MICROSCOPIC ANATOMY OF THE SPLEEN IN MAN AND MAMMALIA.

63

improvement

our opinion of on the bronchial respiration has decreased’, into a mucous rattle, which is now heard in the left as well as in the right lung, the cough is more rare, and the’ I sputa of a different nature; they are critical sputa with out any admixture of gall. The morbid process is proceeding towards a resolution, but has not yet entirely disappeared ; hence proceeds the necessity to continue with the antiphlogistic treatment, but in a more moderate degree. We will continue with our prescription, but reduce the dose to one-half. 24. The satisfactory state in which we left our patient yesterday not only continues to-day, but there is even The an improvement on these favourable symptoms. fever is entirely gone; the pulse is soft, 68 in the minute; the secretion of the skin tolerably copious; the urine discharged in greater quantities, clear, and only troubled with mucus. The state of the local symptoms is likewise favourable ; the cough only appears in the morning, and throws out normal sputa; the bronchial respiration has no where returned, and the mucous rattle has taken its place. The only thing the patient complains of is fatigue, but at this you will not wonder. I will not speak of the individuality of the patient, who is not athletic, but of the morbid process he has gone through, which required, besides a spare diet, copious bleedings, nitrate of potash, tartar emetic, digitalis, &c. It, therefore, now becomes the more necessary to decide whether the continuance of these remedies be necessary, or whether we may hope to attain our end without making any further use of them by a more negative than positive way of acting. But, perhaps, it would now be time to have recourse to the strengthening method-a method which has not only been discussed, but actually put into practice by the majority of physicians. To this method I must declare myself a decided opponent, since it is my firm belief that it has done a great deal of harm, and particularly given occasion to relapses, the source of which is to be found in the remedies made use of. According to the old method of examination, and to the modern physicians who refuse to make use of the new means of exploration (the stethoscope), the disease, once arrived at this point, seemed difficult to manage. As you see very plainly, in this case there is no fever ; the skin is moist; the urine natural;but little cough ; the patient does not complain-phenomena which all seem to tell the physician that the convalescence is complete. Why not now, to supply the loss, nourish the patient well ? Why not give him bark and bitter medicines to stimulate his appetite ? But if we follow this plan the fever soon reappears in the evening, the cough returns, and then we hear the patient has had a relapse. The physician might have steered clear of this error if he had made use of the stethoscope. Thus the pre-eminence of the new mode of investigation is apparent, not only during the illness, but also towards its end. The stethoscope shows us that the bronchial respiration is gone, but in its place we hear the mucous rale, and not yet the great bubble murmur ; therefore there is no restitutio in integrum, no restitution of matters as they were before. To give, in this case, wine, bark, bitter medicines, would be pouring oil upon the fire. We shall, therefore, act negatively, not positively ;discontinue the digitalis and the nitrate of potash, and only prescribe a solution of gum (six ounces) with cherry-laurel water (two drachms), and alternately every hour, to facilitate expectoration, a powder of hydrochlorate of ammonia (two grains) with sulphur (a quarter of a grain) and powder of gum (ten

However,

physical

grains).

we

ground

facts;

2f). The pulse, skin, tongue, and urine, show not a trace of the former symptoms, our chief attention is therefore directed to the state of the organs of respiration, in judging of which we are to rely, not upon the subjective signs (no pain, free breathing), but upon the local examination. The right lung is healthy, but in the depth of the left lung there is still a little mucous rale, and the respiratory murmuring is not yet quite clear, but nothing of bronchial respiration or crepitation remains ; the expectoration is moderate and globular. In this case the inflammation had spread itself, after the relapse, over both luikgs, which, since the earliest times, has been

considered an unfavourable circumstance. P. Frank has even declared pneumonia duplex to be absolutely fatal, which, however, is only the case when the inflammation has invaded both lungs entirely, so that not a single healthy part remains, when the catastrophe is certain. But that an inflammation, co-existing in bmh, lungs, is absolutely fatal, is an error, as your own experience in several cases witnessed in this hospital, besides the present one, proves. The favourable state of the patient made daily progress; the cough gradually dis4ppeared ; the respiratory murmur returned; all traces of fever vanished, even in the evening ; the crisis was terminated; and, in the beginning of August, the patient was sent into the convalescents’ ward.

