fectly fluid and clear throughout; but in the majority of cases, the granular contents bioplasts pass on to further changes of the motionless masses frequently escape from the vacuolated" bioplasts, leaving the appearance of a hyaline capsule, and resulting in the formation of a spherical aggregation of granules, "such bioplasts, in passing through the various changes described,
the
"
will
come
characters
present every modification of appearance and presented by those found in the discharges of patients to
suffering from cholera." " There is one class of bodies in the evacuations, the nature of whicli has hitherto been peculiarly puzzling and obscure, namely, that of flattened, whitish or paleyellow hyaline cells, showing no evidence of stucture or contents, but observations on the changes occurring in the bioplasts of the blood, explain the nature of these also, for the empty capsules persisting after the escape of the molecular contents of the puslike cells are exactly similar to the hyaline bodies of the evacuations." These hyaline cells, resulting, as above described, from the escape of the granular matter from the vacuolated" bioplasts, take some days, and it may be weeks, in forming, and having formed, we are told that " the persistence of these capsules (or hyaline cells) is wonderful, considering their extreme delicacy." Our authors, it will be noticed, now identify these hyaline cells produced from bioplasts, with those described by them as the " peculiar corpuscles" of Dr. Parkes, and noticed by him as occurring in the stools of patients suffering from cholera. It is quite possible that the hyaline cells found in cholera-stools, and those described by Drs. Lewis and Cunningham as occurring in the decomposing organic matter of the blood, may be similar in appearance to those found in the stools of cholera-patients; but the " hyaline bodies produced from bioplasts are wonderfully perthe cells of the cholera-stools are whereas sistent," hyaline it is true their rapid disappearance may remarkably evanescent; be due, in some measure, to the alkaline fluid of the stools ; nevertheless, the fact remains that their existence is a matter of a few hours, as opposed to the persistent character of the hyaline cells, produced from changes in decomposing human blood. "We do not pretend to dispute the fact, that bioplasts in considerable number may find their way from the congested vessels of the intestines in cholera into the intestinal canal, and be washed away into the rice-water stools; but Drs. Lewis and Cunningham have much work before them ere they can convince us that the hyaline cells in cholera evacuations are formed from changes such as above described, taking placo in tho bioplasts of the blood. We are far more disposed to think that these cells are the products of the columnar intestinal epithelium; in fact, that they are mucus cells produced as described in tho latest and best work on pathological histology?that of Dr. E. Rindfleisch, as follows. He says :??' It is an established fact that "
MICROSCOPICAL RESERACHES INTO THE AGENTS PRODUCING CHOLERA. Dhs.T.R. LEWisandD. D.Cunningham have carefully examined patients suffering from cholera. They noticed,
the blood of
large bioplastic masses gradually separating collecting in the marginal serum ; the movement of these masses is extremely constant, but they soon begin to sub-divide into innumerable smaller masses, resembling the previous generation in their delicacy of outline and great activity. At the close of twenty-four hours from the commencement of the observation, only a few bioplasts remain freely movable, and the majority have considerably increased in size; their contents become granular, and many show a tendency to become spherical, motionless, and more or less distinctly " vacuolated," and contemporaneously they tend to accumulate in masses of varying extent, and "having reached this stage, for weeks, the serum continuing permay remain unchanged under the microscope,
from the blood
clot,
and
the mucus, which covers the surface of is
our
mucous
membranes,
produced on the spot by epithelial cells. (Vide also Indian Medical Gazette, Vol. VII., page 217.) By adding a sufficiency of water to the detached epithelia, the formation of large spherules of clear mucus in the interior of the cells may actually be followed under tho microscope ; they push aside the other cell contents, together with the nucleus, making them look like mere appendages ; they finally escapo, leaving the body of tho cell in a very mutilated condition ; indeed, the development of mucus might be conceived as a mucous transformation, and we might even assume with Frerichs, Donders, and 0. Weber, that a given quantity of secreted mucus represents a proportionate shedding
February 1,
of epithelial cells; that during the development "
FUND FOE WIDOWS AND ORPHANS OF MEDICAL OFFICERS.
1873.]
the
epithelial
cells
are
actually
shed
Itindfleisch continues.
of mucus."
Choleraic catarrh differs from ordinary diarrhoea, partly by the
absence of albumen from the transuded fluids, and
partly by the implication of the whole tract from the eardia to the anus, finally by the volume of the transuded fluids, and the rapidity with which it accumulates. This rapidity is occasionally so great, that the epithelium of the small bowel, together with the epithelial lining of the follicles of Lieberkiihn, is stripped off and swept away in shreds of variable size (rice-water evacuations). On one surface of these shreds we see the long epithelial coats of the villi projecting like the fingers of a glove ; the opposite surface exhibits the shorter and more globular outlines of the The intestinal mucous membrane is left
crypts of LieberTcuhn. as
if
'
flayed,'
and is
exposed without protection
to
the hostile
action of its contents?a circumstance which must not be for-
gotten in endeavouring to account for the patches of superficial gangrene, which the bowel usually exhibits in the second stage of cholera."
