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Lectures ON SOME OF THE MORE IMPORTANT POINTS IN SURGERY.
FEBRUARY 15, 1851. of the minute structures of arteries, which differ in some respects from those of the histologists who have preceded him. labours I rely in preference to all others, as it is my ON Uponashismuch as it is my inclination to do, from his situation, duty SOME OF THE MORE IMPORTANT from the accuracy, perseverance, and ability he has shown on and which have placed him at the head of so occasions, many POINTS IN SURGERY. that branch of knowledge in Great Britain, if not in Europe. He is present, or I should say more in his praise. The presi(Delivered before the Medical Society of London.) dent of the College has granted permission for the college BY G. J. GUTHRIE, ESQ., F.R.S., microscopes, diagrams, &c., to be made use of on this occasion; LATE PRESIDENT OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND; and Mr. Quekett will show any part I shall allude to in its CONSULTING SURGEON TO THE WESTMINSTER HOSPITAL, ETC. fresh state to such gentlemen as may be disposed to judge, with their own eyes, of these matters, when enlarged by 250 diaFirst Lettsomian lecture; election of the lecturer to the Lettsomian meters. was stated formerly by some gentlemen, and perhaps Professorship of Surgery; advancement of science by the Council a It few think so still, that the Council of the College of of the College of Surgeons ; light thrown on systemic anatomy by the microscope; structure of arteries; modifications of epithelium ; Surgeons have never done anything for the advancement of and these gentlemen have repeated it so often, that formation and development of cells ; means adopted by Nature science; they at last really did believe it themselves. The facts I shall for the suppression of hœmorrhage from arteries. draw your attention to during the present and ensuing lectures MR. PRESIDENT,- When the two Societies of Bolt-court and will show you the contrary; and the explanations I shall give, of Westminster were pleased to form a junction, with the even on a single point, will I hope be satisfactory, whilst view of constituting a more consistent and important whole, perhaps it can come from no one more properly than myself, under the title of the Medical Society of London, the mem- as, chemically speaking, the protein cause of part of the good has followed. bers of the united body, whom, with you, I have now the which The College instituted some years ago three studentships in pleasure to address, did me the unexpected honour of ap- anatomy and surgery, for three years each, with an annual pointing me their surgical professor. Sir Robert Walpole, salary of a hundred pounds; and obtained for these gentlewhen premier, is reported to have said, that his experience men, when this period was completed, an assistant-surgeoncy in the House of Commons enabled him to state that every in the army, the navy, or the East India Company’s serviceoffices, you all know, many sigh for in vain, as only procurable man had his price - money with some, honours and flatby great personal influence. The future position of these tery with others; and the favour you conferred so unhesi- gentlemen was thus, if they pleased, ensured. Mr. Owen, our tatingly, in electing me your professor, induces me to believe very learned professor of physiology and comparative anatomy, that there is some truth in his remark; for I had given up all came to us, a young but well-informed man, at eighty pounds year. The apparently poor employment thus afforded, thought of further lecturing to a full-grown audience, and aenabled him gradually to become the greatest man now in have been induced to accept the task you have allotted me, in the branches of science he has cultivated. Mr. Europe solely under the influence which the honour conferred by so Quekett was one of the first appointed college students. The learned a body of estimable men must necessarily create. It industry, perseverance, and ability shown during his three It reminds me of the lady, with whom years gained for him the approbation of the Council, who felt-, was quite irresistible. I afterwards became acquainted, who, having yielded to the they ought not to part with him; that the public interests blandishments of her seducer, and deserted a husband she demanded from them the expense of his retention as assistanthad unwillingly married, threw away, as the fugitive carriage conservator ; and he stands before you now, without exception, turned from Clarges-street into Piccadilly, a camphor bag she the first man in histological lorein England, and whose exhad worn round her neck, as a protecting charm against all cellency is acknowledged throughout the Continent of Europe unholy desires, thus abandoning herself to the delusions of love and America. It is not without some satisfaction I can look back to the and error; and as mankind has always been alike, the lover day when I proposed to the Council the establishment of these protesting at the moment, in the words of Horace, studentships. The proposition was met unanimously. I had Tecum vivere amem, tecum obeam libens;" only the merit of anticipating for a moment the wishes of the like her, Mr. President, I have thrown off my talisman-the whole body; and I hope many of you will live to see others protection which privacy would have given me; I have placed rising up year after year capable of filling similar situations, myself, if not in your arms, at least at your feet, that I may with equal honour to themselves and advantage to the procomply with your wishes; and can only now pray your indul- fession. This is not all; the microscope in the hands of Mr. Quekett gence and your pardon for the error I have committed in supposing that I could for one whole hour occupy your attention, discloses the nature of the diseased as well as the healthy in a manner which should be deserving of the approbation of structure of parts. The secretion from a diseased part will the learned body over which you so worthily preside. often show the nature of the disease itself, and enable the The subject I have selected for the present lecture is, 11 the surgeon to judge whether an operation may or may not be means adopted by Nature and by Art for the suppression of performed with a reasonable hope of success; whether it is haemorrhage from the larger arteries;" and I have done so, necessary to do it or not; and the knowledge which Mr. because it is one which is comparatively unattended to, per- Quekett has thus acquired is at the service of every member haps but little understood; not so much from the failure of of the profession who stands in need of it, and cannot fail to information on this point, as from a disinclination to use, or a be to them of the