ORIGINAL COMMUNICATIONS. MICROSCOPIC ANATOMY OF THE SPLEEN IN MAN AND MAMMALIA.

EVANS, M.D., London. ROYAL SOCIETY.] the before [Read

By W.

JULIAN

THE spleen in man and the other mammals always observes the same relative position within the abdomen. It differs widely in shape and external form in the different genera, and somewhat also in internal appearance, yet the latter always sufficiently preserves its distinctive character to prevent the organ being mistaken for any other. The differences which it presents internally in different animals arise from the greater development of one or more of its component parts in some than in others; so that although its structure is composed of the same number and variety of elementary tissues in them all, and these tissues are similarly blended in each, giving to the organ an uniformity of structure throughout this class, the spleens of certain animals are preferable to those of others for the demonstration of particular parts. When the spleen is laid open, its internal structure appears to consist of a reddish-brown pulp, occasionally almost fluid in consistence; but on a closer examination this tissue is found to offer a certain degree of resistance to the forceps in consequence of its being intersected by small fibres. In this state it presents no appearance of cells. But when inflated from its vein and then dried, its structure will be found to consist of cells and spaces which separate the cells from each other. If a portion of spleen be placed under a gentle stream of water, the reddish pulp is wasted away, and a reticulated trabecular network remains. This network is composed of vessels, nerves, and of fibres of a peculiar elastic tissue. These fibres arise from the enveloping membrane in small nbrill ; they enlarge during their course, becoming much thicker and more expanded in some places, and again diminish in size in others. They intersect each other in all directions, twisting about throughout the organ, and form a kind of skeleton, which possesses great elasticity. If we watch this process with care, it becomes evident that the pulpy matter has been washed away from arotind the fibres, and that the spaces between the ramifications of the latter constitute what, in the inflated spleen, are found to be cells. By these two methods of manipulation we ascertain, Ist, that the spleen consists of cells and intercellular spaces; 2ndly, that it consists of a reticulated skeleton, composed of a fibro-elastic tissue, and a reddish coloured pulp or parenchyma; 3rdly, that the reddish coloured pulp or parenchyma separates the cells from each other; and that the spaces between the trabecular structure form the cells. , In describing the anatomy of this organ I shall follow the arrangement which nature points out, and divide the. subject into, I st, the cells ; and 2nd, the substance which separates them from each other. To make the description more intelligible I will, however, enumerate all the constituent parts or tissues which enter into the formation. of the spleen, leaving a detailed account of each to be given in its proper place. They consist of- I,thearteries, splenic 2, veins ; 3, nerves ; 4, transparent vessels ; 5, corpuscles, or granules, from which the transparent

