Manual of pathology : including bacteriology, the technic of postmortems, and methods of pathologic research

Front matter

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Preface To Third Edition

In presenting to the profession and students of medicine the third edition of this work the author wishes gratefully to acknowledge the cordial reception that was accorded the last edition. Although over twice the size of the first edition, the second was exhausted in nearly the same length of time ; it appeared late in the autumn of 1897 and was exhausted in the following year.

The pressure of other duties rendered it impossible for the author to give the work the revision that seemed necessary, and therefore it has been out of print for nearly two years. During that time the author has occupied his spare moments in revising, rewriting, and rearranging the subject-matter. A number of the old illustrations have been replaced by new, and many original drawings have been added.

The author's conviction that properly prepared figures are of the utmost importance in elucidating the subject under consideration remains unchanged ; in accord with this view the number of illustrations has been increased from two hundred and sixtyeight to three hundred and thirty ; practically all those added are original. For the first time, a few colored plates are introduced.

The chapter on postmortems has been revised, and new methods have been introduced in the chapters on technic. Bacteriologic technic has been placed in a chapter by itself, and the technic of blood examination has been transferred to the chapter on the blood, with which it properly belongs. Special technic has been added throughout the book ; whenever it was necessar>' to adopt any special means for demonstrating a reaction or for satisfactorily staining morbid products, the method lias been

V

•VI PREFACE TO THIRD EDITION.

given with the consideration of the materials to be treated. New chapters have been added, including the following : The thymus body, ductless glands, muscles, bones and joints, and the nervous system. These, added to the very much lengthened chapters originally present, have increased the size of the volume by a little over one-third.

The chapter on diseases of the nervous system has been written by Dr. H. F. Harris, Associate Professor of Pathology in the Jefferson Medical College, whose experience as a clinical teacher of diseases of the nervous system and work as an investigator have fitted him for the consideration of the subject with which the chapter deals. The author has been placed under many obligations to Dr. Harris for his supervision of the additional drawings, many of which have been made under his direct superintendence.

The author is also greatly indebted to Dr. Randle C. Rosenberger for aid in the compilation of stain reactions and biologic peculiarities of the bacteria, as well as for arranging the index of parts I and II. Dr. Frederick J. Kalteyer has aided by kindly loaning specimens for illustrations. The table on the blood occupying pages 448 and 449 is largely the product of his energy. Mr. Duncan L. Despard has assisted in the preparation of the index.

The reproduction of the new illustrations, both in black and white and in colors, has been trusted entirely to the publishers, to whom the author is under many obligations for the careful execution of this most difficult task.

In conclusion the author wishes to state that'the object of the book has not been changed, and that the present edition, although greatly enlarged, remains exactly what the author intended the previous edition to be : namely, "not a treatise or book of reference, but, .is its title indicates, a manual that the author hopes may be useful in the laboratory and postint)rtem room and in clinical diagnosis by the aid of the microscope."

Preface To Second Edition

During the winter of 1894 and 1895, Messrs. P. Blakiston, Son & Co. published, in serial form, abstracts of the writer's lectures, entitled *' Lectures on Pathology." At the close of the college session the fasciculi were bound, and the resulting volume placed on the market. Very much to the surprise of the publishers, as well as of the writer, the edition lasted less than nine months. It was exhausted at a time when the teaching of the college year precluded the revision which the matter so much needed. During the past six months the entire book has been revised, the larger part having been entirely rewritten. The first edition contained 250 pages and 51 illustrations ; the present volume, in the face of every effort to condense without sacrificing accuracy, has reached 638 pages and contains 268 illustrations. The most difficult problem has been to keep the volume from assuming undesired dimensions, and, now that the work is completed, the writer wishes to say, parenthetically, that a volume of twice the size could have been produced with probably less labor. Being practically a new book, there are, no doubt, typographic and grammatic errors. The writer acknowledges in advance his appreciation of any communication calling his attention to such lapses.

In the publication of the original fasciculi the writer was favored by the aid of Professor Kyle and Dr. Bevan. Professor Kyle wrote the fasciculus on ** Tumors," and Dr. Bevan the article on " Bacteriology." In the revision of the work both articles have been somewhat enlarged, but the thoroughness of the original has not demanded any extensive revision. There have been made some additions and a rearrangement of subjects, in order to secure greater conformity with the remainder of the

Vlll PREFACE TO SECOND EDITION.

book. In the original, acknowledgment of the assistance was given with the fasciculi ; it is now incorporated here.

Practically, all the added illustrations apjxiar for the first time in a work on pathology in the English language. The source is credited with each cut. Of the original illustrations it is not the author's province to speak. They have been prepared in the writer's laboratory from specimens and slides of which the clinical and pathologic histology were fully known. In this connection the writer wishes to acknowledge the invaluable assistance of Professor H. F. Harris, who personally sujxTintended the execution of most of the original drawings. Miss K. G. Harding, artist, has, with great patience, made the original drawings, often redrawing an illustration a number of times before submitting it for approval.

