462 dermoid of the scrotum attached to the testicle. The recent increase in size of the swelling was presumably due to the growth of the tumour. The tumour may have arisen (1) from the testicle, in which case the presence of the
a
dermoid is
dermoid;
merely or
(3)
a
coincidence ; (2) from the wall of the some tissue forming part of a
from
teratoma. 1. The tumours with an alveolar structure occurring in the testicle are carcinoma and endothelioma. The carcinoma arising from the testis is of the spheroidal-celled variety ; when the columnar-celled occurs it has arisen in the hypoblast of a teratoma. In endothelioma there are several layers of cells around the lumina, which are either blood or lymph spaces. It therefore seems unlikely that the tumour arose from the testis. 2. The tumour cannot be seen to reach the lining of the dermoid at any point, and the lining is continuous throughout; had it arisen from the lining it would have If the tumour arose been a squamous-celled carcinoma. from some appendage of the dermoid epithelium-e.g., sebaceous or sweat glands-one would expect it to show some signs of its presence within the cyst. Its cells and alveoli have very little resemblance to those of these
appendages. 3. The last alternative-that the tumour has arisen in a teratoma from some hypoblastic structure-seems to have fewer arguments against it than the two preceding. It is true that other tissues-e.g., bone, cartilage, nervous tissue, &c.-so often found in testicular teratomata have not been found in the present case, but any examination short of complete destruction of the specimen is necessarily incomplete. The nature of the cysts containing mucinous substance is uncertain; they do not appear to be mere dilatations of the alveoli of the tumour, since no intermediate cysts are present and the fibrous tissue separating their epithelium from the cells of this tumour is as thick as that surrounding other parts of the tumour. The projection into the cavity of the dermoid, which has been described in other cases as having a different structure from the rest of the cyst, is absent in the present case. In conclusion, I wish to thank Mr. J. G. Pardoe for his kindness in allowing me to publish the case.
Bibliography.—Bland-Sutton: Archives of the Middlesex Hospital, 1903, vol. i. Jackson Clarke : Transactions of the Pathological Society, vol. xlvii. Nicholson : Guy’s Hospital Reports, vol. lxi. Bilton Pollard : Transactions of the Pathological Society, vol. xxxvii. D’Arcy Power : Ibid., vol. xxxviii. Verneuil: Archives Générales de Médicine, 1855. Wilms: Ziegler’s Beiträge, 1896.
A CASE OF EXTRA-UTERINE PREGNANCY OCCURRING TWICE IN THE SAME PERSON. BY W. W.
following ten days became more severe and more continuous, the tumour larger in size, and the discharge more copious,I diagnosed the case to be one of extra-uterine pregnancy, and had the patient removed to the North Ormesby Cottage Hospital, Middlesbrough, under Mr. H. D. Levick, who opened the abdomen next day and removed the distended left Fallopian tube, which upon examination was found to contain a tubal pregnancy of some six weeks’ duration. The right ovary and tube were normal in appearance, and the uterus was only slightly enlarged. The patient made an uneventful recovery. In February, 1908, the patient became pregnant, and in the following October gave birth to a full-time male child. Four months after the child was born the patient men. struated normally, and continued to menstruate normally each month until Sept. 13th, 1909, when she noticed that the period was one day later than usual. On the evening of the 14th a severe attack of abdominal colicky pain set in, accompanied by violent vomiting of bilious matter. A few hours after the pain commenced a slight sanguineous discharge appeared from the vagina. The patient kept in bed, and on the 14th sent for me after having passed what she thought to be a miscarriage. On examination of the supposed miscarriage I found it to be a complete decidual cast of the uterus. The uterus itself was much enlarged, the os uteri was soft and patulous, and in the right fornix could be felt a freely moveable mass, very tender to the touch and dis. tinctly separate from the uterus. Remembering the patient’s previous history, and the fact that the pain in this instance was of the same character, I came to the conclusion that one had again in all probability to deal with a similar condition taking place in the right Fallopian tube. This opinion was confirmed a few hours later, when the patient experienced a violent attack of abdominal pain occurring during the effort to pass urine. She became faint, collapsed and pulseless, and appeared to be in extremis. As immediate operation was out of the question the treatment resolved itself into the administration of cardiac stimulants by hypodermic injection and copious salines per rectum. In a few hours the general condition markedly improved and the patient had some refreshing sleep. Twelve hours after the immediate attack Mr. Levick again operated. Douglas’s pouch was filled with recent blood-clot, which being cleared away brought to view the right Fallopian tube seen to be very much distended. No rupture of the tube could be found, and as no adhesions existed little difficulty was experienced in removing the mass, there being no active haemor. rhage present. On examination of the tube and blood-clots it was found that a tubal abortion had taken place into the abdominal cavity through the abdominal ostium. The patient made an excellent recovery.