64 vessels appear to arise; 6, Malpighian glands; 1, reticu- the fluid being retained within it. From this we might lated fibro-elastic tissue ; 8, cellular membrane ; 9, blood; suppose that it had dll7’ing life possessed another contrac10, the fluid contained in the transparent vessels and tile property besides elasticity. To examine the cells well we must first inject minutely Malpighian glands; 11, investing membrane, or tunica propria; 12, peritoneal covering. Such are the anatomi- the splenic artery, either with chromate of lead or size; cal elements of the spleen; but a mere description ofthen inflate the cells from the vein, and either hang the each would add little to our knowledge either of its ana- organ up to dry, or lay it open under water. The spleen tomy or physiology, to arrive at which we must also of the sheep, ox, or horse, is best adapted for the purpose. know how they are arranged and blended together, so as Thus examined, the cells are found to be formed of a to form the entire organ, for which reason I have thought framework or skeleton of fibro-elastic tissue, formerly fit to divide the subject, as just mentioned, into the cells mentioned, and a membrane spread over it, filling up the and intercellular substance. framework and lining the cavity of the cell. This memThe Splenic Cells -From the time of Ruysch the brane completes the formation of the cell and separates existence of cells in the humrrn spleen has been almost the parenchyma from its cavity. It is a continuation of universally denied; on what grounds it would be difficult the lining membrane of the vein. Nearly all of the cells to say, for nothing is more easy than to convince ourselves are traversed by filaments of the fibro-elastic tissue, imthat the spleen of man, as well as of the other mammalia, bedded in which a small artery and vein may frequently is distinctly cellular. By inflating the organ from the be observed; over these filaments the lining membrane is splenic vein it acquires a size double or triple that it had reflected in folds, and in this manner each cell is incombefore. If, in this state, it be hung up until dry, and pletely divided into two or more smaller compartments. then laid open, its cellated structure becomes apparent. The cells communicate with each other by means of cirMany of those, however, who have most strenuously cular openings formed by a reflection of their lining memdenied the cellated structure of the spleen in man brane upon itself, each cell having one or more of these have readily admitted it in that of the graminivora. I openings. It is by means of these communications that air or liquid introduced into one cell passes into all and can only account for this by supposing that such an opinion was formed without a sufficient investigation ; for it distends the entire organ. Besides these openings the is very certain that we cannot always succeed in showing cells communicate, as we shall presently find, with the the cellated structure of this organ in spleens taken out splenic vein and its branches, by means of oval or circular of the dissecting-room, by means of inflation. This foramina, leading directly from the cavity of the vein into arises either from the cells being filled with blood in a the cells (of course this communication is found only in semifluid or coagulated state, or in consequence of the those cells which arise immediately from the vein). There organ being injured in its coats or elsewhere. The cells is still a third kind of communication, viz., between the may be shown also by the injection of tallow (or any cells and the small veins which return the blood from the other substance proper for the purpose) into the splenic capillaries of the organ. vein. I When the splenic artery has been well injected, its The size of the cells, or the ratio they bear to the paren- branches are found to ramify minutely over the parietes chyma, we have no means of accurately ascertaining. of the cells, being separated from the cavity by the lining Their size will, of course, depend upon their amount of membrane; they appear in bold relief in consequence of distention. The spleen of a sheep, weighing four ounces, their traversing filaments of the trabecular structure which will contain thirty ounces of water thrown into its cells, surrounds them like a sheath. Many of the arterioles without apparent injury. If another be distended to the are