greatest advantage. I venture to think negligence in applying, that which at present exists. At the that they should honour and cherish the body which has raised same time, it is proper to state, that there is new matter which up for them such men as Mr. Owen and Mr. Quekett. A I hope to bring before you, in aid of those opinions I have little firmness on the part of the profession at large, if accombefore advanced; for histology, or the doctrine of the tissues panied by a moderate quantity of reason, judgment, and - in other words, microscopic observation-has unfolded much common sense, would soon leave little to be desired; and the of the ultimate structure of parts, which was formerly un- time is I think at hand, when a happy adjustment of all known, or at most only suspected; and the proof thus obtained, difficulties and differences might be readily effected, as much in relation to the structure of arteries, has given that confir- to the advantage of the profession as the public. As the efforts resorted to by nature for the suppression of mation to my opinions which was heretofore deficient. The application of the microscope to the intimate structure haemorrhage depend on the capabilities of the arteries as reof arteries is due, in the first instance, to Henle, and is detailed sulting from their structure, it becomes an object of imporin the " Allgemeine Anatomie," published at 1841, tance to inquire minutely into it. With this view, the old and in Mr. Paget’s excellent abridgment in 1842. This has division of an artery into three coats may be continued; the been followed by Remak, " Histologische Bewerkunden uber difference between ancient and modern anatomy being in their die Blutgefasswunde;" by Donders, Jansen, Kolliker, Schultze, subdivision into different textures, or layers. The annexed and others, and particularly Drs. Quain and Sharpey in their diagram shows the edge of a large artery, which has been Anatomy, and last not least, by Mr. Quekett, the assistant- divided circularly, and magnified so as to exhibit six layers in a conservator of the Royal College of Surgeons, to whom I am distinct manner. The ancient three coats are each divided into indebted for the views I shall hone to be enabled to give vou two. The inner or old serous coat, is shown to be separable into No. 1433.
Lectures
"
Leipzig in
174 The spheroidal or glandular epithelium consists of cells, more two: the epithelial, marked 1, and the fenestrated, marked 2. The middle coat is also separated into two; the inner, or or less circular or spherical in figure, each having a large muscular, marked 3, and the outer, or elast’ic, marked 4. The nucleus in its centre. This epithelium is met with in all outer coat is divisible also into two layers, the inner, marked glandular organs, such as the liver, kidney, lachrymal and 5, and the outer, marked 6; number 5 being composed more salivary glands, and in these cells the proper secretion of the of elastic fibres; number 6 more of areolar fibres, by which gland is developed. The tesselated and cylindrical kinds are, tissue, in a less condensed state, the arteries of the extremities on the contrary, more or less protective. are attached to their sheaths. Such may be considered to The two first kinds are sometimes ciliated by the addition, be the general composition of a large artery, each particular at their free extremities, of several fine, pellucid, blunt, and structure remaining to be examined. pliant hair-like processes or cilia, about 1/50000 of an inch long, which are, during life, in constant motion. This kind of epithelium, known as the ciliary, lines the whole respiratory tract of mucous membrane; the palpebral conjunctiva, as opposed to the tesselated on the eye-ball; the ventricles of the brain; the posterior half of the uterus, and the Fallopian tubes. The epithelium is placed upon the second layer of the internal coat, which, from certain appearances of apertures or
windows, has been called the perforated or fenestrated layer. (See diagram No. 2.) It can be peeled off in small pieces only, and shews under a power of 250 diameters a series of
If a small portion of the inner coat of an artery be gently scraped with a knifp, or if the inside of the cheek be treated in a similar manner, a little white soft substance is brought away on it, called epithelium, a name given to it by Ruysch, from the delicate layer of epidermis investing the female nipple,∈&pgr;&tgr;,upon, &thgr;&e gr;&lgr;&e gr;, a nipple. The epithelium of the human body is divided into three kinds by microscopists-the tesselated, pavement, or scaly ; the cylindrical, or conical; and the spheroidal, or glandular. The tesselated, as it exists in arteries, is represented in diagram No. 1, in three different stages-in the young person,
in middle age, and in the very old person;
one
stage gra-
dually degenerating or changing into the other, at each different period of life. It is composed of one or more layers of nucleated cells, of a flat, oval, round, hexagonal, or polygonal form, and about 1/1400 of an inch in diameter; the nucleus in each cell containing within itself one or more nucleoli, and even several paler granules. The epithelium has a thickness proportioned to the friction or pressure to which it is exposed, particularly when covering the skin. In the arteries of the young, and in the mammalia generally, the epithelium is strongly marked; in older persons all traces both of cells and nuclei have disappeared. It lines not only the internal surface of the arteries and veins, but the mouth with its cutaneous glands; the conjunctiva of the eye; the pharynx and eesophagus; the vagina and cervix uteri; the entrance of the female urethra, and the serous
well-marked fibres running in almost parallel lines upon a comparatively structureless membrane, resembling the inner layer of the cornea, as in the left hand figure of the diagram, the fibres being arranged in the length of the vessel. They frequently bifurcate, and almost immediately join again, so that an oval space, resembling a hole, is perceived. This is not always a hole or perforation, as it is generally described to be, as may be seen and proved by the fact of the supposed opening being sometimes filled up by small bodies, like nuclei, as if the oval space were occupied by a cell. This fenestrated layer varies in thickness in differentvessels, and is more strongly developed in the lower animals than in man. When this layer is very thick, the fibres which are yellow, do not all run in the direction of the length of the vessel, for others crossing at right angles may sometimes be observed, as delineated in the right hand figure of diagram No. 2. These two layers compose the ancient inner coat of an artery, and are frequently the seat of disease. No. 2.
membranes. No. 1.
