L 
 
p r 
 
 THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 
 OF CALIFORNIA 
 
 PRESENTED BY 
 
 PROF. CHARLES A. KOFOID AND 
 
 MRS. PRUDENCE W. KOFOID 
 
With the Compliments of 
 The 3\dedica/ Faculty 
 
 of McQill University 
 
 ■^•AinMnMka 
 
DESCRIPTIVE CATALOGUE 
 
 OF THE 
 
 MEDICAL MUSEUM 
 
 OF 
 
 McGILL UNIVERSITY 
 
OXFOKD UNIVERSITY PRESS 
 HUMPHREY MILFORD M.A. 
 
 PTTBLISHER TO THK tTNIVERSITY 
 
DESCRIPTIVE CATALOGUE 
 
 OF THE 
 
 MEDICAL MUSEUM 
 
 OF 
 
 McGILL UNIVERSITY 
 
 ARRANGED ON A MODIFIED DECIMAL SYSTEM 
 OF MUSEUM CLASSIFICATION 
 
 AND EDITED BY 
 
 MAUDE E. ABBOTT, B.A., M.D., Curator 
 
 PART IV: SECTION I 
 
 THE H HEMOPOIETIC ORGANS 
 
 CATALOGUE AND DIDACTIC INTRODUCTIONS 
 
 BY 
 
 OSKAR C. GRUNER, M.D. 
 
 PATHOLOGIST TO THE ROYAL VICTORIA HOSPITAL, BIONTREAL 
 ASSISTANT PROFESSOR OF PATHOLOGY, MoGILL UNIVERSITY 
 
 OXFORD 
 AT THE CLARENDON PRESS 
 
 1915 
 
Digitized by the Internet Archive 
 
 in 2008 with funding from 
 
 IVIicrosoft Corporation 
 
 http://www.archive.org/details/descriptivecatalOOmcgirich 
 
6 ^^ 
 
 TABLE OF CONTENTS 
 
 '^ PAGE 
 
 PREFACE ix 
 
 CLASSIFICATION . xiii 
 
 CATALOGUE . . . '. . ... . . i 
 
 41 Bone-marrow : ' 
 
 Introduction ....... 3 
 
 Detailed Contents of Section ..... 6 
 
 Catalogue ........ 8 
 
 42 Lymph-nodes : 
 
 Introduction ........ 27 
 
 Detailed Contents of Section ..... 32 
 
 Catalogue ........ 34 
 
 43 Spleen : 
 
 Introduction ........ 69 
 
 Detailed Contents of Section ..... 76 
 
 Catalogue ........ 81 
 
 44 Thymus Gland : 
 
 Introduction . . , , . . . .187 
 
 Detailed Contents of Section . . . . .189 
 
 Catalogue ........ 190 
 
 a 3 
 
 TWiii^m 
 
LIST OF PLATES 
 
 FACING 
 PLATE PAGE 
 
 I. 41 1 Bone-marrow of an Infant from Transverse 
 Section of Normal Sternum. Hsem. & Eryth. 
 Zeiss imm. oc. 6. Presented by Dr. Gruner . 8 
 
 II. 41. 711^ Bone-marrow of a Young Adult showing 
 Erythroblastic and Leucoblastic Reaction. 
 From case of Malignant Endocarditis . Triacid Stain, 
 Zeiss imm. oc. 12. Presented by Dr. Gruner . 16 
 
 III. 41.711* Bone-marrow showing Leucoblastic Reaction. 
 
 From a case of Puerperal Fever, Jenner Stain. 
 Zeiss imm. oc. 12. Presented by Dr. Gruner . 17 
 
 IV. 42.361 1^ Tuberculosis of Mesenteric Lymph-nodes in 
 
 Monkey. Dr. Duval 41 
 
 V. 42.514^ Lymph-nodes in Lymphatic Leukemia. Dr. 
 
 Wolbach 43 
 
 VI. Variations in Size of Spleen in Different Conditions . 81 
 
 VII. 43. 17^ Accessory Spleen, Attached to Organ of Normal 
 
 Size. 82 
 
 VIII. 43.2620 Old Infarct in Cardiac Spleen. Dr. C. F. Martin 92 
 
 IX. 43.325^ Septic Infarct, Abscess in Spleen, of Malignant 
 
 Endocarditis. Dr. Eraser Gurd . . . 101 
 
 X. 43.361^ Subacute Miliary Tuberculosis of Spleen. 
 
 Dr. Adami ....... 117 
 
 XI. 43.513^ Spleen from Banti's Disease, Primary Spleno- 
 megaly, WITH Cirrhosis Hepatis. Hyaloseros- 
 itis OF Capsule. Dr. Wolbach . . . .129 
 
 XII. 43.513^ Spleen in Banti's Disease. Hyaloserositis. 
 
 Dr. Gruner 130 
 
TO THE MEMORY OF 
 WYATT GALT JOHNSTON 
 
PREFACE 
 
 The present volume of the Descriptive Catalogue of 
 the Medical Museum of McGill University, although the 
 fourth in the order of the Museum classification, is the first 
 portion ready for publication. We owe its timely appear- 
 ance to the activity of Professor Gruner, who, as collaborator 
 on this section, has catalogued the specimens, written 
 the didactic introductions, and appended a detailed table 
 of contents in catalogue numbers. The specimens have 
 also been examined microscopically wherever this was of 
 interest, and the corresponding slides filed in the Museum, 
 where they are readily accessible to the student. This 
 feature is of especial importance in the present series on 
 the hsemopoietic organs, both because the gross appear- 
 ances are here frequently insufficient for diagnosis, and 
 because the pathogenesis of these conditions is in many 
 cases still obscure. 
 
 A word of explanation on the system of cataloguing 
 as applied in this Museum is necessary. 
 
 The Museum Classification. The specimens are arranged 
 on a system of Museum classification after a plan suggested 
 by the late Professor Wyatt Johnston, and introduced in 
 the year 1899. A descriptive number is used, in which 
 the number representing the anatomical condition precedes, 
 and that representing the pathological follows the decimal 
 point, the individual specimen being indicated by a small 
 index figure placed to the right of, and above, the descrip- 
 tive number. The advantage of this system is that it allows 
 of indefinite expansion, the catalogue number becoming 
 
^ PREFACE 
 
 the shelf number and each descriptive number forming 
 a unit group to which specimens may be added at will 
 without disturbing the logical sequence of the collection 
 as a whole. A further subdivision of specimens in a given 
 group is also followed in some cases by leaving a gap in 
 the small index figures of five or ten numbers : thus 
 42.36P~" are specimens of human tuberculosis of the 
 lymph-glands ; 42.36P^~^^ tuberculosis of glands in a monkey; 
 42.361'"'-^° bovine tuberculosis of lymphatic glands, &c. 
 
 The classification is published in this volume in a 
 slightly abridged form. It will appear in full in Part I of 
 the Catalogue, which volume is not yet ready for the 
 press. 
 
 Expert Collaboration. The Catalogue of this Museum is 
 being carried out on a more detailed and scientific scale 
 than would otherwise be possible, through the collaboration 
 of various members of the Teaching Staff engaged in clinical 
 or pathological research, who have undertaken to work 
 over the material on a given subject in the light of their 
 expert knowledge. The ideal aimed at has been the forma- 
 tion of a Museum collection consisting of good specimens 
 carefully studied and described, with clinical histories and 
 microscopic findings attached, and arranged in teaching 
 series. The collaborator's work consists in completing 
 the particular series under his care by the selection of repre- 
 sentative material from storage, indicating lacunae to be 
 supplied from the hospitals or elsewhere, examining and 
 cataloguing the specimens, and writing a short didactic 
 introduction upon them, the whole being done with the 
 assistance and active co-operation of the Museum Staff, 
 and subject to the revision of the Professor of Pathology. 
 In this connexion the attention of the student is directed 
 to page 30, where, under the Introduction to the Section 
 
PREFACE xi 
 
 on Lymph-nodes, an elucidation of our present knowledge 
 on the leukaemias and allied states is added by Professor 
 Adami. 
 
 The plan of cataloguing in collaboration with clinical 
 workers is not original, but is carried out in several of 
 the English museums, notably that of University College, 
 London, where it has been in practice for a number of 
 years. In extent and thoroughness, however, the proceed- 
 ing is, we think, unique here. It is hoped that the fine 
 illustrative series presented in this, the first fasciculus 
 issued, as well as its general construction, will justify the 
 conception it embodies, and encourage the successful 
 continuance of the Catalogue along similar lines. 
 
 The Descriptive Catalogue of the Museum of McGill 
 University has become the peculiar property of the Medical 
 Graduates by the practical action of one whose early 
 connexion with the School forms one of its chief distinc- 
 tions, and whose personality is the object of its warmest 
 affection. It is our privilege to acknowledge that the expen- 
 diture incurred in the publication of this volume is covered 
 by a fund raised for this purpose among the Graduates in 
 Medicine by the Regius Professor of Medicine at Oxford 
 University, Sir William Osier, Bart., at whose instance also 
 it is now issued. In a circular sent out by Sir William in 
 1905 the attention of Graduates was drawn to the wealth of 
 material in the Museum and to the importance which a careful 
 catalogue would have in preserving the historic traditions of 
 the Medical School, as weU as in developing its scientific 
 and teaching capacity. The response to this appeal was 
 immediate, the $1,200.00 requested being subscribed within 
 a few weeks. The fire of 1907 interrupted the work, and has 
 
xU PREFACE 
 
 led ultimately to the substitution of this volume for the 
 one originally intended to be first published, that on the 
 Circulatory System, which is still in course of preparation. 
 The initiative taken by Sir William Osier in this matter, 
 and the generosity'- of the spirit in which it was met, form 
 an inspiration and supply a stimulus that will, we hope, 
 continue to be reflected in later volumes, until the extensive 
 task of cataloguing the Museum is complete. 
 
 MAUDE E. ABBOTT. 
 
 March 2, 1914 
 
KEY TO THE CLASSIFICATION 
 
 IN USE IN THE MEDICAL MUSEUM, McGILL UNIVERSITY, 
 
 MONTREAL 
 
 DEPARTxMENT OF SPECIAL PATHOLOGY 
 
 Note. — ^The anatomical condition is represented by numbers before and the 
 pathological conditions by numbers after the decimal point. The number of the 
 individual specimen is represented by a small index figure placed to the right of the 
 catalogue number, e.g. 43.26'^ Infarction of the Spleen. A further subdivision of 
 specimens is followed in some cases, by leaving a gap in the small index figures of 
 five or ten numbers : thus 42.361^"^^ are specimens of human tuberculosis of lymph- 
 glands ; 42.361^^"^' tuberculosis of glands in a monkey ; 42.361*°"*' bovine tuber- 
 culosis of lymph-glands.* 
 
 PART I. ANATOMICAL CLASSIFICATION 
 1. Circulatory System. 
 
 11. Pericardium. 
 
 12. Myocardium. 
 
 13. Endocardium. 
 
 14. Heart as a whole. 
 
 15. Arteries. 
 
 16. Veins. 
 
 2. Respiratory System. 
 
 21. 
 
 Nares. 
 
 22. 
 
 Larynx. 
 
 23. 
 
 Trachea and Bronchi. 
 
 24. 
 
 Lungs. 
 
 25. 
 
 Pleura. 
 
 3. Digestive System. 
 
 31. 
 
 Teeth. 
 
 32. 
 
 Mouth. Tongue. Pharynx. 
 
 33. 
 
 (Esophagus 
 
 34. 
 
 Stomach. 
 
 35. 
 
 Intestines. 
 
 36. 
 
 Peritoneum and Mesentery. 
 
 37. 
 
 Liver. 
 
 38. 
 
 Gall-bladder and Bile Ducts 
 
 39. 
 
 Pancreas. 
 
 * For further explanation see 'On the Classification of Museum Specimens', 
 American Medicine, 1903, p. 541. 
 
xiv KEY TO THE CLASSIFICATION 
 
 4. HEMOPOIETIC Organs and Ductless Glands 
 
 41. 
 
 Bone-marrow. 
 
 42. 
 
 Lymph-nodes. 
 
 43. 
 
 Spleen. 
 
 • 
 
 431. Spleen capsule. 
 
 44. 
 
 Thymus Gland. 
 
 45. 
 
 Thyroid. 
 
 46. 
 
 Parathyroids. 
 
 47. 
 
 Adrenal. 
 
 48. 
 
 Carotid and Coccygeal Glands. 
 
 49. 
 
 Pituitary Body. 
 
 6. Urogenital System. 
 
 51. Kidney. 
 
 52. Ureter. 
 
 53. Bladder. 
 
 54. Prostate. 
 
 55. Urethra. 
 
 56. Penis. 
 
 57. Seminal Vesicles, Vas Deferens, and Cord. 
 
 58. Testis, Epididymis, Tunica Vaginalis. 
 
 59. Perineum. 
 
 6. Female Genitalia. 
 
 61. External Genitalia. 
 
 62. Vagina. 
 
 63. Uterus. 
 
 64. Fallopian Tube. 
 
 65. Ovary and Parovarium. 
 
 66. Pelvic Peritoneum and Connective Tissue. 
 
 67. Breast. 
 
 68. Generative System in Pregnancy 
 
 69. Ovum as a whole. 
 
 7. Nervous System. 
 
 71. Membranes. 
 
 72. Cerebral Vascular System. 
 
 73. Cerebrum. 
 
 74. Cerebellum. 
 
 75. Spinal Cord. 
 
 76. Nerves. 
 
 77. Nerve GangUa. 
 
 78. Eye. 
 
 79. Ear. 
 
KEY TO THE CLASSIFICATION xv 
 
 8. MUSCULO-CUTANEOUS SYSTEM. 
 
 81. Skin. 
 
 82. Hair. 
 
 83. Nails. 
 
 84. Muscle. 
 
 85. Fascia. 
 
 86. Cellular Tissue. 
 
 87. Tendon. 
 
 88. Ligaments. 
 
 89. Bursse. 
 
 9. Osseous and Articular System. 
 
 91. Bones of Cranium. 
 
 92. Bones of Face. 
 
 93. Vertebrae. 
 
 94. Sternum. 
 
 95. Ribs. 
 
 96. Bones of Upper Extremity. 
 
 97. Pelvic Girdle. 
 
 98. Bones of Lower Extremity. 
 
 0. Regional. 
 
 01. Head. 
 
 02. Face. 
 
 03. Neck. 
 
 04. Back. 
 
 05. Thorax. 
 
 06. Abdomen. 
 
 07. Pelvis. 
 
 08. Upper Extremity. 
 
 09. Lower Extremity. 
 
 PART II. PATHOLOGICAL CLASSIFICATION 
 
 Antenatal Structures and Abnormalities of Development. 
 
 .11 Foetal Structures (Normal Anatomy). 
 
 .12 Malformations of Incomplete Development. 
 
 .13 Reduction in Size (Hypoplasia). 
 
 .14 Reduction in Number (Syndactylism, &c.). 
 
 .15 Persistent Foetal Structures. 
 
 .16 Excess in Size. 
 
 .17 Excess in Number. 
 
 .18 Malposition or Heterotaxis ; Aberrant Structures. 
 
 ,19 Anomalies due to Foetal Disease. 
 
xvi KEY TO THE CLASSIFICATION 
 
 .2 Circulatory Disturbances. 
 
 .21 Anaemia. 
 
 .22 Congestion or Hyperaemia. 
 
 .23 Haemorrhage. 
 
 .24 Thrombosis. 
 
 .25 Embolism. 
 
 .26 Infarction. 
 
 .27 (Edema. 
 
 .3 Inflammatory Processes. 
 
 .31 Catarrhal or Desquamative. 
 
 .32 Exudative. 
 
 .321 Sero -fibrinous Inflammation. 
 
 .322 Fibrinous or Plastic Inflammation. 
 
 .323 Diphtheritic or Membranous. 
 
 .324 Haemorrhagic. 
 
 .325 Suppurative or Purulent (Abscess). 
 
 .33 Destructive. 
 
 .34 Specific Inflammations due to Cocci. 
 
 .341 Lesions due to Micrococci. 
 
 .342 Lesions due to Staphylococci. 
 
 .343 Lesions due to Streptococci. 
 
 .344 Lesions due to Pneumococci. 
 
 .345 Lesions due to Gonococci. 
 
 .346 Lesions due to Meningococcus. 
 
 .35 Specific Inflammations due to Bacilli. 
 
 .351 Lesions due to Colon and Typhoid. 
 
 .352 Lesions due to Intermediate Forms of Intestinal 
 
 BaciUi. 
 .353 Lesions due to Dysentery. 
 .354 Lesions due to Diphtheria. 
 .355 Lesions due to Eye Bacilli. 
 .356 Lesions due to Anaerobes. 
 .359 Lesions due to B. Pestis (Bubonic Plague). 
 
 -36 Specific Inflammations due to Acid-fast Bacilli, Spirilla, 
 and Yeasts and Moulds. 
 .361 Lesions due to Bacillus Tuberculosis. 
 .362 Lesions due to the Bacillus Leprae. 
 .363 Lesions due to Malignant Granuloma. 
 .364 Lesions due to the Bacillus MaUei (Glanders). 
 
 37 Specific Inflammations due to Protozoa. 
 
 .371 Lesions due to Amoeba Dysenteriae (Tropical 
 
 Dysentery). 
 .372 Lesions due to Treponema Pallidum (Syphilis). 
 
KEY TO THE CLASSIFICATION xvii 
 
 .373 Lesions due to Trypanosoma Gambiense (Sleep- 
 ing Sickness). 
 
 .374 Lesions due to Spirochsetes (Sp. Obermeieri, 
 Relapsing Fever ; Sp, Vincenti, Vincent's 
 Angina, &c.). 
 
 .375 Lesions due to Leishmania (L. Donovani, Kala- 
 azar). 
 
 .376 Lesions due to Hsemosporidia (Malaria). 
 
 .38 Specific Inflammations, Causative Agents still unde- 
 termined. 
 
 .39 Productive or Proliferative Processes. 
 
 .4 Infections and Parasites. 
 
 {Note. — As this section is used chiefly in the collections of bacteriology and 
 parasitology, its subdivisions are not given here.) 
 
 .41 Cocci. 
 
 .42 Bacilli. 
 
 .43 Spirilla. 
 
 .44 Higher Bacteria. Also Yeasts and Moulds. 
 
 .45 Cryptogenic Infections (Organism still undetermined). 
 
 .46 Protozoa. 
 
 .47 Flat Worms. 
 
 .48 Round Worms. 
 
 .49 Insecta and Arachnida. 
 
 .6 Disorders of Metabolism and Intoxications. 
 
 .51 Diseases Associated with Changes in the Blood and Blood- 
 forming Organs. 
 .511 Chlorosis. 
 
 .512 Splenomegaly with Polycythaemia. 
 .513 Splenic Anaemia. Banti's Disease. 
 .514 Leukaemia. 
 .515 Hodgkin's Disease. 
 .516 Pernicious Anaemia. 
 
 .52 Intoxications Associated with Disorders of Ductless Glands. 
 
 .521 Exophthalmic Goitre. 
 
 .522 Myxoedema. 
 
 .523 Cretinism. 
 
 .524 Acromegaly. 
 
 .525 Achondroplasia. 
 
 .526 Status lymphaticus. 
 
 .53 Diseases due to Autochthonous or Heterochthonous 
 Poisons of Organic Nature. 
 .531 Acute Yellow Atrophy. 
 
xviii KEY TO THE CLASSIFICATION 
 
 .54 Diseases due to Heterochthonous Poisons of Inorganic or 
 
 Plant Nature. 
 
 .55 Art erio -sclerosis. 
 
 .56 Diseases due to Defects of Nutrition. 
 
 .57 Diseases of Disordered Metabolism. 
 
 .58 Organic Nervous Disorders. 
 
 .59 Functional Nervous Disorders. 
 
 .6 Retrogressive Changes. 
 
 .61 Atrophy. 
 
 62 Degenerations. 
 
 ,621 Acute, toxic, cloudy swelling. 
 
 .622 Fatty, Atheromatous. 
 
 .623 Mucoid. 
 
 .624 Hyaline and Fibro -hyaline. 
 
 .625 Amyloid. 
 
 .626 Colloid. 
 
 .627 Calcareous. 
 
 .628 Hydropic and Cystic. 
 
 .629 Keratinization. Degenerations with Overgrowth 
 
 of Fibrous Tissue. Arterio -sclerosis. 
 .620 Various. Osseous, Gelatinous, Elastoid, Waxy, 
 Fragmentation, Basophilic, 
 
 .63 Infiltrations. 
 
 .631 
 
 .632 Fatty. 
 
 .633 Biliary. 
 
 .634 Iron, Haemosiderosis. 
 
 .635 -Metallic. 
 
 .636 Other pigments. 
 
 .637 Anthracosis. 
 .64 Concretion. Calculus Formation. 
 .65 The Necroses. 
 .66 Stenosis due to Disease. 
 .67 Dilatation due to Disease. 
 
 ,7 Progressive Changes, 
 .71 Regeneration. 
 
 .711 Hypertrophy. 
 .712 Metaplasia. 
 .72 Hypertrophy. 
 
 .731 
 .74 
 
 Benign Tumours (of one of the modifications of fully 
 formed connective tissue). 
 
KEY TO THE CLASSIFICATION xix 
 
 .75 Benign Tumours (of Epithelial Origin). 
 
 .76 Indeterminate Group (Tumours of Uncertain Histology or 
 
 Malignancy). 
 .77 Malignant Tumours. Sarcoma, Tissue-forming Varieties. 
 
 .78 Malignant Tumours. Sarcoma. 
 
 .781 Round-celled Sarcoma. 
 
 .782 Spindle-celled Sarcoma. 
 
 .783 Mixed-celled Sarcoma. 
 
 .784 Giant-celled Sarcoma. 
 
 .785 Melanotic Sarcoma. 
 
 .786 Lymphosarcoma. 
 
 .79 Malignant Tumours of Epithelial Origin. 
 
 .791 Epithelioma. 
 
 .792 Carcinoma Simplex (Spheroidal-celled). 
 
 .793 Carcinoma Simplex, Medullary type. 
 
 .794 Carcinoma Simplex, Scirrhus type. 
 
 .795 Columnar-celled Carcinoma. 
 
 .796 Adenocarcinoma. 
 
 .70 Cystoma. 
 .8 Traumata (from Mechanical, Chemical, or Physical Causes). 
 
 .81 Wounds. 
 
 .811 Incised. 
 
 .812 Punctured. 
 
 .813 Contusions, 
 
 .814 Lacerations. 
 
 .815 Crushing Accidents. 
 
 .816 Gunshot Wounds. 
 
 .817 Bedsores. 
 
 .818 Abrasions. 
 
 .819 Ruptures. 
 
 .82 Fractures. 
 
 .83 Dislocations and Sprains. 
 
 .84 Displacements. 
 
 .841 Hernia. 
 
 .842 Intussusception. 
 
 .843 Volvulus. 
 
 .844 Prolapse. 
 
 .85 Impaction of Foreign Bodies. 
 
 .86 Thermal Injuries. 
 
 .87 Chemical Lesions. 
 
 .88 Pressure Efifects produced by compression or traction from 
 
 without, or distensions from within. 
 .89 Birth Processes. 
 
XX KEY TO THE CLASSIFICATION 
 
 .9 Operative Procedures. 
 
 .91 Amputations. 
 
 .92 Excision. 
 
 .93 Plastic. 
 
 .94 Ligature. 
 
 .95 Incision. 
 
 .96 Union and Replacement. 
 
 .97 Fixation. 
 
 .98 Experimental Surgery. 
 
 .99 Miscellaneous Operations. 
 
 LIST OF ABBREVIATIONS USED IN THIS CATALOGUE 
 
 Ref. = Reference. 
 
 E. or E. No. = Museum Entry number. 
 
 P.M. = Post Mortem or Autopsy. 
 
 A — 
 
 ■'^' »> It i> 
 
 S. = Sm'gical. 
 
 R.V.H. = Royal Victoria Hospital, Montreal. 
 
 M.G.H. = Montreal General Hospital. 
 
 P.H.I. = Protestant Hospital for Insane, Montreal. 
 
 St. Bart's. = St. Bartholomew's Hospital, London. 
 
 A.M.M. = Army Medical Museum, Washington, D.C. 
 
CATALOGUE AND INTRODUCTIONS 
 
 BY 
 
 0. C. GRUNER 
 
 41. BONE-MARROW " 
 
 42. LYMPH-NODES 
 
 43. SPLEEN 
 
 44. THYMUS GLAND 
 
 IT. I 
 
41. BONE-MARROW 
 
 INTRODUCTORY 
 
 The varying condition of the bone-marrow is most conveniently 
 observed in the sternum, where there is an abundance of formative 
 tissue, and sufficiently scanty compact bone to prevent the task 
 of opening the interior from being irksome. The series of specimens 
 here exhibited expose to view the long axis of the bone, with the 
 exception of 41.61^, which shows the appearance on cross section. 
 While the sternum forms so convenient a material for study, valuable 
 specimens are also afforded by the tibia (41.7112), femur (41.515^), 
 vertebrae, &c. This is important in view of the fact that circum- 
 stances may arise under which the examination of the sternum 
 is not permissible at autopsy. Where a permit for abdominal 
 incision only is received, the lumbar vertebrae may be examined 
 by sawing out a small wedge. Where no permit is received at all, 
 it is feasible to employ a trocar for drawing enough marrow from the 
 head of the tibia to enable a histological examination to be made. 
 In this case the fact that the marrow tissue is much more abundant 
 and much redder in the lumbar vertebrae must be taken into 
 consideration before pronouncing on the character of the change. 
 
 The naked-eye points to observe in the series are : (1) the relative 
 proportion between marrow tissue and compact bone, (2) the colour 
 of the marrow, (3) the texture of the cut surface, (4) the abundance 
 of bone trabeculae, (5) the occurrence of fat. 
 
 The differences shown with successive ages will be noticed to 
 depend on the formative activity of the marrow tissue rather 
 than on the age itself ; thus 41^ (from an infant) is no different 
 from 41.7lP^ (aged 43) as far as the naked eye will show; 41.71P 
 (aged 16) is very similar to 41.71P (aged 58). 
 
 The essential changes exemplified by the series are those of 
 (1) increased formative activity (41.71P'") ; (2) diminished forma- 
 tive activity (41.61^) ; (3) actual degenerative change dependent on 
 acute intoxication (41.620^"-) and malnutrition (41. 61^) ; (4) atrophic 
 changes (41.612), 
 
 The term ' increased formative activity ' signifies an increased pro- 
 duction of either red cells or white cells or both. If the main pheno- 
 menon is red-cell formation, the marrow is called erythroblastic, if 
 
 b2 
 
4 THE H.EMOPOIETIC ORGANS 
 
 white-cell formation the term leucoblastic is applied. In either case 
 there are three main features present : (a) redness up to a prune- 
 juice colour ; (b) paucity of bone trabeculse (41.7112) ; (c) abundance 
 of marrow tissue (41.71 P). The second and third points are inter- 
 dependent. When the bone is cut open, the marrow tissue is found 
 soft and tends to run or ooze out beyond the surface of the cut, 
 while the scarcity of bone is evidenced hy the ease with which 
 a knife-tip or the finger-nail will indent the central parts of the 
 bone. In 41.71 P and 41.71 P the abundance of the marrow tissue 
 is the more striking because the compact layer is very much thinned 
 out, and the sternum appears much thicker than usual owing to the 
 large amount of red-coloured tissue between the opposite surfaces. 
 
 Increased formative activity is not always associated with 
 redness, as shown in 41.711^, where the tissue is pale; and 41.71P 
 and 41.71 P°, where the cut surface is brightly mottled with red 
 and yeUow. Paucity of bone trabeculse, however, is always charac- 
 teristic, as well as the third point — that of abundance of marrow 
 tissue. 
 
 It is not possible to decide by the naked ej^e between a leuco- 
 and an erythro-blastic reaction ; 41.711^^ and 41.514^, for instance, 
 do not appear to be very different. The terms were obviously intro- 
 duced with the study of this tissue under the highest powers of the 
 microscope, and cannot be expected to coincide with naked-eye 
 characters. 
 
 It has been found convenient in this Catalogue to designate all 
 these marrows as ' hyperplastic ', since, in a general way, all of 
 them are of this nature. 
 
 Diminished formative activity may be dependent on definitely 
 atrophic conditions, or may be the result of degenerative processes. 
 Inhibition of formation may also arise under the influence of 
 certain morbific agents. The distinctive features are different in 
 the two cases. In atrophies, the bony trabeculae are scanty, so that 
 the cut surface of the bone is very decidedly honeycombed. But 
 more than that, hardly any marrow substance is found to be 
 present, inasmuch as the honeycomb-Hke spaces appear empty. 
 In other cases, the atrophy of the marrow is associated with a pre- 
 ponderance of bony trabeculse, the cut surface being highly resistant 
 to knife-tip or finger-nail, and the pits in which the marrow lies 
 are found to be very minute. This condition amounts to one of 
 sclerosis of bone, and is due to inflammatory causes, or may be 
 part of a general senile tendency to ossification of connective 
 tissue. It is easy to see how premature sclerosis may destroy the 
 available space for marrow tissue, and so interfere with recovery 
 
41. BONE-MARROW 5 
 
 from such infections as demand vigorous over-growth of the forma- 
 tive cells. 
 
 Degenerative changes are shown by the great pallor and semi- 
 translucence of the tissue. In some cases (41.620^) the translucence 
 is marked and justifies the diagnosis of gelatinous degeneration — 
 a condition still more conspicuously discernible in microscopic 
 sections because the formative cells are very few, and expose an 
 abundant hyaline and pale pink staining material. This is welL 
 shown in the microphotograph of 41.620^. 
 