We still hold to the
opinion
found in cholera-stools are formed from the
intestinal, canal rather
than from
"
that the
hyaline cells epithelial cells of vacualated" bioplasts the
by Drs. Lewis and Cunprevious observers have done, ningham. that there is no indication of a microscopically demonstrable morbid poison in the blood; and, further, there is no evidence of the existence of fungal elements or of bacteria in the blood of patients suffering from cholera. derived from the blood
They hold,
as
as
described all
47
the
"
will
come
characters
present every modification of appearance and presented by those found in the discharges of patients to
suffering from cholera." " There is one class of bodies in the evacuations, the nature of whicli has hitherto been peculiarly puzzling and obscure, namely, that of flattened, whitish or paleyellow hyaline cells, showing no evidence of stucture or contents, but observations on the changes occurring in the bioplasts of the blood, explain the nature of these also, for the empty capsules persisting after the escape of the molecular contents of the puslike cells are exactly similar to the hyaline bodies of the evacuations." These hyaline cells, resulting, as above described, from the escape of the granular matter from the vacuolated" bioplasts, take some days, and it may be weeks, in forming, and having formed, we are told that " the persistence of these capsules (or hyaline cells) is wonderful, considering their extreme delicacy." Our authors, it will be noticed, now identify these hyaline cells produced from bioplasts, with those described by them as the " peculiar corpuscles" of Dr. Parkes, and noticed by him as occurring in the stools of patients suffering from cholera. It is quite possible that the hyaline cells found in cholera-stools, and those described by Drs. Lewis and Cunningham as occurring in the decomposing organic matter of the blood, may be similar in appearance to those found in the stools of cholera-patients; but the " hyaline bodies produced from bioplasts are wonderfully perthe cells of the cholera-stools are whereas sistent," hyaline it is true their rapid disappearance may remarkably evanescent; be due, in some measure, to the alkaline fluid of the stools ; nevertheless, the fact remains that their existence is a matter of a few hours, as opposed to the persistent character of the hyaline cells, produced from changes in decomposing human blood. "We do not pretend to dispute the fact, that bioplasts in considerable number may find their way from the congested vessels of the intestines in cholera into the intestinal canal, and be washed away into the rice-water stools; but Drs. Lewis and Cunningham have much work before them ere they can convince us that the hyaline cells in cholera evacuations are formed from changes such as above described, taking placo in tho bioplasts of the blood. We are far more disposed to think that these cells are the products of the columnar intestinal epithelium; in fact, that they are mucus cells produced as described in tho latest and best work on pathological histology?that of Dr. E. Rindfleisch, as follows. He says :??' It is an established fact that "
MICROSCOPICAL RESERACHES INTO THE AGENTS PRODUCING CHOLERA. Dhs.T.R. LEWisandD. D.Cunningham have carefully examined patients suffering from cholera. They noticed,
the blood of
large bioplastic masses gradually separating collecting in the marginal serum ; the movement of these masses is extremely constant, but they soon begin to sub-divide into innumerable smaller masses, resembling the previous generation in their delicacy of outline and great activity. At the close of twenty-four hours from the commencement of the observation, only a few bioplasts remain freely movable, and the majority have considerably increased in size; their contents become granular, and many show a tendency to become spherical, motionless, and more or less distinctly " vacuolated," and contemporaneously they tend to accumulate in masses of varying extent, and "having reached this stage, for weeks, the serum continuing permay remain unchanged under the microscope,
from the blood
clot,
and
the mucus, which covers the surface of is
our
mucous
membranes,
produced on the spot by epithelial cells. (Vide also Indian Medical Gazette, Vol. VII., page 217.) By adding a sufficiency of water to the detached epithelia, the formation of large spherules of clear mucus in the interior of the cells may actually be followed under tho microscope ; they push aside the other cell contents, together with the nucleus, making them look like mere appendages ; they finally escapo, leaving the body of tho cell in a very mutilated condition ; indeed, the development of mucus might be conceived as a mucous transformation, and we might even assume with Frerichs, Donders, and 0. Weber, that a given quantity of secreted mucus represents a proportionate shedding
February 1,
of epithelial cells; that during the development "
FUND FOE WIDOWS AND ORPHANS OF MEDICAL OFFICERS.
1873.]
the
epithelial
cells
are
actually
shed
Itindfleisch continues.
of mucus."
Choleraic catarrh differs from ordinary diarrhoea, partly by the
absence of albumen from the transuded fluids, and
partly by the implication of the whole tract from the eardia to the anus, finally by the volume of the transuded fluids, and the rapidity with which it accumulates. This rapidity is occasionally so great, that the epithelium of the small bowel, together with the epithelial lining of the follicles of Lieberkiihn, is stripped off and swept away in shreds of variable size (rice-water evacuations). On one surface of these shreds we see the long epithelial coats of the villi projecting like the fingers of a glove ; the opposite surface exhibits the shorter and more globular outlines of the The intestinal mucous membrane is left
crypts of LieberTcuhn. as
if
'
flayed,'
and is
exposed without protection
to
the hostile
action of its contents?a circumstance which must not be for-
gotten in endeavouring to account for the patches of superficial gangrene, which the bowel usually exhibits in the second stage of cholera."
We still hold to the
opinion
found in cholera-stools are formed from the
intestinal, canal rather
than from
"
that the
hyaline cells epithelial cells of vacualated" bioplasts the
by Drs. Lewis and Cunprevious observers have done, ningham. that there is no indication of a microscopically demonstrable morbid poison in the blood; and, further, there is no evidence of the existence of fungal elements or of bacteria in the blood of patients suffering from cholera. derived from the blood
They hold,
as
as
described all
47