The middle coat, as it was termed, forms by much the greatest part of the thickness of an artery, and generally speaking, is of a more or less yellow colour. It appears fibrous to the naked eye, and can be peeled off not unfrequently in a series of circular layers; when examined microscopically, it is seen to be composed of two sets of fibres arranged in a circular direction. The inner layer is composed of muscular fibres, of the organic or involuntary kind. (See line, marked 3, on the circular diagram.) The outer layer is composed of elastic fibres, and marked line 4 on the same diagram. These conjoined layers form the muscular coat of Mr. Hunter, the fibrous or contractile coat of later anatomists, who denied its muscularity from the supposed absence of fibrine-an error fallen
OLD.
MIDDLE.
YOUNO.
The conical, or cylindrical, is composed of cells closely set together, of a conical cylindrical, or pyramidal form, about 1/1200 of an inch long, each cell enclosing a flat nucleus, with
into from chemical science being unequal at that time to its discovery, or rather of its more elementary part, called protein, the principal constituent both of albumen and fibrine, which two are now found to differ from each other in the addition only of three per cent. of sulphur. Mülder says, in his " Animal
andVegetable Chemistry," (Part II., p. 307,) "Thecombinations of sulpho-phospho protein (fibrin and albumen) and of sulphoprotein casein, with acids, alkalies, and salts, are especially
nucleoli. It lines the urethra in the female, from the entrance where the tesselated ends, and extends inwards to the urinary Protein is soluble in weak alkalies. Since tubules of the kidneys; the greater part of the male organs the serum of the blood is always slightly alkaline, in a similar manner; the digestive canal and gland ducts, being a proteate of soda, with sulphur and phosphorus, it keeps from the cardia to the anus. the sulpho-phospho protein in solution. This property is the
remarkable. therefore
175 of the blood remaining in a liquid state-a chief requl site for animal life. If a weak alkaline solution of protein is neutralized by an acid, the solubility of sulpho-phospho protein is greatly diminished. The sulphuric and phosphoric acids, by not dissolving protein, stanch bleeding. Acetic acid, by which protein is dissolved, does not, neither does the hydrochloric. Protein, according to Mülder,-although it is doubted by Liebig,-is a complex substance, consisting of several heterogeneous organic compounds united into one whole, easily acted upon by strong reagents. If a protein compound be brought into contact with an alkali, ammonia is immediately disengaged, and the alkaline solution can hardly be made weak enough to prevent the disengagement of ammonia. If either fibrine or coagulated albumen be dissolved in a weak potass ley, ammonia is always perceptible. Protein therefore is always in a state of decomposition, as serum is alkaline." In diagram No. 3,fig. 3, the organic or involuntary muscular fibres are shown, consisting of more or less flattened bands, the fibres of which are soft, and marked with minute granules, sometimes exhibiting traces of nuclei. These purely muscular fibres are most abundant next to the inner coat of the artery,and diminish in number as they approach the outer layer, their place being occupied by firmer and more elastic fibres of a yellow colour, seen collectively in the circular diagram, as line 4, and separately in diagram 3, fig. 4, and in diagram 4. The involuntary muscular fibres of an artery are rather smaller than those found in the intestines, bladder, and uterus. The voluntary muscular fibres differ from the involuntary, in having cylindrical fibres, of much larger size, with transverse and longitudinal markings, unlike the flattened fibres of less size of the involuntary muscles, which have also a faintly granular appearance, instead of the more determined transverse and longitudinal lines of the voluntary muscles. But this subject I shall pursue in a subsequent lecture.* cause
No. 3.
become real spaces, meshes, or areolse, conis now called areolar tissue, rather than the cellular of the older anatomists, from the circumstances that the areolae communicate, and that perfect cells in any tissue do not. These elements of areolar tissue can be readily distinguished by the action of acetic acid, under which reagent the white fibres will almost disappear, leaving only a slight trace of fibres containing oval nuclei, as seen and marked in diagram 3, fig. 5. It is seen when unravelled in b, diagram 5. 5. No. 5. No.
compact form, stituting what
The outerorelasticlayer of theancient middle coat,represented byline 4 in the circular diagram, is formed of strong elasticfibres
,difficult of
separation, and when torn across, have curled extremities, as shown in the diagram marked 4, differing only in
size from those found in the ligaments of the spine, and in the ligamentum nuchae of quadrupeds, as shown in the separate
diagram marked
4. The external coat of an artery divided also into two layers is shown on the circular diagram by lines 5 and 6. These two layers are composed of the yellow elastic fibres last noticed, and another set of fibres, white in colour and inelastic in structure, arranged in various directions; the inner layer predominating in yellow elastic, the outer layer in white inelastic fibres,and constituting a firm investment to all the other layers of which the artery is composed. The white inelastic fibres are shown in diagram No. 3, fig. 5,with a yellow elastic fibre curling round them. The constant crossing and re-crossing of these two sets of fibres form certain spaces, which, when not in a * For further information on the subject of muscular analysis, see Retzius in Muller’s Handbuch der Physiologic des Menschen, 1844 ; Mulder’s in his Hollandische Beitrage; Donder, Chemistry of Vegetable and Animal Physiology, translated by Fromberg and Johnston ; and Dr. Kirkes’ Handbook of Physiology, in which he reports as the result of Dr. Donder’s analysis, that when strong nitric acid is applied to any compound of protein, it forms with it xantho-proteinic acid, which with ammonia produces a yellow xantho-proteinate of ammonia. On applying this to the coats of bloodvessels, he found the muscular coat alone assumed the yellow colour which this agent causes, the other parts, as well as the
coats of veins,
remaining unchanged.
