into the connective-tissue spaces or the maternal blood vessels, marks the transformation from a benign tumor into an invading mole or an ectoplacentary epithelioma. 2. In the hydatiform vesicle the budding syncytial covering is full of vacuoles, most of which contain mucin. Although the center of the vesicle is composed of mucous tissue, there is here neither a myxoma nor a myxomatous degeneration, but simply a mucous edema. 3. This budding of the epithelial covering, which preserves its physiologic relations to the subjacent mesoderm without altering materially the normal structure of the organ, places this tumor not among the mixed tumors nor among the epitheliomas, but in the adenomas. Resulting from a functional hyperplasia of the epithelial syncytium, the mole must be considered as a villous or syncytial adenoma. It has the benign character of the adenoma as long as it vegetates like a mole; and, like the adenomas, only becomes malignant when the epithelium begins to proliferate on its own account. 4. Like adenomas, it may undergo subsequently fatty and fibrous change; and finally the ectoplacentary epithelioma, which represents the carcinoma of this adenoma, and results from the irregular proliferation of the syncytium abandoning the mesoderm and rapidly invading the maternal vessels, will rapidly cause death by metastasis. 3 SYPHILIS. Flexner reports a case of syphilitic ulcer of the stomach in a man of 52 years. The ulcer had perforated. The liver contained a large tumor, formed by the confluence of several gummatous nodules. The microscopic features of the ulcer were as follows: The submucosa was principally affected, and presented infiltration with large epithelioid cells. The infiltration extended into the muscular coat, and to a less degree into the mucous layer. Foci of necrosis were found within the cellular accumulations. In these, fragmented nuclei and emigrated polymorphonuclear leukocytes were found. The blood vessels showed a simple infiltration of the adventitia, except in the necrotic areas, where they were obliterated. More frequent than these acute phenomena were the chronic features, consisting in the presence of dense fibrous tissue with blood vessels showing endarteritis and endophlebitis obliterans and hyaline thrombosis. Flexner believes that the ulceration was not due to the 1 Virchow's Archiv, vol. eliii., p. 29. 2 Arch. de Méd. expér., 1898. 3 Am. Jour. Med Sci., Oct., 1898. breaking down of a gumma, but that the necrosis of the mucous membrane was indirectly brought about by the combined softening of the submucous gummatous infiltration and the obstruction and obliteration of blood vessels in the same situation. E. Fränkel1 reports a case of acquired gastrointestinal syphilis in which the stomach (see Plate 5) presented no less than 13 separate ulcers. The specimens were obtained from a man 47 years of age. The ulcers in the stomach were for the most part on the posterior wall, and had quite a smooth base, with projecting borders. In the small intestine 31 areas of more or less deep losses of substance were found. One of the ulcers had perforated. The mesenteric and epigastric glands were scarcely swollen. The spleen contained a gumma. Histologically, it was found that the gastric and intestinal lesions were of the same nature-they represented newly formed granulation-tissue in the wall of the stomach and bowel, which tissue, at certain points, had undergone necrosis. The cells of this tissue were in nowise specific; giant cells were not present. The arteries and veins of the submucosa showed peculiar modifications, consisting in at growth, in the walls of the vessels, of a granulation-tissue similar to that found diffusely in the intestinal wall. The Changes in the Blood vessels in Syphilis.-The majority of writers on syphilitic disease of the blood vessels have confined their study to the cerebral arteries, and a sentiment has gained vogue that syphilis affects only the vessels of the brain. In addition to showing that syphilis may attack the arteries of other organs, Abramow's studies 2 also throw light on the nature of the changes that take place in the vessels. The first case reported is that of a youth of 19 years, without a history of syphilis, who died of Bright's disease. At the autopsy the following macroscopic lesions were found: Generalized arteriosclerosis, multiple small subepicardial aneurysms, cirrhotic kidneys, the seat also of parenchymatous nephritis; acute lobar pneumonia, and edema of the brain. Microscopic examination of sections from the heart showed a high degree of thickening of the intima of the blood vessels, the media and adventitia being for the most part normal. In the liver the vessel-walls were uniformly thickened. The renal vessels presented changes similar to those of the heart. The endothelium was entirely gone. The second case was that of a student of 25 years, who had acquired a chancre 2 years before his entrance into hospital, and who had received active antisyphilitic treatment. His symptoms were those of interstitial nephritis, with hypertrophy of the heart and arteriosclerosis. There was also a multiple neuritis. The autopsy revealed sclerosis of the coronary arteries, generalized arteriosclerosis, chronic interstitial nephritis, edema of the brain and its membranes and of the lungs; pleural adhesions on the right side. The vessels of the heart presented on microscopic examination localized intimal thickenings, with scattered involvement of the adventitia. In the coronary artery the thickened intima was on its inner side the seat of hyaline degeneration; there was also mucoid change in the new tissue of the intima. The pulmonary vessels presented nothing abnormal; nor did those of the thyroid gland. In the liver the intima of the blood vessels was hyperplastic; this was also true of the kidney, of 1 Virchow's Archiv, Band 155, Heft 3. 2 Ziegler's Beiträge z. path. Anat. u. z. all Heft 2. |