To Drs. R. C. Rosenherger and W. P. Read the author wishes to acknowledge valuable aid in proof-reading and other detail work in the completion of the volume.

Instead of the usual method of inserting a table of illustrations, arranging the figures in the same order as they appear in the pages, an alphabetic list, by subjects, is inserted, for the arrangement of which I am indebted to Mr. L. H. Prince.

In conclusion, the writer wishes to submit the volume, not as a treatise or book of reference, but. as its title indicates, as a manual that he hoi)es may be useful in the laboratory, postmortem room, and in clinical (lia;j;n(rsis by the aid of the microscope. To attain as fully as ])ossil)le the last-named aim, the chapters on the microscopic examination of tissues, blood, and urine have been most fully illustrated.

Thanking the profession for its kindly reception of the previous edition, this volume is respectfully submitted for consideration.

CHAPTER II. Histologic Mkthods, 48-72

Fixing Methods. — Intiltration of Tissue — Section Cutting.— Staining and Mounting. — The Microscope. — The Use of the Microscope.

CHAPTER HI.

Culture Media and Their Methods of Preparation. — Culture Containers.— Sterilization. — Storing of Media. — Plating. — Preparation of Cultures. — Bacteriologic Examination of Water and Other Fluids. — Bacteriologic Examination of Air. — Staining Bacteria. — Gas Formation.— .\naerobic Cultures. — Mounting Drop Cultures. — Indol. — Thermic Disinfection. — Inoculation of Animals. — Preparation of Toxins and Antitoxins. — Widal's Test for the Diagno.sis of Typhoid Fever. — Table Illustrating Method of Recording the Principal Characteristics of an Organism.

CHAPTER IV. Microscopic Examination of the Urine, 118-130

Collection of Sample. — Method of Conducting Examination. — Sedimentation.— Use of the Centrifuge. — Organized Sediment : B1o<k1, Pus, Epithelium, Casts, Spermatozoa, Fungi. — Unorganized Sediment : Illustrations of Crystalline and Amorphous Urinary Sediments.

CHAPTER V. Technic of Sputum Examination, 1 31-133

How to Obtain the Specimen. — Method of Mounting.— Blood-cells, Epithelium, Elastic Fibers, Curschmann's Spirals, Fibrinous Casts, Charcot- Leyden Crystals, Bacteria.

X TABLE OF CONTENTS.

CHAPTER I. PAGE General Considerations, 137-216

Development. — Growth. — MaI|)o.sition. — Malformation. — Disease. — Pathogenesis. — Starvation and Allied Conditions. — ^Thermal Causes of Disease : Sunstroke, Trauma, Alterations in Atmospheric Pressure. — Morbid Processes Induced by Poisoning. — Bacteria as Causes of Disease.— The IVinciples of Bacteriology. — Bacterial Products. — Immunity.—Subdivisions and Forms of Bacteria. — Molds. — Yeasts. Schizomycetes. — Animal Parasites.

CHAPTER II. Hyi'Ertrophy. — Hyperplasia. — Metaplasia. — Heteroplasia

Atrophy. — Hypopi^sia. — Agenesis or Aplasia, 217-224

CHAPTER III. Infiltration and Defeneration, 225-247

Fatty Infiltration. — Lardaceous Disease. — I*ignientar)' Infiltration. — Jaundice. — Calcareous Infiltration. — Uric Acid I)e|x>sits. — Glycogenic Infiltration. — Cholesterin Infiltration. — Hydropic Infiltration. — Parenchymatous Degeneration. — P'atty Degeneration. — Hydropic Degeneration.— Colloid Degeneration. — Myxomatous Degeneration. — Hyaline Degeneration.

CHAITER IV.

Necroses 248-256

Forms and Cau.«ies of Necrosis. — Termination of Necrosis. — Liquefaction Necrosis. — (Coagulation Necrosis. — Fat Necro.sis. — Chee.sy Necrosis. — Gangrene.

CHAFrFR V.

CiRrriJVTORY DiSTURBANCKS, 257-279

Ischemia. — Hyperemia. — Plethora. — Hemorrhage. — Congestion. — Stasis. — Edema. — Thrombosis and Eniboli.sm.

(IIAITKR VI.

Infi-ammation and Repair, 280-303

CH AITFR VH.

TiMORs, 304-3^>-

CHAITKR Vlll. iNFECTiors Granulomata, 3^>3 .v^^i

CHAPTER IX.

Temperatike Changes, 3S2 393

TABLE OF CONTENTS. XI

Chapter I. Page

Technic of Blood Examination. — Estimation of Hemoglobin. — Hemoglobinometers. — Counting of Blood-cells. — General Pathology. — Composition and Structure of the Blood. — Blood Diseases. — Table of Blood Diseases.