,
a, Yellow elastic fibres. c, Nuclei.
b, White inelastic fibres. d, Fibre, with nucleus.
The inner layer of the middle coat, or muscular coat, as it may be justly termed, forms, it will be seen, the greatest part of the thickness of the wall of certain arteries, and in some instances, as in the anterior tibial artery, constitutes nearly the entire thickness of the vessel. The internal coat is in all frequently seen puckered in a longitudinal direction. The arteries are supplied with blood by vessels of small size, which do not come off immediately from the part of the artery they are destined to supply, but principally from neighbouring vessels. They are called vasa vasorum. They are arranged precisely in the same manner as those of areolar tissue. A few of these vessels penetrate as far as the middle or muscular coat, but do not reach the inner, which has no vessels; proximity to the circulating fluid being apparently sufficient for its nutrition. Arteries are supplied with nervous influence by branches from the sympathetic system running in their walls, and through their connexion by ganglions with the organs they supply with blood. I have spoken to you of cells, nuclei and nucleoli, without giving any explanation, believing it to be unnecessary to allude to them before so learned a body. As there may be,
176 however, some few who have not attended particularly to this mother produced twenty-eight living children in the first subject, I may add that histological physiologists and philo- twelve years of her married life. My friend, the late Dr.H——,, sophers are very material persons, especially when much in- well known near Bath, was the thirty-fifth child of his mother. clined to chemical inquiries. They have decided that all of She had I believe another; so that a lady of forty-eight may you, gentlemen, brave, intelligent, learned, accomplished, as perhaps some day be seen taking an airing with some three Malthus and you may be, young or old, handsome or plain,-for I do not dozen of her offspring behind her. What
Mr.
presume to say ugly,-had a beginning when an embryo as a Miss Martineau would say or have said in such a case, I cannot vesicle or elementary cell filled with, and surrounded by a divine. (To be continued.) liquid called cyto-blastema, and containing a kernel or nucleus. This discovery is due to Schleiden in vegetable, to Schwann in animal bodies; and sometimes this kernel exhibits one or more dark little spots, which are called nucleoli. The kernels are CASES OF STRICTURE TREATED BY considered to be little cells united with the original cell; the EXTERNAL INCISION. nucleoli are not satisfactorily proved to be either openings, JAMES BY SYME, ESQ., F.R.S.E., vesicles or solid little spheres, situated at the internal wall of PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF EDINBURGH. the kernel. The manner in which the cells or main forms of the organic may be proper to repeat that this series of cases is intended kingdom are produced is thus represented by Mulder. In a IT to illustrate and establish the following positions :to sometimes almost shapeless, consistent, gelatinous mass, 1. That strictures of the urethra may be divided by exwhich the name of cyto-blastema or formative substance has been given, containing the materials requisite for the produc- ternal incision upon a grooved director passed through the tion of cells, small round grains or nucleoli are perceived in contracted part, without incurring any of the ordinary dangers the act of formation. Around these grains a layer of granular attending surgical operations. ("I have now operated on matter is deposited, which continually increases in thickness, thirty-eight cases without any fatal result.") 2. That there is no stricture of the urethra through which and constitutes the kernel or nucleus. This is oval-shaped or may not be passed, not by force, but round, almost always opaque, has a granular surface, and such a guide for the knife is considered to be a vesicle, a little cell itself. From the by gentle insinuation, so as to cause neither pain nor bleeding. 3. That strictures of the utmost obstinacy and greatest dissurface of this kernel a small very thin transparent vesicle is to resent interference, even of the gentlest kind, may raised, appearing as a segment of a sphere, which soon ex- position be speedily removed, so as to permit the introduction of thus so when full that the kernel and becomes large grown, pands, lies as a minute corpuscle upon its interior wall; the material full-sized instruments without difficulty or inconvenience. 4. That the relief thus afforded is more permanent than for its formation being supplied by the cyto-blastema, and is converted into a vesicle by the kernel which is first formed, that which can be obtained in any other way. CASE 2.-George T-,aged forty-five, began to suffer from its embryo existing in the formative substance. The first trace of organisation is the production of a small stricture about eight years ago. Between six and seven years perceptible body or nucleolus, which deposits on the surface ago he was twice under my care; first for a short period, a granular substance from the cyto-blastema, to give rise to a during which the contraction was only partially dilated, and little producing organ, the kernel or nucleus. This further afterwards for six weeks, when the process was completed transforms the surrounding cyto-blastema into a granular sur- through the use of simple bougies. He then went to Canada, face, from which the vesicle is formed, raised, expanded, and and was employed in a remote part of the colony as the agent filled with a liquid, in which vesicle thus enlarged the kernel of a mercantile establishment. Finding the stricture again remains enclosed, and adhering to a certain spot of its wall. troublesome, he had repaired to -, where various attempts If two nucleoli lie close to one another, they coalesce and were made to pass instruments, but without success. In become one solid mass, capable of producing one cell only, these circumstances he was advised to seek my assistance; containing one kernel and two nucleoli. This view is that of and having crossed the Atlantic with this view, was admitted Schleiden and Schwann, supported by Mulder, but not entirely into the Royal Infirmary on the 12th of June last. The by Henle; inasmuch as no kernel can be perceived perinseum was greatly swelled and very hard, so as to form approved in the cells