 Another form of reaction met with in the marrow is that known 
 as lytnphadenoid. This term is used to indicate the production of 
 an undue number of non-granular cells of the white-cell series. 
 The naked -eye appearance of such a marrow is that of a pale, rather 
 abundant, tissue, well filling moderately large marrow-spaces. The 
 condition is exempHfied by 41.515^, although it will there be seen 
 that there is Httle indication of specific marrow changes as far as 
 the naked eye will show. A lymphadenoid reaction is not uncommon 
 in a variety of conditions besides the one named. 
 
 The student will gather from the above remarks that he will 
 not be able to diagnose morbid conditions of the bone-marrow in 
 anything but a very general way, and he is introduced to the subject 
 more for the purpose of showing him that the bone-marrow does 
 vary a Httle macroscopically, than for the purpose of suggesting 
 there is any possibiUty of identifying any given disease from their 
 inspection. In this respect we encounter a wide difference from 
 other organs of the body. 
 
 It is essential to realize here that the highest powers of the 
 microscope alone enable one to form an opinion of the nature of the 
 marrow tissue, film preparations being made and differential counts 
 instituted for the purpose, as in the investigation of the blood itself. 
 
 The conclusion is also forced upon the student that no marrow 
 state is pathognomonic of any disease, but that any of the 
 types exhibited in this series may be found in any morbid state. 
 A simple microbic infection in a distant part of the body will be 
 associated with an erythroblastic, or leucoblastic, or degenerative, 
 or atrophic marrow, according to various factors, the chief of which 
 perhaps is the personal peculiarity of the patient's ' resisting power '. 
 
 When the infective process occurs in the bone itself, we have 
 before us examples of various forms of osteomyehtis, which are 
 best studied in connexion with this subject (Section 9). 
 
 0. C. G. 
 
DETAILED CONTENTS OF SECTION 
 
 41. BONE-MARROW 
 
 Abundant . 
 
 Age .... 
 
 Anaemia, Bone-marrow in, 
 
 Secondary 
 
 Pernicious 
 Arterio-sclerosis, Marrow in 
 Atrophy of 
 Cancer, Marrow in 
 Child, Bone-marrow in 
 Colour, Red 
 
 Congenital syphilis 
 
 Congestion, Focal 
 
 Degenerative marrow . 
 
 Endocarditis, Marrow in 
 
 Erythroblastic marrow 
 
 Febrile marrow . 
 
 Femur 
 
 Focal congestion ; see Congestion. 
 
 Fragilitas Ossium, Bone-marrow in 
 
 Gelatinous .... 
 
 Histological characters 
 Erythropoiesis diminished 
 Dra\vings .... 
 
 Photographs .... 
 
 Hodgkin's disease. Bone-marrow in 
 
 Hyperplastic .... 
 
 Inanition, Bone-marrow in . 
 Infant, Marrow of . . . 
 
 Leucoblastic marrow 
 Leukaemia, Bone-marrow in 
 Lymphosarcoma . . . 
 
 Malnutrition, Bone -marrow in 
 Osteomyelitis, Bone-marrow in 
 Pernicious anaemia ; see Anaemia. 
 Puerperal fever. Bone-marrow in . 
 Purpura, Bone-marrow in 
 
 41.7111.2,3,5,6,7 
 
 411 Infant ; 4P Child; 4L61^ (old). 
 
 41.611-4. 
 
 41.5161. 
 
 41.612; 41.71110. 
 
 41.611-4. 
 41.613; 41.6202. 
 412. 
 
 41.7111° (focal) ; see also Red bone- 
 marrow. 
 411. 
 
 41.6P; 41.71110. 
 41.6P; 41.62012. 
 412; 41.7111,5. 
 
 41.7111. 
 
 41.7112'3. 
 
 41.5151. 
 
 41.5141. 
 41.6201 >2. 
 
 41.5141 
 
 41.7114; 411; 41.7111. 
 
 41.6201. 
 
 41.5151. 
 
 41.711i'2; 41.711iO'ii (focal). 
 
 Quoted in 43.5143.i3. 
 411. 
 411. 
 41.7114.5.6. 
 
 41.5141. 
 41.7861. 
 41.6P. 
 41.7112. 
 
 41.7114. 
 41711' 
 
41. BONE-TklARROW 7 
 
 Red marrow .... 41.6P; 41.711i'2,7. Quotedin 43.5751. 
 
 Renal disease, Bone-marrow in . 41. Gl^'^. 
 
 Sarcoleukaemia, Bone-marrow in . 41.514^. 
 
 Secondary anaemia ; see Anaemia. 
 
 Semi-translucent marrow . . 41.515^ ; 41.620^'^. 
 
 Septicaemia, Bone-marrow in . 41.711^^. 
 
 Sublymphsemic .... 41.514^. 
 
 Syphilis, Bone-marrow in . . 41.711^° ;■ 4P. 
 
 Toxaemia, Bone-marrow in . . 41.620^. 
 
 Tuberculosis, Bone-marrow in . 41.711^. 
 
 Typhoid, Bone-marrow in . . 41.71P. 
 
 Uraemia, Bone-marrow in . . 41 .CP'^. 
 
41. BONE-MAEROW 
 
 CATALOGUE* 
 
 Anatomical Series 
 
 (The two specimens directly below, Nos. 41^ and 41^, showing the appearance 
 of the normal bone-marrow, are introductory to the pathological series following.) 
 
 41^ Bone-marrow of an Infant. 
 
 The specimen shows the relative amount of bony and marrow 
 tissue at this age. The marrow is extremely dense, dark red in colour 
 from vascularity, especially near the epiphysis, against the white of 
 which it stands out in marked contrast. Trabecular tissue is incon- 
 spicuous. 
 
 An original coloured drawing is also shown from a microscopic 
 section taken from this specimen at a point where there are few 
 bony trabeculse, so as to afford a field without any bone visible. 
 Two large cells are seen, one with a pale vesicular nucleus, the other 
 with multiple fragmenting nucleus. A number of small cells, 
 obviously lymphocytes, are scattered about. Some cells, three or 
 four times as large, occur at the right border. These are myelocytes. 
 A large degenerating cell is also shown, besides a number of erythro- 
 cytes. Three eosinophiles are present. This shows the average 
 cellular composition of normal bone-marrow. (Hsem. and Eosin, 
 Zeiss Imm. Oc. 6.) The detailed cell-characters can only be 
 ascertained by special stains. 
 
 M. L., aged 4 months. Died of inanition. He had been fed on 
 Nestle's milk since birth, which was premature (8th month). Signs 
 of congenital syphilis were present. 
 
 P.M. Showed apparently normal organs. 
 
 Ref. : E. 5244. R.V.H. 111.12. 
 
 Presented by Dr. Gruner. 
 
 * For abbreviations used in this Catalogue see page xviii. 
 
PLATE I 
 
 • ! -/Hi 
 
 /•^ #A 0^ # 
 
 41' BONE-MARROW OF AN INFANT FROM TRANSVERSE 
 SECTION OF NORMAL STERNUM 
 
 Haem. & Eryth. Zeiss imm. oc. 6 
 Presented by Dr. Gruner 
 
41. BONE-]VIARROW 9 
 
 4P Bone-marrow in a Child. 
 
 The specimen shows a small sternum sawn longitudinally. The 
 marrow tissue is divided off by three cartilage septa, two of which 
 are very broad. The shell of compact bone is rather thick. The 
 marrow tissue is very red and the supporting bone trabeculee very 
 firm but not visible. 
 
 R. R., female, aged 9, admitted March 13th, died April 9th. A case 
 of endocarditis following recurrent attacks of acute rheumatic fever. 
 Died from failure of compensation. 
 
 P.M. Pericarditis, adherent pericardium, recurrent granular 
 endocarditis, mitral stenosis, aplasic aorta, multiple infarcts of 
 lungs, lobar pneumonia, fibrinous pleurisy, advanced fatty nutmeg 
 liver, purpura, anasarca. 
 
 Ref. : E. 5501. R.V.H. 40.13. 
 
 Presented by Dr. Gruner. 
 
10 THE HEMOPOIETIC ORGANS 
 
 Pathological Series. 
 
 .1 ANOMALIES. 
 
 None in this series. 
 
 .2 CIRCULATORY DISTURBANCES. 
 See Cat. No. 41.6F. 
 
 .3 INFLAMMATIONS. 
 
 See under .4 Infections. 
 
 .4 INFECTIONS. 
 
 See under 41.620 Gelatinous Degeneration and 41.711 
 Hyperplasia. 
 
41. BONE-MARROW 11 
 
 .5 GENERAL OR CONSTITUTIONAL DISEASES. 
 
 .51 Diseases of the Blood and Blood-forming Organs. 
 .514 Leukaemia. 
 
 41.514^ Bone-marrow in an Atypical Leukaemia. 
 (Sarcoleukaemia.) 
 
 The marrow tissue is very mottled in colour, parts being intensely 
 injected. It is very abundant, and the trabeculse are scanty, 
 allowing the medulla to be easily cut with a knife. 
 
 Mrs. L. M., aged 72, was admitted to the R.V.H. Dec. 2, 1911, 
 with pains in the bones, enlarged glands, and pain in the abdomen. 
 Death occurred the following day after 24 hours' stupor. The 
 spleen was enlarged. The blood-count gave : Reds, 2,360,000 ; 
 Whites, 10,000 ; Hb, 50 %. The cerebro-spinal fluid contained 
 4-8 grm. urea per litre. 
 
 P.M. Sarcomatosis. Tumours in left rib, liver, Iddneys, pan- 
 creas, meninges, and thyroid. Spontaneous fracture of affected rib. 
 Osteosclerosis of bones of skull. Subcutaneous haemorrhage into 
 psoas, imder mucosa of bladder into uterus, and into floor of fourth 
 ventricle. Atheroma of aorta. All the ribs were very fragile. The 
 vertebral column could be cut with a knife. Fragilitas Ossium. 
 
 Micro. Exam. Marked changes in the direction of preponderance 
 of lymphoidocyte cells, marked diminution of myelocyte forms, 
 and diminution of erythropoiesis. 
 
 Note. A sublymphsemic change in the blood with the appearance 
 of Rieder cells and myelolymphocytes. A small spleen whose 
 cytology resembles that of a leukaemic spleen. Histological changes 
 in the glands approximating those seen in lymphatic leukaemia, 
 though not conspicuously enlarged. 
 
 Reported in full, in R.V.H. Bulletin No. 2, August 1912, imder 
 title ' Subleukaemic Sarcoleukaemia '. 
 
 Ref. : E. 4784c. R.V.H. 169.11. 
 
 Presented by Dr. Gruner. 
 
12 THE HJEMOPOIETIC ORGANS 
 
 .515 Hodgkin's Disease. 
 41.515^ Marrow of Femur in Hodgkin's Disease. 
 
 A portion of the upper end of the femur opened to show the pale 
 pink, soft, semi-translucent marrow permeating the trabecular 
 masses. The tissue shows diffuse caseation of moderate grade. 
 
 Male, aged 27. Ill for nine months with fever and swollen 
 lymph glands. 
 
 P.M. Combined tuberculosis and Hodgkin's disease. Change 
 in liver, spleen, pancreas, femur, and retroperitoneal lymph glands. 
 
 See also specimens No. 42.515^ and 43.515^, and under Liver 
 and Pancreas. 
 
 Ref. : E. 5097d. 
 
 Presented by Prof, de Josselin de Jong, Rotterdam. 
 
 .516 Pernicious Anaemia. 
 41.516^ Bone-Marrow in Pernicious Anaemia. 
 
 This specimen shows the sternum rich in marrow of rather pale 
 colour, but uniform in tint. The bone trabeculse are just distin- 
 guishable. 
 
 This marrow presents the natural or average naked-eye appear- 
 ance of an adult marrow, although it comes from a case in which 
 marked changes would be expected (pernicious anaemia). 
 
 A. T., female, aged 34. Admitted to the R.V.H. Nov. 27, 1912, 
 with signs and symptoms of severe anaemia of six months' duration. 
 
 Whites, 1,800 
 2,700 
 3,400 
 
 Hb, 20% 
 
 10% 
 10% 
 
 Nov. 30th, Reds, 1,270,000 
 
 Dec. 8th, „ 780,000 
 
 Dec. 16th, „ 970,000 
 
 Died with multiple haemorrhages. 
 
 P.M. Cryptogenetic anaemia, fatty degeneration of organs. 
 Haemosiderosis of liver. The spleen was moderately enlarged. Its 
 outer surface showed moderately conspicuous Malpighian follicles 
 and a relative increase in the amount of fibrous tissue. The pulp 
 was rather soft. Notching was natural. The sternum was cut in 
 half to show the pale marrow ; where fresh it was moderately deep 
 purple in colour, but not typically of pernicious type. Bone- 
 marrow was abundant, rather firm, and almost ghstening in some 
 places. The bone trabeculae were abundant. 
 (See also Specimens Nos. 43.516, 37.63.) 
 
 Ref. : E. 5375. R.V.H, 174.12. Canadian Practitioner and 
 Review, March 1912. 
 
 Presented by Dr. Gruner. 
 
41. BONE-MARROW 13 
 
 .6 RETROGRESSIVE CHANGES. 
 .61 Atrophy. 
 41.61^ Atrophic Bone-marrow in Anaemia. 
 
 The marrow is very scanty, of a pale colour throughout. The 
 bone is thinned also, so that the total volume of the marrow is very 
 small. The excess of bone is shown by the honeycombed appear- 
 ance. 
 
 This change is the result of atrophy of the marrow tissue proper, 
 while the bony trabeculse have shared in the general atrophy. 
 
 J. W., male, aged 25. Admitted to the R.V.H. on August 30, 
 1911, with signs of uraemia (dyspnoea, continuous epistaxis). He 
 had been ill six weeks. Red cells 750,000, whites 10,000. 
 
 P.M. Chronic mixed nephritis. Chronic adhesive pleurisy. 
 Hypertrophy and dilatation of the heart. Fatty Hver. Hyper- 
 plastic spleen and lymph-nodes. Ecchymoses of stomach. 
 
 Ref. : E. 4729. R.V.H. 145.11. 
 
 Presented by Dr. Gruner. 
 
 41.61- Atrophic Bone -marrow. 
 
 This specimen shows almost exactly the same change as the 
 preceding specimen. The marrow is here shown in cross section in 
 place of longitudinal. 
 
 T., male, aged 53. Admitted to the R.V.H. April 17, 1912, 
 in a state of uraemia from which he died on the day of admission. 
 He had had convulsions for four days. 
 
 P.M. Chronic interstitial nephritis. Arterio-sclerosis of main 
 arteries. Atrophic spleen. Atrophic marrow. 
 
 Ref. : E. 4971a. R.V.H. 54.12. 
 
 Presented by Dr. Gruner. 
 
14 THE HiEMOPOIETIC ORGANS 
 
 41. 6P Atrophic Bone-marrow from Malnutrition. 
 
 The specimen shows focal congestion, but is chiefly of grey- 
 yellow colour. The marrow tissue is abundant, completely filHng up 
 the sternum from compacta of one surface to that of the other. 
 The compact tissue is thin. 
 
 Bone trabeculse through the marrow tissue are inconspicuous. 
 
 S. C, female, aged 63. Admitted to the R.V.H. on Jan. 22, 
 1913, for stomach trouble of many years' duration, but worse during 
 the last 6 months. Whites count 18,000, 
 
 P.M. Carcinoma of cervix, extending to aU adjoining organs. 
 Bilateral hydronephrosis. Atrophy of spleen, marrow, and all 
 organs. 
 
 Ref. : E. 5398. R.V.H. 9.13. 
 
 Presented by Dr. Gruner. 
 
 41.61* Atrophic Bone-marrow in Secondary Anaemia. 
 
 The sternum opened to show a very fragile spongy centre with 
 a very soft, scanty, pale bone-marrow. The appearance is the result 
 of degenerative changes and breaking down of the marrow tissue. 
 
 M. McK., female, aged 60, was admitted to the R.V.H. Nov. 21, 
 1912, suffering from gastric symptoms. The condition was of more 
 than seven years' duration and consisted of recurrent attacks of severe 
 dyspepsia, latterly hsematemesis. Red cells, 2,600,000 ; white 
 cells, 6,000 ; Hb, 65 %. Operation revealed hour-glass stomach 
 with adhesions. Death 13 days later. The case gave an interesting 
 X-ray picture during life. 
 
 P.M. Hour-glass stomach. Enterogastrostomy. Plastic peri- 
 tonitis. Death from asthenia. Old gastric ulcer. Senile atrophy 
 of organs. Enlarged mesenteric and lumbar glands. Accessory 
 spleen. 
 
 Ref, : E. 5401c. R.V.H. 164.12. 
 
 Presented by Dr. Gruner. 
 
41. BONE-MARROW 15 
 
 .62 Degenerations. 
 .620 Gelatinous Degeneration. 
 41.620^ Gelatinous Bone-marrow in Toxaemia. 
 
 The marrow tissue is extremely abundant along the whole of 
 the manubrium. It is maroon-coloured, and the central parts are 
 quite semi-translucent, the distribution of this degenerative change 
 being quite irregular. Bony trabeculse are inconspicuous, 
 
 T. T., male, aged 55. Admitted to the R.V.H. on Feb. 12, 1913, 
 for extravasation of urine, dying two days later. He had had diffi- 
 culty of mictiurition 10 years. Admitted toxsemic, with local parts 
 gangrenous from diffusion. 
 
 P.M. Septic cystitis and pyeUtis. Passive congestion of organs. 
 Fibroid myocardium (extreme). CEdema of lungs. 
 
 Micro-photograph. Shows a number of smaU fat spaces of fairly 
 uniform size ; between these are a few small round cells with deeply 
 staining nuclei, the marrow cells. One-third of the photo shows 
 much dense grouping of the cells, and some larger forms (or megalo- 
 karyocytes) are present among them. The feebly stained structure- 
 less matrix between the fat spaces is degenerate material that gives 
 the character to the condition. 
 
 Ref. : E. 5338. R.V.H. 14.13. 
 
 Presented by Dr. Gruner. 
 
 41.620^ Gelatinous Bone-marroAv. 
 
 A sternum sawn longitudinally, showing a rather abundant 
 marrow tissue in which bone trabeculae can be readily seen. The 
 compact layer is thick. The marrow tissue itself is mottled red 
 and yellow ; the yellow areas are rather translucent. 
 
 E. P., male, aged 46. Admitted April 21st, died April 22nd. 
 Has suffered from pain in epigastrium, vomiting, and loss of weight 
 for one year, admitted in a moribund condition. 
 
 P.M. Primary carcinoma of the pylorus (secondary in liver) 
 leucoplakia of oesophagus, dilated aorta, fatty aorta and coronaries, 
 emphysema, gastrectasis. 
 
 Ref. ; E. 5520. R.V.H. 46.13. 
 
 Presented by Dr. Gruner. 
 
16 THE HEMOPOIETIC ORGANS 
 
 .7 PROGRESSIVE CHANGES. 
 .71 Regeneration. 
 .711 Hyperplasia. 
 41.7ir Bone-marrow of a Young Adult. (Hyper- 
 plasia in Malignant Endocarditis.) 
 
 This shows oblongs of deep red marrow, homogeneous in character 
 and neither soft nor hard. The bony trabeculse are conspicuous 
 throughout the tissue. 
 
 An original coloured drawing is also shown from a microscopic 
 section of this specimen showing the erythroblastic and leucoblasfic 
 reaction. Red cells of various shapes are seen (distorted by the 
 process of smearing). At the right hand is a normoblast above and 
 two megalocytes with fragmented nuclei below. The other cells 
 of greenish tint and bearing fine granules are various forms of myelo- 
 cytes. At the upper edge is a mast cell with feebly coloured granules 
 and an eosinophile with dark purphsh granules. (Triacid Stain. 
 Zeiss Imm. Oc. 12.) 
 
 W. S., male, aged 16. Admitted to the R.V.H. on Dec. 4, 1912, 
 because of endocarditis following attacks of rheumatic fever seven 
 weeks and two years previously. He had had mastoid disease on 
 the left side. He died on Dec. 17th. Reds, 4,420,000 ; whites, 
 10,600; Hb 51%. 
 
 P.M. Recurrent endocarditis (mitral and aortic). Hydro- 
 thorax (L.). Ascites, fatty liver, passive congestion of organs. 
 Chronic tuberculous nephritis. 
 
 Ref. : E. 4785. R.V.H. 173.12. 
 
 Peesented by Dr. Gruner. 
 
 41.71F Bone-marrow of Febrile Type. (Hyperplasia 
 in Acute Osteomyelitis.) 
 
 A portion of the tibia in section. The lower end of the specimen 
 is very yellow in colour, but mottled with brilliant red markings. 
 The upper end is of a uniform intense red. Marrow tissue is abun- 
 dant, but is Umited by a broad zone of compact bone on either side. 
 Bony trabeculae hardly occur through the medulla. 
 
PLATE 11 
 
 
 
 
 :_ T- f^^iv 
 
 41.711' BONE-MARROW OF A YOUNG ADULT SHOWING 
 ERYTHROBLASTIC AND LEUCOBLASTIC REACTION 
 
 From case of Malignant Endocarditis 
 
 Ti'iacid Stain. Zeiss imm. (tc. 12 
 
 Presented 1)}' Dr. Oruner 
 
PLATE III 
 
 41.711^ BONE-MARROW SHOWING LEUOOBLASTIC REACTION 
 
 From a case of Puerperal Fever 
 
 Jenner Stain. Zeiss imm. oc. 12 
 
 Presented by Dr. Giuner 
 
41. BONE-MARROW 17 
 
 This specimen presents the typical prune- juice marrow charac- 
 teristic of good reaction towards infections. 
 
 J. F., male, ItaUan, aged 58. Operated on in the R.V.H. on 
 Dec. 6, 1912, for osteomyeUtis. The leg was amputated below the 
 knee. 
 
 Microscopic examination shows loose oedematous marrow tissue. 
 
 Ref. : E. 5350. R.V.H. S. 2626.12. 
 
 Presented by Dr. Gruner. 
 
 41.71F Diffluent Bone - marrow in Febrile State. 
 (Hyperplasia.) 
 
 The specimen shows an exuberance of brownish marrow, oozing 
 out from between the trabeculse, which are everywhere present. 
 The colour is rather pale, but imiform. The compact bone at the 
 edge is scanty. 
 
 Mrs. H. C, aged 35. Admitted to the R.V.H. April 13, 1912, 
 with obscure abdominal symptoms. She had been ill for three 
 months. There was evidence of peritonitis. She died next day. 
 
 P.M. Typhoid fever with perforation of ulcer and general 
 suppurative peritonitis. Mesenteric and lumbar adenitis. 
 
 Ref. : E. 4963. R.V.H. 51.12. 
 
 Presented by Dr. Gruner. 
 
 41.711^ Painting of Microscopic Section of Bone- 
 marrow showing Leucoblastic Reaction. 
 
 This drawing shows the aspect of the normal marrow cells when 
 stained by Jenner's method (consists of methylene blue). The 
 red cells are of uniform size (stained yellow). Eosinophile leucocytes 
 occur. Of the remaining large cells most are finely granular (purple) 
 — the myelocytes of different forms — while two others have a deeply 
 stained cytoplasmic ring — myeloblasts. Much more deeply stained 
 smaller lymphoid cells are later generations, conveniently classed as 
 ' indifferent ' cells, because this stain does not allow of their better 
 definition. 
 
 From a case of puerperal fever. (Jenner stain. Zeiss Imm. Oc. 12.) 
 
 Presented by Dr. Gruner. 
 
 IV. I f! 
 
18 THE H.EMOPOIETIC ORGANS 
 
 41.71P Leucoblastic Bone-marrow. 
 
 A sternum sawn longitudinally to show a very abundant maroon- 
 coloured marrow. The compact layer is very thin. The marrow 
 tissue is supported by a considerable amount of bone, but this fact 
 is only obvious by palpation. The marrow tissue is not quite as 
 dark red as in 41.711*. 
 
 T. F., male, aged 40. Admitted March 28, died April 19. Typical 
 history of endocarditis with failing compensation. Anasarca, 
 dyspnoea, palpitation, cough and blood-stained sputum, Corrigan's 
 pulse. 
 
 P.M. Recurrent mahgnant endocarditis (aortic), lobar pneu- 
 monia, pericardial effusion, degeneration of heart muscle, aneurysm 
 below aortic valve, nutmeg liver, mixed nephritis, old infarcts of 
 spleen and kidneys, dilated arch of aorta, dilatation of heart. 
 
 Ref. : E. 4570. R.V.H. 37.13. 
 
 Presented by Dr. Gruner. 
 
 41.711® Leucoblastic Bone-marrow. 
 
 Sternum sawn in half to show a very abundant dark-red marrow. 
 The compact layer is reduced to a mere shell, the sternum being 
 wholly occupied by a soft trabecular tissue obscured from view by 
 the marrow tissue proper. Two cartilage septa appear across the 
 red areas. This is an instance of a leucoblastic tissue. 
 
 A. C, aged 32. Admitted June 27th, died Oct. 9th. 
 
 P.M. Tuberculosis of left hip with chronic suppuration, tuber- 
 culous broncho-pneumonia with cavities in right apex, calcified 
 tubercles of spleen and bronchial glands, atrophic pancreas, miliary 
 tuberculosis of diaphragm, sinuses in thigh. 
 
 Ref. : E. 5330. R.V.H. 140.12. 
 
 Presented by Dr. Gruner. 
 
 41.7ir Bone-marrow in Purpura. 
 
 The specimen shows a bright-red abundant marrow of firm 
 consistence. The bony tissue is obscured by a preponderance of 
 marrow tissue. 
 
 A. E,, male, aged 11, was admitted to the R.V.H. Feb. 19, 1913, 
 suffering from purpura hsemorrhagica, supposed to be haemophihc. 
 
41. BONE-MARROW 19 
 
 P.M. Purpura, petechial hsemorrhages throughout the body, 
 anaemia of organs, hsemolymph nodes, haemorrhagic appendicitis, 
 persistent thymus, small spleen. There were necroses in the 
 lymphoid foUicles. 
 
 Ref. : E. 5415. R.V.H. 15.13. 
 
 Presented by Dr. Gruner. 
 
 41.711^*' Bone-marrow showing Focal Hyperplasia. 
 
 The marrow tissue itself is excessively abundant, and is much 
 mottled with alternating areas of congestion and paUor. The 
 bony trabeculae through it are abundant. 
 
 The congested foci are areas of intense haemopoiesis. 
 
 M. S., male, aged 43. Admitted to the R.V.H. for headache 
 and loss of power on left side, symptoms of which existed three 
 weeks. Death two days later from heart failure. 
 
 P.M. General luetic arterio-sclerosis, cor bovinum, nutmeg 
 liver, mottled kidney. 
 
 Ref. 4728. R.V.H. 142.11. 
 
 Presented by Dr. Gruner. 
 
 41.711^ Bone-marrow in Septicaemia. (Focal Hyper- 
 plasia.) 
 
 Longitudinal section of sternum to show the marrow. The 
 marrow is dark coloured, mottled with pale areas of pimctate form ; 
 towards the lower portion many of these areas are confluent. The 
 compact bone is thin and dry. The trabecular structure of the 
 central portion is easily seen. 
 
 A. v., male, aged 55, was admitted to the R.V.H. in August 1910, 
 and an enlarged prostate was removed. Perineal abscess followed 
 and septicaemia supervened. There were mihary abscesses in the 
 kidneys and lungs, with septic pelvic phlebitis. 
 
 Ref. : R.V.H. 117.10. 
 
 Presented by Dr. Gruner. 
 
 C2 
 
20 THE HEMOPOIETIC ORGANS 
 
 .78 Malignant Tumours. (Sarcoma.) 
 .786 Lymphosarcoma. 
 .41.786^ Bone-marrow in Lymphosarccmia. 
 
 A portion of sternum showing a very honeycombed bony net- 
 work whose spaces contain translucent marrow. Portions of 
 vertebrae are also present in which the marrow tissue is rather 
 pale although the bony tissue is very dense. 
 
 Another portion of bone shows dark-red central marrow and 
 similar change superficially to that seen in the vertebrae. 
 
 This specimen is more of historical interest than useful for the 
 student. It merely exemplifies the condition of the marrow in the 
 same case from which No. 44.786^ is derived. (For history see this 
 specimen.) 
 
 Ref. : E. 4900. R.V.H. 162.11. 
 
 Presented by Dr. Gruner. 
 
41. BONE-MARROW 21 
 
22 THE HEMOPOIETIC ORGANS 
 
41. BONE-MARROW 23 
 
24 THE HiEMOPOIETIC ORGANS 
 
41. BONE-MARROW 25 
 
26 THE HEMOPOIETIC ORGANS 
 
42. LYMPH-NODES 
 
 INTRODUCTORY 
 
 The most conspicuous changes to be looked for in studying the 
 naked-eye appearances of lymph-nodes are : (1) change of size, 
 (2) change of colour, (3) replacement by new growth. 
 
 (1) Change of size. The ordinary variations are well exhibited in 
 42.361^, where all gradations from the normal to great bulk are 
 shown in a series taken from one patient. The inflammatory 
 changes incident to lymph-glands do not usually enlarge them more 
 than the size shown in 42.35P or 42.361^, but when a number of 
 enlarged nodes are massed together, as in 42.361^ and 42.516^ they 
 give the impression of greatly increased bulk. 
 
 The character of the cut surface will afford some clue to the 
 nature of the enlargement. It is here that change of colour calls 
 for consideration. 
 