CHAPTER H.

Spleen, 450-459

CHAPTER III. Lymph-glands, 460-467

CHAITER IV.

Thymis Body, 468-469

CHA1>TER V. .Serous Me&ibranes, 470-486

CHAPTER VI.

Heart. — Endocardium. — Arteries. — Veins. — Lymph-vessels.

CHAPTER VII.

Normal Structure. — Congestion. — Hemorrhage. — Infiltrations. — Degenerations. - Inflammations.

CHAPTER VIII.

Nose. — Larynx and Trachea. — Bronchi. — Lungs.

CHAPTER IX.

Urinary Organs, 608-636

CHAI'TER X.

Mouth, Including the Pharynx. — Salivary Glands. — Esophagus. — Stomach. — Intestines.

CHAPTER XI.

Liver, ..... 664-684

CHAPTER XII.

Pancreas, 685-689

XU TABLE OF CONTEXTS.

Ductless Glands, 690-696

Thyroid Gland. — Suprarenals.

CHAPTER XIV.

CHAITER XV.

Bones and Joints, 705-739

CHAPTER XVI.

Nkrvois System, 740- 793

LIST OF ILLUSTRATIONS.

COLORED PLATES.

rtJkTK PAGE

L Cut Surface of Spleen Showing Lardaceous Change, and lodin Reaction

[,*■'' Atlas of Piithotogy^^^ Sydenham Society^ ^ Facing 230

II. Lung, Croupous Pneumonia, Stage of Red Hepatization i^Fox" s **/l//fis^^).

Facing 582

III. Lung, Croupous Pneumonia, Stage of Gray Hepatization (BoHinger),

Facing 585

IV. Diseases of the Kidney {''''Atlas of Pathology, ^^ Sydenham Society) , Facing 618

Fig. I. — Kidney, Chronic Interstitial Nephritis.

Fig. II. — Part of Kidney, Subacute Parenchymatous Nephritis. From girl, six and a half years old ; scarlet fever ; death on the fortyseventh day. More advanced degenerative change than in figure IV.

Fig. in. — Part of Kidney, Chronic Parenchymatous Nephritis.

Fig. IV. — Part of Kidney, Acute Parenchymatous Nephritis. From a boy, nine years old ; scarlet fever ; death on the twenty-second day of the disease. The initial stage of engorgement is no longer present.

V. Tuberculosis of the Bladder, . . Facing 631

VI. Section of Bladder Wall, Tuberculosis of the Bladder, Facing 632

FIG. pa(;k

1. Complete Postmortem Case, 18

2. Modified Virchow Postmortem Knife, 24

3. The Sternum, Costal Cartilages, and Articulation of the Clavicle, as Ex-

poseti after Turning Back the Soft Parts {Modified from Virchow), ... 25

4. Costotome, 26

6. Heart Showing the Lines for Incisions in the Preliminary Examination and

Final Section Fully Exposing the Valves {after l'ircho7c), 28

7. Heart Showing the Ititerior of the Right Ventricle and Pulmonary Artery

{after yirchotv\, 29

8. Heart with the I^ft Ventricle I^id Open, Showing the Aortic Cusps and

the Ventricular Aspect of the Mitral Valve {after Virchoiv), 30

9. Scissors, . 31

10. (Jnxjved Director, 32

11. Ixmg. Thin, Brain Knife, 34

12. Enterotome, 35

13. Probes, 36

14. Dissecting Force|)s, 37

15. Mallet or Hammer, 37

16. Heavy Line Indicating Course Taken by Saw-cut in So-called Undertaker's

Method 38

17. Circumferential Saw-cut 39

18. \Ve<lgc shaped Calvaria Removed by the Line of Saw-cut Recommended, 40

20. Myelotome, 42

21. Scalpel with Blade Shaped Somewhat Like a liistoury, 42

22. Double Saw for Sawing through the Laminae of Both Sides at Once, . . 44

xiii

XIV LIST OF ILLUSTRATIONS.