of many cellular systems, whilst in the act of with the posterior part of the scrotum one mass of induration. formation. In the elementary parts of animals which have ’, On proceeding to examine the urethra, I found a tight striclong since lost their cellular form, the remnants of kernels are ture anterior to the bulb, through which a bougie of the frequently found, as I have demonstrated in the diagrams before smallest size was passed fairly into the bladder at the first us. The manner however in which the elementary first-seen attempt. I then carried on the dilatation with the effect of granules are formed in the cyto-blastema, science has not yet removing the perinseal hardness, and relieving the patient been able to discover. The chemists have proved that all from his distressing symptoms, so that he was dismissed as elementary organic substances consist of carbon, hydrogen, cured on the llth of September. On the 21st of November he returned in a worse plight oxygen, and nitrogen, susceptible of endless modifications of their respective forces, under which an organic molecule or than ever; the swelling in the perinseum having recurred to ovum is produced, and after that, under certain circumstances, more than its former extent, and there being not only very one of yourselves in man. The learned professor of Utrecht is frequent calls to void his urine, but also an inability of retainnot, however, quite satisfied with his theory of life, and says ing it. I had no doubt that through the use of bougies tem"that his efforts are only to endeavour to discover what means porary relief might again be afforded; but from the repeated the Deity has used to give to organized nature its present relapses which had taken place, distrusting the permanency form, which, he says, is the study of nature. Its aim is to of any good effect obtained in this way, I concluded that diviacquire a knowledge of the laws which regulate it; its highest sion of the stricture would be expedient, and, to facilitate this aim the deduction of even the very remotest results from the proceeding, made a free longitudinal incision through the perivery first causes throughout all their phases." He should nseal swelling, which was afterwards poulticed for a few days. have added-the very first causes human intellect is permitted On the 28th, the swelling having become greatly diminished in size and hardness, I introduced a grooved director, divided to inquire into. Whatever may be the true reading of the book of Nature the stricture, and secured a moderate-sized catheter in the by the histologistical physiologist and chemist, they seem at bladder. The bleeding at the time of the operation and subleast to have made out, in a satisfactory manner, that a sequently to it did not altogether exceed two tea spoonfuls. virgin lady of the bimanus breed carries in her ovaria at least The catheter was removed on the 30th. The urine came four hundred of these cells or ova, ready for use after the partly by the urethra and partly by the wound until the 17th proper application of something which they seem to think of December, when it flowed entirely by the natural channel. analogous to electro-magnetism or a galvanic battery. In the On the 24th the wound was completely healed; instruments of the largest size were introduced and withdrawn without common fowl, nothing is wanting after this, but the application of a well-regulated temperature; and Mr. Cantelo, in the slightest difficulty or feeling of constriction, and the Leicester-square, can with it produce chickens from the eggs perinaeum was perfectly natural in form as well as consistence. more certainly than the hen herself. Luckily, in man, months The patient remained another week, and was then dismissed, are required for this process, and the whole four hundred expressing the most confident persuasion, founded upon the ova cannot be evolved, even if every facility were difference of his feelings from those experienced on any offered. In the museum of the College of Surgeons there is former occasion of relief, that he was at length free from a large bottle, containing five young ladies and gentlemen, all stricture; his reply, when asked how the stricture was, always brought forth at one birth, and destroyed by an accident; and being, "Ihave no stricture now :’ I was for many years acquainted with a gentleman, whose Edinburgh. Feb. 3. 1851.
I
Lectures
"
Leipzig in
174 The spheroidal or glandular epithelium consists of cells, more two: the epithelial, marked 1, and the fenestrated, marked 2. The middle coat is also separated into two; the inner, or or less circular or spherical in figure, each having a large muscular, marked 3, and the outer, or elast’ic, marked 4. The nucleus in its centre. This epithelium is met with in all outer coat is divisible also into two layers, the inner, marked glandular organs, such as the liver, kidney, lachrymal and 5, and the outer, marked 6; number 5 being composed more salivary glands, and in these cells the proper secretion of the of elastic fibres; number 6 more of areolar fibres, by which gland is developed. The tesselated and cylindrical kinds are, tissue, in a less condensed state, the arteries of the extremities on the contrary, more or less protective. are attached to their sheaths. Such may be considered to The two first kinds are sometimes ciliated by the addition, be the general composition of a large artery, each particular at their free extremities, of several fine, pellucid, blunt, and structure remaining to be examined. pliant hair-like processes or cilia, about 1/50000 of an inch long, which are, during life, in constant motion. This kind of epithelium, known as the ciliary, lines the whole respiratory tract of mucous membrane; the palpebral conjunctiva, as opposed to the tesselated on the eye-ball; the ventricles of the brain; the posterior half of the uterus, and the Fallopian tubes. The epithelium is placed upon the second layer of the internal coat, which, from certain appearances of apertures or
windows, has been called the perforated or fenestrated layer. (See diagram No. 2.) It can be peeled off in small pieces only, and shews under a power of 250 diameters a series of