 (2) Change of colour. Ordinarily the lymph-node is very pale, 
 almost quite white. Varying shades of redness are produced by 
 congestion of different degrees up to that associated with intense 
 inflammation. Very red nodes may be examples of adenitis or of 
 haemolymph nodes — two different conditions for whose differentia- 
 tion the microscope must be invoked. The hsemolymph change 
 may be regarded as a metaplasia (42.7121) and consists in a meta- 
 morphosis of the lymphocyte-forming tissue into erj^throcyte- 
 destroying, and occasionally into erythrocyte-forming tissue. That 
 is to say, the change amounts to one of formation of accessory 
 spleens in unusual parts of the body. The impossibihty of distin- 
 guishing between acute adenitis and haemolymph nodes is the less 
 remarkable because conversion into the latter may be produced by 
 infective agents which sometimes act in one maimer (inducing 
 adenitis) and sometimes in another, leading to appearances only 
 classifiable by the aid of the microscope. Thus, from the gross 
 appearances, 42.351^ may be equally typhoid adenitis or haemo- 
 lymph formation. Similarly 42.514- may be classified as specifically 
 leuksemic, or as haemolymph change. 
 
 The development of a lemon-yellow colour, especially in the form 
 of irregular mottling, is usually due to tuberculous disease, though 
 also met with in lymphosarcoma and Hodgkin's disease. In tuber- 
 
28 THE HEMOPOIETIC ORGANS 
 
 culosis, in place of having a very finely granular sandy surface, the 
 tissue shows a smooth, homogeneous, cheesy character. 42.36 1^ 
 shows a mass of caseous cervical glands, in which the number, 
 shape, outhne, and consistence of the degenerative foci are suffi- 
 ciently variable to demonstrate in the one specimen all the various 
 changes that may be met with in tuberculosis in these structures. 
 Accessories to diagnosis are supphed by noticing (1) the condi- 
 tion of the capsule, because tuberculous adenitis is so frequently 
 associated with the formation of firm adhesions binding one gland 
 to another ; (2) the occurrence of calcareous change, as shown in 
 42.361^. 42,627^ is a specimen in which the whole gland was 
 converted into a calculus ; it lay at the bifurcation of the trachea. 
 
 As characteristic of tuberculosis in cattle 42.36 1^" may be 
 instanced, where the enormous size, mottling, radial streaking, 
 fibro-caseous appearance, and calcareous change are specially note- 
 worthy. 
 
 A change of colour that is very frequently observed is through 
 various shades of grey up to intense black. This is the famiHar 
 anthracosis shown in 42.637^. Sometimes such glands are fleshy 
 and succulent, at other times they grate with the knife. 42. 79^ 
 illustrates the association of anthracosis and infiltration with new 
 growth — a phenomenon no more remarkable than is the association 
 of carcinoma with tuberculosis in lymph-nodes. 
 
 Variations of shape do not occur in connexion with lymph- 
 nodes, save those produced by fusion of adjoining glands. 
 
 Variations of consistence do not count for so much as obtains 
 with other viscera. The glands are usually semi-elastic to the feel, 
 and retain that character in the various morbid processes to which 
 they are liable. In museum preparations the feature of consistence 
 is of little value except in connexion with the process of calcification, 
 which is unaltered by hardening fluids and is practically diagnostic 
 of obsolete tuberculosis. 
 
 (3) Replacement hy new growth. The commonest examples are 
 metastatic associated with primary growth elsewhere : 42.79^"^, 
 a series also illustrating varying degrees of' enlargement. 42.79^ is 
 a very massive infiltration. The characters to look for in the cut 
 surface of such glands are the same as those which would be found 
 in the original tumours. Thus, 42.79' is epitheHoma, 42.79^ is 
 acinous carcinoma, and 42.79* is colloid carcinoma. 
 
 The sarcomas are divisible into two groups, those belonging 
 to the true sarcoma class, and those which some authorities 
 would consider as constituting transitions to lymphogranulomatosis 
 (42.515^ 42.7861, and 42.5155). These masses are often matted 
 
42. LYMPH-NODES 29 
 
 together and show little when examined externally. The cut surface 
 is, however, fairly characteristic, being fleshy, very finely granular, 
 bulging, juicy, and either homogeneous or marked with smaU, 
 irregular, very pale lemon-yeUow foci of degeneration. Without 
 the aid of a microscope it is not possible to draw any distinction 
 between sarcoma and Hodgkin's disease even by noting the above 
 points, and indeed there is room for much difference of opinion 
 even when the microscope is employed. 
 
 It was stated that the existence of periglandular adhesions 
 formed an accessory means of diagnosis of tuberculosis. Frequently 
 enlargements of Hodgkin's disease are unencumbered by such 
 adhesions (42.515^), though in a few cases the enlarged glands are 
 bound together. 
 
 Cystic change in glands is exemplified by two specimens (42. TO^'^)^ 
 and is apparently due to breaking down of new inflammatory tissue 
 which has first enlarged the glands to a considerable degree. 
 
 There are certain considerations to be brought forward in order 
 to give the student some idea of the processes at work in the lymph- 
 nodes under the influence of morbific agents. It is evident that 
 the naked eye gives very Httle real information, and a study of the 
 microscopic preparations in this collection will reveal numerous 
 points in which difficulty is likely to arise. Very briefly, the structure 
 of the lymph-node is as follows : The cortical portion is made up 
 of a collection of folHcles of ovoid shape, each surrounded by a 
 lymphatic sinus which receives material from without. The central 
 portion is made up of pulpar tissue permeated by a close network of 
 small channels draining the sinuses just named, and emptying into 
 the efferent vessels. The two series of tissue have a separate series 
 of vessels of supply, though these come off the main trunks which 
 enter at the hilum. According as the brunt of change is borne by 
 folHcles, pulp, or sinuses, so the histological picture varies. Thus 
 the simple inflammatory processes referred to involve the sinus 
 system, and metastatic deposits become lodged here. There is, 
 however, a whole series of morbid conditions, usually classed as 
 blood diseases, which involve the other portions of the gland. In 
 Hodgkin's disease and its variants, the changes are in the follicles 
 and the immediate vicinity, as described at length in the Catalogue 
 under specimen 42.786^, where the morbid process has gone on to 
 the lymphosarcomatous type. The pseudoleukaemias ^ are asso- 
 ciated with changes in either folhcular or pulpar tissue, which may 
 
 ^ What Cohnheim originally termed pseudoleukaemia is the aleuksemic stage of 
 leukaemia, or lymphadenosis of Schridde and AschofE. See Dr. Adami's note at 
 end of this Introduction (page 31). — Ed. 
 
30 THE HEMOPOIETIC ORGANS 
 
 be briefly described as processes of blurring of normal structure, 
 the whole organ becoming lymphoid (small round-celled) in 
 character. Leukoemias are associated with folUcular and pulpar 
 changes also, but the process is now one of metaplasia, or trans- 
 formation of the tissue into one which produces either myelocytes 
 or lymphoblastic cells, according to the type of leukaemia. The 
 metaplasia is produced by a change of process of development of 
 the specific cells lying in the pulp cells, which are essentially similar 
 to those met with in the splenic pulp. Probably it is of minor 
 importance whether the process is acute or chronic, but in the 
 former class of case the clinical features of the disease affords evidence 
 in favour of the view that acute leukaemia is due to an infective agent, 
 whose nature must have several points in common with those 
 possessed by better known infections. Histologically, too, there is 
 the interesting fact that the eruptive fevers frequently show similar 
 changes in the pulp of lymph-nodes to those found in leukaemia 
 on a large scale, just as the blood in such cases is also liable to con- 
 tain myelocytes. 
 
 The enlargement in lymphatic leukcemia (lymphadenosis with 
 leukaemia) is well shown in 42.514^. The reddish colour and succulent 
 appearance of the cut surface and the moderate size are to be noted 
 as points of distinction from an enlargement due to lymphosarco- 
 matous change. In lymphosarcoma the tumour infiltrations are much 
 paler and more closely connected with one another. 
 
 The dark colour of the glands in acute lymphatic leukaemia 
 not infrequently gives them a close resemblance to haemolymph 
 glands and toxic adenitis. 42.514^ affords a very good illustration 
 of this point. 
 
 It is with a knowledge of the limitations to the information 
 yielded by gross appearances that the student should approach 
 the study of the specimens on the shelves. He will then not fail 
 to examine the microscopic preparations, and piece together the 
 complete pathological picture by adducing the clinical data with 
 which the Catalogue provides him. O. C. G. 
 
 [Inasmuch as the student is constantly being thrown into confusion by the 
 different terminologies employed both by the text-books and his clinical teachers 
 in connexion with the series of disturbances summarized above, it becomes necessary 
 for us to state clearly what we understand by these various terms : 
 
 Hodgkiri's disease (lymphogranulomatosis of modern authors, pseudoleukaemia 
 of some earlier writers) : a specific infective inflammatory hyperplasia of lymph- 
 nodes. 
 
42. LYMPH-NODES 31 
 
 Lymphadenosis : a diffuse, apparently non-inflammatory hyperplasia of lymphoid 
 elements throughout the body which may or may not be accompanied by excess of 
 lymphocytic elements in the blood : 
 
 (1) When so accompanied = Lymphatic leukaemia. 
 
 (2) When not so accompanied = Pseudoleukaemia of Cohnheim, aleukaemia or 
 pre-leukaemic leukaemia of other authorities. 
 
 ' Leukaemia ' ought only to be spoken of as a symptom : we should speak of 
 lymphadenosis with, or without, leukaemia. 
 
 Myelosis : a diffuse, apparently non-inflammatory, hyperplasia of the myelo- 
 genous elements of the bone-marrow and lymphoid tissues, which similarly may 
 or may not be accompanied by leukaemia of the myeloid type. 
 
 (1) Myelosis with leukaemia = Myelogenous leukaemia. 
 
 (2) Myelosis without leukaemia = Aleukaemic leukaemia. 
 
 Lymphosarcoma and Lymphosarcomatosis. Any of the above conditions may 
 show, either locally or generally, the development of malignancy, characterized by 
 infiltrative growth of lymphoblastic or myeloblastic elements beyond the limits of 
 the organ ; such infiltrative invasion of other parts constitutes sarcoma ; if diffuse, 
 sarcomatosis. 
 
 J. G. Ad AMI,] 
 
 (For a fuller exposition of this subject, see The Principles of Pathology, 
 J. George Adami, vol. i, chap. xix. — Ed.) 
 
DETAILED CONTENTS OF THE SECTION 
 
 42. LYMPH-NODES AND SYSTEM 
 
 Adenitis .... 42.3P; 42.3511-3. 
 Age, Infant . . . 42.36112. 
 Anatomical regions : 
 
 Aortic .... 42.311; 42.515^; 42.79^. 
 
 Axillary. . . . 42.793. 
 
 Cervical . . . 42.3613.4,io ; 42.5151. 
 
 Inguinal . . . 42.79'. 
 
 Mediastinal . . . 42.3612.2i. 
 
 Mesenteric . . . 42.351i-3.5.7.8,ii,i5 ; 42.514i>2 ; 42.641; 
 
 42.795. Quoted in 44.5261-2, 
 
 Pelvic .... 42.79«. 
 
 Peribronchial. . . 42.361i'9'i2 ; 42.515^; 42.627i'2 ; 42.7121; 
 
 42.791-2; 42.701. 
 
 Periportal . .' . 42.721. 
 
 Subcostal . . . 42.5154. 
 
 Tracheal ; see Peribronchial. 
 Animals, cow . . . 42.36120.2i ; monkey, 42.36115. 
 
 Anthracosis of . . . 42.3612; 42.6271; 42.6371; 42.7121; 
 
 42.791. 
 Appendicitis, Glands in . 42.31i. 
 Bovine tuberculosis . . 42.36P ; 42.36120-2i. 
 
 Calcified glands . . 42.3612; 42.6271-2; 42.64i ; 42.79^; 
 
 42.701. 
 Carbon-pigment in ; see Anthracosis. 
 Carcinoma of . . . 42.79i'2.3,4,5,6,7,8_ 
 
 Scirrhus . 
 CoUoid . 
 Squamous 
 Softening 
 Caseation of 
 
 . 42.793. 
 
 . 42.794. 
 
 . 42.79'. 
 
 . 42.79'. 
 
 . 42.3611-3.6-12,15,20,21. 42.722. 
 
 Cirrhosis of liver. Glands in . 42.72i. 
 
 Comparative anatomy ; see Cow, Monkey. 
 
 Congestion of . . . 42.3511.2; 42.72i ; 42.798. 
 
 Cow .... 42.36120-21. 
 
 Cystic .... 42.701. 
 
 Fibrosis .... 42.5155; 42.6371. 
 
42. LYMPH-NODES 
 
 33 
 
 Hsemolymph nodes . . 42.5142; 42.5151 ; 
 
 42.514". 
 Histological features of lymphatic glands : 
 
 42.7121. Quoted in 
 
 Dilated sinuses 
 Erythroblastic change 
 Fibrosis . 
 
 Haemorrhagic areas . 
 Loss of follicular structure 
 Necrotic foci . 
 Phagocytes in 
 Hodgkin's disease 
 
 Hyperplasia of . 
 Infant, Glands of 
 Lymphatic leukaemia . 
 Lymphosarcoma 
 Monkey, Gland of 
 Necrotic change in glands 
 Periadenitis 
 
 Purpura . 
 Softening of 
 Solitary follicles. Large 
 Tonsils . . 
 Tuberculosis of . 
 
 Bovine . 
 
 Softening 
 
 See under Caseation. 
 Typhoid, Glands in . 
 
 42.3P. 
 
 42.5142. 
 
 42.5155. 
 
 42.7121. 
 
 42.311; 42.35P. 
 
 42.3512.3; 42.798. 
 
 42.7121. 
 
 42.5151-5 ; 43.5152-5 ; 24.515 ; 37.515 ; 
 
 39.515; 57.515. 
 42.721.2; 44.5261.2. Quoted in 41. GP. 
 42.36112. 
 42.5141.3. 
 42.7861. 
 42.36115. 
 
 42.3512; 42.798; see Histological features 
 42.311 ; 42.5155 ; 42.361^'6.7.i<».ii.20.2i ; 
 
 42.722; 42.79«. 
 42.5142. 
 
 42.361«; 42.79'. 
 44.5262. 
 44.5262. 
 42.3611-12.15. 
 42.361«'20.2i. 
 42.361«. 
 
 42.3511-3. 
 
 Tbc* 39-44. 
 Tbc* 45. 
 
 * Tbc. These numbers refer to specimens in Tuberculosis series of the General 
 Pathology Section. 
 
 IV. 1 
 
42. LYMPH-NODES 
 
 CATALOGUE * 
 
 .1 ANOMALIES. 
 
 None in this series. 
 
 .2 CIRCULATORY DISTURBANCES. 
 
 See under 42.711 Hyperplasia, also 42.515^ 
 
 .3 INFLAMMATIONS. 
 .31 Catarrhal or Desquamative Inflammation. 
 42.31^ Aortic Glands. Acute Toxic Adenitis. (Peri- 
 adenitis.) 
 
 A portion of the abdominal aorta with adjoining lymph-glands. 
 These are enlarged, and many are bound together by adhesions. 
 Some are pale in colour and others fleshy. 
 
 L. M., male, aged 24. Admitted to the R.V.H, on July 10, 
 1912, with jaundice and abdominal pain of two days' duration, onset 
 sudden. No blood-count. Operated on for cholecystitis. Widal 
 negative on July 16. July 24, sutures gave way and Uver appeared 
 cystic. August 3rd, colon vaccine given. Died on August 13th. 
 
 P.M. Gangrenous appendicitis with pelvic abscess and suppura- 
 tive pylephlebitis, general peritonitis, ascites, jaundice, general 
 lymphadenitis, atrophy of gall-bladder, acute splenitis. 
 
 Micro. Exam. The lymphatic channels are widely dilated and 
 in a state of catarrh. Folhcular tissue is lost. 
 
 Ref. : R.V.H. 113.12. E. 5243d. 
 
 Presented by Dr. Gruner. 
 
 * For abbreviations used in this Catalogue see page xviii. 
 
42. LYMPH-NODES 35 
 
 .32 Exudative Inflammation. 
 
 None in this series. 
 
 .33 Destructive Inflammation. 
 
 See under 42.361 Caseous Tuberculosis. 
 
 .34 Specific Inflammation due to Cocci. 
 None in this series. 
 
 .35 Specific Inflammation due to Bacilli. 
 .351 Lesions due to B. Typhosus. 
 42.351^ Enlargement of Mesenteric Glands in Typhoid. 
 
 The specimen consists of a piece of small intestine, caecum, and 
 appendix, with the glands in the mesentery at the angle. The 
 posterior surface shows a gland cut open, the cut surface being 
 granular and of pale colour. The anterior surface shows a typhoidal 
 ulcer near the ileocaecal valve and a group of enlarged glands. 
 One of these is very large and presents alternate dark and pale 
 areas, the dark areas being probably originally red from congestion. 
 The other glands of this group are much smaller than usual in a case 
 of this kind. 
 
 Ref. : R.V.H. E. 561. 
 
 Presented by Dr. Adami. 
 
 42.35P Mesenteric Glands from a Case of Typhoid 
 Fever. 
 
 The specimen consists of a portion of the mesentery, the bowel 
 having been removed. It is dissected to show that it is studded 
 with elongated, bean-shaped, enlarged glands, many of which are cut 
 across and present a deeply coloured dusky surface. The periphery 
 is congested. The glands are all approximately of the same size. 
 
 C. A., male, aged 17, was admitted to the M.G.H., having been ill 
 
 D 2 
 
36 THE HEMOPOIETIC ORGANS 
 
 with typhoid fever for 11 days. He died three days later from 
 toxaemia, 
 
 P.M. Typhoid ulceration of ileum and csecum, enlarged soUtary 
 follicles, infarct of spleen, acute splenitis, cloudy sweUing of organs. 
 Enlarged mesenteric glands with central necrosis. 
 
 Ref. : M.G.H. 207.09. E. 4064. 
 
 See also Specimen No. 43.3251 and 43.3515. 
 
 Presented by Dr. Wolbach. 
 
 42.35P Mesenteric Glands, Typhoid Fever. 
 
 A chain of greatly enlarged glands lying in the mesentery. The 
 largest mass is close to the appendix angle. The glands are pale 
 and fleshy. Some are discrete, others are confluent. 
 
 H. B., male, aged 24, a trench labourer, was admitted to the 
 R.V.H. on July 21, 1912, with symptoms of typhoid fever. He had 
 been ill six days. The infection was apparently obtained on the 
 Back River. 5,900 leucocytes per c.mm. Copious haemorrhage on 
 August 9th. Widal negative. Died August 10th, on 26th day of 
 disease. 
 
 P.M. Enteric fever (three ulcers only) with death from haemor- 
 rhage. Myasthenia cordis, cloudy swelhng of organs, marked 
 mesenteric and lumbar adenitis, acute splenitis. 
 
 Micro. Exam. There is marked catarrh of the lymph passages 
 and the follicular arrangement has been largely lost. Characteristic 
 necrosis is seen in the centres of the remaining foUicles. 
 
 Ref. : E. 5242. R.V.H. 110.12. 
 
 Presented by Dr. Gruner. 
 
42. LYMPH-NODES 37 
 
 .36 Specific Inflammation due to Acid-fast Bacilli, &c. 
 
 .361 Lesions due to B. Tuberculosis. 
 
 Human Tuberculosis. 
 42.361^ Tuberculosis of Peribronchial Glands. 
 
 A group of enlarged glands about the bifurcation of the trachea, 
 two the size of a walnut. The cut surface shows caseation, softening 
 of the larger and anthracosis of the smaller glands. 
 
 Old Museum specimen. 
 
 42.36P Tuberculosis of Mediastinal Glands. 
 
 The specimen consists of a large, partly calcified, partly caseous, 
 mass hmited by a distinct capsule, situated in close relation to the 
 aortic arch. Carbon-pigmented area can be seen through the 
 capsule in some situations. 
 
 Ref. : E. 4002c. , " 
 
 See also specimen No. 43.72^. 
 
 Presented by Dr. Klotz. 
 
 42.36P Caseating Tuberculous Cervical Glands. (Re- 
 moved by Operation.) 
 
 The specimen consists of 46 glands of varying size, arranged 
 according to magnitude ; the larger ones are laid open, and show 
 a homogeneous cheesy surface. The largest presents an irregular 
 puckering on its anterior surface. The glands possess a rounded 
 smooth outline. 
 
 Ref. : E. 239. M.G.H. S. 100.96. 
 
 Presented by Dr. Shepherd. 
 
 42.361* Tuberculosis of Cervical Glands. (Removed 
 by Operation.) 
 
 A nodular tumour the size of a kidney, consisting of enlarged 
 glands which are adherent to each other, showing the appearances 
 
38 THE H.EMOPOIETIC ORGANS 
 
 of a mass of glands in a typical case of tuberculous adenitis of the 
 neok. 
 
 Ref. : Old Museum specimen. 
 
 Presented by Dr. Roddick. 
 
 42.361^ Tuberculosis of Mesenteric Glands. 
 
 Part of the mesentery, with the peritoneal covering dissected 
 o& to show enlarged glands, varying in size from a pea to an acorn. 
 
 K. McR., female, aged 32. Obsolescent tuberculosis of pleura 
 and both lungs. Acute leptomeningitis from infection with 
 B. infiuenzce, causing death. 
 
 Ref. : R.V.H. 23.98. E. No. 38. 
 
 Presented by Dr. Adami. 
 
 42.361® Tuberculosis of Mesenteric Glands. 
 
 A mass of enormously enlarged glands, firmly adherent to each 
 other. The appearances resemble bovine tuberculosis, but the 
 specimen is from a human subject. Extensive caseation has occurred, 
 and from some of the glands the contents have been lost, leaving 
 what amount to abscess cavities. 
 
 Presented by Dr. Adami. 
 
 42.36r Tuberculosis of Mesenteric Glands. 
 
 A mass of mesenteric glands, varying in size from the normal 
 
 to several centimetres in diameter. They are very closely packed 
 and are bound together by adhesions, producing a lobulated mass. 
 
 The cut surface of one is shown, to demonstrate the caseation which 
 
 is present. 
 
 42.361^ Mesenteric Glands. Tuberculosis. 
 
 A piece of mesentery, showing a number of large oval glands. 
 The largest measures 3xl'5x9 cm.; many of them have a pink 
 
42. LYMPH-NODES 39 
 
 colour ; several of the glands have been laid open to show that 
 they are almost completely caseated. 
 
 From a male Greek, aged 32. He was said to have been ill only 
 three weeks ; the symptoms were pulmonary, 
 
 P.M. Chronic ulcerative tuberculosis of lungs, with cavitation ; 
 miliary tuberculosis of kidney, Uver, and peritoneum ; tuberculous 
 ulcers of intestine. The glands in the thorax were not involved. 
 Tubercle bacilli were found in the peritoneum. 
 
 Ref. : E. 3855b. R.V.H. 106.09. 
 
 Presented by Dr. Klotz. 
 
 42.36F Caseous Tuberculosis of Bronchial Glands. 
 
 Two bronchial glands cut across to show caseous masses within. 
 An indication of a septum shows that the specimen originally 
 consisted of two discrete glands. The upper is entirely caseous, with 
 the capsule intact except at the point of contact with the larger 
 lower gland, where the caseation spreads continuously through, and 
 almost entirely replacing it. The interior of the caseous area is lobed. 
 The gland tissue itself is congested. 
 
 For history see 43.361ii. (Same case.) 
 
 Micro. Exam. The capsule is seen to be much thickened, and 
 the structure of the gland is obscured by a mass of caseous tissue. 
 Around it are some giant cells. The blood-vessels around these are 
 intensely engorged. There is marked inflammatory ceU infiltration 
 along the trabeculge. Endothelial hyperplasia was marked in some 
 sections of other glands in the same case. 
 
 Ref.: E. 4364b. R.V.H. 115.10. 
 
 Presented by Dr. Klotz. 
 
 42.36r° Caseous Tuberculosis of Glands of Neck. 
 
 The specimen consists of a lobulated gland cut open longi- 
 tudinally. The outer surface is smooth with a few tags of adhesions ; 
 the cut surface shows irregular extensive caseation. The whole of 
 one pole is involved, the other pole showing three or four discrete 
 foci separated by gelatinous-looking fibrous tissue. 
 
 J. M., male, aged 21. Admitted to M.G.H. April 25, 1910, 
 with indurated painless swelHng in right side of neck, which was 
 first noticed five months previously ; it was then a small lump 
 
40 THE HEMOPOIETIC ORGANS 
 
 the size of a marble and had increased gradually to the present 
 size. A few days before admission almost choked with difficult 
 breathing, and sought relief by operation on this account. The 
 enlarged glands were enucleated entire on April 26th. No signs of 
 tuberculosis in lungs and no bacilli in sputum. 
 Ref. : E. 4931. M.G.H. S. 10.252. 
 
 Presented by Dr. Wolbach. 
 
 42.361^^ Tuberculosis of Mesenteric Glands. 
 
 A loop of bowel with the mesentery attached. In the mesentery 
 is a mass of enlarged lymph-nodes, some of them discrete, others 
 united together, forming a broad, roUed-up mass. Smaller pinhead- 
 size nodules intervene between this and the bowel itself. The glands 
 are very hard and the cut surface is pale ochre-coloured and almost 
 homogeneous. In this respect the specimen simulates lympho- 
 sarcoma. 
 
 Micr0. Exam. The tissue is occupied by large hyaUne rounded 
 bodies with caseous centres. There are large, well-formed giant 
 cells in their periphery, and very sharply defined groups of meso- 
 lymphocytic elements here and there. 
 
 Ref. : E. 5603d. P.H.I. 
 
 Presented by Dr. Kaufmann. 
 
 42.361^^ Tuberculosis of Bronchial Node in an Infant. 
 
 An infant's trachea with a large gland below the bifurcation. 
 The cut surface reveals almost complete substitution by caseous 
 matter, while there is linear marking by carbon infiltration. 
 
 F. M., female, aged 4. Admitted April 23rd. Died May 16th. 
 Father died of tuberculosis at 32 years. Child semi-stuporose. 
 Tubercle bacillus found in cerebrospinal fluid. There were a leuco- 
 cytosis and scattered areas of moist rales throughout both lungs. 
 Clinical diagnosis of miliary tuberculosis and tuberculous meningitis. 
 
 P.M. General miliary tuberculosis. Caseous tubercles of peri- 
 bronchial and peritracheal nodes. Caseous tuberculosis of spleen. 
 Miliary tuberculosis of pleurae, peritoneum, lungs, spleen, fiver, 
 kidneys. Tuberculoma of pons. Tuberculous meningitis. Acute 
 bronchitis. Tuberculous broncho -pneumonia. Acute cystitis. In- 
 ternal hydrocephalus. Acute suppurative otitis media (bilateral). 
 Acute suppurative mastoiditis (left). 
 
PLATE IV 
 
 42.361'^ TUBERCULOSIS OF MESENTERIC LYMPH-NODES IN MONKEY 
 
 Dr. Duval 
 
 P. 41 
 
42. LYMPH-NODES 41 
 
 Note. The bronchial glands appear to be the earliest site of 
 tuberculosis. The amount of pus on the base of the brain was 
 greater than usual. 
 
 Ref. : E. 3397. R.V.H. 55.07. 
 
 Presented by Dr. Klotz. 
 
 Monkey Tuberculosis. 
 
 42.361^^ Tuberculosis of Mesenteric Nodes in Monkey. 
 
 A specimen of small intestine with the mesentery attached. 
 In the mesentery there are some enlarged glands, the largest of which 
 measures 1 cm. in diameter, is slightly oval in shape, smooth, and 
 hard, a few dilated capillaries run across it. The other glands 
 are much smaller, but are hard in consistence ; they are all discrete 
 and show no trace of inflammation about them. One of the glands 
 has been cut through to show its complete caseous transformation. 
 
 History. From a ring-tailed monkey that was in captivity about 
 eight months, and died with symptoms of pulmonary tuberculosis 
 and enteritis. 
 
 Micro. Exam. Section shows numerous giant and epithelioid 
 cells and areas of necrosis. 
 
 Ref. : E. 2961. M.G.H. 
 
 Presented by Dr. Duval. 
 
42 THE HiEMOPOIETIC ORGANS 
 
 Bovine Tuhercidosis. 
 
 42.361-° Tuberculous Nodes from a Cow. 
 
 A mass of greatly enlarged glands, partially dissected behind, 
 the anterior surface formed by a longitudinal cut. This shows one 
 large and three smaller masses of a dark yellow colour, traversed 
 
 by delicate strands of fibrous tissue. The centre of the large mass 
 
 presents a focus of bright yellow colour, indicative of caseous change. 
 
 The surrounding tissues are thickened. 
 
 From a case of generahzed bovine tuberculosis. 
 
 Ref. : E. 3204. 
 
 Presented by Dr. Higgins, Government Bacteriological 
 Laboratory, Ottawa. 
 
 42.36r^ Bovine Tuberculosis of Mediastinal Glands. 
 
 A slab of tissue, the cut surface of which shows large rounded 
 caseous masses bound together by firm fibrous tissue. Some white 
 suet-hke fat limits them off at the one end, and muscular tissue at 
 the other. The individual masses are dotted with pale-yellow foci 
 of calcification. These alternate with ochre-yellow cheesy areas 
 and semi-translucent peripheral borders. 
 
 Ref. E. 3204. 
 
 Presented by Dr. Higgins, Government Bacteriological 
 Laboratory, Ottawa. 
 
PLATE V 
 
 W \4^^- 
 
 42.514' LYMPH-NODES IN LYMPHATIC LEUKEMIA 
 
 Dr. Wolbach 
 
 P. 43 
 
42. LYMPH-NODES 43 
 
 .4 INFECTIONS AND PARASITES. 
 See 42.3511-^ and 42.3611"*. 
 