seen to terminate in a rounded extremity from which same extent by inflation, and when dry examined, it minute capillaries arise as rays from a centre; but there appears to consist entirely of cells of considerable mag- is no direct communication between the arterioles and the nitude, the intervening parenchyma, partly from pres- cells; on the contrary, they are seen to end, as elsewhere, sure, and partly from being dried, is reduced to merely in capillaries, and these in minute short veins which membranous-looking septa. The human spleen, when carry the blood into the cells. manipulated in a similar manner, affords the same Besides the above appearances, M. Bougerie has lately results, except that the parenchyma preserves a much described minute floating glandular bodies scattered larger ratio with respect to the cells, and thelatter are through the cells, suspended to the extremities of minute capable relatively of containing a smaller amount of in- arteries and lymphatics, to which he has given the name jection ; in other words, the proportion of parenchyma of corpuscules vasculaii-e3 jlotlans, Since I have been in which enters into the formation of the spleen of man to possession of his work on this subject I have over and the capacity of the cells, is considerably greater than in over again sought for these bodies, but without success. The splenic vein, joining the trunk of the vena portae the graminivora. A frequent condition of the human spleen found after at an obtuse angle, runs towards the left side, and meetdeath, which is sometimes described as a peculiarity of ing the splenic artery, it divides, in man, into several inorbid organisation, giving a granular appearance to the branches, each of which, accompanied by a correspondorgan, consists in the cells being filled with firmly coagu- ing branch of the artery, plunges suddenly into the spleen lated blood. If this be taken as a fair criterion of the and immediately subdivides into smaller branches. These average distention of the cells during life, I should de- smaller branches are pierced with numerous small holes scribe them as being pretty uniform in size, pentagonal which communicate directly with the cells. At a still further distance from the trunk the holes became larger, or hexagonal in form, and from one-third to half a line in diameter; but I repeat that we can form no correct more elongated in form, until at length the coats of the opinion on the subject, as the elasticity of the organ vessel no longer form a continuous whole, but seem sepamight admit of a distention greatly beyond this without rated into filaments, producing the appearance of extensive lacerations, and thus the vein is ultimately lost in exceeding its normal limits. Although we have no means of measuring exactly the the cellated structure of the organ. In the herbivora this size of the cells in any animal, we know that their dilata- arrangement commences immediately on the entrance of (,ility is greater in some animals than in others. It is the vein into the spleen. As the tunics of the vein split greatest in the herbivora, and least in man, and up, as above described, the internal one can be traced into the cells, of which it forms the lining membrane and seems to be in proportion to the elasticity of the entire organ. Thus, in the human spleen, not only can we falciform or curtain-like septa. The outer tunic seems to throw a proportionably small quantity of injection into merge in the filaments of the fibro-elastic tissue. The splenic vein in all animals of the first class is very the cells from the splenic vein, but the injection returns ilowly when the syringe is removed; whereas, however large, almost equal in size to the trunk of the vena portx. fully we may distend the cells in the sheep, ox, or horse, Like all the veins of this system, it is unprovided with the injection is returned immediately with considerable valves. Injection thrown into it passes with the greatest force, and the organ is restored immediately to almost facility into the splenic cells, the only obstacle to the its former size, more particularly when the animal has operation being the elasticity of the spleen, which a died from haemorrhage. It never, however, is restored to moderate force is sufficient to overcome. The facility trie small size it possessed before, a certain quantity of with which the cells are filled from the splenic vein, is