If a small portion of the inner coat of an artery be gently scraped with a knifp, or if the inside of the cheek be treated in a similar manner, a little white soft substance is brought away on it, called epithelium, a name given to it by Ruysch, from the delicate layer of epidermis investing the female nipple,∈&pgr;&tgr;,upon, &thgr;&e gr;&lgr;&e gr;, a nipple. The epithelium of the human body is divided into three kinds by microscopists-the tesselated, pavement, or scaly ; the cylindrical, or conical; and the spheroidal, or glandular. The tesselated, as it exists in arteries, is represented in diagram No. 1, in three different stages-in the young person,
in middle age, and in the very old person;
one
stage gra-
dually degenerating or changing into the other, at each different period of life. It is composed of one or more layers of nucleated cells, of a flat, oval, round, hexagonal, or polygonal form, and about 1/1400 of an inch in diameter; the nucleus in each cell containing within itself one or more nucleoli, and even several paler granules. The epithelium has a thickness proportioned to the friction or pressure to which it is exposed, particularly when covering the skin. In the arteries of the young, and in the mammalia generally, the epithelium is strongly marked; in older persons all traces both of cells and nuclei have disappeared. It lines not only the internal surface of the arteries and veins, but the mouth with its cutaneous glands; the conjunctiva of the eye; the pharynx and eesophagus; the vagina and cervix uteri; the entrance of the female urethra, and the serous
well-marked fibres running in almost parallel lines upon a comparatively structureless membrane, resembling the inner layer of the cornea, as in the left hand figure of the diagram, the fibres being arranged in the length of the vessel. They frequently bifurcate, and almost immediately join again, so that an oval space, resembling a hole, is perceived. This is not always a hole or perforation, as it is generally described to be, as may be seen and proved by the fact of the supposed opening being sometimes filled up by small bodies, like nuclei, as if the oval space were occupied by a cell. This fenestrated layer varies in thickness in differentvessels, and is more strongly developed in the lower animals than in man. When this layer is very thick, the fibres which are yellow, do not all run in the direction of the length of the vessel, for others crossing at right angles may sometimes be observed, as delineated in the right hand figure of diagram No. 2. These two layers compose the ancient inner coat of an artery, and are frequently the seat of disease. No. 2.
membranes. No. 1.
The middle coat, as it was termed, forms by much the greatest part of the thickness of an artery, and generally speaking, is of a more or less yellow colour. It appears fibrous to the naked eye, and can be peeled off not unfrequently in a series of circular layers; when examined microscopically, it is seen to be composed of two sets of fibres arranged in a circular direction. The inner layer is composed of muscular fibres, of the organic or involuntary kind. (See line, marked 3, on the circular diagram.) The outer layer is composed of elastic fibres, and marked line 4 on the same diagram. These conjoined layers form the muscular coat of Mr. Hunter, the fibrous or contractile coat of later anatomists, who denied its muscularity from the supposed absence of fibrine-an error fallen
OLD.
MIDDLE.
YOUNO.
The conical, or cylindrical, is composed of cells closely set together, of a conical cylindrical, or pyramidal form, about 1/1200 of an inch long, each cell enclosing a flat nucleus, with
into from chemical science being unequal at that time to its discovery, or rather of its more elementary part, called protein, the principal constituent both of albumen and fibrine, which two are now found to differ from each other in the addition only of three per cent. of sulphur. Mülder says, in his " Animal
andVegetable Chemistry," (Part II., p. 307,) "Thecombinations of sulpho-phospho protein (fibrin and albumen) and of sulphoprotein casein, with acids, alkalies, and salts, are especially
nucleoli. It lines the urethra in the female, from the entrance where the tesselated ends, and extends inwards to the urinary Protein is soluble in weak alkalies. Since tubules of the kidneys; the greater part of the male organs the serum of the blood is always slightly alkaline, in a similar manner; the digestive canal and gland ducts, being a proteate of soda, with sulphur and phosphorus, it keeps from the cardia to the anus. the sulpho-phospho protein in solution. This property is the
remarkable. therefore
175 of the blood remaining in a liquid state-a chief requl site for animal life. If a weak alkaline solution of protein is neutralized by an acid, the solubility of sulpho-phospho protein is greatly diminished. The sulphuric and phosphoric acids, by not dissolving protein, stanch bleeding. Acetic acid, by which protein is dissolved, does not, neither does the hydrochloric. Protein, according to Mülder,-although it is doubted by Liebig,-is a complex substance, consisting of several heterogeneous organic compounds united into one whole, easily acted upon by strong reagents. If a protein compound be brought into contact with an alkali, ammonia is immediately disengaged, and the alkaline solution can hardly be made weak enough to prevent the disengagement of ammonia. If either fibrine or coagulated albumen be dissolved in a weak potass ley, ammonia is always perceptible. Protein therefore is always in a state of decomposition, as serum is alkaline." In diagram No. 3,fig. 3, the organic or involuntary muscular fibres are shown, consisting of more or less flattened bands, the fibres of which are soft, and marked with minute granules, sometimes exhibiting traces of nuclei. These purely muscular fibres are most abundant next to the inner coat of the artery,and diminish in number as they approach the outer layer, their place being occupied by firmer and more elastic fibres of a yellow colour, seen collectively in the circular diagram, as line 4, and separately in diagram 3, fig. 4, and in diagram 4. The involuntary muscular fibres of an artery are rather smaller than those found in the intestines, bladder, and uterus. The voluntary muscular fibres differ from the involuntary, in having cylindrical fibres, of much larger size, with transverse and longitudinal markings, unlike the flattened fibres of less size of the involuntary muscles, which have also a faintly granular appearance, instead of the more determined transverse and longitudinal lines of the voluntary muscles. But this subject I shall pursue in a subsequent lecture.* cause
No. 3.