 .5 DISEASES OF METABOLISM AND INTOXICATIONS. 
 .51 Changes in Blood-forming Organs. 
 .514 Leukaemia. 
 42.514^ Lymph-nodes in Lymphatic Leukaemia. 
 
 A large mass of discrete, evidently enlarged, fawn-coloured 
 lymph-glands, taken from the mesentery. One side has been 
 dissected. The cut surface has a uniform, absolutely homogeneous 
 appearance. 
 
 (For history see. under Spleen, 43.514^^.) 
 
 Micro. Exam, shows the normal structure of the lymph-gland 
 to be entirely lost. The tissue consists of uniformly distributed, 
 closely packed, small, round, mononuclear cells, separated into large 
 masses by scanty thin bands of fibrous tissue. With the oil-immer- 
 sion lens these cells are seen to be uniform in character, of rather 
 large size, Mith a very scanty rim of cytoplasm, and a trachychromatic 
 round nucleus in which there is one central or two or three evenly 
 distributed nucleoH. Some of the nuclei show peripheral chromatic 
 thickening. Here and there are seen capillaries hned by swollen 
 endothehal cells, containing a relatively large number of lympho- 
 cytes. Some of these capillaries have distinctly thickened walls. 
 There is no other supporting structure among the lymphocyte-Kke 
 masses. In size and character the cells of which the tissue is almost 
 entirely composed have a strong resemblance to that of the germ- 
 centre cells of ordinary lymph-gland. There are no cells of strikingly 
 large size amongst these and no multinucleate cells. 
 
 Ref. : E. 3530. M.G.H. 08.79. 
 
 Presented by Drs. Finley and Wolbach. 
 
 42.514^ Mesenteric Glands. Haemolymph Nodes in 
 Acute Lymphatic Leukaemia. 
 
 Two pieces of mesentery containing a few much enlarged glands 
 of dull reddish colour. The original outhne of the glands is preserved. 
 Many appear mottled externally. The cut surface shows an intense 
 
44 THE H.EMOPOIETIC ORGANS 
 
 engorgement, giving them a fleshy, and in parts haemorrhagic, appear- 
 ance. 
 
 D. B,, male, aged 44. An Itahan labourer. Admitted to the 
 R.V.H. July 15th, dying U\o days later with purpuric symptoms and 
 left hemiplegia. 
 
 P.M. Acute lymphatic leukaemia with purpura haemorrhagica. 
 Extensive haemorrhages through the body. 
 
 Micro. Exam. The lymphatic follicular tissue has become 
 increased so as to invade the whole organ. Some deeply congested 
 areas occur in which an erythroblastic change occurs. The cellular 
 elements are mesolymphocytic in type. Red blood cells are diffusely 
 scattered through the organ. 
 
 Microphotograjph (mounted beside specimen) shows parts of 
 three bands of closely packed, very darkly stained cells of various 
 sizes. A capillary vessel with thick walls and unduly full of leuco- 
 cytes (stained black) is seen. The very variably sized cells in the 
 tissue are immature atypical blood-cell parent cells, intermingled 
 with small lymphocyte forms. This is characteristic of the structure 
 of a haemopoietic tissue in this disease. 
 
 See also Spleen, 43.514^1. 
 
 Ref. : E. 5207. R.V.H. 100.12. 
 
 Presented by Dr. Gruner. 
 
42. LYMPH-NODES " 45 
 
 .515 Hodgkin's Disease. 
 42.515^ Lymph-nodes in Hodgkin's Disease. (In two 
 jars, a and h.) 
 
 (a) The specimen consists of the neck organs dissected to show 
 some enlarged glands by the side of the carotid artery. Their cut 
 surface is dark in colour, and a focus of pale, necrotic-looking material 
 is seen in one place. The glands about the bifurcation of the trachea 
 are deep red in colour like hsemolymph glands with no evidence of 
 caseation. The follicles at the root of the tongue are conspicuous, 
 but not unduly large. The tonsils are not shown. 
 
 (6) A chain of greatly enlarged glands of deep-red colour. The 
 cut surface shows that in many of them there are discoloured areas 
 of pecuKar form ; caseation seems to be taking place in some. All 
 these glands are discrete, and there is no periadenitis. 
 
 Mrs. R. T., aged 76. Illness set in about ten weeks before death 
 (Sept. 6, 1911), with widespread glandular enlargement, moderate 
 pyrexia, 99^ to lOl"", and general malaise. There was a mass the 
 size of a hen's egg in the right axilla, and one the size of a plum 
 above the clavicle, and a soUtary gland 1 cm. long in the right groin. 
 On the left side the glandular enlargement was less marked, though 
 palpable. On Sept. 23rd, as the axillary mass seemed softening, 
 aspiration was performed, and blood and a few flakes of pus withdrawn. 
 Slight improvement took place under tubercuHn ; three inoculations 
 1 : 3000 to 1 : 3500 given. No cough. Nov. 7th, diarrhoea, with 
 marked prostration, for the past ten days. Progressive enlargement 
 of left supraclavicular, axillary, and suboccipital glands ; mass in 
 right axilla shghtly diminished. (Edema of left leg from intra- 
 abdominal pressure. Abdomen distended, spleen palpable. Sat up 
 in bed with difficulty during examination. Decubital pneumonia. 
 Diarrhoea a marked feature. Differential count of white cells showed : 
 polymorphonuclears, 50 per c. mm. ; small mononuclears, 40; large 
 mononuclears, 5 ; eosinophiles, 1. Died Nov. 19, 1911. Clinical 
 diagnosis : Lymphatic leukaemia or Hodgkin's disease. 
 
 P.M. Supraclavicular, inguinal, axillary, and retroperitoneal 
 glands much enlarged, the latter 3 mm. to 4 cm. in diameter. Right 
 axillary glands were removed intact and formed a chain 11 cm. long, 
 discrete, easily separated, everywhere encapsulated, varying in size, 
 on section pale greyish-red, some showing irregularly distributed 
 yellowish-white foci. From left axilla a chain of 16 lymph-nodes was 
 removed, not as large as those from right axilla, but of the same 
 character, one gland presenting pale yellowish-white areas within 
 its substance resembling areas of caseation seen in tuberculosis. 
 Mesenteric glands not generally hypertrophied but firm and very 
 pale. Lymph-nodes along the course of the internal Uiac vein 
 
46 THE HEMOPOIETIC ORGANS 
 
 hypertrophied, 1 to 3*5 cm. in diameter, of similar characters to those 
 enlarged elsewhere. 100 c.c. of fluid in peritoneal cavity. 
 
 Bilateral broncho-pneumonia ; acute ileocoHtis ; extensive 
 intestinal ulceration ; secondary anaemia ; necrosis of submaxillary 
 glands ; lymphoid hyperplasia of axillary, mediastinal, retroperi- 
 toneal, and supraclavicular glands, Hodgkin's disease ; tuberculosis 
 of left apex of lung ; chronic adhesive pleurisy and chronic locaUzed 
 peritonitis ; ulcer of stomach ; cholehthiasis ; arterio-sclerosis. 
 
 Micro. Exam. — Spleen : The trabecular tissue is enormously 
 hypertrophied, leaving mere islands of splenic tissue here and 
 there. These islands are composed of closely grouped, moderately 
 large, rounded cells with deeply staining ceU-body and vesicular 
 nucleus (atypical lymphoblasts). Cells with dusky cytoplasm and 
 horseshoe nucleus also occur, along with plasma cells and very few 
 scattered red cells. In some is a large central vessel with thick walls 
 showing that the cell groups in question are really Malpighian 
 bodies, while the strands of fibrous tissue is the sclerosed pulpar 
 tissue with scanty red cells in the narrow vascular clefts permeating it. 
 
 Lymph-nodes : The capsule is a little thickened and sparsely 
 infiltrated with small round cells. The capillaries of the gland are 
 very conspicuously dilated. The connective-tissue septa are some- 
 what thickened. Ordinary folUcular tissue is quite lost, the whole 
 parenchyma being loose in texture, made of cells of various sizes, 
 some lymphocytes, others mesolymphocytic, while many are almost 
 lymphoblastic in form and size, though not presenting any charac- 
 teristic arrangement. 
 
 Ref. : E. 4608. M.G.H. A. 10.202. 
 
 Presented by Drs. von Eberts, Patch, and Rhea. 
 
 42.515^ Gland in Hodgkin's Disease. 
 
 A greatly enlarged gland of a uniform creamy colour and homo- 
 geneous cut surface. 
 
 Male, aged 27. Ill for nine months with fever and swollen lymph- 
 glands. 
 
 P.M. Combined tuberculosis and Hodgkin's disease. Changes 
 in liver, spleen, pancreas, femur, and retroperitoneal lymph-glands. 
 
 Micro. Exam. The section shows very characteristic multi- 
 nucleate cells, scattered irregularly through the tissue. They lie 
 in large rounded groups of small round cells separated by rather 
 broad bands of fibrous tissue. 
 
 See Specimens Nos. 41.515^ and 43.515^, and under Liver, Pan- 
 creas, and Kidney. 
 
 Ref. : E. 5097f. 
 
 Presented by Prof, de Josselin de Jong, Rotterdam. 
 
42. LYMPH-NODES 47 
 
 42.515^ Lymph-nodes in Hodgkin's Disease. 
 
 A piece of a much enlarged gland, showing the smooth regular 
 cjntour of the surface, and the extensive pallor of the cut surface. 
 Indications of distinct rounded pale masses separated by narrow 
 bands of fibrous tissue can be observed. 
 
 No history. 
 
 See also Specimen No. 43.515^, and under Liver. 
 
 Micro. Exam. The normal lymphatic tissue is replaced by an 
 irregularly formed granulation tissue, through which the typical 
 giant cells of Hodgkin's disease are scattered. There is not much 
 fibrosis. 
 
 Ref. : E. 4880c. 
 
 Presented by Prof, de Josselin de Jong, Rotterdam. 
 
 42.515^ Lymph-nodes in Hodgkin's Disease. 
 
 The specimen shows a few subcostal and a group of greatly 
 enlarged bronchial glands. They are regular in contour, smooth, 
 discrete, and the cut surface is of a homogeneous, pale fawn colour, 
 with one or two slender tracts of fibrous tissue traversing it. 
 
 Female, aged 23. Became ill in September 1907, with fever and 
 cough. Von Pirquet negative. No tubercle baciUi in sputum. Marked 
 anaemia. Died August 1908. 
 
 P.M. Many small and large tumours (Hodgkin's disease) in 
 lungs, liver, spleen, lymph-glands, kidneys, and pancreas. Cavse 
 injected with tumour mass. No trace of tuberculosis. 
 
 Micro. Exam. The lymph-node structure is quite obscured, 
 owing to loss of diflEerentiation between folficular and pulpar tissue. 
 Parts are replaced by a loose granulation tissue containing giant 
 cells typical of Hodgkin's disease. There is a decided tendency to 
 fibrosis. 
 
 See also Specimen No. 43.515* and under Lung, Liver, Pancreas, 
 and Kidney. 
 
 Ref. : E. 5096f. 
 
 Presented by Prof, de Josselin de Jong, Rotterdam. 
 
 42.515^ Glands in Hodgkin's Disease. 
 
 Several groups of glands ; one mass envelops the aorta. Their 
 contour is lost in adhesions which bind the individual glands together. 
 One of the glands has been cut through, showing a perfectly homo- 
 geneous, pale, creamy surface. 
 
48 THE HEMOPOIETIC ORGANS 
 
 F. H., aged 48. Married, 7 children, 1 abortion. Alwaj-s healthy 
 previous to onset of present iUness. December 1910 complained of 
 always feeling tired. Temperature elevated, liver and spleen enlarged. 
 Died March 20, 1911. 
 
 P.M. Hodgkin's disease. Granulomata in liver, spleen, kidneys, 
 pancreas, and retroperitoneal glands. Weight of liver 2,200 grm., 
 of spleen 600 grm. No nodules in lungs. 
 
 Micro. Exam. There is a considerable amount of fibrosis in the 
 form of interlacing bands, infiltrated with small round cells and 
 multinucleate cells of characteristic form. This and the preceding 
 cases should be compared by the student. 
 
 See also Specimen No. 43.515^, and under Liver, Pancreas, and 
 Kidney. 
 
 Ref. : E. 5098e. 
 
 Presented by Prof, de Josselin de Jong, Rotterdam. 
 
42. LYMPH-NODES 49 
 
 .6 RETROGRESSIVE CHANGES. 
 .62 Degenerations. 
 .627 Calcification. 
 42.627^ Calcification and Anthracosis of Bronchial 
 Glands. 
 
 A small, inky-black mass of tissue at the bifurcation of the 
 trachea, and an enlarged calcified gland adjacent. 
 Old Museum specimen. 
 
 42.627^ Calcified Gland. 
 
 An irregularly shaped calcareous mass of stony hardness, mottled 
 with carbon deposit. It measures 3-1 X 1-8 x 1-2 cm. It was obtained 
 from within a mass of enlarged peribronchial glands. 
 
 Mrs. A., aged 52, was admitted to R.V.H. in May 1910, with 
 signs of cholecystitis. The first illness had subsided without active 
 treatment. She died two days after the gall-bladder operation. 
 
 P.M. Cholelithiasis, cholecystitis, and choledochitis. Fat- 
 necrosis of pancreas. Obsolete tubercles of lung, bronchial, and 
 mesenteric glands. Extreme degeneration of heart. 
 
 See also Specimen No. 24.627. 
 
 Ref. : E. 4764. R.V.H. 82.10. 
 
 Presented by Dr. Gruner. 
 
 42.627^ Calcified Mesenteric Glands. 
 
 Two small, rounded, calcareous masses. The larger one is sHghtly 
 lobulated. They are of pale ochre-yellow colour. 
 They lay embedded in fatty tissue. 
 Ref. : E. 5510c. P.H.I. Ap. 23.13. 
 
 Presented by Dr. Kaufmann. 
 
 IV.T B 
 
50 THE HEMOPOIETIC ORGANS 
 
 .63 Infiltrations. 
 .637 Anthracosis. 
 42.637^ Anthracosis of Bronchial Glands. 
 
 The bifurcation of the trachea, embedded in enlarged glands, 
 which have a firm, fibroid structure and a mottled appearance due 
 to the presence of inky pigment. 
 
 Old Museum specimen. 
 
 Presented by Dr. Seaton. 
 
42. LYMPH-NODES 61 
 
 .7 PROGRESSIVE CHANGES. 
 .71 Regeneration. 
 •711 Hyperplasia. 
 42.71P Hyperplasia of Periportal Glands in Obstruc- 
 tive Biliary Cirrhosis. 
 
 Several enormously enlarged glands, of firm consistency, the 
 largest measuring 7-5x5 cm. ; cross section of another 4x4 cm. 
 The outer surface is smooth. The cut surface is absolutely structure- 
 less to the naked eye. 
 
 M. v., aged 28. History of typhoid, with well-marked indica- 
 tions of old ulcerative cholecystitis and obhteration of the cystic 
 duct. 
 
 P.M. Obstructive bihary cirrhosis of Uver. Obhteration of 
 cystic duct. Group of greatly enlarged glands in portal fissure 
 about hilum of hver and in mediastinum. 
 
 Micro. Exam. Marked congestion ; the lymphoid elements of 
 the pulp seem relatively few, as the endothehoid plates and stroma 
 cells show particularly well. 
 
 Ref. : R.V.H. 91.98. E. 114. 
 
 See also Specimen No. 37.39. Reported by Dr. W. W. Ford, 
 Amer. Journ. of Med. Sciences, January 1901. 
 
 Presented by Dr. Nicholls. 
 
 42.711^ Hyperplasia of Lymph-nodes. 
 
 A concatenate mass of very large lymphatic glands, bound 
 together closely by fibrous adhesions. The glands possess a pale 
 brown colour, are of rounded shape, and regular contour. The cut 
 surface of the largest mass is marked with numerous irregular 
 caseous areas of pale brown colour. The intervening tissue is fawn 
 in tint, and homogeneous. 
 
 E. 5163. 
 
 E 2 
 
52 THE HiEMOPOIETIC ORGANS 
 
 .712 Metaplasia. 
 42.712^ Haemolymph Glands. 
 
 The specimen consists of the lower part of the trachea and the 
 main bronchi, with portion of lung attached on the left side. 
 Numerous lymphatic glands occur all around these parts, some being 
 dark from carbon-infiltration, and others dark from intense vascu- 
 larity. Note especially one riding on the left bronchus. 
 
 M. K., male, aged 20, was admitted to the R.V.H, in September 
 1910, suiGfering from septic endocarditis of six months' duration. 
 There were scattered petechial haemorrhages. The tonsils were hyper- 
 trophied. The spleen was enlarged. 
 
 Micro. Exam. The capsule is thickened. There are numerous 
 pigment-bearing phagocytes throughout the tissues, and much 
 blood through the gland substance, with active organization of the 
 edges of the haemorrhagic areas. Another section shows loss of 
 arrangement in lymphoid tissue centres, increase of epithelial cells, 
 and infiltration of many of the lymphatics with mast-ceUs and a few 
 eosinophiles. 
 
 Ref. : R.V.H. 118.10. E. 4380a. 
 
 Peesented by Dr. Gruner. 
 
42. LYMPH-NODES 53 
 
 .78 Malignant Tumours. 
 .786 Lymphosarcoma. 
 42.786^ Lymphosarcoma of Cervical Glands Infil- 
 trating Thyroid. 
 
 A mass 12x5 cm. in diameter, embracing the root of the tongue 
 and the anterior and lateral aspects of the trachea. It consists of 
 greatly enlarged glands merged with the thyroid. A few moderately 
 enlarged glands he adjacent. 
 
 Micro. Exam. The tissue consists of small round mononuclear 
 cells devoid of typical arrangement and supported by a minimum of 
 connective tissue. In some parts of the section the cells are much 
 more densely arranged than in others, and here the fibrous tissue 
 is more abundant, giving the cell masses an appearance of lobation. 
 Studied with an oil-immersion lens these small round cells are seen 
 to be very similar one to another, having a very narrow rim of 
 cytoplasm and a trachychromatic nucleus, within which are a few 
 chromatic spots drawn out into short slender processes. The cells 
 vary httle in size, but here and there are one or two larger cells 
 with large spherical nucleus staining less intensely. There are scanty 
 rehcs of a delicate reticulum between the cells, and in relation to the 
 reticulum are a few occasional cells of endotheUal character. No 
 multinucleate cells are to be seen. One or two eosinophile cells are 
 to be observed. 
 
 Ref. : Old Museum specimen. 
 
 42.786^ Glands. Lymphosarcoma. 
 
 The specimen consists of (1) the neck organs, supporting many 
 large glands, loosely bound together by adhesions. They are oval, 
 pale brown in colour, and the cut surface is fleshy and pale. (2) A 
 mass enclosed in the mesentery, composed chiefly of closely packed, 
 very much enlarged, lymphatic glands. These present similar 
 characters to the above, but are somewhat larger. The peritoneal 
 surfaces of the mesentery are surmounted by a covering of fine 
 villous tags. (3) A huge mass of enlarged retroperitoneal glands. 
 The cut surface is soft and marrowy, mottled with white streaks. 
 
 From the same case as 43.786^, which see for full history and 
 histology, 
 
 Ref. : E. 566. R.V,H. 62.99. Journ. Med. Research, 1901, 
 pp. 249-57. 
 
 Presented by Drs. Martin and Adami. 
 
54 THE HEMOPOIETIC ORGANS 
 
 .79 Carcinoma. 
 42.79^ Peritracheal Gland, showing Anthracosis as 
 well as Carcinoma. 
 
 The specimen consists of a piece of trachea and bronchi at the 
 angle of which is a mass of enlarged glands which are infiltrated 
 irregularly and diffusely with a new growth of white colour ; per- 
 meating it is also some black pigment. There are pieces of enlarged 
 gland which show definite nodules of new growth in addition to diffuse 
 infiltration. Pigment is here less conspicuous. 
 
 Ref. : M.G.H. 65.95. 
 
 42.79^ Carcinoma of Bronchial Glands. 
 
 The trachea with its bifurcation and the arch of the aorta em- 
 bedded in an enormous mass of enlarged adherent glands, which 
 on section are firm, not caseating. 
 
 Ref. : Old Museum specimen. 
 
 Presented by M.G.H. 
 
 42.79^ Metastatic Cancerous Infiltration of Axillary 
 Glands. (Petri dish Specimen.) 
 
 A group of glands embedded in fat ; they are aU of a size 
 (3x1-6x1 cm.). They are discrete and firm in consistence ; the cut 
 surface of one shows a fleshy aspect, and its central part is streaked 
 with red. The normal gland tissue seems to be entirely defaced. 
 The capsule is infiltrated with blood. 
 
 Mrs. T., aged 49. Carcinomatous infiltration of axillary glands 
 secondary to carcinoma of breast. Operation. 
 Ref. : M.G.H. S. 10.577. E. 4817. 
 
 Presented by Dr. Rhea. 
 
 42.79^ Colloid Cancer with Calcification of Lymph- 
 glands. 
 
 Two small, irregular masses of tissue, consisting of central opaque 
 and creamy white substance, of hard consistence, enclosed in a trans- 
 parent jelly-like material. 
 
42. LYMPH-NODES 65 
 
 The primary growth was in the transverse colon. 
 For details see Spleen 43.79. 
 Ref. : R.V.H. 140.09. E. 4042. 
 
 Presented by Dr. Klotz. 
 
 42.79^ Carcinoma of Mesenteric Gland spreading by 
 the Lymphatics. 
 
 A small piece of intestine. Just at the root of the mesentery 
 is a group of moderately enlarged glands, from one of which coarsely 
 nodular strands radiate outward over the surface of the intestine, 
 showing beautifully extension of the growth along the lymphatics. 
 
 Old Museum specimen. 
 
 Presented by Dr. Adami from M.G.H. 
 
 42.79^ Pelvic Glands. Metastasis of Carcinoma. 
 
 A group of enormously enlarged glands, the largest 6x6 cm. 
 across. The external surfaces are rough with adhesions. The cut 
 surfaces show a trace of whorled structure, are of yellow colour, 
 and appear to be breaking down in places. The cut ends of a throm- 
 bosed vessel are seen ; otherwise the tissue is non- vascular. 
 
 B. A., female, aged 22, was in hospital a month, suffering from 
 pain in the left leg of knife-like character, also a yellowish foul- 
 smelling vaginal discharge. Had felt ill for four years. Removal of 
 a portion of tissue for diagnosis caused some haemorrhage. A month 
 later death occurred. There was a carcinoma of the cervix extending 
 to the vagina, with metastases in the pelvic glands and peritoneal 
 tissue. 
 
 P.M. A mass of glands occurred over the sacro-lumbar articula- 
 tion, fixed to the underlying bone. The consistence was firm. Some 
 yellowish fluid exuded here and there. A similar mass occupied 
 almost the entire inner aspect of the left half of the pelvis and 
 extended through the great sacro-sciatic notch to the soft tissues 
 about the pelvis, involving the sacro-sciatic ligament. 
 
 Ref. : M.G.H. A. 07.204. E. 3242. 
 
 Presented by Dr. Duval. 
 
56 THE H.EMOPOIETIC ORGANS 
 
 42.79' Secondary Carcinoma of Inguinal Gland, with 
 Central Breaking Down. 
 
 The specimen consists of half of an enlarged gland the size of 
 a grape, indurated, having thickened walls and a central cavity and 
 containing debris. 
 
 From a man, aged 71. 
 
 P.M. Primary lesion, epithelioma of penis. 
 
 Ref. : R.V.H. S. 164.96. E. 140. 
 
 Presented by Dr. Bell. 
 
 42.79^ Enlarged Lymph-glands. Carcinoma. 
 
 A mass of enlarged glands situated along the abdominal aorta 
 close to its bifurcation. The glands are mottled with pink areas of 
 congestion and show scattered small caseous foci. They vary in 
 size from a pea to a Brazil nut. A separate specimen mounted at the 
 upper end of the jar has been cut through to show necrotic areas 
 scattered through the gland substance, presenting the appearance 
 of small abscesses. 
 
 McN., male, aged 50. Died of a f ungating medullary cancer 
 of the stomach with numerous secondaries in the hver, situated 
 chiefly in the right lobe. He had only had symptoms three weeks 
 before admission. For stomach see Specimen No. 34.79. 
 
 Micro. Exam. Shows the presence of tongue-like acini of 
 spheroidal-celled carcinoma. 
 
 Ref. : E. 4378. R.V.H. 124.10. 
 
 Presented by Dr. Adami. 
 
42. LYMPH-NODES 67 
 
 .70 Cysts. 
 42.70^ Cystic Enlargement of Bronchial Glands. 
 
 The trachea to its bifurcation and the aortic arch at the origin of 
 the great vessels. A cyst the size of an orange, with loculated interior 
 and calcified walls, hes in the mediastinal tissue just anterior to 
 the origin of the great vessels and to the left of the bifurcation of 
 the trachea. Masses having a partly cystic, partly calcified interior 
 lie on either side of the trachea, just below the larynx, the left the 
 size of a pigeon's, the right of a turkey's egg. There is much gelatinous 
 change. 
 
 Old Museum specimen. 
 
 Presented by M.H.G. 
 
58 THE H.EMOPOIETIC ORGANS 
 
42. LYMPH-NODES 59 
 
60 THE HiEMOPOIETIC ORGANS 
 
42. LYMPH-NODES 61 
 
62 THE HEMOPOIETIC ORGANS 
 
42. LYMPH-NODES 63 
 
64 THE HEMOPOIETIC ORGANS 
 
42. LYMPH-NODES 65 
 
 IV. I 
 
66 THE HiEMOPOIETIC ORGANS 
 
42. LYMPH-NODES 67 
 
 F 2 
 
68 THE H.EMOPOIETIC ORGANS 
 
43. SPLEEN 
 
 INTRODUCTORY 
 
 Anatomy. ' Weight of normal organ, 90-120 grm. ; average size, 
 12x8x4 cm. Possesses a fibrous tissue capsule, covered by a single 
 layer of endothelial cells (peritoneal reflection). From this capsule 
 trabeculce, consisting of fibrous, elastic, and muscular tissue, pass 
 into the substance of the organ, forming a coarse network, in the 
 meshes of which he the pulp and the spleen folhcles. The follicles 
 are masses of adenoid tissue formed around terminal branches of the 
 splenic artery. The pulp consists of blood-channels traversed by 
 a fine network formed by flat endothelial cells and their processes ; 
 in the meshes of the pulp Ue splenic cells, red corpuscles, leucocytes, 
 macrophages, and a number of other cell-forms. 
 
 While the various types of morbid lesions that occur in other 
 organs are recognizable in the spleen, the naked-eye appearances 
 are apt to be so indefinite that microscopic examination is often 
 the only satisfactory means of differentiation between them. 
 
 Changes in size. A review of the specimens shown in this section 
 reveals striking changes in size as the most obvious source of varia- 
 tion in macroscopic appearance. AU grades, from a very small 
 organ (43. 13^, 43. 61^) the appearance of which is indistinguishable 
 from that of an infantile spleen, through moderately large (43.3251) 
 and very large (43.513^) to massive or giant spleens (43.614^, 43.786^), 
 are demonstrated in the series. What may be looked upon as the 
 natural size of the adult spleen is shown in specimen 43.17^. 
 
 It must be borne in mind that the mere measurements of the 
 viscus are unimportant, whereas the bulk or volume is of significance. 
 One spleen may be apparently large (in contour), but thin and plate- 
 like, and yet be really smaller (less actual volume) than one that is 
 shorter, narrower, but much thicker. Specimen No. 43. 34^ shows 
 an instance of a rather small but bulky spleen. 
 
 With great increase in size, there goes a tendency to rounding 
 of the contours of the organ. If notches be present they are exag- 
 gerated ; the presence or absence of these may be evidence of excessive 
 enlargement of the splenic substance. Many of the specimens shown 
 here are devoid of notching (43.222^, 43.61^). Shrinkage of the organ 
 is usually manifested by wrinkUng of the capsule (43.61^) rather 
 than by an absence of notching. 
 
70 THE HiEMOPOIETIC ORGANS 
 
 The macroscopic evidences of increase in splenic tissue then are : 
 (1) increase in total size of the organ ; (2) increase in bulk ; (3) tense- 
 ness of the capsule ; (4) rounding of edges ; (5) exaggeration of 
 notches ; (6) bulging outwards of the cut surface of the viscus ; 
 (7) increase in weight. 
 
 It will be borne in mind that increase in size may be due either 
 to engorgement (43.35P) or to an actual increase of tissue. The latter 
 may consist in an increase of pulp tissue (43.343^) or it may depend- 
 on the presence of deposit of tumour or granulomatous masses 
 (43.792, 43.36r). In this connexion attention must be drawn to 
 the existence of physiological variations in size of the spleen, which 
 may be considerable in degree. With the exception of the giant 
 spleens, and such specimens as 43.513^, 43.513^, and 431.39ii, which 
 would not show cychcal changes of size because of the inabihty to 
 contract in the one case, and because of the restraining inflammatory 
 tissue enclosing the viscus in the others, each of the specimens on 
 the shelves may be looked on as an instance of an organ suddenly 
 arrested and fixed at the moment of having attained that particular 
 size, which would have changed had the organ lived. 
 