65

explained by the abrupt way in which the latter commu- spleen, we immediately find that it is not the half-fluid nicates with and terminates in the former,-an arrange- pulp that its appearance would indicate; on the contrary, ment admirably adapted to admit of such a phenomenon, ’, we have to employ some force to tear away even a small for the cellated structure of the spleen is nothing more portion, in consequence of its being intersected by what nor less than a multilocular reservoir, receiving, on the appears to be minute fibres. Having torn away a small, one hand, the blood of the organ itself, and, on the other, portion and gently pressed it between two pieces of glass, that of the abdominal venous circulation, whenever its an unctuous-looking fluid, of a reddish-brown colour, passage into the vena cava is obstructed. escapes, and the remaining portion, if shaken gently in a The Trabecular Structure.-The arrangement of this little water, puts on a cottony or tomentous appearance. structure has been already described. It passes in all The former is the liquid known under the name of liquor directions through the organ ; it possesses great elasticity, lienis, or splenic blood. The latter, viewed under the microand is probably identical in structure with the tunica scope, appears to consist of vessels of capillary minute-, propi-ia, from which it appears to arise, or with which, at ness, and granules which are but indistinctly seen. The liquor lienis, or red blood, expressed as above deleast, it is most closely connected. To its elasticity, and that of the tunica propna, are to be referred the great scribed, when diluted with serum, and placed in the field increase of size of which the spleen is susceptible, and of the microscope, is found to contain two kinds of its return to its former size when the cause of the increase organic particles,-the one kind being ordinary bloodis removed. It forms an additional coat or sheath to particles ; the other, smaller, globular, and nucleated, many of the arterioles, enters into the formation of the resemble exactly the globules found in the lymphatic, Malpighian glands and their attachments, and forms a glands of the animal. The cottony substance which remains, when examined trellis-work, around which many lymphatic vessels are in water and rendered sufficiently minute, is found to seen to twine, while others of these vessels run in the interior of its structure, either alone or in company consist of a sanguiferous capillary tissue, filled with the inwith an arterial branch. This tissue is best studied in jection which was thrown into the artery; a set of capillary the horse. It has been supposed to be muscular, and has vessels, into which the injection has not penetrated, but been compared to the columnae carneae. This opinion is which are transparent, and the larger of which are seen to supported by the fact that certain medicinal agents are possess valves; and a number of corpuscles, much smaller said to possess the property of exciting its contractility than blood-particles, pretty uniform in size, spherical in when taken into the stomach. It is quite certain that shape, and usually corrugated on the surface: these the salts of quina possess this property. I have observed bodies I denominate the splenic-corpuscles. To examine it in cases of intermittent fever oftener than once; but I the whole of this minute structure accurately we should by no means am certain that the diminution in size of take the small piece of parenchyma already employed, the organ depends upon an inherent muscular contrac- lay it carefully in a drop of water on a piece of glass some tility which it possesses and which the medicine excites. hours after the former experiment (during which time it Under the microscope this tissue has not the appearance should have remained macerating in water until all the of muscle. It closely resembles the tunica ]1/’opria-is blood-particles are dissolved, and the tissue has become fibrous-is similar to what have been called fibro-elastic opened and diaphanous), and then examine it as a transtissues elsewhere. parent body with a compound microscope possessing a Envelopes of the Spleen--The external covering of the a magnifying power of four hundred diameters. We then spleen is that which it receives from the peritoneum in observe that between the meshes of the sanguiferous capilIn man laries are strewn innumerable quantities of splenic corcommon with the other organs of the abdomen. it is united very firmly to the subjacent tunica roprM; puscles about dõö or of an inch in diameter, and conthis union is effected by a loose cellular tissue, and the nected with each of them, and apparently arising from them, vessels are seen more minute in diameter than two are easily separated. Tunica propria.-This tissue is corpuscles themselves. Several of these minute vesevidently fibrous, and, as we have seen, is possessed of great elasticity. It has been supposed to be muscular, sels soon unite and form a trunk, which in its turn unites but there is not, I think, sufficient evidence to support with another of a similar kind. The larger trunks are such an opinion. In the herbivora it adheres so firmly transparent to allow us to distinguish valves to the subjacent parenchyma that the two cannot be sepa- intersecting them, as in the external lymphatics. rated without injury to the latter; while, in man, it can 7hf
transparent the

sufficiently

light,

66 eflt0r and pass out of them, but a number of lymphatic vessels also. When one of these bodies is separated entirely from the parenchyma which surrounds it (which is not very readily done), it is found to possess considerable firmness; and if it be laid open under water, a milkylooking fluid escapes, which falls to the bottom of the glass. When examined under the microscope this fluid is found to be contained in part in minute vessels, or parts of vessels, and in part extravasated in consequence of injury, and in it are numerous spherical nucleated particle’s, to which it owes its white appearance and opacity, and which are precisely similar to those contained in the milky fluid expressed from a lymphatic gland. They are abøut one-third or one-half the diameter of a bloodparticle, when seen in water, but, by drying, become smaller and shrivelled. After the escape of this fluid, the interior of the Malpighian body sometimes appears to possess a small cavity, but for the most part it is filled by a network of minute arteries and the vessels which contained the fluid. In man the Malpighian bodies are seen with great difficulty, except in certain cases, owing partly to their not being arranged in bunches, as in the sheep, partly to their strong connection with the parenchyma, and partly to their colour, which is rarely so white as in the herbivora. In man they are generally arranged in palmated branches, and are placed one over the other. In all other respects, except that they are smaller, they resemble those in the From their organisation, their general ox and sheep. appearance, their contents, and the fact that vessels are seen to enter and pass out of them, which must be lymphatics from their structure, I think we can entertain little doubt that these bodies are nothing more nor less than lymphatic glands. That in them the minute particles which resemble lymph-globules are formed, appears probable; at least, I have not been able to trace them in any of the transparent vessels before their arrival at these glands, whereas in the tortuous lymphatics in their interior, and in the efferent vessels, they can be observed in numbers.