STAINTHORPE, M.D., B.S. DURH.
with much interest in THE LANCET of July 9th, p. 101, Dr. G. A. Gordon’s report of a case coming to In a somewhat his notice having the above heading. similar case to be described the two facts-(1) of the patient having given birth to a full-term child in the interval between the two extra-uterine pregnancies ; and (2) that there was practically no cessation of menstruation in the second extra-uterine pregnancy-warrant me in recording it. A married woman, aged 32 years, gave birth to a female child in 1900 ; she enjoyed good health and menstruated regularly until March, 1907, when she noticed the menstrual period lasted one month, during which time she experienced severe colicky pain in the left iliac fossse, coming on at intervals and lasting in some instances a quarter of an hour and at others two or three hours; as the pain became more severe in character the discharge from the vagina became more profuse. On April 9th she consulted me for what she thought was " colic of the bowels." Upon examination a blood-stained discharge was found coming from the vagina. The os uteri felt soft and patulous, and the body In the left fornix a of the uterus felt a little enlarged. tender swelling of about the size of a small pear, distinctly separate from the uterus, was felt. As the pain during the I
READ
Guisborough,
THE
Yorks.
EFFECT OF RADIUM ON THE HEALTHY TISSUE CELL.
BY G. PERCIVAL
MILLS, M.B., B.S.LOND., F.R.C.S. ENG.,
RESIDENT SURGICAL OFFICER, GENERAL
HOSPITAL, BIRMINGHAM.
Tms preliminary note is the result of some experimental work done on the comparative effects of radium on normal and malignant tissues. The mouse was chosen as a suitable animal in which to study the matter owing to the ease with which it can be inoculated with carcinoma. Here, however, only the effect of exposure to radium on the normal body cells will be dealt with. Since the liver is conveniently situated for application, the radium was applied over the anterior abdominal wall and the subsequent changes in the liver tissue were observed. The applicator used was one of 500,000 units and was guarded by a shield which cut off the a and rays, while allowing the more penetrating -y rays to pass through. It was applied for 30 minutes in each case. The mice were billed at varying intervals after exposure and the liver examined
microscopically. The earliest definite change noticed occurred about one hour after irradiation. The liver cells in this section were more granular than usual, and there were none of the cleat glycogen-containing vacuoles which are present in the
463 liver. Otherwise the liver cells themselves The connective tissue elements also showed the early stages of a reaction. This was manifested by the presence of numerous groups of round and spindle cells in the neighbourhood of the veins. There was distinct hyperoemia, but at this stage there was no general increase of the Psycho-therccpy. By HUGO MUNSTERBERG, M.D., Ph.D., &c., Professor of Psychology in Harvard University. London : mesoblastic cells. T. Fisher Unwin. 1909. Pp. 401. Price 8s. 6d. net. Three hours after irradiation the liver cells were profoundly altered. The protoplasm was deeply granular and the THE useful term psycho-therapy, introduced to indicate the nucleus stained very clearly and was considerably swollen. practice of treating the sick by influencing the mental life, The latter averaged in diameter fully one-half that of the even before it was generally accepted by the medical proliver cell, whereas in the normal condition it averages from one-quarter to one-third. The whole cell also was slightly fession, had been seized upon by those whose pleasure and increased in size, but not nearly to such an extent as the profit it is to exploit the little known, and had too often been nucleus. The areas of mixed-celled infiltration round the used to cover an incongruous blend of mysticism and science. veins were larger and more numerouc. They consisted It has been Professor Munsterberg’s aim in this present work mainly of lymphocytes and spindle cells, but there were first to counteract the misunderstandings which prevail on occasional polymorphonuclear leucocytes. There was here also a general increase in connective tissue cells throughout the this important matter, and secondly to state a case for the section. The hyperasmia was intense, but no hasmorrbages further elaboration of the study of psychology during the were observed. process of medical education. There is but little that is new Sections taken six hours after irradiation showed that the in the methods of psycho-therapy, though we believe the term liver cells had become more normal in appearance. The itself to have been but recently devised ; but there is no protoplasm was no longer granular, but the nucleus was doubt that the systemizings of the method under scientific still enlarged. The hyperasmia was less, and there was less as well as the use of analogous methods by religious infiltration with connective tissue cells than in the previous auspices, section. and quasi- or pseudo-scientific bodies, have attracted a vast In 24 hours the vast majority of the liver cells appeared amount of notice to a subject which has, unfortunately, in the normal. There were, however, scattered about the section a, received but the scantiest attention at the hands of our few cells