become real spaces, meshes, or areolse, conis now called areolar tissue, rather than the cellular of the older anatomists, from the circumstances that the areolae communicate, and that perfect cells in any tissue do not. These elements of areolar tissue can be readily distinguished by the action of acetic acid, under which reagent the white fibres will almost disappear, leaving only a slight trace of fibres containing oval nuclei, as seen and marked in diagram 3, fig. 5. It is seen when unravelled in b, diagram 5. 5. No. 5. No.
compact form, stituting what
The outerorelasticlayer of theancient middle coat,represented byline 4 in the circular diagram, is formed of strong elasticfibres
,difficult of
separation, and when torn across, have curled extremities, as shown in the diagram marked 4, differing only in
size from those found in the ligaments of the spine, and in the ligamentum nuchae of quadrupeds, as shown in the separate
diagram marked
4. The external coat of an artery divided also into two layers is shown on the circular diagram by lines 5 and 6. These two layers are composed of the yellow elastic fibres last noticed, and another set of fibres, white in colour and inelastic in structure, arranged in various directions; the inner layer predominating in yellow elastic, the outer layer in white inelastic fibres,and constituting a firm investment to all the other layers of which the artery is composed. The white inelastic fibres are shown in diagram No. 3, fig. 5,with a yellow elastic fibre curling round them. The constant crossing and re-crossing of these two sets of fibres form certain spaces, which, when not in a * For further information on the subject of muscular analysis, see Retzius in Muller’s Handbuch der Physiologic des Menschen, 1844 ; Mulder’s in his Hollandische Beitrage; Donder, Chemistry of Vegetable and Animal Physiology, translated by Fromberg and Johnston ; and Dr. Kirkes’ Handbook of Physiology, in which he reports as the result of Dr. Donder’s analysis, that when strong nitric acid is applied to any compound of protein, it forms with it xantho-proteinic acid, which with ammonia produces a yellow xantho-proteinate of ammonia. On applying this to the coats of bloodvessels, he found the muscular coat alone assumed the yellow colour which this agent causes, the other parts, as well as the
coats of veins,
remaining unchanged.
,
a, Yellow elastic fibres. c, Nuclei.
b, White inelastic fibres. d, Fibre, with nucleus.
The inner layer of the middle coat, or muscular coat, as it may be justly termed, forms, it will be seen, the greatest part of the thickness of the wall of certain arteries, and in some instances, as in the anterior tibial artery, constitutes nearly the entire thickness of the vessel. The internal coat is in all frequently seen puckered in a longitudinal direction. The arteries are supplied with blood by vessels of small size, which do not come off immediately from the part of the artery they are destined to supply, but principally from neighbouring vessels. They are called vasa vasorum. They are arranged precisely in the same manner as those of areolar tissue. A few of these vessels penetrate as far as the middle or muscular coat, but do not reach the inner, which has no vessels; proximity to the circulating fluid being apparently sufficient for its nutrition. Arteries are supplied with nervous influence by branches from the sympathetic system running in their walls, and through their connexion by ganglions with the organs they supply with blood. I have spoken to you of cells, nuclei and nucleoli, without giving any explanation, believing it to be unnecessary to allude to them before so learned a body. As there may be,
176 however, some few who have not attended particularly to this mother produced twenty-eight living children in the first subject, I may add that histological physiologists and philo- twelve years of her married life. My friend, the late Dr.H——,, sophers are very material persons, especially when much in- well known near Bath, was the thirty-fifth child of his mother. clined to chemical inquiries. They have decided that all of She had I believe another; so that a lady of forty-eight may you, gentlemen, brave, intelligent, learned, accomplished, as perhaps some day be seen taking an airing with some three Malthus and you may be, young or old, handsome or plain,-for I do not dozen of her offspring behind her. What
Mr.
presume to say ugly,-had a beginning when an embryo as a Miss Martineau would say or have said in such a case, I cannot vesicle or elementary cell filled with, and surrounded by a divine. (To be continued.) liquid called cyto-blastema, and containing a kernel or nucleus. This discovery is due to Schleiden in vegetable, to Schwann in animal bodies; and sometimes this kernel exhibits one or more dark little spots, which are called nucleoli. The kernels are CASES OF STRICTURE TREATED BY considered to be little cells united with the original cell; the EXTERNAL INCISION. nucleoli are not satisfactorily proved to be either openings, JAMES BY SYME, ESQ., F.R.S.E., vesicles or solid little spheres, situated at the internal wall of PROFESSOR OF CLINICAL SURGERY IN THE UNIVERSITY OF EDINBURGH. the kernel. The manner in which the cells or main forms of the organic may be proper to repeat that this series of cases is intended kingdom are produced is thus represented by Mulder. In a IT to illustrate and establish the following positions :to sometimes almost shapeless, consistent, gelatinous mass, 1. That strictures of the urethra may be divided by exwhich the name of cyto-blastema or formative substance has been given, containing the materials requisite for the produc- ternal incision upon a grooved director passed through the tion of cells, small round grains or nucleoli are perceived in contracted part, without incurring any of the ordinary dangers the act of formation. Around these grains a layer of granular attending surgical operations. ("I have now operated on matter is deposited, which continually increases in thickness, thirty-eight cases without any fatal result.") 2. That there is no stricture of the urethra through which and constitutes the kernel or nucleus. This is oval-shaped or may not be passed, not by force, but round, almost always opaque, has a granular surface, and such a guide for the knife is considered to be a vesicle, a little cell itself. From the by gentle insinuation, so as to cause neither pain nor bleeding. 