ments of the fibro-elastic tissue, which serves the vessels of this series as an additional strong coat or sheath, giving them support and protection during the changes in volume to which the spleen is so liable. This series of arterioles, continuing its course in the fibro-elastic tissue, again subdivides, sending off branches, some of which penetrate the

Malpighian glands, run superficially through them, and again emcrge in longpencillated tufts, which are lost in the capillaries of the parenchyma; others ramify, in company with the vessels described as lymphatics, in the interior of the glands. Another set of arterial branches are sent to the cells, over the parietes of which they are seen to ramify, separated from the cavity by its lining membrane. For the most part they are observed to terminate, as elsewhere, by repeated subdivisions, until they become capillary in size and arrangement ; but they also terminate in another manner very frequently, and many such terminations may be occasionally seen in each cell, that is, by an enlarged club-shaped extremity, from which numerous minute capillaries suddenly spring, like rays from a centre. I think it probable that it is this arrangement which has been described by M. Bourgerie as corps vasculairesflottans. To me they appear simply what I have described them to be. On injecting the splenic artery, these vessels of the cells are liable to rupture, and the injection may thus be extravasated, the cells being filled, although the capillaries are not injected. When a portion of spleen, which has been laid open after the artery has been injected, is examined, we observe stellated spots of injection scattered over it. By gently agitating it in water, these spots are found to be formed of bunches of arterioles, which gradually display themselves as they become unfolded. This induced Ruysch to deny the existence of Malpighian bodies in the human spleen, for he evidently mistook these little bundles of convoluted arteries for those bodies.

Pare2ichyma. -When the spleen has been and carefully distended by means of injection thrown into its vein, not only are the cells filled, but the whole of the external surface of the organ is covered with a vast number of arborescent veins, which appear as if painted upon it. They are wide in proportion to their length, and present somewhat the appearance of a fernleaf, from the way in which they unite to form a wide trunk, which can be traced to the nearest cell, where it empties itself. These veins bring the blood from the capillaries of the organ. Frequently several of these veins empty themselves into an elongated cell or canal, formed in the usual manner, but resembling somewhat, in miniature, a sinus of the dura mater. These veins are visible in the interior of the organ, as well as on the outside, and in that situation have even more of an arborescent appearance. Lymphatics of the 81)leeit.-I have already described a. set of minute transparent vessels arising from, or connected with, the splenic corpuscles. These vessels gradually unite and form trunks, which can be traced from the parenchyma into the Malpighian glands, from which, after numerous convolutions, they emerge fewer in The splenic artery in man, previously to its entrance number but larger in size, accompanying the arteriole into the spleen, divides into several branches. Its size is which supplies the gland, or assisting to form the stalk to great compared with that of the organ itself, particularly which the glands are attached in branches. The larger in certain persons who have resided in some of the un- lymphatics are already well known ; they consist of two healthy climates of the tropics. It is generally equal in size sets, an external and internal one. The external lympha to the hepatic, and sometimes larger. In the herbivora it tics are situated between the peritoneal coat and the is much smaller proportionably to the size of the spleen tunica propria. They are very large in the herbivora, than in man (although the accompanying vein in these and easily injected with mercury. In man they are very animals is very large), and it entersthe organ entire, or, at small but numerous, and terminate, in common with the most, dividing into two branches. With these exceptions, trunks from the internal set, in numerous lymphatic this artery differs in no respect in the different animals of glands at the sulcus of the spleen, or around the trunk of thefirst class. Each of its subdivisions goes to a separateI the splenic artery in brutes. The deep-seated lymphatics portion of the organ, and does not communicate with the are both large and numerous in man, but smaller in the remaining ones; so that, to inject the whole, it is neces- sheep and ox. They pass out of the spleen in company sary to do so from the common trunk, or from each sub- with the artery and vein, and they can be traced backdivision separately. This arrangement is continued wards accompanying the subdivisions of the artery. I through all the small branches. The arterioles on the have never succeeded in injecting them either backwards parietes of the cells anastomose freely, but anastomosis with mercury, or from the splenic artery, as has been said between the larger divisions is not common. When the to have been done by others. This is the less to be regretted, artery enters the spleen, and even in its first or as by a little trouble they can be traced along by the side second series of branches, it presents no other covering of the artery, and in the parenchyma they are discovered than its proper coats .but the next subdivision enters fila- by their transparency. Veins of the