which appeared to have degenerated completely. past The in which we live is, perhaps even age With hasmatin and Van Gieson’s stain the protoplasm stained profession. more than the age of the last generation, one in which a dull brown and the nucleus a darker brown, showing no It is probable that these were cells philosophic thought lay for the most part in materialistic structure whatever. which had failed to recover from the condition noted categories, in a perpetual and very praiseworthy hunt for I above. the connexion between the appearances of our experience While these changes were found in the liver generally, that the perfection of technical there was in most of the sections a place near the edge where and in the profound belief the cells had suffered a greater and permanent change. civilisation can make life more worth living. The author There was in the sections taken three hours after irradiation believes that while the real achievements of the age will a mass of liver cells which had completely lost their leavea permanent mark, that yet there are signs proving the The outline of the cell was lost, the nucleus realistic wave to be structure. ebbing and a new period of idealism to be stained a fair structureless brown, and the condition ’’ The aim of the last generation was to explain the A similar condition was rising. resembled coagulation necrosis. next will be to interpret the world ; the aim of the the found in the sections examined up to the eighth day after world, one was and in the later ones some of seeking laws, the other will seek ideals." Psychoirradiation, organisation signs of the affected part were observed. Presumably this mass therapy has the two tendencies in its composition ; there is of necrosed tissue corresponded to the spot immediately something of the naturalistic movement and something of over which the radium was applied, and represents the effect the idealistic, and the mixture results in a confusion which of the rays at very close range. It is of interest that in no is detrimental. To reduce this confusion to order must be case was any inflammation of the skin observed. this of intense the liver area action, then, Neglecting may the work immediately before us. be said to have become normal again in three days after In Part I. of his book Professor Munsterberg sets himself irradiation. A few areas of infiltration remained near the to expound the psychological basis of psycho-therapy. veins, but as these occurred to a slight extent in some normal In chapters on Mind and Brain and Psychology and livers they could not be considered pathological. Similarly, at intervals of five and eight days after irradiation the main Medicine we have most interesting accounts of that mass of the liver appeared to be normal. aspect of the borderland between psychology and metaIn the sections taken 14 and 15 days after irradiation, physics which appeals to a slowly increasing group of however, there were obvious signs that a second or late philosophers who appear to derive their inspiration from reaction was taking place. This was confined to the conthe teaching of Hegel. Our inner life can be looked nective tissue elements and consisted of a marked general at from two most opposite standpoints-the purposive infiltration of the liver with lymphocytes, connective tissue cells, and a few polymorphonuclear leucocytes, and this to a and causal, the latter being an abstraction in the realm greater extent than in any of the sections taken during the of psychology from the former, which is immediate and few days immediately following irradiation. There were non-psychological. To the physician as such, however, also large masses of similar cells clustered round the veins. the interest in mental life lies in the aim of producing These changes were associated with a general hypersemia. No area of necrotic cells was observed. It would appear that a certain effect-namely, that of health-and to him the this is the histological basis of the radium reaction " mental life of the whole personality comes in question as observed clinically by radiographers, and it is of interest to belonging to a causal system-that is, to the domain of note that it is confined to the connective tissue elements. scientific psychology. It must be remembered also that This late reaction lasts longer than the initial one, for 20 faith in the processes of psycho-medicine by no means leads days after irradiation the liver was still found to be in a to a of other means at our hands. Even as in the neglect similar condition. an unconscious the of effect radium on normal past, psycho-therapy has been used as an tissues as Briefly, then, exemplified by mouse liver is a follows: 1. There is a adjuvant to drugs and other physical therapeutic agencies, transient change in the liver cells somewhat resembling so now where psycho-therapy is consciously employed other "cloudy swelling." 2. There is an early inflammatory and adjuvant means should not be neglected. Herein lies reaction lasting a few days. 3. There is a late inflammatory bodies which Tpaction coming on in about 14 days and lasting much at least one of the errors of those unscientific normal
mouse
appeared normal.
Reviews and Notices of Books.
I
longer.
Birmingham.
practise psycho-therapy on a vast scale ; therapeutic process is relied upon to do that
the
psycho-
which in
our