FUi- PACK

23. Hone-cutting Forceps, 45

24. Postmortem Needles, 46

25. Metallic Table for Fixation and Paraffin Infiltration, 51

26. Hlock for Mounting Tissues Infiltrated with Paraffin, 52

27. Properly Trimmed Block, 52

28. Method of Applying Paper to Block, 52

29. Block Showing Tissues in Position, 53

30. Mounted Tissue Ready for Sectioning, 53

31. Naple's Paraffin Bath for Infiltrating Tissues in Paraffin, 54

32. Forceps Convenient for Handling Cover-glasses, Blocks of Tissues, and

Sections, 54

^^. Laboratory Microtome, 55

34. Small Microscopic Scissors, 56

35. Ryder Microtome, 57

36. Ranvier's Microtome i^IUustrattd from GouU^s Dictionary)^ 57

37. Minot Microtome, 58

38. Drying Oven, 59

39. Needles and Brush Suitable for Handling Sections, 60

40. Dish for Removing Paraffin and Corrosive Sublimate and for Dehydrating, 61

41. Dropping Bottle with Barnes' Dropper, Which Closes the Mouth of the

Bottle Like a Rubber Stopper, 65

42. Pro|)cr Si/e labels for I^l>eling Microscopic Slides, 65

43. Microscope Suitable for General Pathologic and Bacteriologic Work, ... 70

44. Moist Chamber for Potato Culture, 75

45. Instrument for Cutting Plugs of I'otato for Potato Cultures, 76

46. Agate- ware Water-bath (Farina Kettle), 77

47. Agate- ware Funnel for Filtering Hot Fluids 78

48. Test-tube Basket, Made of Tinned Metal, for Holding Test-tubes, ... 80

49. Double Wall Hot-air Sterilizer, for Sterilizing Test-lubcs, Glassware, and

Other l^borator)' A|)pliances and Instruments 81

50. Diagram of Interior of Hot air Sterilizer ( Cc///// ^///./ //crv///), 81

51. Apparatus for Filling Culture Containers, 82

52. Arnold's Steam Sterilizer fur Sterilizing Culture Media, etc., 83

53. Arnold's Steam Sterilizer, Boston Board of Health Form 84

54. Autoclave, or Dijjeslor, Used for Steriliziiii; by Steam Under Pressure, . . 85

55. Blake Bottle Csed for Bottle Plates (C '('///// i/W/y^7v///i, 86

56. Dish Devise<l by Petri, . 86

57. Platinum Inoculating Needles Mounted in Glass Rods, 87

58. Meth(Kl of Holding Tub(r>, Cotton, and Platinum Wire while Inoculating

59. Meth<Kl of Holding Tul>es, Cotton, and Platinum Wire while Inoculating

Li(}uid Media, 89

60. Apparatus for Counting C'olonies, 91

62 and 63. Two Forms of Stewart' sCover-gla.s> Forcei)*^, 93

64. Kalteyer's Cover glass Forcep>, 95

65. Novy's Apparatus for Anaerobic Cultivation in Plates and Test-tubes, . . 99

66. Sternberg's Anaerobic Culture-tube 99

67. Wright's MethcMl for Anaerobic Cultivation in Li'juid Media, 100

68. Drop-culture Slide, loi

69. Small Incubator Sufficiently I^irge for Individual WOrk, . 105

70. Ap{)aratus for Holding a Moir-i*.' or Rat f<»r Inoculation ( I)e\is(«l 1)\ I »i.

71. Koch's Syringe for Hy|)o<lennic, Intraj)eritoneal, and Hilu 1 Injeiti.in

Methotls for Int>culating Animals, k .S

72. S|)atula Used for Searing the Surfaces of Organs Before Making lu(i>i< n>

into Their Interiors for Obtaining Culture Material, i(><)