 [Examples of Enlargement of the Spleen : 
 
 (a) Moderate : 
 
 Early passive congestion ....... 43.222^ 
 
 Acute splenitis ........ 43.34^ 
 
 Typhoid ^3.35V'^-*'^fi 
 
 Malignant endocarditis ....... 43.343^-^ 
 
 Pneumonia ......... 43.344^ 
 
 Cerebrospinal meningitis ....... 43.348^ 
 
 Miliary tuberculosis (acute) ...... 43.36P 
 
 Syphilis 43.372^ 
 
 Tuberculosis (subacute) ....... 431.361^ 
 
 Amyloid 43.625^ 
 
 (6) Still larger (intermediate to Splenomegaly) : 
 
 Spleen in cirrhosis of liver (size due to passive congestion plus 
 
 irritation from noxa producing liver condition) . . 43.72^"^ 
 
 Spleen in Hodgkin's disease ...... 43.515^ 
 
 Spleen in lymphatic leukaemia ...... 43.514^" 
 
 Spleen in secondary sarcoma ...... 43.786^ 
 
 Spleen in syphilis 43.372^ 
 
 (Also earlier stages of giant spleen) 
 
 (c) Giant spleen (Splenomegaly) : 
 
 Malaria 43.376^ 
 
 Splenic anaemia, Banti's disease, &c. ..... 43.513^ 
 
 Splenomyelogenous leukaemia . . . ... . 43.514^ 
 
 Lymphosarcoma . . • . . . . . . 43.786^ 
 
 Lymphatic leukaemia . . . . , . .43.514^^ 
 
43. SPLEEN 71 
 
 Examples of Reduction in size of the Spleen : 
 
 Congenital aplasia . . . . . . . .43.13^ 
 
 Passive congestion (late stage) ...... 43.222* 
 
 Senile atrophy 43.61^'2>' 
 
 Hyaloserositis of capsule ....... 431.39^ 
 
 —Ed.] 
 
 Alterations in shape are rarely met with (43.792). 43^ shows a 
 long thin spleen, but this is not human. 
 
 Alterations in number are not infrequent. One or more accessory 
 spleens may be found in various situations. See Specimens 43. 17^"*. 
 The existence of such rounded masses or miniature spleens is of 
 interest in that there is evidence pointing to their being formed 
 during life, as a hyperplasia. (For microscopic appearances of 
 accessory spleens, see under Specimen No. 43.17*.) 
 
 Changes of colour are striking. All shades from pale pink (43.222^) 
 to deep red (43.351^) and purple or slate (43.514i^) indicate varying 
 degrees of congestion, and are best seen in the unopened organ. The 
 cut surface may show a similar range of colours (excluding the slate- 
 greys), though these are less easily preserved in a museum specimen. 
 Other colours, creamy (43.513^), yellow (43. Bl^), pale greys (43.514^), 
 ochre (431.39"), fawn (431.3923), brown (43.5141), are met with 
 where the capsule is changed, or where a new deposit such as 
 tubercle or tumour-formation occurs. The most obvious colour- 
 changes are those seen in the collection of infarcts (43.26i"^29j exhibited 
 in the series. Here the varying change of colour depends partly on 
 circulatory conditions in the inf arcted area, and partly on the process 
 of repair, the very old forms being chalky- white with a brilliant yellow 
 contour (43.2620), and perhaps a vivid but very fine hne of red at the 
 extreme edge of the area (43.262^). The infarctions, as dealt with 
 fully in the Text-book of Pathology, by Drs, Adami and McCrae, 
 are of various types, single, multiple, white, red, recent, old, calci- 
 fying, breaking-down, &c., and each of them is represented in the 
 series herein referred to. The marked variabihty in the contour 
 of the area will be noticed, some being sharp and clean-cut, while 
 others have very irregular outhnes rich in sinuosity. 
 
 The specimens of infarcts are arranged thus : Beginning with 
 a definite red infarction (43. 26^) of very dark uniform colour, we pass 
 to 43.26* whose centre is white, and then to 43.26^-12^ which are all 
 characterized by a slate-grey centre and very clean-cut outHne. 
 This change of colour is indicative of autolytic breaking-down of the 
 dead splenic substance. The gross result of this is such a degree of 
 softening (especially noticeable after the cut surface has been stand- 
 ing in the jar) as to be difficult to differentiate from the suppurating 
 
72 THE HEMOPOIETIC ORGANS 
 
 infarcts shown in 43.3251' 2. It will be noticed that the breaking- 
 down is more of a honeycomb form in 43.325^, which forms a useful 
 guide to the diagnosis. Passing on from these types, we come to 
 43.2Q^^~^*, whose cut surface shows a very homogeneous, almost 
 cheesy appearance, while the sharp contour and retracted edges 
 mark the advanced age of the lesion. Chalky-white infarcts are 
 shown in 43.26^5-27, The interesting variant described as arterio- 
 sclerotic in origin is well shown in 43. 26^®, where three broad grey 
 bands traverse the organ without a very clear hne of demarcation. 
 Lastly, 43. 26^^'^ afford a convenient transition from the 43.26 series 
 to the suppurating infarcts (43.3251"^) already referred to. 
 
 Inflammations. Acute splenitis is indicated to the naked eye by 
 enlargement and intense deepening of colour. While the diagnosis 
 of this condition is usually deductive, there can be no doubt as to 
 its existence in such specimens as 43.324^, where the cut surface 
 shows a number of foci of deep red colour, rather clearly demarcated 
 from the surrounding pale pulp. 43,3242 is an example in which 
 the whole organ is very deep in colour. Several of the specimens 
 grouped under the infections — streptococcic 43.343^, meningococcic 
 43.3481, colon group 43.357^, typhoid 43.3511"^ — are also examples of 
 acute splenitis ; when such specimens are fresh and in the hand 
 they are conveniently referred to as diffluent or febrile spleens. 
 Sometimes these infective conditions are associated with abscess 
 formation, 43,351^'^ being interesting examples (due to infarction) 
 from cases of typhoid fever. 43.325^ also exemplifies suppurative 
 inflammation (abscess), but it is not clear whether this is de novo 
 or a later change in a previous infarct. The sharp definition of the 
 lesion is strongly in favour of the latter view. On the other hand, 
 43.325* is a good example of multiple foci of suppuration disseminated 
 through the organ. 
 
 Chronic inflammatory hyperplasia is shown in 43.372^^^2^ 43.376^, 
 43.5131"^, and manifests its existence in the gross specimens by 
 increase in size (43.376^), change of colour (43.372^), or abundance 
 of fibrfllar strands through the cut surface (43.513^). To be sure 
 of the diagnosis, however, one must call in the aid of the micro- 
 scope. 
 
 Inflammatory changes in the capsule are demonstrated in the 
 series 431.391^3 (perisplenitis) and 431.39i^~23 (hyaloserositis and 
 * lamellar fibroma '). One instance of suppurative perisplenitis 
 (43I.3251) serves to demonstrate the fink between this condition and 
 general plastic peritonitis. Thickening due to tubercle is shown 
 in 431.3611^2 
 
 Tuberculosis. The series 43.361i~2o ghows different forms of this 
 
43. SPLEEN 73 
 
 disease, beginning with the miUary forms of successively lessening 
 degree of acuteness (43.361i~ii) and passing on to the obsolete 
 forms 43.36P^^". 43.3612 presents the characteristic change met 
 with in bovine tuberculosis, and here there is enormous thickening 
 of the capsule and almost cartilaginous appearance of the cut 
 surface of the tubercles. The acute miliary forms appear as a pepper- 
 ing of the cut surface with minute white specks hardly any larger 
 than Malpighian bodies. The subacute forms present larger lesions 
 which often show a brilHant red contour. 43.36 P shows much larger 
 tubercles whose centres are breaking down in a crateriform manner. 
 The appearance in 43.3611^ is rather different in that the lesions 
 vary very greatly in size. The obsolete character of 43.361^^ i' is 
 shown by the dead- whitish colour and clear definition without any 
 limiting Une. 43.357^ is a case of tuberculosis which should fit in 
 between 43.361^0 ^nd 43.36P, but does not show the tuberculous 
 lesions very well owing to riddling of the whole organ with the 
 spaces produced by B. aerogenes capsulatus, and it is therefore 
 classed under lesions due to this organism. 
 
 Degenerations. Reference has been made to the small spleens 
 43.61^"^, where the diminution in size is due to atrophy of the organ 
 as a whole. The four specimens 43.625^ * illustrate different degrees 
 of amyloid disease from a diffuse change (' bacon spleen '), 43.625^, 
 through more discrete and larger foci, to 43.625^, where the individual 
 foci of amyloid change are merely conspicuous against the remaining 
 splenic tissue, appearing almost hyaUne. 
 
 Progressive Changes. Specimens illustrating these changes are 
 grouped under 43.721-^^ 43.786i>2, 43.78^, and 43.79i-3^ but the 
 fundamental nature of the change may in many cases be misunder- 
 stood if the student takes the idea that these are the only instances 
 in the whole collection. It is hard to draw the line between 43. 72^ 
 (enlargement in cirrhosis of Uver and Banti's disease) and 43.513^, and 
 even 43.343^ (acute splenitis of streptococcus origin) may be placed 
 in the same category because the hypertrophy must be due in each 
 case to an overgrowth of the pulp tissue, and as far as the naked-eye 
 character goes there is no difference between hypertrophy, hyperplasia, 
 and metaplasia. Without an analysis of the cUnical and anatomical 
 factors (aided by the microscope) no one could say that 43. 72^ is 
 not really more correctly placed under 43.513 (Banti's disease). 
 
 The new growths are classified as primary and secondary, the 
 latter being more common. The enormous size of 43.7861 (primary 
 lymphosarcoma) is of interest, especially if one attempts to reaUze 
 the weight that it would have within the body. The secondary 
 deposits of carcinoma, 43. 79^"^, are of comparatively little interest. 
 
74 THE HEMOPOIETIC ORGANS 
 
 Their identification with the naked eye would depend on the same 
 rules as apply to these tumours in general. 
 
 Cysts. These are usually small and difficult to demonstrate 
 in a mounted specimen. They are usually intracapsular or sub- 
 capsular, and hned by lymphatic endothehum (43. 70^). 
 
 Rupture. 43.819^ is an interesting example of this condition ; 
 the mofe so as the patient recovered. 
 
 Pernicious anoemia. The two specimens (43.516^^^2) taken from 
 cases of this disease show merely the relative increase of fibrous 
 tissue and the pale maroon colour of the splenic substance. The 
 more specific changes in such a case would be found \^ith the micro- 
 scope, and are described in the Catalogue under the specimens 
 quoted above. 
 
 Leukcemias. There is little to be said on this subject in connexion 
 with the gross specimens. In all varieties of the disease there is 
 a great enlargement, and it is not possible to see with the naked eye 
 whether the change is dependent on the pulp or the follicular tissue. 
 (Note that 43.514i is probably much shrunken in consequence of 
 the method of preservation.) In each case the points to notice are : 
 great bulk, prominent notching, perisplenitic areas, occasionally 
 infarcts. 
 
 It is important for the student to reahze that leukaemia is never 
 a disease of the spleen as such ; it is a system-disease of the hsemo- 
 poietic organs, and the enlargement of the spleen is only part of 
 a morbid process disseminated widely throughout the whole body. 
 Consequently none of the specimens of the series 43.5141"^^ can be 
 looked upon as representative of even the main lesion of the disease. 
 
 Once this is understood, it becomes easy to see that ' lymphatic ' 
 leuksemia may provide a spleen as large as 43. 5 M^^^. 
 
 The word ' lymphatic ' in this connexion is correctly employed to 
 represent two features : (a) the existence of immature white cells 
 of the lymphoid series in the blood, (6) excessive formation of 
 immature lymphocytic cells in every blood-forming tissue in the body. 
 Frequently the lymph-nodes constitute the main source of lympho- 
 blasts (parent cells of lymphocytes) even in disease, hence they are 
 the most conspicuously enlarged in lymphatic leukaemia. Never- 
 theless, the Malpighian folhcles of the spleen are very important 
 centres of lymphoblastic activity, and are hkely to participate in 
 the morbid process. In such a case this viscus becomes more and 
 more enlarged. 
 
 Again, in ' myeloid ' leukaemia there are the following two 
 features : (a) existence of immature white cells of the myeloid 
 (or polymorphonuclear leucocyte) series, myeloblasts, myelocytes, 
 
43. SPLEEN 75 
 
 &c. ; (h) excessive formation of immature myeloid cells. Wherever 
 there are blood-formative cells capable of developing into myelo- 
 cytes, they assume this character actively. The 'bones are the most 
 likely centres of this tumour-Uke overgrowth of myelocytoid cells, 
 but the pulp of the spleen and lymph-nodes is equally potent in 
 this direction. Hence the frequency with which enlargement of the 
 spleen is noted in this disease, and the apparent paradox that 
 lymph-nodes may be enlarged in ' myeloid ' leukaemia. 
 
 The difference between this conception of the disease and that 
 in vogue earher is at once evident. Formerly, myeloid leukaemia 
 was regarded as a disease of the bone-marrow, splenic leukaemia 
 as one of the spleen ; the perplexity of a splenic case giving a 
 * myeloid ' blood-picture seemed insuperable. As soon as it was 
 reaUzed (1) that leukaemia is a proliferative process set up by intoxi- 
 cation of some sort, simulating malignant disease in certain interest- 
 ing ways ; (2) that this process may run on either myeloid or 
 lymphatic Hues ; (3) that each group of blood-forming organs contains 
 myelo- or lympho-potentiaUties — these apparent paradoxes, e.g., 
 that a spleen may be enormous and yet belong to a case of lymphatic 
 leukaemia, ceased to be strange. 
 
 Hodgkin's disease. The series of specimens 43.5151 -^ taken 
 from cases of Hodgkin's disease, exemplify two types of lesion in 
 the spleen, the first one being diffuse (no nodules), whUe the second 
 exhibits numerous discrete whitish masses simulating new growth, 
 and classifiable macroscopically with the subacute tuberculoses 
 (cf. 43.361^'). The disease is more famihar in connexion with the 
 lymph-nodes, and is best discussed under that heading (see 42.5 15i*). 
 
DETAILED CONTENTS OF SECTION 
 
 43. SPLEEN 
 
 Abscess 
 Accessory spleen 
 
 . 43.35P ; 43.315* ; 43.3641 (multiple). 
 . 43.171-4 ; 43.2224 ; 43.324^ ; 43.35P ; 
 43.721; 431.3611. 
 Acute yellow atrophy, Spleen in 43.5311. 
 
 Acute splenitis 
 
 Adhesions : 
 Bands . 
 Dense . 
 Old 
 
 Shaggy . 
 
 Shreds of lymph 
 
 43.341 ; 43.3441 ; 43.3512 ; 
 
 Haemorrhagic splenitis. 
 
 see also 
 
 43.5141. 
 43.36111 
 431.391. 
 43.2225 ; 
 
 431.392. 
 
 43.2611 ; 43.2629 ; 43.262^ 
 43.3252; 43.3761; 43.3618; 43.516^ 
 43.61 ; 43.726 ; 43.7861 ; 431.3251 
 431.3612. 
 
 43.2222 ; 43.26« ; 43.26' ; 43.2622 ; 43.2624.26 
 43.3511; 43.5132; 43.5142; 43.6P 
 43.6254; 43.721; 431.391; 431.39i2.i3 
 431.7961. 
 
 43.3641; 43.6251-4. 
 
 431 (cat) ; 43.36120 (cow). 
 
 431 ; 43.26'. 
 
 43.341. 
 
 43.5162. 
 
 43.611-8 (4-7 are senile). 
 
 Amyloid disease 
 
 Animals . 
 
 Anomaly of shape 
 
 Appendicitis, Spleen in 
 
 Aplastic Anaemia, Spleen in 
 
 Atrophy of spleen 
 
 Bacillus aerogenes capsulatus infection 43.3571. 
 
 Banti's disease . . . 43.513i'2.3. 
 
 Blood-channels, Dilated ; see Histological characters. 
 
 Calcareous nodule in . . 43.6 P, 
 
 Carcinoma of . . . 43.791-^ ; 431.7961. 
 
 Cat, Spleen of . . . 43i. 
 
 Cerebrospinal fever, Spleen in 43.3481. 
 
 Cirrhosis of liver. Spleen in . 43.513^ ; 43.72i'3.4. 
 
 Comparative anatomy of spleen ; see Cat, Cow. 
 
 Congestion : 
 
 Focal . .. . . 431; 43.262; 43.325* ; 43.3441 
 
 Passive . 
 Cow 
 
 Cysts 
 
 Endocarditis, Malignant 
 
 43.2221-5; 43.26'; 43.2624; 43.3252. 
 
 43.36120. 
 
 43.701; 431.70i'2. 
 
 43,263,6,8.21,22. 43.3253; 43.3431; 43.3432. 
 
43. SPLEEN 77 
 
 Erythrsemia . . . 43.5 12^. 
 Febrile spleen ; see under Size, 
 
 Fibrosis of spleen . . 43.2222.3.5; 43.3721 (syphilis); 43.5133; 
 
 43.5162 (histological) ; 43.61*-8 ; 
 
 43.725.6; 431.3911'21,22, 
 
 Gaucher's splenomegaly . 43.513^^. 
 Glanders, Spleen in . . 43.364^. 
 Haemorrhagic splenitis . 43.324i~3 
 
 Hsemorrhagic mottling . 43.2221; 43.2625; 43.3241-3; 43.34i ; 
 
 43.351« (typhoid) ; 43.361" ; 43.3721 ; 
 43.72«; 43.8191. 
 Histological characters of spleen : 
 Blood-channels, Dilated . 43.2222; 43.262.29; 43.3241-3; 43.34i ; 
 
 43.3441 ; 43.3722 ; 43.5132 ; 43.5151-3 ; 
 43.5161-3; 43.5311; 43.61«-8; 431.391. 
 Fibrosis of pulp ; see under Fibrosis of spleen. 
 Malpighian bodies, q. v. 
 Pulp-tissue : 
 Congestion of . . 43.17* ; 43.222* ; 43.26' ; 43.3481 ; 43.351«. 
 Crystals in . . . 43.3253. 
 Foci inflammatory cell infiltration 43.3241-^. 
 Hsemorrhagic areas in . 43.3612 ; 43.3722. 
 Hyaline change in . 43.3722. 
 Lymphoid structure . 43.26io ; 43.514i». 
 Necrotic focus in . 43.3515. 
 
 Pigment in . . . 43.3253 ; 43.5153.5 ; 43.725. 
 Pigmentophages conspicuous 43.3481; 43.3611'; 43.3761; 43.51413; 
 
 43.5155; 43.61*.«.8; 43.6253. 
 Pulpoid change universal 43.514ii. 
 
 Reticulum conspicuous 43.2222 ; 43.2628 ; 43.361" ; 43.5131.2 ; 
 
 43.5151 ; 43.5161; 431.39ii.20; gee 
 also Fibrosis of spleen. 
 Trabecular tissue, hyaline 43.3241; 43.3722; 43.514i« ; 43.515i'3 ; 
 
 43.5162; 43.726. 
 Hodgkin's disease. Spleen in 43.5151-5. 
 Hyaloserositis . . . 43.222*; 43.72i-». 
 Multiple foci . . . 43.2612; 431.391*. 
 
 Single large patch . . 43.32512; 43.3612"; 43.5131-3; 43.61*; 
 
 431.3612 ; 431.3910-13.20-23. 
 Infection with Bacillus aerogenes capsulatus 43.3571. 
 Infarcts : 
 
 Hsemorrhagic . . . 43.262.3. 
 
 Multiple . . . 43.261-5.6.7.8.9.10,25,28,29. 43.361i« ; 43.3432 ; 
 
 43.5142.3 ; 43.5162; 43.6251 ;43.26i.'.o.25; 
 43.351*. 
 
78 
 
 THE HEMOPOIETIC ORGANS 
 
 Old 
 
 Pale 
 
 Softening 
 
 Suppurating 
 
 White . 
 Lamellar fibroma 
 Large spleen ; see under Size. 
 Leukaemia, Spleen in . 
 Lymphoma of spleen . 
 Malpighian bodies : 
 
 Absent . , . . 
 
 Hyaline change in 
 Central vessel of : 
 
 Fibrotic 
 
 Hyaline 
 
 Tortuous 
 Necrotic change in 
 Numerous 
 
 Size : 
 Large . 
 
 Medium 
 
 Small . 
 
 Passive congestion 
 
 . 43.2221-5; 43.2( 
 
 
 (late). 
 
 Perisplenitis : 
 
 
 Bands . 
 
 . 43.5141. 
 
 Chronic 
 
 . 431.391-2.10-14.21.23. 
 
 Lamellar 
 
 . 431.3921.22. 
 
 Suppurating . 
 
 . 431.3251. 
 
 Tuberculous . 
 
 . 431.3611-2. 
 
 43.2611.21.24; 43.3514. 
 
 43.2620; 431.3920. 
 
 43.5144. 
 
 43.3251.3.4 (multiple) ; 43.3431. 
 
 43.264.'.12.22,23,a4,25,26,27,28^ 
 431.3921-22. 
 
 43.5141-13 (10-13 aj.g acute lymphatic). 
 43.5162. 
 
 43.2224; 43.3242; 43.325^ ; 43.3441; 
 
 43.3512; 43.5133; 43.5141; 43.514io.ii.i3; 
 
 43.615. 
 43.174; 43.5151 ; 43.5163. 
 
 43.5133. 
 
 43.3243; 43.361"; 43.61« ; 43.6251-4 
 
 (amyloid) ; 431.391. 
 
 43.2222.4; 43.5151 ; 43.793. 
 
 43.3481. 
 
 43.174; 43.3241; 43.5163; 43.611.8; 
 43.793. 
 
 43.2610.12; 43.341 ; 34.3511; 43.361i.20 ; 
 
 43.51412; 43.5153; 43.614. 
 431 ; 43.172; 43.2221; 43.2225; 43.26'; 
 
 43.5151 ; 43.5163; 43.724.5. 
 43.174; 43.2222-4; 43.262; 43.3241.3; 
 
 43.3254 ; 43.3516 ; 43.3722 ; 43.513i'2 ; 
 
 43.5161.2; 43.617.8; 431.3251; 431.701. 
 
 43.2624 ; 43.3252 
 
 Pernicious anaemia, Spleen in 43.5161 3. 
 
 Plague, Spleen in Bubonici. 43.359. 
 
 Pneumonia, Spleen in . 43.3242 ; 43.3441. 
 
 Pulp-tissue ; see under Histological characters. 
 
 Purpura . . . 43.514io.ii ; 43.6188 
 
 Rupture of . . . 43.8191. 
 
 Sago spleen . . . 43.6251-4. 
 
 43.7862. 
 
43. SPLEEN 
 
 79 
 
 Sarcoma . 
 Senile spleen 
 Septicaemia, Spleen in 
 Shape, anomalous 
 Size : 
 Large . 
 
 Febrile 
 
 Giant . 
 
 Passive congestion 
 
 Tuberculous 
 Miniature 
 Small . 
 
 Small febrile . 
 Splenectomy 
 Splenomegaly, Primary 
 
 Banti's . 
 
 Gaucher's . - 
 Splenitis, Acute . 
 Spots on. 
 
 Pin-point 
 
 Yellow . 
 Syphilis, Spleen in 
 Trabecular tissue ; ate 
 Tuberculosis of 
 
 Miliary . 
 
 Obsolete 
 
 43.781 ; 43.7861-2 
 43.36115; 43.61*-'. 
 43.3431. 
 431 ; 43.26^ 
 
 43.3641; 43.3722; 43.5162; 43.6251; 
 43 721.3,4,5. 43.791. 
 
 43.26»; 43.3242; 43. 34i ; 43.3431 ; 43.3441; 
 
 43.3481; 43.3511; 43.3513.5.6. 
 43.3761; 43.5131; 43.514i-i3. 
 43.2624. 
 43.361'. 
 
 43.131 ; 43.261. 
 
 43 264.5,21,27,30. 43.3611.15; 43.611-8; 
 
 431.3251 ; 431.3912.14.22. 
 
 43.2625; 43.3514. 
 
 43.728; 43.8I91. 
 
 43.5131-3. 
 
 43.5131". 
 
 43.341 ; 43.3441 ; 43.3512. 
 
 . 43.2222.4; 43.3614-« ; 43.5162; 43.72'; 
 
 43.793 ; ste also Hyaloserositis. 
 . 43.261 . 43.7862 ; . 43.793. 
 . 43.3721. 
 under Histological characters. 
 . 43.3618.10.18.17.20 ; 43.5152. 
 . 43.2624; 43.3571 ; 43.3611.2.3-6.11. 
 . 43.36115; 431.3611.2; Tbc* 46 and 47 ; 
 43.361' ; Tbc* 48. 
 Typhoid, Spleen in . . 43.2625; 43.3251; 43.351i~«. 
 
 * Tbc. 46, 47, 48 refer to the collection of Tuberculosis in the General 
 Pathology Section of the Museum. 
 
PLATE VI 
 
 h 
 
 VARIATIONS IN SIZE OF SPLEEN IN DIFFERENT CONDITIONS 
 
 a. Congenital Hypoplasia (43.13'). 
 
 b. Passive Congestion, late stage, with small infarct (43.26'). 
 
 c. Passive Congestion, earlier stage than h (48.222''). 
 
 d. Acute Splenitis in Typhoid (43.351'). 
 
 e. Enlargement of Spleen in Cirrhosis of Liver (43.72*). 
 /. Splenomegaly in Lymphatic Leukaemia (48. 514'-)' 
 
 g. Splenomegaly in Banti's Disease (or Malaria?) (48. 72"). 
 h. Splenomegaly in Myelogenous Leukaemia (43.514^). 
 
 P. 81 
 
43. SPLEEN 
 
 CATALOGUE * 
 Anatomical Series 
 
 .1 ANOMALIES. 
 
 .12 Malformations of Incomplete Development. 
 See 43.13^ 
 
 .13 Reduction in Size. (Hypoplasia.) 
 43.13^ Miniature Spleen. 
 
 An abnormally small organ, measuring only 4-5x2 cm. The 
 notches are indistinct, but the shape is otherwise natural. The 
 vessels entering the hilum are very large. 
 
 From a man of about 40, in whom no other anomalies of the 
 lymphoid structures were observed. The cause of death was unknown. 
 Ref. : Dissecting Room. 
 
 Presented by Dr. J. G. McCarthy, 1902. 
 
 .14 Reduction in Number. 
 None in this series. 
 
 .15 Persistent Foetal Structures. 
 None in this series. 
 
 .16. Excess in Size. 
 
 None in this series except as a result of post-natal disease. 
 
 * For abbreviations used in this Catalogue, see page xviii. 
 IV. I G 
 
82 THE HEMOPOIETIC ORGANS 
 
 .17 Excess in Number. 
 43.17^ Multiple Accessory Spleens. 
 
 Five flattened round bodies, of different sizes, the largest 2 cm. 
 in diameter, and the smallest 0.6 cm. The surface in each case is 
 wrinkled and opaque. 
 
 Ref. : E. 3122. 
 
 Presented by Dr. Klotz. 
 
 43.17^ Accessory Spleen. 
 
 Half of a spleen with a piece of the gastrosplenic omentum. 
 A small round accessory organ, measuring 2x2x1-5 cm., covered 
 with areolar tissue, is attached to the omentum at a distance of 
 1'5 cm. from the spleen. The capsule is thin and has a smooth 
 surface resembling that of the spleen proper. Its consistence 
 is rather soft, and the cut surface shows the Malpighian bodies 
 distinctly. 
 
 Presented bv Dr. Adami. 
 
 43.17^ Accessory Spleen. 
 
 Spleen with tail of pancreas, near which is an accessory organ, 
 measuring 2-5 x 1-5x1 cm., which Hes beneath the tail of the 
 pancreas. The surface is wrinkled, and has the same appearance 
 as that of the spleen itself, which is of normal size (8x8x3 cm.). 
 The cut surface shows no characteristic feature. 
 
 A. J., female, aged 53. The accessory spleen was situated in 
 a fold of the omentum, rather to the inner side of the organ, near the 
 tail of the pancreas. No other abnormaUties noted. 
 
 Ref. : R.V.H. 32.99. E. No. 540. 
 
 Presented by Drs. Bell and NichoUs. 
 
PLATE VII 
 
 .' \ 
 
 lO- 
 
 — — — Accessory Spleen. 
 
 V 
 
 en 
 
 a 
 
 I- 
 ul 
 
 z 
 
 Ul 
 
 o 
 
 43.17^ ACCESSORY SPLEEN, ATTACHED TO ORGAN 
 
 OF NORMAL SIZE 
 
 p. 82 
 
43. SPLEEN 83 
 
 43.17* Multiple Accessory Spleens. 
 
 A number of small spleens, measming respectively 5-5 X 4-5 x 
 2 cm. ; 3-4xl'6x2-4 cm. ; 2-5 cm. ; 2 cm. ; 2 cm. ; 1-7 cm. ; 
 1-7 cm. The five last named measm*ed the same in each direction 
 of space. 
 
 These are aU red in colour and connected together by a fatty 
 mesentery. Each structure presents the appearance of a natural 
 spleen, the capsule being a Httle wrinkled, while the cut surface is 
 dark in colour. The Malpighian bodies are easily seen as minute 
 white specks. The trabecular tissue is moderately conspicuous. 
 
 Mrs. M. L., aged 25. Admitted comatose. Died of acute 
 encephaUtis, pneumococcus infection. 
 
 P.M. Acute cerebro-spinal meningitis and encephalitis, throm- 
 bosis of left lateral sinus. Calcified plaques in arachnoid of spinal 
 cord (see Specimen No. 72.627^). (Edema and congestion of lungs. 
 Multiple spleens, bilateral hydronephrosis and hydro-ureters, 
 anomalous attachment of intestines. 
 
 Micro. Exam. Shows numerous moderately large Malpighian 
 bodies. The intervening pulp-tissue is congested, poor in pulp-cells, 
 and rather scanty in amount. Some Malpighian bodies show hyaline 
 degeneration. The trabecular tissue is moderately conspicuous. 
 
 Ref. : M.G.H., A. 10.97 ; E. 4515. 
 
 Presented by Dr. Rhea. 
 