3. That strictures of the utmost obstinacy and greatest dissurface of this kernel a small very thin transparent vesicle is to resent interference, even of the gentlest kind, may raised, appearing as a segment of a sphere, which soon ex- position be speedily removed, so as to permit the introduction of thus so when full that the kernel and becomes large grown, pands, lies as a minute corpuscle upon its interior wall; the material full-sized instruments without difficulty or inconvenience. 4. That the relief thus afforded is more permanent than for its formation being supplied by the cyto-blastema, and is converted into a vesicle by the kernel which is first formed, that which can be obtained in any other way. CASE 2.-George T-,aged forty-five, began to suffer from its embryo existing in the formative substance. The first trace of organisation is the production of a small stricture about eight years ago. Between six and seven years perceptible body or nucleolus, which deposits on the surface ago he was twice under my care; first for a short period, a granular substance from the cyto-blastema, to give rise to a during which the contraction was only partially dilated, and little producing organ, the kernel or nucleus. This further afterwards for six weeks, when the process was completed transforms the surrounding cyto-blastema into a granular sur- through the use of simple bougies. He then went to Canada, face, from which the vesicle is formed, raised, expanded, and and was employed in a remote part of the colony as the agent filled with a liquid, in which vesicle thus enlarged the kernel of a mercantile establishment. Finding the stricture again remains enclosed, and adhering to a certain spot of its wall. troublesome, he had repaired to -, where various attempts If two nucleoli lie close to one another, they coalesce and were made to pass instruments, but without success. In become one solid mass, capable of producing one cell only, these circumstances he was advised to seek my assistance; containing one kernel and two nucleoli. This view is that of and having crossed the Atlantic with this view, was admitted Schleiden and Schwann, supported by Mulder, but not entirely into the Royal Infirmary on the 12th of June last. The by Henle; inasmuch as no kernel can be perceived perinseum was greatly swelled and very hard, so as to form approved in the cells of many cellular systems, whilst in the act of with the posterior part of the scrotum one mass of induration. formation. In the elementary parts of animals which have ’, On proceeding to examine the urethra, I found a tight striclong since lost their cellular form, the remnants of kernels are ture anterior to the bulb, through which a bougie of the frequently found, as I have demonstrated in the diagrams before smallest size was passed fairly into the bladder at the first us. The manner however in which the elementary first-seen attempt. I then carried on the dilatation with the effect of granules are formed in the cyto-blastema, science has not yet removing the perinseal hardness, and relieving the patient been able to discover. The chemists have proved that all from his distressing symptoms, so that he was dismissed as elementary organic substances consist of carbon, hydrogen, cured on the llth of September. On the 21st of November he returned in a worse plight oxygen, and nitrogen, susceptible of endless modifications of their respective forces, under which an organic molecule or than ever; the swelling in the perinseum having recurred to ovum is produced, and after that, under certain circumstances, more than its former extent, and there being not only very one of yourselves in man. The learned professor of Utrecht is frequent calls to void his urine, but also an inability of retainnot, however, quite satisfied with his theory of life, and says ing it. I had no doubt that through the use of bougies tem"that his efforts are only to endeavour to discover what means porary relief might again be afforded; but from the repeated the Deity has used to give to organized nature its present relapses which had taken place, distrusting the permanency form, which, he says, is the study of nature. Its aim is to of any good effect obtained in this way, I concluded that diviacquire a knowledge of the laws which regulate it; its highest sion of the stricture would be expedient, and, to facilitate this aim the deduction of even the very remotest results from the proceeding, made a free longitudinal incision through the perivery first causes throughout all their phases." He should nseal swelling, which was afterwards poulticed for a few days. have added-the very first causes human intellect is permitted On the 28th, the swelling having become greatly diminished in size and hardness, I introduced a grooved director, divided to inquire into. Whatever may be the true reading of the book of Nature the stricture, and secured a moderate-sized catheter in the by the histologistical physiologist and chemist, they seem at bladder. The bleeding at the time of the operation and subleast to have made out, in a satisfactory manner, that a sequently to it did not altogether exceed two tea spoonfuls. virgin lady of the bimanus breed carries in her ovaria at least The catheter was removed on the 30th. The urine came four hundred of these cells or ova, ready for use after the partly by the urethra and partly by the wound until the 17th proper application of something which they seem to think of December, when it flowed entirely by the natural channel. analogous to electro-magnetism or a galvanic battery. In the On the 24th the wound was completely healed; instruments of the largest size were introduced and withdrawn without common fowl, nothing is wanting after this, but the application of a well-regulated temperature; and Mr. Cantelo, in the slightest difficulty or feeling of constriction, and the Leicester-square, can with it produce chickens from the eggs perinaeum was perfectly natural in form as well as consistence. more certainly than the hen herself. Luckily, in man, months The patient remained another week, and was then dismissed, are required for this process, and the whole four hundred expressing the most confident persuasion, founded upon the ova cannot be evolved, even if every facility were difference of his feelings from those experienced on any offered. In the museum of the College of Surgeons there is former occasion of relief, that he was at length free from a large bottle, containing five young ladies and gentlemen, all stricture; his reply, when asked how the stricture was, always brought forth at one birth, and destroyed by an accident; and being, "Ihave no stricture now :’ I was for many years acquainted with a gentleman, whose Edinburgh. Feb. 3. 1851.
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