73. Sternberg's Flask, 1 1 1

74. Kitasato's Filter, 111

LIST OF ILLUSTRATIONS. XV

riC. PAGE

75 Bacillus Typhi Abdominalis, 114

76. A Positive Reaction, 114

77. A Pseudo- reaction, 115

78. Water Centrifuge, 1 19

79. Conic Glass Suitable for the Sedimentation of Urine (Coplin and Sevan) ^ . 120

80. Centrifuge with Hematocrit Attachment, .... 120

81. Phantom and Distorted Red Blood-cells Found in Urine, Most Commonly

That of Renal Hematuria {Lant/ois), 123

82. Blood-cells in the Urine ( C7^/#/*/), 123

S^. Blood cells in the Urine, Lymph-corpuscles, Leukocytes or PuscelLs, and

84. Pus-cells in Urine {GouIJ ), I23

85. Epithelium from the Conducting Part of the Urinary Apparatus, Mostly

from the Bladder, 123

86. Renal Epithelium, 123

87. Seminal Elements, Some of Which May be Found in Urine, 124

88- Illustrating the Formation of Casts (^/«<f^/j^^), 124

90. Blooil -cells and Blood-cast (Lafufois), 125

91. Tube Casts {Lamiois)^ 125

92. Granular Ca.sts (ZrtW<?/V), 125

93. Urinar)' Casts [Landois), J 25

94. Crystals of Uric Acid ; Bacteria, Molds, and Yeasts (Z,rt/;</(t>/j), 125

95. Some Forms of Uric Acid (/.</// </t?/5), 126

90. Acid Ammonium Urate, 126

97. Hippuric Acid. Four-sided Prisms with Two or Four Beveled Edges

98. Some L)eposits in Acid Fermentation of the Urine (Z<m</t>/V), 127

99. Some Deposits from Ammoniacal Urine, 127

100. Whetstone and Irregular Crystals of Uric Acid (Landois)^ 1 27

loi. Ammonium Urate. ** Hedgehog" Crj'stals {Gould), 127

102. Stellate and Feathery Crystals of Triple Phosphate ( 7Vj(?//), 128

103. Forms of Cry.stals of the Ammoniomagnesium Pho.sphatc ( /Vj^j//), ... 128

104. Ammoniomagnesium Phosphate (Triple Phosphate) ((7<7«/f/j, 128

105. Magnesium Phosphate [Gould), 1 28

100. .Amorphous (iranules of Calcium Carbonate (6^<>///</), 128

107. Oxalate of Lime, 129

108. Amorphous Granules, Wedge-shaped Crystals, Some Arranged in Rosels,

of Calcium Phosphate (GV///</), 129

109. Dumb-bell and Octahedral Crystals of Calcium Oxalate (6V/////), . . . 129 no. Calcium Sulphate ; Elongated Tran.sparent Needles or Tablets (^i»;//</), 129

111. Crystals of Cystin and Oxalate of Lime, 129

112. I^ucin and Tyrosin, 130

113. I^eucin and Tyrosin, 130

114. Cystin {Gould\ 130

115. Cliolesterin [Lnttdois), 130

117. Sijuamous Epithelium, 13'

118. Cursch man n's Spirals (.Vt-Aw<7///), 132

119. Charcot- Leyden Crystals (///Wo/i), 133

120. Projmgation by Fission (C<f*M*« rt'/// ^<7vi«), 147

121. Frr»m Culture of Bacillus Megalerium (C(»//m /?//</ ^<^w;/), 148

122. liacillus Butyricus, 152

123. Bacillus Acidi I^ctici, 152

124. Actinomyces (Ray Fungus). From Bovine Actinomycosis (Coplin and

126. Microsporon Ywxiwx {Coplin and Bevan), 163

127. Saccharomycetes Cerevisiae {Coplin and Sevan ,, 164

XVI LIST OF ILLUSTRATIONS.