fully

z

&mid ot;

67

closely questioned on the point he admits that he has at subject to a beating in the chest. His pulse 76, regular, and no thrill can be detected; nor does the very numerous, particularly in man. The nerves of the spleen are large ; they accompany the stethoscope lead to the discovery of any inordinate sound like that of aneurism; but a dull sound is yielded by artery, and are lost in the parenchyma. The cellular tissue is smaller in quantity, and does not, percussion in the left thoracic cavity. 11. At a quarter to nine, a.m. he had a violent paroxysm properly speaking, enter into the structure of the organ. It consists only of the cellular envelopes of the vessels and of difficult respiration, from some obstruction (as it apnerves, and on their entering the spleen it is soon lost. peared) in the trachea, under the upper portion of the The lymphatic glands at the sulcus and around the

artery

and vein in which both these sets

terminate,

are

times been

I

.

From what has been stated I think

we are

entitled to

draw the following conclusions :-That the spleen is a double organ, and performs two. sets of functions ; the cells and splenic vein performing one function, the paren-

His face and hands became purple and the attack lasted about ten minutes, during which time he lay struggling for breath and all but suffocated. At last he hawked up a little tenacious mucus, the constriction gradually abated and the purpleness disappeared. Tincture of squills, sweet spirits of’ nitre, gum mucilage. Noon. He breathes freely, his pulse is now somewhat accelerated, and I fancy I feel more action than natural about the region of the heart, but it is trifling and obscure. He has some pain in the forehead, probably from disturbed function. Although by degrees, and custom, I believe the brain becomes capable of bearing a certain admixture of venous blood without its producing such deleterious effects as those described by Bichat; for some live on with the foramen ovale open, and reason well in spite of their blue countenances. ! Night. His skin is hot, his respiration hurried, and his pulse quick ; but he appears too weak to admit of sternum.