 G 2 
 
84 THE HEMOPOIETIC ORGANS 
 
 .2 CIRCULATORY DISTURBANCES. 
 .22 Congestion or Hyperaemia. 
 .222 Passive Hyperaemia. 
 43.222^ Spleen in Passive Congestion of Cardiac 
 Origin. 
 
 A spleen of normal size, 12x 8x 5 cm., with a smooth, tense sur- 
 face, free from adhesions and showing normal notching. At each 
 pole the capsule shows extensive hsemorrhagic mottling. The cut 
 surface is dark red in colour and shows the trabeculse very distinctly. 
 The Malpighian bodies are distinct but normal. 
 
 E. L., male, aged 62, was admitted suffering from cardiac failure 
 following old aortic stenosis. The patient was born in France, but 
 was in Canada for thirty years ; had never done heavy physical 
 work. 
 
 P.M. Aortic stenosis, chronic myocarditis, hyaloserositis of 
 hver, choleUthiasis, chronic interstitial nephritis. 
 
 Ref. : R.V.H. 54.06. E. 1567. 
 
 43.222^ Passive Congestion of Spleen in Cardio-renal 
 Disease. 
 
 Half of an enlarged spleen (15x9 cm.), whose capsule is more 
 opaque than usual (slate-grey) and slightly wrinkled. The surface 
 everywhere is dotted with white pin-point elevations. The cut 
 surface is pale (loss of colour) and almost homogeneous, though close 
 inspection reveals a number of small Malpighian bodies. There is 
 ' an increase in the trabeculee. The cut surface bulges outward. 
 
 Mrs. C. B., aged 64, was admitted for the effects of cardiac 
 failure, which had existed for five months and steadily progressed. 
 
 P.M. Cardio-hepato-renal disease with extreme ascites, cedema 
 of lungs, bronchitis, dilated hypertrophied heart, general fatty 
 arterio-sclerosis, cirrhosis of Uver, chronic cholecystitis, perisplenitis, 
 ascites, adiposity, chronic interstitial nephritis. 
 
 Micro. Exam. The capsule is thickened, but the trabeculse are 
 not. The Malpighian bodies are unaltered in number. The central 
 vessel is thickened and tortuous. The reticulum is conspicuous and 
 the blood-vessels are engorged. 
 
 Ref. : R.V.H. 3.11. E. No. 4573. 
 
 Presented by Dr. Gruner. 
 
43. SPLEEN 85 
 
 43.222^ Spleen. Early Passive Congestion in Acute 
 Broncho-pneumonia. 
 
 The spleen of a child laid open ; one-half has a finely puckered 
 surface, the other half is roughened with long threads of lymph. 
 The cut surface shows increase in the amount of fibrous tissue, the 
 trabeculse being very conspicuous. The colour is very dark. The 
 Malpighian bodies are not visible. 
 
 S. C, male infant, aged 6 months. Cough and diarrhoea developed 
 July 13, 1906. Admitted to R.V.H. August 8th, almost moribund. 
 Died next day. 
 
 P.M. Acute broncho-pneumonia in both lower and in right 
 upper lobes. Empyema and interstitial emphysema. Acute 
 muco-purulent bronchitis. Fatty infiltration of fiver. Passive 
 congestion of spleen. 
 
 Micro. Exam. Spleen congested so that section appeared to be 
 made up of numerous lacunae. The dilated blood spaces were fined 
 with endothefium. 
 
 Ref. : E. 4029. R.V.H. 107.06. 
 
 Presented by Dr. Keenan. 
 
 43.222'' Spleen. Passive Congestion in Chronic Heart 
 Disease. 
 
 Half of a sfightly enlarged spleen 15x7x5 cm., weight 345 grm., 
 with very much rounded edges, slaty colour, and firm consistence. 
 There are spots of hyaloserositis on the outer surface. The cut 
 surface shows little differentiation of structure, and is very dark in 
 colour. Malpighian bodies cannot be made out. The trabeculsa 
 are moderately conspicuous. The organ was firm. 
 
 Mrs. M. B., aged 38, was admitted to the R.V.H. on July 30, 
 1902, for cardiac incompetence. She had been in the hospital many 
 times before, because of sequelae of acute rheumatism 14 years 
 previously. She died of faifing compensation, Nov. 12, 1912. 
 
 P.M. Cor bovinum, tricuspid regurgitation, mitral stenosis, 
 patent foramen ovale ; bilateral hydrothorax, ascites ; passive 
 congestion of organs ; accessory spleen. 
 
 Micro. Exam. There is diffuse increase of the interstitial tissue 
 with great congestion of the pulp. The Malpighian bodies are few, 
 small, and contain only lymphoid cells. The waUs of the central 
 vessels are increased in thickness and show hyafine change. 
 
 Ref. : E. 5353c. R.V.H. 159.12. 
 
 Presented by Dr. Gruner. 
 
86 THE HEMOPOIETIC ORGANS 
 
 43.222^ Passive Congestion of Spleen in Cardiac 
 Disease (Late Stage). 
 
 An organ, slightly reduced in size, having a finely granular surface 
 with a few shaggy adhesions, of firm consistency. The natural shape 
 is preserved (anatomical depression due to stomach). The cut sur- 
 face is of a dark maroon colour, and shows increased fibrous tissue. 
 The Malpighian bodies are conspicuous against the red background. 
 
 E. A., female, aged 42. From a case of chronic heart disease of 
 long standing. 
 
 Ref. : R.V.H. 80.02. E. No. 816. See also 11.398. 
 
 Pbesented by Drs. Adami and Hamilton. 
 
43. SPLEEN 87 
 
 .26 Infarction. 
 43.26^ Multiple Infarcts of the Spleen with Miliary 
 Abscesses (?) 
 
 The spleen of an infant, measuring 6-5x3x 1-5 cm., dark red in 
 colour, soft and spongy over the greater part of its surface, but hard 
 and firm in a few locaUzed areas. These hard parts are the infarcted 
 areas ; dark reddish-brown irregular-shaped patches are scattered 
 over all sides of the organ and sharply defined from the surrounding 
 tissue. The largest of these measures about 1 cm. in diameter ; 
 on section it is seen to consist of a firm, dark-red outer area, and a soft, 
 almost necrotic, bright-red central portion. The organ is studded 
 all over with tiny yeUow nodules closely resembling miliary abscesses. 
 
 Ref. : St. Bart's. 1907. Entry No. 3816. 
 
 Presented by Dr. C. F. Martin. 
 
 43.26^ Haemorrhagic Infarction of Spleen. 
 
 A portion of a spleen cut open to show a small infarct of dark 
 colour. The external surface is purpHsh in hue, but neither raised 
 nor depressed. The cut surface shows the lesion to be sharply 
 demarcated from the pale pulp. A few foci of deep congestion, 
 clearly marked off against the pale pulp, are shown in the other por- 
 tions. The organ measured 12-5 X 5-5 X 2-5 cm. and weighed 200 grm. 
 
 A. B., male, aged 62, was admitted to R.V.H. on Nov. 22, 1911, 
 because of rupture of the urethra five days before. The genitalia 
 were gangrenous ; the local condition was very bad. 
 
 P.M. Stricture of urethra following gonorrhoea ; rupture of 
 urethra ; extravasation ; cellulitis ; abscess of right lung ; haemor- 
 rhagic infarcts of kidneys ; thrombosis of pelvic veins. 
 
 Micro. Exam. The Malpighian bodies are few in number, and 
 small in size. The trabecular tissue is inconspicuous. The venous 
 sinuses are engorged. 
 
 Ref. : E. 4770b. R.V.H. 165.11. 
 
 Presented by Dr. Gruner. 
 
88 THE HEMOPOIETIC ORGANS 
 
 43.26^ Red Infarct of Spleen following Malignant Endo- 
 carditis, 
 
 A piece of a spleen cut through to show a red infarct at the edge. 
 This has an ill-defined sinuous outHne. The surface of the infarct 
 is level with that of the spleen and shows hardly any change in 
 colour. A pale border can be detected with a very narrow zone 
 of congestion next to it. 
 
 Mrs. S. T., aged 24. Two weeks before death suddenly developed 
 weakness, followed by right-sided paralysis and aphasia. High 
 septic temperature. Was pregnant seven months ; labour was 
 induced, followed in a few hours by death. 
 
 P.M. Malignant endocarditis ; generalized septicaemia ; soften- 
 ing of area of Broca ; infarcts of spleen and kidney ; acute endo- 
 metritis. 
 
 Ref. : M.G.H., A. 11.143. E. 4935. See also Specimen No. 13.33. 
 
 Presented by Dr. Rhea. 
 
 43.26* Infarct in Spleen of Passive Congestion. 
 
 A small spleen, whose capsule shows a few adherent tags of 
 adhesions. The organ is laid open to show a small wedge-shaped 
 infarct with a white centre and a broad reddened periphery. There 
 is an increase in the fine reticular tissue throughout the pulp. 
 
 Presented by Dr. Adami. 
 
 43.26^ Multiple Infarcts in a Cardiac Spleen. 
 
 A small spleen, measuring lOx 6x 3 cm., of very pointed shape. 
 The cut surface shows some large infarcts of grey colour, with 
 bright-red sinuous borders. The spleen pulp is bright red in colour. 
 The capsule is very markedly wrinkled but otherwise natural. 
 
 Old Museum specimen. 
 
 43.26^ Multiple Infarction of Spleen in Acute Endo- 
 carditis. 
 
 A moderately enlarged organ with tense capsule. A series of 
 wedge-shaped white infarcts, of very irregular outHne, are scattered 
 
43. SPLEEN 89 
 
 through the middle third of the organ, and their central parts are 
 softened. The capsule of the spleen over the infarcted areas is 
 opaque but not thickened, although there are tags of lymph adherent 
 to its surface in other parts. 
 
 Daniel McK., aged 29. Tonsillitis at 29, but no rheumatic 
 history. Illness commenced nine months previously with pneumonic 
 symptoms and later cerebral thrombosis, or embolism. 
 
 P.M. Recurrent aortic endocarditis with vegetations on and 
 perforation of left anterior cusp. Acute sero-fibrinous pericarditis. 
 Acute sero-purulent peritonitis with thrombosis of superior mesenteric 
 artery and gangrene (infarction) of intestines. There are white 
 infarcts of the hver and Iddneys and infarction of brain. 
 
 The spleen weighed 225 grm., and measured 13 X 10 X 3 cm. 
 
 Ref. : R.V.H. 49.02. 
 
 Presented by Dr. Adami. 
 
 43.26' Multiple Infarcts and Passive Congestion of 
 Spleen following Cardiac Thrombosis. 
 
 A spleen, weighing 155 grm. and roughly of normal size. There 
 are some recent plastic and some older organized adhesions with 
 fibroid patches of thickening of the capsule ; some more recent 
 fine granulations, as from recurrent perisplenitis, also occur. At 
 the inner border of the upper end is a white area corresponding 
 to an infarct, 2 cm. wide, which has been cut across. Several other 
 infarcts show through the capsule. A constriction occurs at the 
 lower end, cutting off, as it were, a subsessile portion of the organ, 
 2x2 cm., but this is probably congenital in origin, as there is no 
 increase of fibrous tissue to account for it pathologically. Two 
 recent and somewhat redder infarcts occur in the middle third 
 of the organ. The cut surface shows hsemorrhagic zones round the 
 infarcts, and a very large infarct, partly softened in the middle, 
 occupjdng nearly one-third of the organ. The Malpighian bodies 
 are very distinct and the pulp very congested and dark in colour. 
 
 WilHam H., aged 27, janitor, admitted to the R.V.H. Sept. 19, 
 1909. Had been ill for three weeks before admission, and had had 
 pains in the legs for two months. Died on Dec. 11, 1909. 
 
 P.M. GeneraHzed arterio-sclerosis, hypertrophy and dilatation 
 of the heart, parietal thrombi of both ventricles, multiple infarcts 
 of the lung and one of the heart. The pelvic veins were thrombosed, 
 
90 THE HEMOPOIETIC ORGANS 
 
 and there was passive congestion of all organs with anasarca. 
 Infarcts of spleen. 
 
 Micro. Exam. There is thickening of the coats of the smaller 
 vessels. The Malpighian bodies are very distinct and the pulp 
 congested. 
 
 Ref. : R.V.H. 138.09. E. 4035a. 
 
 Presented by Dr. Adami. 
 
 43.26^ Multiple Infarcts of Spleen following Acute 
 Vegetative Mitral Endocarditis. 
 
 The spleen shows several irregular areas of Hght yellowish colour 
 on the surface, wedge-shaped on section. Depressions and puckering 
 are present at the upper pole. There is also a large deep depression 
 along the posterior border of the upper pole. On the cut surface 
 a number of yeUow wedge-shaped areas are seen along the border 
 of the organ. 
 
 B. R., female, aged 35, was admitted to the R.V.H. August 16, 
 1909, having been ill five weeks. She was found to have chronic 
 endocarditis with mitral stenosis. 
 
 P.M. Mahgnant endocarditis, acute vegetative mitral endo- 
 carditis with septic myocarditis, bilateral hydrothorax, multiple 
 necroses of Hver. Infarcts of spleen ; weight, 150 grm. ; size, 13 X 9 x 
 3-5 cm. 
 
 Ref. R.V.H. 110.09. E. 3853b. 
 
 Presented by Dr. Gruner. 
 
 43.26^ Multiple White Infarcts in Enlarged (Febrile) 
 Spleen of Case of Acute Vegetative Endocarditis. 
 
 A slab, 17x8-5 cm., from a greatly enlarged spleen showing 
 two large infarcts. The surface is smooth, the capsule tense, and 
 there is a depression at the upper edge of the lower infarct. The 
 surfaces of both are shghtly roughened with lymph and partly 
 pitted. The cut surface shows retraction of the splenic pulp, almost 
 complete replacement of splenic tissue by infarctions. The edges 
 are very irregular and finely scalloped. The central parts are dark 
 brown in colour and a httle hollowed. The pulp itself is very dark- 
 
43. SPLEEN 91 
 
 coloured, and the Malpighian bodies are obscured. Another piece 
 of spleen in the same jar shows an old white infarct of wedge-shape, 
 with a smooth surface, uniform yeUow colour on section, scalloped 
 edge, and narrow translucent Hmiting Une. 
 
 Mrs. McN., aged 43, was admitted to the M.G.H. May 29, 1908, 
 suffering from cough, weakness, and anaemia. History of exposure to 
 cold in February 1908 ; since then had had drenching night-sweats 
 and had lost 40 pounds in weight. Examination showed enlarge- 
 ment of spleen, hver, and heart, and marked secondary anaemia. 
 The patient gradually failed and had four convulsions during 
 the last ten days of hfe. Death occurred in coma following dehrium. 
 
 P.M. The spleen weighed 1,005 grm. and projected 8 cm. 
 below the left costal margin. It was adherent to the diaphragm. 
 Other findings were acute vegetative endocarditis (mitral and 
 aortic), fatty hver, acute and chronic nephritis. 
 
 Ref. : M.G.H., A. 08.167. E. 3532. 
 
 Presented by Dr. Wolbach. 
 
 43.26^'' Multiple White Infarcts of Spleen. 
 
 The specimen consists of half a large spleen, measuring 16-5 x 
 10-5x3 cm., whose cut surface reveals at the lower third a large 
 triangular infarct of white colour (5-5 x 3-2 cm.), raised, and having 
 shghtly serrated margins. It is separated from the splenic tissue 
 by a narrow translucent line. A second smaller infarct occurs at 
 the junction of the upper and middle thirds. A few white spots 
 seen in the immediate vicinity of the main white mass are portions 
 of the same infarct, which have been cut through irregularly owing 
 to the shape of its lower end. 
 
 The remainder of the cut surface is pale and shows large Mal- 
 pighian follicles. The capsule presents no abnormahty. The sur- 
 face of the infarct is hardly visible beneath the capsule. 
 
 Miss E. R., aged 83. Admitted with impacted fracture of left 
 femur. Died from exhaustion. 
 
 P.M. Chronic myocarditis. Purulent bronchitis. Calcareous 
 lymph-nodes. Enteroptosis and dilatation of stomach. Chronic 
 nephritis. Arterio-sclerosis and calcification. Decubitus ulcers. 
 Infarcts of spleen. 
 
 Micro. Exam. The spleen substance away from the infarct 
 shows loss of ordinary structure, being almost entirely lymphoid. 
 
92 THE HiEMOPOIETIC ORGANS 
 
 The cells amongst the trabeculse are very numerous, uniformly 
 distributed, and aU of a size, as if a pseudo-leuksemic condition was 
 present. 
 
 Ref. : M.G.H., A. 10.152; S. 10.1064. E. No. 4523. 
 
 Presented by Dr. Rhea. 
 
 43.26^1 Spleen. Infarct. 
 
 A slab from a markedly enlarged spleen, showing an old infarct 
 of large size, whose surface is shaggy and whose cut surface is pale, 
 mottled, and shows a scalloped edge, marked off by hyaline fibrous 
 tissue. 
 
 Presented by Dr. Abbott, 1902. 
 
 43.26^- Spleen shelving White Infarct -with Depressed 
 Scars and Patches of Hyaloserositis. 
 
 A small spleen whose surface shows a triangular area of yellowish 
 discolouration with three small outlying irregular plaques of opaque 
 substance. Across the upper end is a transverse deep furrow. Other 
 plaques occur above this, as well as a small infarct. On the pole 
 opposite to the first-named wedge-shaped area is a second deep 
 pucker. The cut surface shows thickenings of the capsule, corre- 
 sponding to the plaques, and a yellow discolouration around the 
 edges of the second furrow. The wedge-shaped area has the same 
 shape on section, and is of dark colour in the centre, but its edges 
 are white and there is a very fine red line dehmiting it. The Mal- 
 pighian bodies are enlarged. The pulp is dark in colour, and there 
 is no increase in the fibrous trabeculse. 
 
 Ref. : E. 3599. 
 
 43.26^^ Infarct of Spleen following Acute Mitral Endo- 
 carditis. 
 
 A slice of spleen showing a large wedge-shaped infarct of pale 
 pink colour occupjdng the centre of its length. At each border the 
 
PLATE VIII 
 
 lA- 
 
 lA 
 III 
 
 a 
 
 I- 
 yi 
 
 Z 
 
 z 
 
 lU 
 
 u 
 
 43.26'« OLD INFARCT IN CARDIAC SPLEEN 
 Di-. C. F. Martin 
 
 P. 93 
 
43. SPLEEN 93 
 
 capsule is depressed. The outline, within the spleen substance, is 
 regular and sharply mapped out by a narrow ochre-coloured Une. 
 
 From a girl Avho died of infective mitral endocarditis comphcating 
 otitis media. 
 
 Ref. : St. Bart's. E. 2246. 
 
 Presented by Dr. Martin. 
 
 43.26^1 Old Infarct of Spleen following Acute Vege- 
 tative Endocarditis. 
 
 A small spleen whose posterior border is occupied at the junction 
 of middle and lower thirds by a large white infarct 4-5 X 3-5 cm., 
 which is triangular in shape externally. It is very clearly marked 
 off by deep sulci all round it. The spleen is smooth everywhere 
 except over the infarcted area. A depressed puckered area, due to 
 another infarct, occurs 3 cm. above the first. 
 
 The organ weighed 230 grm., and measured 13 X 6-5 x 3-5 cm. 
 It was flabby. 
 
 C. B., female, aged 45, was admitted to hospital for heart 
 failure. Attacks of failing compensation had occurred repeatedly 
 during the past five years. The infarction of the lung occurred on 
 the day of death. 
 
 P.M. Acute vegetative endocarditis (mitral and aortic) and 
 buttonhole stenosis of mitral valve. Multiple infarcts of lungs, 
 spleen, kidneys. Extreme congestion of lungs. Septic thrombosis 
 in right auricular appendix. Eccentric hypertrophy of the heart. 
 B. coli communis was recovered from the heart, thrombus, and 
 splenic juice. 
 
 Ref. : E. 4787. R.V.H. 164.11. 
 
 Presented by Dr. Gruner. 
 
 43.26^^ Old Infarction of Spleen in Malignant Endo- 
 carditis. 
 
 A greatly enlarged spleen, measuring 14 x 9 X 5 cm. The pulp is 
 soft and bulges outward. At the upper pole is a large quadrangular 
 infarct of white colour, measuring 4x2 cm. At the lower pole and 
 running up to the hilum is another enormous white infarct 9 cm. 
 
94 THE HEMOPOIETIC ORGANS 
 
 long, involving the portion of the spleen comprising the lower 
 two notches. It has no characteristic shape. The surface is 
 roughened over each infarct. 
 
 Louisa L., aged 34. History of miscarriage. 
 
 P.M. Septic endometritis. Acute vegetative endocarditis of 
 mitral value (staphylococcus and streptococcus infection). Septic 
 infarct of spleen with necrosis and rupture of organ. Acute locaUzed 
 fibrino-purulent peritonitis of upper abdomen. 
 
 Ref. : R.V.H. 38.03. 
 
 Presented by Dr. Adami. 
 
 43.2623 White Infarct of Spleen. 
 
 A spleen measuring 14x 5x 3 cm. The surface is pale in colour, 
 smooth, save over the infarction, where there is a rough depression 
 2 cm. wide and having tags of lymph adherent to iU The infarct 
 occupies the whole thickness of the organ, is chalky- white in colour, 
 has a smooth granular surface, and is almost homogeneous in struc- 
 ture. There is a very thin grey translucent Hmiting line. The 
 infarct is an old one. 
 
 The rest of the splenic tissue is normal in appearance. 
 
 F. G., male, aged 46. Pain in leg set in eight weeks before admis- 
 sion. Amputation of thigh. Blood-culture showed streptococcic 
 septicaemia. 
 
 P.M. Septicaemia following acute osteomyeUtis of right leg ; 
 septic infarct of lung, kidney, and spleen ; pyelonephritis ; diph- 
 theritic ulceration of caecum and ascending colon. 
 
 Ref. : R.V.H. 48.08. E. 3374. 
 
 Presented by Dr. Adami. 
 
 43. 26^^ Old Infarct of Spleen. Passive Congestion of 
 Cardiac Origin. Miliary Tubercles. 
 
 A much enlarged spleen, measuring 17x9x5 cm., showing very 
 deep irregular puckering across the middle hne, due to old infarction. 
 The surface is everywhere smooth and tense, except near the tip, 
 which is roughened by recent lymph. The cut surface shows a large 
 
43. SPLEEN 95 
 
 ochre-coloured homogeneous patch, firm in consistence, of irregular 
 outHne, mapped out with a fine translucent fine, and separated off 
 from the spleen pulp by fibrous bands. The large vessels below 
 show blood-clot in their lumen, and some minute white nodules 
 enclosed in a bright-red zone occur, which are tubercles. There was 
 tuberculosis of the fiver. The spleen weighs 500 grm. 
 
 E. M., male, aged 52. The condition followed recurrent heart 
 disease affecting the aortic cusps. Tuberculosis set in one and a half 
 years before death. 
 
 Micro. Exam. Here and there are some small miUary tubercles 
 whose centres are necrotic. One large one, occupying nearly the 
 whole of a low-power field, is visible in the section. It shows 
 centrally a hyahne mass with radiating clefts ; at the periphery 
 a narrow zone of infiltration enclosed in an outer zone of pale- 
 staining hyahne matter. The zone of reactive infiltration round 
 the whole is narrow. The trabeculse are large, but the capsule 
 is not thickened. 
 
 Ref. : R.V.H. 70.07. E. 3132a. 
 
 See also Specimen No. 37.361. 
 
 Presented by Dr. Klotz. 
 
 43.2625 Spleen. White Infarcts in Typhoid Spleen. 
 
 A portion of a small spleen, cut open to show a relatively white 
 infarct (3-5 cm. in diameter) of ovoid shape. Its edges are depressed 
 and its cut surface shows a regular contour. It is of pale fawn 
 colour, and there is a semi-translucent hyahne border separating it 
 from the splenic substance. The spleen appears otherwise normal. 
 (Weight 345 grm.) 
 
 R. de C, male, aged 24, was admitted to the M.G.H. on Dec. 20, 
 1912, with signs of typhoid fever. Widal positive. White cells, 7,900. 
 Fluid was found in the chest. 
 
 P.M. Pyopneumothorax ; abscess of lung ; bronchopneu- 
 monia ; ulcerative enteritis ; chronic peritonitis. The spleen was 
 bound down by many fibrous adhesions to the stomach, trans- 
 verse colon, and sigmoid. There were several infarcts, some under- 
 going softening. They were more numerous on the under surface 
 near the hilum. 
 
 Note how smaU the spleen is for a ' febrile ' type. 
 
 Ref, : E, 5570, M.G.H. , A. 13.12. 
 
 Presented by Drs. Finley and Burgess, 
 
96 THE HEMOPOIETIC ORGANS 
 
 43.26^^ Infarction of Spleen of Long Standing. 
 
 HaK of a slightly enlarged spleen. A large, wedge-shaped white 
 infarct, raised above the surface and demarcated from the surround- 
 ing tissue by a deep ridge, is situated at the upper pole (lower in 
 jar). Its cut surface is of cheesy consistency and shows a deep 
 yellow narrow delimiting line (remains of hsemorrhagic zone). At 
 the junction of the lower and middle thirds of the organ is a retracted 
 Unear scar with cheesy matter in its centre, which represents the 
 remains of a second old infarct. The surfaces are a little shaggy 
 with lymph. 
 
 Ref. : E. No. 936. 
 
 43.26^' Infarct in Cardiac Spleen. 
 
 A small organ of deep-red colour. The cut surface shows a marked 
 increase of fibrous tissue, and the outer surface is finely granular. 
 Towards the upper pole there is a depressed yellowish wedge-shaped 
 area, of cheesy consistency, sharply delimited from the rest of the 
 spleen (old infarct). The pale tract in the centre is artefact. 
 
 J. McE., male, aged 47. Recurrent mitral endocarditis in old 
 mitral stenosis. Infarcts of spleen, lung, kidney, and colon (ulcers 
 from infarction). Early cirrhosis of liver. 
 
 Ref. : M.G.H. 190.03. E. No. 976. 
 
 Presented by Dr. Gillies. 
 
 43.26^^ Spleen showing White Infarcts (Arterio- 
 sclerotic). 
 
 Half a spleen, measuring 9x6 cm., showing three large infarcts, 
 one at each pole and one stretching across the middle third. They 
 are sharply marked ofiE by deeply congested splenic tissue which is 
 rather fibrous. The surface of the spleen is unaltered and neither 
 depressed nor elevated. 
 
 Jane E., aged 58. Died on admission. No clinical notes. 
 
 P.M. Pyonephrosis ; acute cystitis ; arterio-sclerotic atrophy of 
 kidney ; obsolete and active tuberculosis of lungs and intestine 
 and glands ; sclerosis and tortuosity of the splenic arteries with 
 
43. SPLEEN 97 
 
 a mural thrombus partially occluding the lumen. The spleen weighed 
 100 grm. 
 
 Micro. Exam. Fibrosis of the spleen with infarct of some days' 
 duration, with, however, little organization. 
 
 Ref. : R.V.H. 9.10. E. 4152a. 
 
 Presented by Dr. Adami. 
 
 43. 26^^ Multiple Infarcts of Spleen. 
 
 A moderately large but bulky spleen, showing tags of lymph 
 upon its surface and several infarcts. The lower pole is occupied by 
 one large infarct with clean-cut borders marked off by a bright 
 ochre-red Hne, and a hyaline Une within that. The centre of this 
 infarct is markedly softened. String adhesions are attached all 
 round its border. There is a sulcus demarcating it superficially. 
 At the upper pole is a small wedge-shaped infarct definitely raised 
 about the surface, having an irregular purple fine enclosing it. 
 On the cut surface there is a similar appearance to the preceding, 
 but the softening is not as intense in the infarct at the lower pole. 
 A still smaller infarct occurs half-way along the spleen. The pulp- 
 tissue is pale. There is some dark mottling in the central portion. 
 
 From a girl, aged 13, who had chronic heart disease follo%ving 
 attacks of rheumatism at the ages of 5 and 7. 
 
 P.M. Chronic myocarditis ; chronic interstitial and acute 
 parenchymatous nephritis ; chronic passive congestion of liver ; 
 infarction of spleen ; acute and chronic bronchitis ; acute inflam- 
 mation of bronchial lymph-nodes. 
 
 Micro. Exam. The section for the most part shows necrotic 
 tissue in which scarcely any cellular element can be made out and in 
 which are collections of fibrin. In other places the splenic tissue 
 has been preserved, but the sinuses are greatly dilated and empty, 
 except for occasional red blood-cells. 
 
 Ref. : E. 4627. R.V.H., A. 09.104. 
 
 Presented by Dr. Gruner. 
 
 IV I 
 
98 THE HiEMOPOIETIC ORGANS 
 
 .3 INFLAMMATION. 
 
 .324 Haemorrhagic Inflammation. 
 43.324^ Haemorrhagic Splenitis and Accessory Spleen. 
 
 Part of a spleen, measuring 15x8x4 cm. and weighing 215 grm., 
 cut open to show numerous rounded areas of extremely dark colour, 
 varying in diameter from 2-12 mm. Their contour is regular. The 
 remainder of the organ is congested and shows innumerable small 
 Malpighian bodies. * * 
 
 The exterior shows nothing worthy of special note, except that 
 there is an accessory spleen in the attached gastro-splenic omentum. 
 
 Mrs. A. McE., aged 41. Admitted to the R.V.H. Nov. 6, 1910, 
 for vomiting and jaundice. An operation for gall-stones was 
 performed fifteen days before death. The adnexa of this operation 
 are shown in Specimen No. 38.65. 
 