FIG. PACK

128. Saccharomycetes Albicans (Thrush Fungus) (G>////f aw^^rt'£i»), ... 165

129. Diagram Illustrating the Nomenclature of Schizomycetes Based upon Their

Morphology {after Schenk)^ 166

130. Diplococcus of Gonorrhea, Gonococcus (CV7//m a«<//?rt'a«), 167

131. Diagram of the Diplococcus of Pneumonia, Illustrating Relation of Ca{)-

sule to the Contained Germ (C(f'///w fl:«</^<^<m), 168

132. Micrococcus (Staphylococcus) Pyogenes Aureus (0///« tf^/Z^rt-ww), . . 170

133. Streptococcus of Erysipelas (CV»///« <///</ ^<^r/«}, 172

134. Bacillus (Edematis Maligni, 175

136. Bacillus of Symptomatic Anthrax (C'(£j////i rtwr/i?<^rt«), 176

137. Bacillus of Rhinoscleroma, 178

139. Bacillus Tuberculosis (7W/yrt^jr//), 1 80

140. Diagram Illustrating the Forms of Bacillus Tetani [Coplm and Sevan) y . 182

141. Bacillus Typhosus, Showing Flagella ((7<?///r/), 183

143. Bacillus of Influenza, 185

144. Bacillus of I^eprosy (G?////i /zW /?rtv^//) 188

145. Bacillus Syphilidis {Lustgarttn)^ 189

146. Spirillum Tyrogenum (7w/yi7>tj<7/), 190

147. Spirillum of Q\io\^x^ {Coplin and Bez' all) y 191

148. Spirillum of Asiatic Cholera (7 w/y<r//'j<7/), 191

149. Spirillum of Relapsing Fever ( Spirochjela Obermeieri) ( Cop/in and Bez'an)^ 192

150. Coccidium Ovifonne from the Human Liver {after Leuckart. — Uou/d), 193

151. Distoma Hepaticum, 196

152. Bilharzia ILcmatobia, Male and Female, the letter in the Canalis Gyna;-

cophorus of the Former (/7/?<'/-/t7/^-^</;/. — Could )y 196

156. Cephalic Extremity of Dochmius Duudenalis, Profile and FVont View

[after Lnuktirt. — Cou/d)^ 1 99

157. F'ilaria Embrjo, 200

158. Taenia S;iginata (Gould), 202

159. Cephalic End of Taenia Saginata, 202

160. Head of Txnia Solium. C)n the Right, Egg of Tarnia Solium {Could ), 203

161. Cysticercus Cellulosa:. Completion of Head Fonnation {after Leuckart.

— Coplin aud Jie7'aN)^ 203

163. F'ree-swimming Embryo of the Bolhriocephalus Latus [after I.euckart. —

Gould ), 204

164. Club-shaped Head of the Bothriocephahis Latus (after Leuekarl. —

Gould ), 204

165. TiX'nia P'lavopunctata, 205

166. Ta.'nia Flchiiiococcus (<//?«-r ZrwrXv/;/, — Coplin and Bnan), 205

167. Hydati<l Cyst, Showing I )aughtcr Cysts, 206

168. Fxrhinococcus. A Ciroup of Scolices, 207

lf»9. Ediinococcus, 207

171. Acarus Scabiei and Portion of Ej)idennis Showing the Burrows with Con-

172. Pediculus Pubis, .... 211

173. Illustrating DitTercMjt Fonns of the Malarial Organi.sms with Their Stains

of Development (Ty.son's ** I*ractice of Medicine") (tWt>/v</ ), . . . 213

174. Fatty Inlillration of the Liver 220

175. Pseudohypertrophic Muscular Paralysis { Flatterer), 227

176. Liver evils Showitig Fatty I nfiltratioti (.S«//wr7//.n, 227

177. Amyloid Liver (Semidiagrammatic) [Rindjleiuh), 228

LIST OF ILLUSTRATIONS. XVll

FIG. PAGE

178. Section of Lung Showing Infiltration of the Connective Tissues of the

Alveolar Wall by Coal-dust (Anthracosis) {^Rindfleisch)^ 232

179. Section of a Lung Showing Chalicosis (»SV^///ay«), 233

180. Cloudy Swelling of the Epithelial Lining of the Kidney Tubule (/7«r/-

terer\ * 242

181. Granular Degeneration of a Muscle-fiber i^Schmaus)^ 242

182. Cloudy Swelling of the Liver Cells (Schmtius)^ 242

183. Fatty Degeneration of the Liver Cells {ScA//njtis), 243

184. Confluence of Two Tubercles. Section of Lung, 253

185. Section through a Part of a Vein with Its Contained Organizing Thrombus

{SiAMi7us)f 271

186. Transverse Section of a Thrombosed Blood-vessel in Which Organization

and Canalization of the Thrombus Are in Progress, 273

187. I^ukcKytes of a Frog [Siohr), 285

189. Lymphoid Cells, 287

190. Karyokinetic Figures Obser\-ed in the Epithelium of the Mouth Cavity of

a Salamander {Sio/ir) 297

191. Cellular Elements of Granulation Tissue (Schmaus), 299

192. Granulation Tissue {Schmaus)^ 300

193. Formation of Capillaries {I.atti/ois), 301

194. Section through the Border of a Healing Wound {^Rindfleiscfi)^ .... 302

195. Papilloma [GonU)^ 312

196. Papilloma with Tendency toward Villous P'ormation [S^rhtnaus), .... 313

197. Adenoma of the Cervix Uteri, 315

198. Glioma [GouU), 317

199. Squamous Epithelioma (Gould )^ 322

200. Section of a Stjuamous Epithelioma {Rindfleisch)^ 322

201. Cylindric-cell Cancer of the Stomach, 324

202. .Section of Carcinoma of the Liver, 325

203. Cylindric-cell Epithelioma of the Cervix Uteri, 326