distinct from the former. The cellated structure may be considered as a multilocular reservoir, capable of great distention, lined with a continuation of the inner membrane of the vein ; receiving blood, on the one hand, from the veins of the interior of the organ, and transmitting it onward to the vena portae; and, on the other hand, acting as a reservoir for the blood of the venous circulation of the abdomen, when, from any cause, its passage into the vena cava is obstructed, the venous character of the cellated structure permitting the blood to remain within it for some time without change. The intercellular substance, or parenchyma, is both anatomically and physiologically different from the above. In those animals in which it predominates, as in man, the artery is large ; on the other hand, where the cellated struc- more depletion. 12. He has expectorated some thin mucous fluid, his ture is in excess, as in the herbivora, the artery is com- ! is less obstructed, and pulse more natural. is and but the vein breathing paratively small, large performs 13. Just before daylight he had another violent attack other offices than merely throwing blood into the cells. The artery is distributed principally to the paren- of dyspnoea ; eyes staring, face and hands purple, chyma. The office of the parenchyma would appear to violent struggling, sitting up in bed, loss of speech, inbe that of separating something or other from the quantity sensibility, respiration ceased, and he lay, as the messenger of blood with which it is supplied. This would appear to reported, dead. Hearing this I jumped out of bed, be a transparent fluid, most probably the liquor sanguinis. clothed, and ran to the patient with a scalpel in my This fluid passes along the smaller transparent vessels, and sleeve, and found no signs of life except temperature. is carried by them to the Malpighian glands, in which it j Tracheotomy was immediately performed, but he lay undergoes a change, for it is now found to contain nume- motionless, and showed no indication of pain. As soon rous organic particles which give it a white milky appear- as the scalpel entered the trachea, dark blood flowed out from within in large qnantity. The patient was inance. From these bodies it escapes by the vasa efferentia, which are ultimately traced to the lymphatic glands stantly laid upon his face, with his head low, in order to which surround the trunk of the splenic artery. The drain it away. After about thirteen ounces had escaped, splenic parenchyma may be considered as a complex lym- he still lay inanimate. As the opening (though large enough) seemed to give phatic tissue. In this paper I have avoided all allusion to the labours no relief, an elastic gum-catheter was passed by the orifice of my predecessors and contemporaries, not that I have in the throat down to the bronchi, hoping to render the neglected to acquaint myself with what others have done passage free. The irritation of the instrument (as I conin this intricate inquiry, or that I do not fully appreciate clude) produced spasmodic action in the respiratory the meritorious efforts of many among them, but because muscles, which caused more blood to be expelled by the I wish to confine myself, in my description of the anatomy nose, mouth, catheter, and wound, followed by a feeble of the organ, within due limits, and a reference to the attempt at respiration, which recurred at long intervals ; opinions of others would lead me further than either my and at each dark blood gushed out with a guggling noise, time or the space permitted in these columns would he was at last enabled to breathe a little. The pulse now became perceptible at the wrist, the circulation imallow. proved, the bleeding ceased, and the purpleness of the CASE OF TRACHEOTOMY IN ASPHYXIA. hands and face gradually diminished. After a little more RESUSCITATION. time he recovered the power of articulation, but talked ULTIMATE DEATH FROM ANEURISM EMPTYING ITSELF incoherently. He swallowed some warm water given to wash out his mouth and throat ; and, in about an hour, I INTO THE TRACHEA. had the satisfaction to leave him breathing tolerably in H. the Scots’ W. JUDD, Esq., M.R.C.S., Surgeon By Fusilier Guards, Member of the Royal Society of freely, through a portion of catheter upwards of seven inches in length. It should be observed that but a few Antwerp. drops of blood flowed from the incision, which was an DEC. 30, 1835. Robt. A., setat. 31, a thin, active, ruddy inch and a half in length. Nine a.m. He has had another attack of difficulty in person, of middle stature, with lips, perhaps, a shade and his breathing is not yet free. Tincture respiration, of from more purple than usual.* suffering Complains camphor mixture. pains about the clavicles and between the scapulse. He of opium in Nine. His breathing has become more free Half-past has a slight cough without expectoration ; his breathing and the circulation is stronger. The lips are no longer seems a little hurried, but so triflinglythat he did not mention it. Pulse 70, even and regular; no inordinate action of purple, and since the last improvement he has talked the heart can be felt, or unnatural sounds heard through rationally. He retains his voice, although it is almost a the stethoscope; the carotids do not beat violently, the whisper with little intonation. States he has no knowledge of the operation being perveins of the neck are not unusually turgid. Bleeding to sixteen ounces (blood inflamed) ; calomel and colocynth formed. He has taken some tea. Ten p.m. He now lies on his left side, breathing freely, pill, infusion of senna. Jan. 6, 1836. The symptoms remain the same, and he but has fits of coughing, during which some blood and still complains of pains about the shoulders. After being mucus have been expelled through the wound and catheter. He dozes comfortably. * The colour of the Noon. His breathing is tolerably free and his pulse so of aneurism lips led to and the use of the stethoscope. low it can but just be felt, and he seems weak.-R Sesqui-

chyma another, totally

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suspicion