 P.M. Cholelithiasis ; chronic cholecystitis ; obliteration of 
 cystic duct ; chronic peritonitis ; fat-necrosis of pancreas ; chole- 
 dochostomy ; chronic pancreatitis. 
 
 Micro. Exam. There is slight thickening of the capsule. The 
 trabeculse are hyaline in places. The Malpighian bodies are increased 
 in number, but are smaU and ill-defined in outline. The pulp is 
 undergoing necrosis here and there, and is poor in cells ; many of 
 the splenic channels are dilated, and show desquamating and endo- 
 thelial cells in their lumen. There is no increase in the elastic tissue. 
 Foci of recent inflammatory exudate (fibrinous) occur. 
 
 Ref. : E. 4498b. R.V.H. 162.10. 
 
 Presented by Drs. Gruner and Garrow. 
 
 43.324- Spleen. Acute Haemorrhagic Splenitis ia 
 Lobar Pneumonia. 
 
 Two slabs from an enlarged spleen, measuring 16x7 cm. The 
 capsule is smooth, dark purple in colour, and quite tense. The cut 
 surface is deep red, mottled with almost black markings of arbores- 
 cent pattern. 
 
 E. P., male, aged 45. Illness began on March 16, 1908, with 
 pains in the side and vomiting ; also cough with expectoration, 
 which was profuse and of a rusty colour and sometimes contained 
 blood. Patient died at 1.30 p.m. March 23, 1908. 
 
 P.M. Lobar pneumonia ; acute pericarditis ; acute and chronic 
 nephritis ; acute bronchitis ; chronic and healed mediastinal 
 tuberculosis. 
 
43. SPLEEN 99' 
 
 Spleen was enormously enlarged, weighing 720 grm. The 
 capsule is tense and black. On section the cut surface presents 
 a very curious red and black appearance. The upper portion of the 
 surface is bright red, but scattered through the red parts are 
 numerous black areas with sharp irregular outHne. The organ is 
 very friable and much pulp comes away on scraping. The trabeculae 
 and Malpighian bodies are invisible. 
 
 Micro. Exam. The capsule is moderately thickened. The 
 trabeculse are a little thickened but not conspicuous. The pulp is 
 almost entirely occupied by blood which tensely fills all the sinuses. 
 There are few pulp-cells to be made out. The Malpighian bodies 
 are reduced to traces and contain no germ cells. 
 
 Ref. : E. 3227. M.G.H., A. 08.67. 
 
 Peesented by Dr. Duval. 
 
 43.324^ Haemorrhagic Splenitis 
 
 A small spleen, measuring 9-5x6x3 cm. and weighing 90 grm. 
 It is rather depressed by a deep notch. The capsule is grey from 
 thickening. The cut surface is lightly variegated by alternating 
 areas of pale yellow and dark red, of about equal size, and almost 
 4 mm. in diameter. The Malpighian bodies are somewhat large 
 but not easily seen. 
 
 N. S., male, aged 61, was admitted to the R.V.H. April 15, 1913,. 
 suffering from bladder symptoms which proved to be due to an 
 enormous papilloma of bladder (see Specimen 53.752). Deatk 
 occurred six days after operation. 
 
 P.M. Papilloma of bladder ; petechial haemorrhages in kidney 
 pelvis ; enlarged lumbar glands ; adrenal hyperplasia ; fatty 
 heart. 
 
 Micro. Exam. The main change is one of dilatation of the blood- 
 channels with outflowing of free red blood corpuscles into the pulp- 
 tissue. Fibroblastic cells are very numerous. The central vessels, 
 of the Malpighian bodies have thick hyaline walls. 
 
 Ref. E. 5521. R.V.H. 41.13. 
 
 Presented by Dr. Gruner. 
 
 H2 
 
100 THE H.EMOPOIETIC ORGANS 
 
 .325 Purulent Inflammation (Abscess). 
 43.325^ Spleen with Suppurating Infarcts in Typhoid 
 Fever. 
 
 Half of a moderately enlarged spleen measuring 15x9 cm. 
 The cut surface shows three infarcts of wedge shape, one on the 
 anterior and one on the posterior border, and one at the tip. The 
 central infarct has a soft centre, leaving a small cavity with ragged 
 edges, and roughened yellowish walls. The anterior infarct and that 
 at the tip are also undergoing softening and form cavities with a 
 similar appearance to that of the central infarct. The surrounding 
 spleen substance is diffusely congested. The outer surface shows 
 a diffuse irregular opacity with characteristic linear grooving 
 (a patch of hyaloserositis). Apart from this there is no evidence of 
 perisplenitis. 
 
 Note. A slab from this specimen presents a small suppurative 
 infarct irregularly cavitated, which is shown as a Petri dish specimen. 
 Another slab is mounted in a square jar, and numbered 43.351^. 
 
 Micro. Exam. Section I shows a large area of necrosis with a few 
 scattered collections of small round cells ; the remains of blood- 
 vessels are in their vicinity. 
 
 Section II shows intense outpouring of red blood corpuscles, 
 the edges of the region being well defined. A couple of Malpighian 
 bodies are seen. 
 
 For history see under 43.3515 and 42,3512. 
 
 Ref. : M,G,H., A. 207.09. E. 4064b. 
 
 Presented by Dr. Wolbach. 
 
 43.325^ Broken-down Suppurative Infarct and Hyalo- 
 serositis in Spleen of late Passive Congestion. 
 
 A small spleen, 7Jx4| cm. in cross section, showing semi- 
 translucent, opaque, irregular surface, smooth in some areas, with 
 numerous tags of lymph attached here and there in others. The 
 cut section shows a band of yellowish softened material crossing the 
 middle Hne of the spleen, having clearly defined hyaline scalloped 
 edges. The softened material is shaggy in places, and several 
 irregular cavities appear in it. The cut edge of the surface on the 
 one side is greatly thickened by the semi-translucent cartilaginous- 
 
PLATE IX 
 
 m' 
 
 M. 
 
 lA- 
 
 M 
 
 Ul 
 
 ce 
 I- 
 
 lU 
 
 z 
 
 Ul 
 
 u 
 
 43.325' SEPTIC INFARCT, ABSCESS IN SPLEEN, 
 OF MALIGNANT ENDOCARDITIS 
 
 Note large size and diffluent appearance of organ, and 
 excavated wedge-shaped area 
 
 Dr. Eraser Gurd 
 
 t'. 101 
 
43. SPLEEN 101 
 
 looking material in which a little lamination can be detected. There 
 is a narrow bright-yellow band demarcating the original capsule 
 along the whole of this sm:face of the spleen. The pulp itseK is 
 pale, with red blotchings, in which Malpighian bodies are only faintly 
 discernible. 
 
 G. I. R., male, aged 69. Illness began with acute lobar pneu- 
 monia on the right side four weeks before death. One week before 
 death a quart of foul pus was removed. There was recurrent valvular 
 heart disease (mitral endocarditis). 
 
 P.M. Empyema ; recurrent valvular heart disease ; acute 
 mitral endocarditis on mitral stenosis ; chronic interstitial nephritis 
 and multiple infarcts of the kidneys and spleen. The splenic artery 
 was smaller than usual. 
 
 Ref. : R.V.H. 3.09. E. 3485. 
 
 Presented by Dr. Klotz. 
 
 43.325^ Spleen showing Septic Infarct with Central 
 Breaking Down in Malignant Endocarditis. 
 
 A slab of an enlarged spleen showing a large cystic sweUing 
 occupying the middle portion. Elsewhere the organ is somewhat 
 softened and deep purple in colour. The round swelhng is formed by 
 an abscess, which contained about 180 c.c. of deep purple-coloured 
 purulent fluid. The wall of the cavity is rough and consists of 
 purphsh granular friable material. The part approximating the 
 splenic pulp proper is V-shaped in outline, and consists of bright 
 yellowish, moderately firm tissue, measuring 0-5 cm. in width. The 
 pulp is dark. The Malpighian bodies are not visible. 
 
 C. McC, male, aged 44, had been iU for eight months, and for two 
 months had been laid up with irregular fever, cough, and dyspoena. 
 Enlargement of the heart and a mitral systoUc murmur were found. 
 Three days after admission drowsiness came on, passing into coma, 
 temperature rising to 104°- 105°. Lumbar puncture, Widal and 
 blood-culture were negative. Leucocytes numbered 11,450. Para- 
 lysis of the right eye muscles, and haemorrhage into the fundus 
 shortly preceded death. 
 
 P.M. Acute endocarditis (mitral and aortic) ; infarcts of kidney 
 and spleen ; acute suppurative appendicitis ; chronic pleurisy ; 
 acute locahzed leptomeningitis. Polypus of jejunum (see Specimen 
 No. 351.752). 
 
 Micro. Exam. Section I. Section in general is made up of two 
 
102 THE HEMOPOIETIC ORGANS 
 
 parts — a normal-looking area of splenic tissue and a large necrotic 
 area — which are separated by a broad, dense, fibrous-tissue band. 
 In the normal area the Malpighian bodies are moderately numerous, 
 distinct, and large. Several contain a few cells with a large amount 
 of pink-staining protoplasm and vesicular nuclei (endothehal cells). 
 The sinuses contain a moderate number of red blood-cells. There 
 is an increased number of lymphoid and plasma cells and eosino- 
 philes throughout the pulp, and in places an increase in the connec- 
 tive-tissue stroma. The necrotic area is largely made up of shadows 
 of cells taking the red stain intensely and devoid of nuclei. Through- 
 out these are numerous polymorphonuclear leucocytes. In places 
 there are crystals, bright yellow in colour and needle-shaped in 
 appearance. The broad band of fibrous tissue separating the necrotic 
 from the healthy tissue is infiltrated with numbers of lymphoid 
 and plasma cells and a few polymorphonuclear leucocytes. This 
 tissue also contains large cells, many of them polynuclear with 
 vesicular nuclei, phagocytic for the light-yellow (blood) pigment. 
 Many large cells contain these light-yellow needle-shaped masses. 
 
 Section II. Similar to I. The vessels are more injected, especially 
 those in the fibrous-tissue area and adjacent splenic sinuses. The 
 necrotic zone contains in places strands of fibrin and collections of 
 cocci occurring in chains. The reticulum and cells of the pulp are 
 distinct as pale-red-staining shadows. Collections of crystals are 
 seen throughout the infarcted area and the periphery. 
 
 Section III. The section is injected, especially in the neighbour- 
 hood of the fibrous-tissue area. It is similar to the other two. The 
 polynuclear cells in the tissue surrounding the necrotic zone are 
 very numerous and well formed ; the cells are not very large, few 
 contain more than 6-8 nuclei. The nuclei of several are intensely 
 black and the protoplasm pink : contain bright-yellow needle- 
 shaped crystals, as well as blood pigment. 
 
 Ref. : M.G.H., A. 236.07. E. 3221a. 
 
 Presented by Drs. Molson and Gurd. 
 
 43.325^ Multiple Abscesses of Spleen. 
 
 Half of a spleen with the capsule adherent to the diaphragm, 
 torn from the splenic substance. The surface so exposed is very 
 rough, owing to a fine honeycombing with minute holes of various 
 sizes. 
 
 The cut surface shows a number of rounded pale areas with 
 rather ill-defined outlines. Their centres are irregularly softened 
 (honeycombed). These are the abscesses of varying size, showing 
 no relation to anatomical structures. The remainder of the splenic 
 tissue is very pale. The Malpighian bodies are small. 
 
43. SPLEEN 103 
 
 M. H., female, aged 40. Admitted Sept. 20, 1909, complaining 
 of dyspnoea, abdominal pain, and great weakness. Has been 
 confined to bed with above symptoms one month previously. There 
 was marked orthopnoea, abdominal rigidity, tenderness, and pain 
 in the sides ; oedema of feet. Systolic murmur transmitted to the 
 axilla. Discharging ischiorectal sinuses. Died Sept. 27, 1909. 
 
 P.M. Chronic myocarditis and endocarditis ; hydrothorax 
 fatty liver ; acute peritonitis ; salpingitis ; perirectal abscesses ; 
 acute cystitis ; multiple fistulae in ano. 
 
 Micro. Exam. Shows the splenic pulp very congested and in 
 places breaking down. The Malpighian bodies are moderately 
 numerous, and lymphoblastic pulp-cells are abundant, rather large, 
 and pale. 
 
 Ref. : E. 4460. M.G.H., A. 09.171. 
 
 Presented by Dr. Rhea. 
 
104 THE HEMOPOIETIC ORGANS 
 
 .34 Specific Inflammations due to Cocci. 
 43.34^ Acute Splenitis in Gangrenous Appendicitis. 
 
 Half of a bulky spleen of moderate enlargement, with rounded 
 edges. The outer surface is purple, slightly mottled, with pale spots 
 here and there. The capsule is tense. The cut surface is character- 
 istic ; it is mottled with dark-purple areas of irregular size and ill- 
 defined outline, alternating with paler ones. Throughout can be 
 seen innumerable minute deep-red spots of round shape with white 
 centres. These are the greatly engorged Malpighian bodies. In 
 some parts the splenic tissue is softening. 
 
 L. M., male, aged 24. Admitted to the R.V.H. on July 10, 
 1912, for jaundice and abdominal pain. He had been ill one month, 
 the onset being sudden. A laparotomy was performed. Died 
 August 12th. 
 
 P.M. Gangrenous appendicitis with pelvic abscess and secondary 
 suppurative pylephlebitis. Acute toxic adenitis of aortic glands 
 (42.31^). Sternum, puriform marrow. 
 
 Micro. Exam. The Malpighian bodies are few, rather small ; 
 the pulp-channels are very wide, and full of blood. The pulp-cords 
 contain a moderate number of many varieties of cells, and the relics 
 of necrotic cells. 
 
 Ref. : E. 5243. R.V.H. 113.12. 
 
 Presented by Dr. Gruner. 
 
43. SPLEEN 105 
 
 .341 Lesions due to Micrococci. 
 None in this series. 
 
 .342 Lesions due to Staphylococci. 
 
 None in this series. 
 
 .343 Lesions due to Streptococci. 
 43.343^ Spleen in Septicaemia (Acute Splenitis). 
 Septic Infarct. 
 
 A very large spleen, 15x11 cm. The capsule is tense, with 
 recent plastic exudate and some small spots of fibroid peritonitis. 
 The recent inflammation was most marked over an area of 8-8 cm. 
 on the anterior inferior aspect, in the centre of which was a softened 
 patch of spleen tissue which ruptured on removal and revealed 
 thin gangrenous contents. When this area was cut open it was 
 triangular in shape, the base 5 cm. across. The rest of the splenic 
 tissue was dark, swollen, and very pulpy. 
 
 Mrs. T. S., aged 36, was admitted to R.V.H. the day before 
 death suffering from puerperal septicaemia, which developed on the 
 third day after labour. Delivery one month previously. 
 
 P.M. Septic endometritis ; septic thrombosis of pelvic veins and 
 inferior vena cava ; streptococcic infection ; infarcts of lung ; acute 
 aortic endocarditis ; acute peritonitis ; acute splenitis with septic 
 infarcts ; focal necrosis of Uver. 
 
 Ref. : R.V.H. 39.09. E. 3579. 
 
 Presented by Dr. Klotz. 
 
 43.343^ Spleen in Acute Endocarditis. 
 
 A large spleen, measuring 21 x 10-5 X 5 cm. and weighing 465 grm. ; 
 of pale colour. There are two slit-Uke notches, and the surface is 
 rendered uneven by the presence of four old depressed infarcts 
 and one deep scar. The surface is slightly granular and shows some 
 
106 THE HEMOPOIETIC ORGANS 
 
 adhesions on the inner side. The cut surface is characterized by 
 possessing the same colour as the outside and by being peppered 
 by very conspicuous Malpighian bodies. The pulp-tissue is quite 
 firm, but trabeculse are not conspicuous. The infarcts have the 
 characteristic wedge shape. The organ is almost pear-shaped. 
 
 J. F., aged 23, male. Admitted August 13th, died Oct. 25th. 
 Illness of three months' duration with pains in joints, dizziness, and 
 cough. The most important physical findings were enlarged heart, 
 capillary pulse, and murmurs of mitral and aortic endocarditis. The 
 blood-culture showed streptococci. 
 
 P.M. Recurrent endocarditis, mitral and aortic ; chronic 
 polyorrhomenitis ; aneurysm of aortic valve ; hypertrophied, dilated 
 heart ; cedema of lungs ; recent pleurisy ; enlarged spleen ; aplastic 
 bone-marrow ; large mottled kidneys ; miliary tuberculosis of lung. 
 
 The case was decidedly ' scorbutic '. The heart and kidneys 
 presented a very instructive picture (see P.M. report). The spleen 
 was not of the cardiac type. The blood-culture showed strepto- 
 diplococci. 
 
 Ref. : E. 5647. R.V.H. 125.13. 
 
 Presented by Dr. Gruner. 
 
43. SPLEEN 107 
 
 .344 Lesions due to Pneumococci. 
 43.344^ Acute Splenitis in Pneumonia. 
 
 A very large spleen, measuring 18x11x7 cm., and weighing 
 675 grm. The edges are rounded and the surface is smooth. There 
 are no notches. The shape is quadrangular. The capsule is tense. 
 
 The cut surface shows little differentiation, the Malpighian 
 bodies not being visible, and the trabeculae not being increased. 
 There is mottling with small areas of congestion. 
 
 N. A., an Italian, male, aged 29, was admitted to the R.V.H. on 
 Nov. 9, 1913, for lobar pneumonia of one week's duration. The 
 clinical side of the case was entirely that of pneumonia. White 
 cells, 17,400. The spleen was palpable. 
 
 P.M. Lobar pneumonia (R.) ; petechial haemorrhages in peri- 
 cardium ; pleural effusion (R.) and recent fibrino-pleurisy (R. and L.) ; 
 enlarged spleen ; congested kidneys. 
 
 Micro. Exam. There is no change in the capsule and trabecular 
 structures. Malpighian bodies are very sparse. The pulp is rich 
 in fibre-ceUs, which leave the blood-channels readily visible in many 
 places. The specific pulp-cells are diminished in number. 
 
 Ref. : E. 5670b. R.V.H. 131.13. 
 
 Presented by Dr. Gruner. 
 
108 THE HEMOPOIETIC ORGANS 
 
 .348 Lesions due to Meningococcus. 
 43.348^ (Febrile) Spleen in Cerebrospinal Meningitis. 
 
 A much enlarged spleen of firm consistence and rounded edges, 
 measuring 17x10-75x5 cm,, and weighing 375 grm. The surface 
 is smooth, grey in colour, and the capsule tense. On the cut surface 
 the Malpighian bodies are visible but not enlarged ; the pulp is 
 abundant, dark red, and rather soft ; the trabeculse are not increased. 
 
 J. S., a Chinaman, aged 18. Admitted to R.V.H. Jan. 21, 1913, 
 with characteristic symptoms and signs of cerebrospinal fever. 
 He had been ill nine days. The organism was grown. Pasteur 
 serum failed to cure. White-cell count, 12,800. Cerebrospinal fluid, 
 135 cells per c.mm. ; lymphocytes, 88-4% ; polymorphs, 10-8% ; 
 endothelials, 1-09%. 
 
 P.M. Suppurative cerebrospinal meningitis, choroiditis, and 
 abscess in lumbar spine. Focal necrosis of hver ; white bile. Ulcer 
 of stomach. 
 
 Micro. Exam. The Malpighian bodies are diminished in size 
 and number. Some necrosis in their centres. The pulp-tissue is 
 preponderant ; it is very congested. There is active desquamation 
 of the endothelium of the vessels. Pulp-cells are moderately 
 numerous. Small pigmentophages are abundantly present. 
 
 Ref. : E. 5413a. R.V.H. 12.13. 
 
 Presented by Dr. Gruner. 
 
43. SPLEEN 109 
 
 .35 Specific Inflammation due to Bacilli. 
 .351 Typhoid. 
 43.351^ Spleen in Typhoid Fever. 
 
 A much enlarged spleen, 16x 8x4-5 cm., smooth, save for a few 
 recent adhesions on the inner surface, and showing a small accessory 
 spleen in the hilum. One constriction occurs which leads to the 
 formation of a pedunculated nodule near the upper end. Notchings 
 are indistinct. The cut surface is very dark and uniform in colour, 
 and shows very conspicuous Malpighian bodies. When fresh the 
 consistence was fairly firm ; not diffluent. The spleen weighed 
 465 grm. The round discolouration on the surface is artefact. 
 
 F. F., male, aged 21, died from haemorrhage on the 13th day 
 of the disease. There were numerous typhoid ulcers in the small 
 intestine, but only one ulcer in the colon, in the trans verse, part. 
 
 Ref. : R.V.H. 11.08. E. 3190b. 
 
 Presented by Dr. McCrae. 
 
 43.351^ Acute Splenitis in Typhoid Fever. 
 
 A moderately large and bulky spleen with rounded edges, and of 
 slate-grey colour. A well-marked notch occiurs near the lower pole 
 in front, and a smaller one half-way along the posterior border. 
 A cautery mark is seen. The outer surface is smooth, grey, rather 
 opaque ; the capsule is tense. The cut surface was homogeneous. 
 Malpighian bodies cannot be seen. 
 
 A. D., male, aged 21, out of work four weeks. Onset with loss of 
 appetite and general malaise ; became deUrious and died with 
 very toxic symptoms and haemorrhage. 
 
 P.M. Typhoid ulceration of small intestine, large intestine, 
 appendix, colon, rectum ; acute splenitis ; pulmonary apoplexy ; 
 cloudy swelHng of organs. 
 
 Ref. : R.V.H. 4.09. E. 3484. 
 
 Presented by Dr. Adami. 
 
no THE HEMOPOIETIC ORGANS 
 
 43.35F Enlargement of Spleen in Typhoid Fever. 
 
 An organ measuring 18x11.5x4 cm., of normal contour, with 
 prominent notches, dark slaty-blue in colour, with smooth tense 
 capsule. The discoloured, wedge-shaped area is an artefact. The 
 specimen shows the size to which the spleen may attain in typhoid 
 fever. 
 
 W. B. M., male, aged 30, Death in the 6th week of typhoid. 
 Physical examination showed splenic dullness in the mid-axillary 
 hne, meeting the costal margin at the point of the tenth rib. The edge 
 of the organ was readily palpable two fingers' breadth below the 
 costal margin on deep inspiration. 
 
 P.M. Secondary mixed infection following upon typhoid. 
 Acute suppurative and hsemorrhagic hemiglossitis. Suppurative 
 follicular tonsillitis with pseudo -membrane. Acute lobar pneu- 
 monia. HeaUng typhoid ulcers of ileum and colon. 
 
 Ref. : R.V.H. 83.95. E. No. 652. 
 
 Report by Dr. Nichols, Montreal Med. Journ., 1896, p. 104. 
 
 43.351^ Enlargement of the Spleen in Typhoid with 
 Septic Infarct. 
 
 A spleen of moderately large size, measuring 15 X 11-5 cm. The 
 surface is slightly wrinkled and dotted by numerous minute white 
 spots. At the upper end on the outer surface is a small, yellowish, 
 slightly depressed area with sinuous markings — the surface of an 
 infarct — in whose centre is a ragged cavity due to softening. Another 
 typical, non-softened, white infarct is seen on the inner side. There 
 are no notches. The cut surface is diffluent and bulges beyond the 
 tense capsule. 
 
 No history. 
 
 43.351^ Abscess of Spleen in Typhoid Fever. 
 
 A slab of a deeply congested febrile spleen, showing an irregular 
 cavity at one end. The edges are darker in colour than the remainder 
 of the organ. The hning of the cavity is irregular. [A duphcate 
 
43. SPLEEN 111 
 
 slab is mounted as a Petri dish specimen, and a second in a square 
 jar (43.3251).] • 
 
 C. A., male, aged 17. Typhoid fever set in Nov. 22, 1909. 
 Died Dec. 6th from toxaemia, on 15th day of disease. Spleen palpable. 
 
 P.M. Typhoidal ulceration and swollen solitary follicles of 
 intestines ; enlarged mesenteric lymph-nodes ; acute splenitis 
 with septic infarcts in spleen ; cloudy swelling of Uver and heart 
 muscle. 
 
 The spleen weighed 350 grm., much enlarged and deep red in 
 colour. At the upper pole on the anterolateral surface was a greyish 
 irregular area which on section proved to be an irregular, somewhat 
 wedge-shaped infarct with the base at the capsule 2x2-5x1 cm. 
 The cut surface of the spleen is a deep-red colour, almost black ; 
 pulp bulges out, trabeculse not seen, surface moist, very friable, 
 a large amount of pulp coming away on scraping. 
 
 Micro. Exam. Section I shows a large area of necrosis with 
 a few scattered collections of small round cells ; the remains of blood- 
 vessels are in their vicinity. 
 
 Section II shows intense outpouring of red blood corpuscles, 
 the edges of the region being well defined. A couple of Malpighian 
 bodies are seen. 
 
 See also Specimens Nos. 42.351- and 351.351, 
 
 Ref. : M.G.H. 207.09. E. 4064. 
 
 Presented by Dr. Baird. 
 
 43.351^ Haemorrhagic Splenitis in Typhoid Fever. 
 
 A much enlarged spleen, weighing 625 grm. and measuring 18 x 
 7x5 cm. The edges are rounded and smooth. There are no 
 adhesions ; it is dark red in colour. The capsule is shghtly wrinkled. 
 The cut surface shows no differentiation of structure, the Mal- 
 pighian bodies being invisible, and the trabeculae are conspicuous ; 
 it is very dark red, the surface is mottled with haemorrhagic areas. 
 (One portion of the organ is cut away to allow the cut surface to be 
 visible, without impairing the impression of the size of the viscus.) 
 The organ was flabby and the pulp diffluent when fresh. 
 
 C. J., aged 42, admitted Nov. 21, 1911, for weakness, fever, 
 headache, and general malaise. The illness began three weeks 
 before with weakness and abdominal pain. The cerebral symptoms 
 increased. White cells 3,200. Death occurred three days later, 
 Nov. 24, 1911, in the fourth week of the disease. 
 
 P.M. Typhoid ulceration ; hypostatic pneumonia ; haemor- 
 rhagic splenitis. 
 
112 THE HEMOPOIETIC ORGANS 
 
 Micro. Exam. The capsule is thickened ; the trabeculse are 
 conspicuous. The Malpighian bodies are small and scanty and the 
 pulp shows congestion. Germ-centre cells are numerous. The pulp 
 sinuses are small, and are filled with lymphocytes and red blood- 
 cells with occasional eosinophiles. There is endothelial hyperplasia 
 around the Malpighian bodies. 
 
 Ref. : R.V.H. 163.11. E. 4767. 
 
 Presented by Dr. Gruner. 
 
43. SPLEEN 113 
 
 .356 Lesions due to Anaerobes. 
 43.356^ Spleen in Infection with B. Aerogenes Cap- 
 sulatus, Congestion, and Miliary Tuberculosis. 
 
 Half of a moderately enlarged spleen, showing a few flattened 
 papules 2-3 mm. in diameter scattered irregularly over its surface. 
 The capsule is a little roughened in one or two places, but is mostly 
 normal and tense. The cut surface shows numerous pittings as if 
 worm-eaten or from action of gas blebs (due to B. aerogenes capsu- 
 latus), and presents closely packed, circular, pale areas throughout 
 its substance. Some of these come to the surface as the nodules 
 already described. 
 
 Female, aged 20, dying of subacute miUary tuberculosis. 
 
 P.M. Chronic pulmonary tuberculosis ; tuberculous ulcers in 
 intestine ; caseous mesenteric and lumbar glands. The spleen was 
 congested and studded with yellowish cheesy masses the size of 
 peas. The capsule showed adhesions. 
 
 Micro. Exam. Large areas of necrosis are noticed. They have 
 ill-defined edges. The splenic tissue is breaking down everywhere 
 without losing the differentiation of its cellular structure. The 
 bacilli are found scattered through it. 
 
 Ref. : A.M.M. 2026. E. 1902. 
 
 Presented by the Army Medical Museum. 
 
 IV. 1 
 
114 THE HEMOPOIETIC ORGANS 
 
 .359 Specific Inflammation due to B. Pestis. 
 43.3591 Splenic Tissue containing B. Pestis. 
 
 Small portions of spleen for microscopic investigation. 
 
 Micro. Exam. The organ is intensely congested and shows 
 a marked tissue reaction. The blood sinuses are filled with immense 
 numbers of short baciUi, in many of which the bipolar staining, 
 so characteristic of B. pestis, can be seen. 
 
 Presented by Dr. J. M. Bell, Hong-Kong, through Dr. C. F. 
 Martin. 
 
43. SPLEEN 115 
 
 .36 Specific Inflammations due to Acid-fast Bacilli. 
 .361 Lesions due to B. Tuberculosis. 
 
 Human Tuberculosis. 
 43.361^ Miliary Tuberculosis of Spleen. (Petri-dish 
 Specimen.) 
 A slice of spleen, showing closely packed innumerable whitish 
 foci of rounded shape. They have the appearance of enlarged Mal- 
 pighian bodies. The organ is small. 
 
 Mrs. J. M., aged 40. Admitted to M.G.H. April 20, 1907, with 
 haemoptysis from pulmonary tuberculosis of nine months' duration. 
 Ten days later hectic temperature. About 100 c.c. of blood were 
 coughed up every night at about 9 p.m. Death occurred May 9th 
 from such a haemorrhage. 
 
 P.M. Chronic pulmonary tuberculosis with cavitation ; caseat- 
 ing and calcareous bronchial, mesenteric, and retroperitoneal glands ; 
 recent pelvic tuberculous peritonitis. 
 
 Micro. Exam. Shows enlargement of Malpighian follicles. The 
 pulp-tissue stains poorly. 
 
 Note. No tubercles in this section. 
 
 Ref. : M.G.H., A. 07.85. E. 4464. 
 