204. Part of Cutaneous .Surface of Right Mamma, the Seat of a Centrally

Placed, Primary Scirrhous Carcinoma and of a Secondary Nodule, . . 329

205. Granular Carcinoma of the Liver, 330

207. Glandular Carcinoma in Which the Stroma Has Been Converted into

Mucoid Tissue {Gould)y 332

208. Colloid Cancer [Rind/leisch), ^^^

209 and 210. Diffuse Lipoma of the Neck. (Illustrations lent the author by

Dr. J. Shelton Horsley), 334

213. .Soft Fibroma, 338

214. Section (Longitudinal) of the Uterus Showing Uniform Myomatous En-

largement, 340

216. Cavernous Hemangioma (6'<?»/<f/), 343

218. Round-cell Sarcoma (AVwri^m^A), 349

219. Round-cell Sarcoma (Gou/d), 349

220. Round-cell Sarcoma of a Lymphatic Gland ( Gould ), 349

221. ."^pindle-ccll Sarcoma {Gould )t 350

222. Giant-cell Sarcoma, 351

223. Alveolar Sarcoma ( (y<?i//(t/), 352

224. Melanotic Sarcoma Springing from the Subcutaneous or Possibly from the

Periosteal Connective Tissues, 353

225. .Alveolar Melanotic Sarcoma (Gould), 353

226. Endothelioma (Gould), J54

Fir.. PAGE

227. Diagram of the Structure of a Tubercle ; a Purely Theoretic Idea, Rarely

Uemonslrated { GouUi ), 368

228. Acute Disseminated Tuberculosis of the Lung (.S«7////«7//j), 370

229. Gower's Hemoglobinomettr, Improved Fonn, 402

230. Von Fleischl's Hemoglobinometer, 403

231. Oliver's Hemoglobinometer, 405

232. Dare's Hemoglobinometer, 409

233. Dare's Hemoglobinometer, 410

234. Thoma-Zeiss Hcmocytomcter, .415

235. Capillary Mixing Tube of the Thoma-Zeiss Apparatus (t'.w y#;>tj<//), . . 416

236. Counting C'hamber of the Thoma-Zeiss Hemocytomeler (Zrf//</t>«), . . . 416

237. Hematocrit Tube 418

238. Rotating Frame of the HematcK-rit, 419

239. A Metho<l of Filling the Centrifuge Tube ... 419

240. Diagrammatic Rej>resentation of Various Fonns and Sizes of Red Cells, . 423

241. Tyi>es of Red I^l<x>d-cells ; also Leukocytes (Zrf//<//vV), 423

242. Poikiloeytcs, 424

243. Crenated Red Hlood-corpuscles ( /«///r/f'/0 424

244. Diagrammatic Representation of Ix-'ukixytes, 428

245. H<Klgkin's Disease, 466

246. Heart Showing Villous Pericarditis ; Ascending anti Transverse Portion of

Arch of Aorta Shnwing Aneurysm, with Contained Clot, and Ruptures

into Pulmonary Artery and Pericanlium, 477

247. Vertical Section through an Inilanu-d Serous Membrane after the Forma-

tion of the- Fibrinous Kxudale (.sV/////*///.0, . . 480

248. Acute Tubercular Pericarditis, Vertical Section of Inllan.matory Exudate

249. Fatty Degt-ncration of the Heart, 494

251. Aortic Orilice Lai<l ( )pen, Showinj^ the Valve Leaflets, Acute Kndocarditis

252. Acute Fnd(Harditis <jf the Mitral \alve. Section at Line of Contact

253. Xarrowt:<l Mitnil ( )rirut' Showing R{••^uU•» of .Vdhoioiis with Considerable

Fibroid Tliicktiiir.^ . l)Utt(Mi luili- Mitral 1 507

254. Adjacent Aoilic Cu>p>, Sh«»\\inj; a l^niail \ «gftalion Developing Just

255. Adherent and riiickeiicd \alve Leallel> (AV//<///<7y«'V), 510

256. Obliterative Fndarleritis. 516

257. Symmetric Aneury-'ni of the .Mxloniin.il Aorta, 521

258. Varict>se Veins of the Leg i (lou/n) 524

259. Section of the Lung, Piieunu)<onio.-.i> ( AV//.///</.», //) 533

260. Section «»f Lung Showing Chalieo>is I .Vr//w////M, 534

261. (iranular I)»'gv'neralion 1 Cloudy Swelling 1 of the Liv«'r Cells (.SV /////<///>) 536

262. Fatly D<'geneiati(»n of the Li \er Cells . .S, /////,///., • 536

263. Ciranular Defeneration of thi' Ki<lney Lpillulimn "Cloudy Swelling)

264. Section of Wall of IJronelm^. ( hroiiie liiondiitis 54O

265. Vertical Seel it »n lhr«»u^h llie P-'endonunibrane an<l Part of the Wall of the

266. Fibrinous (';i>t from I he Prun( hi, Ca^* of Crou|>ous Pneumonia 1 .V. /////. ///.vi, 544

267. Vertical Se«tion of Mucous Menibian**, Sh«)wing I Jiphllieric or (iangreiKUis

Inllannnation, from a Case <»f I )\-«entery (..s<//w.///.. ), 546

26S, Maigin o| Tubereular ricer(»f the Intestine, 549

269. TulMTcular Ll(<'r of tin* Mucous Membrane of the Traehea. X'ertical Sec-

tion of the Trai heal Wall (.SV/////f///s), 357

270. Perichondritis with 1 aryngeal I'lceiaiion, 55S

271. Tracheal and I'artial Lar\n^eal .Stenosis Foll«»winj4 (it :jtri/ati«>ii of a

(.JunuiK), !^6o

LIST OF ILLUSTRATIONS. XIX

FIG. PAGE

272. Chronic Caseous Bronchitis, Tuberculous Bronchitis, Caseous Softening of

the Bronchial Wall, with Thickening of the Peribronchial Tissue, Peribronchitis Chronica (.SV//wrtWj), 562

273. Pulmonary Emphysema {Fliitiercr)^ 573

274. Three Alveoli filled with Fibrinous Exudate. Croupous Pneumonia,

Stage of Hepatization {Sc/itnatts)^ 583

275. Crouj)ous Pneumonia. Single Air Vesicle in the Second Stage, with

Slightly Contracted Exudate, 584

276. Two Alveoli and a Part of a Third from Lung in Catarrhal Pneumonia, . 592

277. Tubercular Pneumonia {SiAmaus), 597

278. Tuberculosis of the Lung, 600

279. Wall of a Tuberculous Cavity {ScA watts), 602

280. Ix>ngitudinal Section of the Kidney ( 7Vj(^/i, r//?^/- //ifw/^), 608

281. Diagram of Blood Supply to Kidney (AV/i<{^/j<^), 609

282. Solitary Kidney 610

2S3. Horseshoe Kidney, 611

284. Persistent F'etal Kidney Due to Anastomoses between the Renal Artery

and Vein, 612

285. Cloudy Swelling of the Epithelium Lining a Kidney Tubule (FiutUrer), . 616

286. Chronic Parenchymatous Nephritis, 621

287. Kidney Showing Chronic Interstitial Nephritis, 624

288. Kidney Showing Advanced Chronic Interstitial Nephritis, 625

289. Kidney, Chronic Interstitial Nephritis, 627

290. Tuberculous Pyelonephritis ; Chronic Ascending Tuberculosis of the

Kidney, 631

291. Congenital Cystic Disease of the Kidney, 632

292. Kidney, Congenital Cystic Disease ; Laid Open, 633

293. Congenital Cystic Disease of the Kidney, 634

294. Congenital Cystic Disease of the Kidney, 635

295. Congenital Cystic Disease of the Kidney. Part of Wall of a Larger Cyst, 636

296. Loss of Tissue Due to Noma, 641

297. Section from Right Parotid, 644

298. Section of the I^eft Parotid under a Very Low Power, 645

299. Intussusception at Ileocecal V^alve, 656

300. Intussuscej)tion Diagram Intended to Show the Relation of the Several

Parts in Figure 299, . . 657

301. Typhoid Ulcer during the Early Part of Third Week of the Disease, 659

302. Section through a Typhoid Ulcer, End of Second Week of the Disease

303. Section of the Intestinal Wall at the Edge of a Typhoid Ulcer, Beginning

of Third Week bf the Disease, 661

304. Tubercular Ulcer {Schmaus), 662

30$. Fatty Infiltration of the Liver (i^7W/f.7vr//), 669

306. Liver, Amyloid Infiltration {RindJIeisch)^ 670

307. Beginning Cirrhosis of the Liver (A*///r//fmr//), 675

308. .Superior As|>ect of Liver, Showing Unusual Degree of Cirrhosis with

•* Hob-nailed'* Surface, 676

309. Atrophic Cirrhosis of the l^iver. Advanced {Schmatts)^ 677

310. Under-surfare of Liver Showing Results of Congenital Syphilis, .... 679

311. .Syphilitic Cirrhosis of the Wv^x i^Schmaus), 680

3f2. Part of Left I^)be of Liver, Showing Primary Cylindric-cell Carcinoma, . 681 313- Pancreas Showing Increa.se of Fibrous Tissue. Chronic Interstitial Pancreatitis, 688

314. .Section Taken from the Ga.strocnemius Muscles of a Child .Suffering from

Pseudohy|)ertrophic Muscular Paralysis, 699

315. Prc^ressive Muscular Dystrophy, Erh Type, . . 700

316. Section of Bone-marrow of Rabbit, Showing the Delicate Connective-tissue

Reticulum Containing the Different Elements of the Marrow (.SV//«?/<'r\ 706

317. Elements of Human Bone-marrow (Sfohr)y 707

XX LIST OF ILLUSTRATIONS.

318. Acromegaly, 713

319. Osteophytes on the Popliteal Aspect of the Lower End of the Femur, . . 714

320. Osteomyelitis Involving the Tibia and, to a Limited Extent, the Ix)wer

End of the Femur, 719

321. Exterior of Femur, Showing Result of Chronic Osteitis Associated with

Chronic IVoductive Periostitis, 723

322. Femur. Ix^ngitudinal Section of Bone Shown in Figure 321, 723

323. Fracture of the Femur, Showing Overlapping of the Fragments with Rota-

tory Displacement of the Ix)wer F'ragment, and Attempted Union in

This Position, 728

324. Ten -day-old Fracture {Sc/imaNs), 729

325. Spina Bifida, 753

326. Section of Cerebral Cortex and Meninges from a Case of Suppurative

Meningitis, 7^

327. Section of Human Brain, Including Wall of Cerebral Abscess, .... 776

328. Spinal Cord, Showing Posterior Sclerosis, 788

329. Nerve. Acute Interstitial Neuritis 79*

330. Longitudinal Section of Musculospiral Nerve Removed from a Man who

Died as a Result of Alcoholic Multiple Neuritis, 792

Introduction

Pathology bears the same relation to a proper study of disease that physiology does to a knowledge of those complicated phenomena the sum total of which is called life. Physiology deals with the normal processes, — the functions of organs and tissues in health, — while pathology is a study of the causes and manifestations accompanying disease. Physiology is the science of normal life ; pathology is the science of abnormal life — disease. It has been said, and quite truly, that pathology is morbid physiology — the physiology of disease. The two subjects demand associated study, as from a knowledge of one is acquired more or less information bearing either directly or indirectly upon the other. A detailed study of the intricate problems of morbid processes, and of the relation^ of tissue change to alteration of function, and a thorough acquaintance with the normal, render at once apparent the intimate association of pathology and physiology.