 Presented by Dr. Rhea. 
 
 43.36P Miliary Tuberculosis of Spleen. 
 
 An enlarged, long, thin spleen, measuring 17x9x3 cm. The 
 surface is covered with shaggy adhesions, and scattered small nodules 
 (tubercles) occur just beneath the peritoneum. The cut surface 
 shows many miliary tubercles of recent character. The pulp is 
 soft and diffluent. 
 
 From a married woman, aged 21. Admitted to the R.V.H. in 
 July 1908, suffering from general symptoms existing three weeks. 
 The first symptom noted was that of synovitis of right knee. On 
 July 14th very severe headache came on, pain down the spine, and 
 a chill occurred. She had Uved in England till three months before 
 her illness. Death occmred from cerebral involvement. The leuco- 
 cytes numbered 7,960. 
 
 P.M. Acute miliary tuberculosis, involving the lungs, heart, 
 spleen, kidneys, and knee-joint, meninges, pleurae, peritoneum, and 
 glands. 
 
 Micro. Exam. There are irregularly shaped tubercles in process 
 of caseation dotted through the spleen substance, and haemorrhagic 
 areas present through the pulp. 
 
 Ref. : E. 3320. R.V.H., H. 83.08. 
 
 Presented by Dr. Klotz. 
 
 I 2 
 
116 THE HEMOPOIETIC ORGANS 
 
 43.36P Miliary Tuberculosis of Spleen. (Petri-dish 
 Specimen.) 
 
 A slab of spleen dotted with millet-grain-sized white nodules of 
 irregularly rounded shape. Some of them are quite punctate. 
 There is no surrounding zone of congestion. 
 
 M. W., female, aged 17. Case of generalized tuberculosis 
 affecting the meninges, lungs, liver, spleen, kidneys, peritoneum, 
 diaphragm, and intestine. There was a caseating tuberculosis of 
 the peribronchial glands, which showed the oldest lesion. The 
 mihary spread of the disease was recent. Symptoms were mainly 
 meningeal, 
 
 Ref. : E. 3140. R.V.H. 84.07. 
 
 Presented by Dr. Klotz. 
 
 43.361* Miliary Tuberculosis of Spleen. 
 
 A slightly enlarged spleen, measuring 14 x 8-5 x 3 cm. The edges 
 are rounded, and the capsule, though slightly thickened, is smooth. 
 The cut surface is pale and studded with minute white nodules. 
 The trabeculse, though perceptible, are not unduly conspicuous. 
 
 M. L., male, aged 33, was admitted to the R.V.H. July 13, 1910, 
 after only a fortnight's illness. He had had an ischio-rectal abscess 
 four years ago. The signs pointed to a chronic pulmonary tuber- 
 culosis, with right pneumothorax. Died Sept. 14, 1910. 
 
 P.M. Generalized tuberculosis ; old cavitation in both apices ; 
 tuberculosis of genital organs, kidneys, lungs, adrenals, ileum. 
 
 Micro. Exam. The capsule is slightly thickened ; the section 
 is dotted over with miUary tubercles containing giant cells ; many 
 of the tubercles show central caseation. There is no definite rela- 
 tion between them and the Malpighian bodies ; the latter are 
 irregular in size. 
 
 See also No. 42.3619. 
 
 Ref. : E. 4364. R.V.H. 115.10. 
 
 Presented by Dr. Gruner. 
 
 43.36P Miliary Tuberculosis of Spleen. 
 
 A small spleen, the surface of which is covered with discrete 
 raised yellowish nodules the size of a hemp-seed, which stand out 
 very conspicuously against the dark spleen-tissue. The cut surface 
 
PLATE X 
 
 «fl 
 
 o 
 
 UJ 
 
 cr 
 
 Ui 
 
 3E — I 
 
 UI 
 
 (J 
 
 43.361^ SUBACUTE MILIARY TUBERCULOSIS OF SPLEEN 
 Note large size of organ, and riddling with discrete white caseous nodules 
 
 Dr. Adami 
 
 P. in 
 
43. SPLEEN 117 
 
 shows that these nodules are very evenly distributed throughout 
 the substance. 
 
 Ref. : E. 3257. Shadwell 7. Tuberculosis Series 47. 
 
 Presented by Dr. Martin. 
 
 43.361^ Miliary Tuberculosis of Spleen. (Petri-dish 
 Specimen.) 
 
 A small spleen cut in half. The surface is dotted with a small 
 number of round white nodules of pin-head size ; they are bordered 
 by a bright-red line, and are sUghtly raised above the surface. 
 The cut surface shows the whole spleen riddled with similar nodules, 
 but they are larger on the cut surface than on the outer surface ; 
 they vary between 2 and 3 mm, in diameter, are whitish in colour, 
 and bordered by a red hne as in the case of the superficial ones. 
 
 M. W., female, aged 3. Had been ill for a month following 
 whooping-cough. Died in coma six hours after admission, 
 
 P.M. Generalized mihary tuberculosis of spleen, intestines, 
 genitalia, kidneys, lungs, pleurae, peritoneum, heart, diaphragm, 
 adrenals. Tuberculosis of mesenteric, peribronchial, retroperitoneal, 
 periportal, gastric, and peritracheal glands. 
 
 The primary focus was in the peribronchial glands leading to 
 a general blood infection. 
 
 Micro. Exam. There were many foci of miliary tuberculosis ; 
 these had mostly a caseating centre with giant cells distributed 
 about them. 
 
 Ref. : E. 3323. R.V.H. 3.07. 
 
 Presented by Dr. Klotz. 
 
 43.361' Subacute Miliary Tuberculosis of Spleen. 
 
 The specimen consists of an enlarged spleen, measuring 17x7-5 
 X 7-5 cm., with a smooth tense surface showing no notching, dark 
 in colour, with numerous white motthngs which are sUghtly raised 
 and have a peripheral hsemorrhagic zone. The cut surface is dry, 
 red in colour, and riddled with white nodules of varying size, the 
 largest ones being 4 mm. across. The centre of all the larger nodules 
 is distinctly softened. The organ weighs 845 grm. 
 
 J. H., aged 19, had been aihng for four to five weeks with typhoidal 
 
118 THE HEMOPOIETIC ORGANS 
 
 symptoms, and was treated as suffering from typhoid, though Widal 
 was absent. Ultimately tubercle bacilli were found in the sputum. 
 Meningeal symptoms supervened, but no macroscopic tubercles were 
 found in the meninges. Lungs, liver, thyroid, and cervical glands 
 were affected. 
 
 P.M. Prof. Adami made the following note : ' The appearance 
 of the tuberculous areas was extraordinary. It was as though the 
 tubercles, after developing up to a certain good size, had suddenly 
 been struck throughout their whole extent by a necrotic change, so 
 that right to the outer border of each tubercle there was apparent 
 caseation, with pycnotic nuclear remains scattered more especially 
 through the peripheral portions of the tubercles.' 
 
 Stained by Gabbett's method, there were found numerous ' large, 
 long, well-staining bacilU, somewhat thicker than normal, but other- 
 wise quite characteristic and in other parts tending to be beaded. 
 The great proliferation of the bacilli showed itself at the borders and 
 outside the areas which histologically were seen to be of the nature 
 of tubercles.' 
 
 Micro. Exam. Shows replacement of normal structure by large 
 caseating areas. They possess cells with (pycnotic ?) nuclei in large 
 numbers. The remainder of the tissue is rich in coagulated exudate, 
 and is very congested. 
 
 Ref. : E. 4097. R.V.H. 29.10. 
 
 Presented by Dr. Adami. 
 
 43.361® Tuberculosis of Spleen. 
 
 The organ is somewhat reduced in size, and is riddled with large, 
 caseating foci. The surface shows coarse nodules, with a some- 
 what flattened exterior standing out from an otherwise smooth 
 capsule. The cut section shows central breaking down of these 
 foci, and characteristic retraction of the separating fibrous bands. 
 The capsule is thickened with adhesions of old perisplenitis. 
 
 Old Museum specimen. 
 
 43.36P Tuberculosis of Spleen. (Petri-dish Specimen.) 
 
 A slab of spleen studded with subacute tuberculous nodules. 
 The capsule is thickened and shows adhesions. The nodules vary 
 in size from a pin-point to 1-4 cm. in long diameter ; they all show 
 an ochre-yellow or pale-yellow centre, and a briUiant-red contour. 
 
43. SPLEEN 119 
 
 The remainder of the spleen is pale. The masses appear to be 
 situated in the Malpighian bodies. 
 
 Ref. : E. 2365. 
 
 Presented by Army Medical Museum. 
 
 43.361^0 Tuberculosis of Spleen. 
 
 The specimen consists of a small slice of spleen, measuring 
 14x4.5 cm., and showing numerous small nodules of growth 
 scattered through its substance. Several of these growths are 
 subcapsular, but most are ill-defined, presenting a clear white centre 
 and an irregular, much larger, brown-coloured zone, which blends 
 off at the margins into the spleen pulp, which is homogeneous and dark 
 in colour. In many cases the brown zone has minute brown spots 
 in it also. The diameter of most of the tubercles is only 2-3 mm., 
 but at one end there are larger mottled areas which present a large 
 central whitish mass surrounded by a narrow brown zone. 
 
 Ref. : E. 4341. 
 
 Presented by Prof. McCallum. 
 
 43.36r^ Spleen. Miliary Tuberculosis. 
 
 A slab from a sUghtly enlarged spleen (measuring 13x5| cm.), 
 containing some tubercles. The cut surface is bright red in colour 
 and shows a few yellowish-white areas scattered through it, soft and 
 caseating in the centres, and enclosed by bright-red lines. They 
 measure 5 cm. in diameter and have slightly lobated edges. One is 
 seen to come to the surface, and here has a wedge-shaped cross 
 section. The Malpighian bodies are visible, but not enlarged. 
 
 The reverse side shows some haemorrhagic infiltration of the 
 pulp. 
 
 The spleen was surrounded by a dense mass of adhesions, which 
 bound it to the thickened parietal peritoneum. The capsule was 
 roughened and thickened. On its surface were several small rounded 
 
120 THE HiEMOPOIETIC ORGANS 
 
 yellowish areas as large as a split pea, having the appearance of 
 coming to the surface from the splenic tissue beneath. 
 
 J. L., aged 49, died of miliary tuberculosis of the lungs, larynx, 
 peritoneum, liver, spleen, pleura. There was chronic pleurisy with 
 effusion. The bronchial glands were tuberculous. (A duplicate 
 slab is mounted in a Petri dish.) 
 
 Ref. : E. 4072. M.G.H. 182.09. 
 
 Presented by Dr. Maclachlan. 
 
 43.361^^ Multiple Tuberculoma of Spleen of Unusual 
 Type. 
 
 Half of an enlarged spleen, measuring 19 x 5 x 7 cm. The capsule 
 is thick and is studded with numerous round elevations, varying in 
 size from a hazel-nut to a pin-head, which are formed by nodules 
 in the parenchyma, pushing forward from within and suggesting 
 at first sight a new growth. The surface of these elevations is 
 slightly umbilicated, greyish-white in colour, and they are dotted 
 along their periphery with minute tubercles. 
 
 The cut surface is thickly sown with the same round nodules, 
 which in some places have become confluent to form areas 5 cm. in 
 diameter. They are of cheesy consistency and yellowish -white 
 colour with hsemorrhagic core, and spring forward sharply above the 
 intervening splenic tissue, which is deeply congested. 
 
 Mrs. D., mother of five healthy children, the youngest 7 months 
 old. Abdominal tumour noticed for seven months, which gave no 
 symptoms and was assigned by her to pregnancy. Examination 
 previous to operation showed a tumour in the left side of the 
 abdomen, appearing from under the margin of the ribs and extending 
 down nearly to Poupart's ligament. The anterior border could be 
 felt throughout, except where it disappeared under the ribs. An- 
 teriorly it extended nearly to the umbihcus, and posteriorly could 
 be felt in the region of the kidney. It was hard and firm, not 
 fluctuating, fixed above and loose below. No urinary or intestinal 
 symptoms. Splenectomy was performed Nov. 12, 1914. Some 
 enlarged glands were seen behind the enlarged spleen, but were not 
 removed. Abdominal and pelvic organs otherwise normal. 
 
 The enlarged spleen measured 20x13x5 cm. and weighed 
 950 grm. Over the surface and throughout the pulp were numerous 
 nodules, the size of a hazel-nut, of soft consistence and red colour, 
 those on the surface showing a greyish centre. 
 
43. SPLEEN 121 
 
 Micro. Exam, of nodules showed a somewhat myxomatous 
 structure. In this are numerous tubercles consisting of a small 
 necrotic area surrounded by a zone of epitheHoid cells. Giant cells 
 are very numerous. Diagnosis : tuberculosis. 
 
 A guinea-pig was injected intraperitoneally with emulsion of 
 spleen-pulp, but remained in apparent health, increased in weight, 
 and showed no signs of disease when killed ten weeks later. 
 
 Ref.: W.G.H. 1086.13. 
 
 Presented by Dr. Jasper Halfpenny and Dr. Sidney Peirce, 
 Winnipeg General Hospital. 
 
 43.361^^ Spleen. Senile, with Multiple Obsolete 
 Tubercles. 
 
 Portion of a spleen whose capsule is wrinkled and presents a 
 small number of round, convex, semi-translucent, lemon-yellow, 
 hard, subcapsular nodules, which project from the surface. Peri- 
 pheral congestion is hardly perceptible. The cut surface shows 
 increased fibrous tissue and several similar nodules. 
 
 The spleen weighed 80 grm. and measured 7-6 X 6-5 X 2. 
 
 Mrs. C. B., aged 72, had symptoms pointing to appendicitis for 
 about six months. No history of tuberculosis in family, none during 
 life in patient. 
 
 P.M. Appendicitis with perforation, fat-necrosis of mesentery 
 and parietes, calcareo-caseous tuberculosis of lungs and peribronchial 
 glands, arterio-sclerosis. 
 
 Micro. Exam. Showed normal structure ; the vessels were 
 slightly thickened. 
 
 See also Specimen No. 25.361. 
 
 Ref. : R.V.H. 109.08. E. 3418. 
 
 Presented by Dr. Adami. 
 
 43.36r® Tuberculosis of Spleen. Multiple Infarcts. 
 
 Half a small spleen (9x5 cm.), showing a wedge-shaped area of 
 white colour, slightly roughened on the surface, and marked out by 
 a broad hyaline and not very sinuous line ; a smaller focus occurs 
 higher. The cut surface is chalky- white and very sharply defined ; 
 there is no area of redness around. The remainder of the cut surface 
 is pale, and mottled with numerous minute Malpighian bodies. 
 
122 THE HEMOPOIETIC ORGANS 
 
 The capsule is opaque and slaty in colour. There is sUght puckering 
 in the vicinity of the nodules ; there are no notches. 
 
 S. S., male, aged 11. Admitted May 2, 1910, with pain, swelling, 
 and tenderness of wrists, elbows, and ankles, fugacious in character, 
 purpuric eruption over whole body (Henoch's purpura), haematuria, 
 and melaena. Later subacute nephritis developed ; oedema and 
 ascites. A week before death meningeal symptoms, headache, 
 internal strabismus, Kernig, stiffness of neck, vomiting. Died, 
 comatose, June 18, 1910. 
 
 P.M. Tuberculous adenitis of peribronchial and mesenteric 
 glands. Miliary tuberculosis of lungs, hver, spleen, and meninges. 
 Solitary tubercles of cerebrum and cerebellum. 
 
 Micro. Exam. Miliary tubercles are seen within the Malpighian 
 bodies. Some show well-marked giant cells ; others are commencing 
 to caseate. The pulp is congested ; the Malpighian bodies are strik- 
 ingly lymphoblastic. 
 
 Ref. : M.G.H., A. 10.106. M. 10.364. E. 4519. 
 
 Presented by Dr. Rhea. 
 
 43.361^' Tuberculosis of Spleen. (Petri-dish Specimen.) 
 
 A slice of spleen showing several discrete rounded areas of 
 pale colour, sharply demarcated from the remainder of the splenic 
 substance. Their centres are softened ; the contours delicately 
 lobate. The Malpighian bodies are just visible. The trabecular 
 tissue is not prominent. 
 
 Mrs. M. G., aged 31. Admitted to M.G.H. May 18, 1907, with 
 cough and symptoms of typhoid. June 14, inguinal glands became 
 swollen. July 10, anterior part of right lower lobe of lung became 
 consolidated. There were finally signs of general tuberculosis. 
 
 P.M. Generalized miliary tuberculosis of lungs, spleen, kidneys, 
 meninges, peritoneum, and pleurae. Chronic perihepatitis and peri- 
 splenitis. Tuberculosis of retroperitoneal and pelvic lymph-glands. 
 
 Micro. Exam. Malpighian bodies few in number, indistinct. 
 Hyahne change in vessels. Pulp contains pigment-bearing cells. 
 Fibrous tissue increased. Numerous small tubercles present, and 
 one large caseous mass is demonstrated. 
 
 Ref. : E. 4470. M.G.H., A. 07.222. 
 
 Presented by Dr. Rhea. 
 
43. SPLEEN 123 
 
 Bovine Tuberculosis. 
 
 43.36F° Spleen of Cow. Tuberculosis and Hyalo- 
 serositis. 
 
 A portion of spleen whose surface is extremely roughened and 
 irregular. The cut surface shows enormous thickening (1 cm.) 
 of a large portion of the capsule by a formation of hyaline substance 
 in which lamination can be detected. Flame-shaped streaks of 
 bright yellow colour occur in the inner border. There are also two 
 large cheesy yellow masses in the spleen substance, one of which 
 shows central breaking down. One mass measures 2-25 X 2-75 cm. ; 
 the other much larger. The edges are bright red, and the non- 
 softened part of the smaller mass has a similar hyaUne appearance 
 to the capsule. The spleen-pulp is scaly, dark in colour, and shows 
 a few enlarged Malpighian bodies. 
 
 (A duplicate slab is mounted under a Petri dish.) 
 
 Ref. : E. 225. 
 
 Presented by Dr. Adami. 
 
124 THE HEMOPOIETIC ORGANS 
 
 .364 Lesions due to B. Mallei (Glanders). 
 
 43.364^ Abscesses of Spleen in Chronic Glanders. 
 Three fragments of a spleen whose capsule is smooth. The cut 
 surface shows several abscesses of irregular contour and varying 
 size. The largest shce presents in the middle an arborescent yellow- 
 ish mass, with small round nodules intermingled and enclosed in 
 a large zone of red colour. A wedge-shaped mass approaches the 
 capsule at one end, and the two are connected by the aforesaid 
 haemorrhagic area. The smaller abscesses are also arborescent, 
 but are clearly defined and have no surrounding zone. The Mal- 
 pighian bodies stand out very distinctly as white specks with an 
 enclosing dark zone identical in appearance with the Malpighian 
 bodies of a sago spleen. (These gave the amyloid reaction.) 
 
 History. L. P. C, a farmer, aged 46, born in the Province of 
 Quebec, always a hard worker. Habits were good and health 
 robust. Never used alcohol in any form and never had venereal 
 disease. Illness began in 1900 with localizing symptoms on forehead, 
 and later on general symptoms appeared. He had been exposed to 
 glanders in horses. Two months later a large abscess was opened 
 in the thigh and then another in the leg, but the sinuses kept on 
 burrowing. The facial lesions did not appear different even three 
 months later, but after that began to heal in one place and track 
 deeply in another. The same feature of heahng and extension 
 occurred in other lesions. Six months later he came to the R.V.H. 
 and a diagnosis was then made. The skuU was involved and the 
 illness continued for two years. He subsequently died of intra- 
 cranial disease. 
 
 P.M. Chronic glanders ; multiple abscesses in glands, muscles, 
 spleen, lungs, and hver ; chronic local granuloma of the dura mater ; 
 compression of the brain ; amyloid disease ; acute fibrinous peri- 
 hepatitis and perisplenitis ; portal pylephlebitis ; acute cohtis ; 
 chronic parenchymatous with early interstitial nephritis. 
 
 The spleen was very large, weighing 620 grm., and rather soft. 
 Its capsule was tense, dark red, and covered in places with adherent 
 fibrinous lymph. Here and there on the surface were a few yellow 
 elevations of dry, fibrino-purulent material the size of a dry pea. 
 
 On section the organ was intensely reddened and thickly studded 
 with abscesses, varying in size from a pin's head to a filbert. 
 
 Micro. Exam. The walls of the sinuses and the sinuses them- 
 selves moderately full of blood. There was well-marked amyloid 
 disease affecting almost exclusively the Malpighian bodies, and 
 necrotic foci with poorly staining contents were seen. 
 
 Ref. : R.V.H. E. 4092b. Studies from the Royal Victoria 
 Hospital, vol. ii, No. 1. 
 
 Presented by Dr. G. D. Robins. 
 
43. SPLEEN 125 
 
 .37 Specific Inflammations due to Protozoa. 
 
 .372 Lesions due to Treponema Pallidum (Syphilis). 
 43.372^ Spleen in Syphilis. 
 
 A spleen, measuring 12x6x4^ cm., and weighing 275 grm. The 
 organ is moderately increased in size, and has an irregularly lobulated 
 surface, due to contraction of the fibrous tissue. The notching is 
 normal. The capsule is much thickened here and there (perisplenitis), 
 showing a ragged surface. The cut surface is mottled with deep 
 brown areas of intense congestion, and shows subdivision of the 
 pulp by thick fibrous tracts ; the consistence is firm. Malpighian 
 bodies can only be made out here and there, but where present are 
 enlarged. The spleen-pulp has been accidentally torn at the lower 
 end. 
 
 J. E. H., aged 41, male. A case of long-standing aortic aneurysm. 
 SyphiUs had been contracted 19 years previously, and the aorta 
 showed definite syphihtic disease, and the liver a diffuse cirrhosis. 
 
 P.M. Spontaneous rupture of aneurysm of aorta ; old peri- 
 hepatitis ; old perisplenitis. 
 
 Micro. Exam. The organ appeared uniformly congested. No 
 evidence of fibrosis in the pulp-tissue itself. 
 
 Ref. : R.V.H. 13.09. E. 3570. 
 
 Presented by Dr. Klotz, February 1909. 
 
 43.372- Spleen in Syphilis. Megalosplenic Cirrhosis. 
 
 A very large spleen, weighing 1,000 grm., and measuring 20-5 X 
 11-5x9 cm. The siu*face is diffusely opaque, especially over the 
 outer curvature and near the upper pole, and is roughened also from 
 the presence of adhesions to the surrounding tissues. Over some 
 areas fine nodulation is visible. The capsule is tense, the organ 
 rather flabby, the cut surface pale red. The Malpighian bodies are 
 very indistinct ; the connective tissue is not obviously increased 
 (to the naked eye) owing to the hyperplastic condition of the pulp- 
 tissue. 
 
 P. S., aged 43, admitted Sept. 12, 1911, died Oct. 3, 1911, com- 
 plained of diarrhoea, abdominal pain, and distension, especially last 
 six months. Patient took four glasses of whisky a day. No vomiting. 
 Blood showed : reds, 4,240,000 ; whites, 5,400 ; polynuclears, 80% ; 
 
126 THE HEMOPOIETIC ORGANS 
 
 mononuclears, 4-5% ; large lymphocytes, 7% ; small lymphocytes, 
 7% ; mast-cells, 1-5%. 
 
 P.M. Unilobular megasplenic cirrhosis, hepatitis, and multiple 
 gummata. Ascites, no jaundice ; chronic pericholecystitis, pan- 
 creatitis, and peripancreatitis. Thrombosis of portal vein and 
 atypical ulceration of stomach wall with polyposis. 
 
 Micro. Exam. The capsule is much thickened and infiltrated 
 with inflammatory cells. The trabeculse are also markedly increased, 
 large trabeculse coursing throughout the section. These trabeculse 
 have a hyaHne appearance and support tortuous vessels. Multiple 
 haemorrhages occur along the lengths of the thickened trabeculse, 
 and blood-pigment is deposited. Malpighian bodies are scanty 
 and quite small ; the central vessels have thick walls and small 
 lumina ; in some the centres of these collections are occupied by 
 fibrous tissue. The ceUs are chiefly lymphocytes ; germ-centres 
 are very numerous ; intermingled with them may be seen a few 
 polymorphonuclear and endothelial cells. The peripheries are 
 invaded by red blood-cells. The peri-Malpighian sinuses are much 
 dilated and filled with red blood-cells and lymphocytes. The pulp 
 sinuses are also dilated, and contain principally red blood-cells with 
 endothelial cells and lymphocytes. Eosinophiles and polymorpho- 
 nuclears are rarely seen. The pulp cords have undergone hyaline 
 transformation in places owing to the replacement of the other cells 
 by fibrous connective tissue. 
 
 Ref. : R.V.H. 148.11. E. 4734. 
 
 Presented by Dr. Gruner. 
 
43. SPLEEN 127 
 
 .376 Lesions due to Haemosporidia (Malaria). 
 43.376^ Spleen in Malaria. 
 
 A giant spleen, measuring 22x17x9 cm. The edges are very 
 rounded, and the colour is rather pale. The surface is smooth over 
 the greater part of its extent, but at the upper pole it is roughened 
 from a brownish deposit upon it. Two small round white nodules 
 occur on the outer surface half-way down the organ. 
 
 The cut surface is rather pale and quite homogeneous in appear- 
 ance. There is no macroscopic increase in the fibrous tissue, and 
 there are no Malpighian bodies to be seen. 
 
 From a Chinaman with an obscure history of malaria. 
 
 Micro. Exam. The Malpighian bodies are very small. The pulp 
 is loose in texture, and is crowded with plasmoid cells, pigmento- 
 phages and polynuclears. The channels are very wide. The pulp- 
 tissue is excessively rich in pigment. 
 
 Ref. : M.G.H. 189.03. E. 975. 
 
 Presented by Dr. Wyatt Johnston. 
 
128 THE HEMOPOIETIC ORGANS 
 
 .5 CONSTITUTIONAL DISEASES. DISEASES OF META- 
 BOLISM AND INTOXICATIONS. 
 .51 Diseases of the Blood-forming Organs. 
 .512 Splenomegaly with Erythraemia. 
 43.512^ Splenomegaly with Erythraemia (Osier's 
 Disease). Chronic Perisplenitis with Multiple 
 Infarcts. 
 
 A slice of a greatly enlarged spleen, 29x 15 cm. in diameter, of 
 very firm consistency and deep red colour. The cut surface shows 
 marked increase, both of the pulpar tissue, which springs forward, 
 and of the fibrous trabeculae. Several wedge-shaped white infarcts 
 lie along the posterior border, only one of these being visible on the 
 surface placed anteriorly in the jar ; they are of cheesy consistency, 
 yellowdsh- white colour, spring forward sharply above the adjacent 
 tissue, and are surrounded by a bright-red hsemorrhagic zone. 
 
 The capsule shows scattered patches of fibrosis, both over the 
 infarcted areas and elsewhere. 
 
 From a case seen by Sir WilUam Osier with Dr. Nathan Brice 
 in Mount Sinai Hospital, New York, in 1910, and pronounced an 
 atypical case of erythraemia. 
 
 Mrs. F., aged 58, born in Russia. Lived in United States 13 years. 
 History of lues, malaria, alcohol. Illness began nine years before death 
 with severe headache, vertigo, and pain in back. One year before 
 admission, pain and tenderness on left side, under costal border. 
 Examined in hospital in 1908, and spleen was found enlarged to 
 level of anterior superior spine. Liver also palpable. Red blood 
 corpuscles, 8,500,000 to 9,100,000 per c.mm. ; Hb, 105 to 119%; 
 poikilocytosis and anisocytosis (moderate) ; white blood corpuscles, 
 8,500 to 21,000 per c.mm; polynuclears, 86%; myelocytes, 2%. 
 In 1912 blood showed 8,500,000 red cells, 110% Hb, 34,000 leuco- 
 cytes per c.mm, A few megaloblasts and many normoblasts. 
 
 Splenectomy was performed July 23, 1912. Two days later 
 Hb 85%, red blood corpuscles 6,592,000, white blood corpuscles 
 44,000. Many ' blasts '. At time of operation ascites was present. 
 There was no cyanosis, but skin was slightly icteroid. Wassermann 
 negative. Died eight days after operation on August 1, 1912. 
 
 P.M. Splenomegaly with erythraemia ; cardio-renal degeneration 
 with arterio-sclerosis. The enlarged spleen measured 31x16x8 cm. 
 and weighed 2,750 grm. 
 
 Ref. : New York Post-Graduate Hospital, No. 8291, Journ. Med. 
 Res., 1914. 
 
 Presented by Dr. 0. S. Hillman, Post-Graduate Hospital, 
 New York. 
 
PLATE XI 
 
 K 
 
 h 
 
 S 
 
 z 
 111 
 u 
 
 43.513' SPLEEN FROM BANTI'S DISEASE, PRIMARY SPLENOMEGALY, 
 WITH CIRRHOSIS HEPATIS. HYALOSEROSITIS OF CAPSULE 
 
 Note huge size of organ and fibrosis of cut surface 
 
 Dr. Wolbach 
 
 r. 129 
 
43. SPLEEN 129 
 
 .513 Primary Splenomegaly. Banti's Disease. Splenic 
 Anaemia. Gaucher' s Disease. 
 43.513^ Splenomegaly in Cirrhosis of Liver (Banti's 
 Disease). Hyaloserositis and Abscess of 
 Spleen. 
 
 A greatly enlarged spleen, measuring 24x14x5 cm., whose 
 sm-face is composed of a greatly thickened, opaque, hyaline substance, 
 to which are adhering shaggy pieces of muscle (diaphragm) and other 
 tissue. Notches are not visible. Occupying the middle one-third 
 of the outer border is a cavity within the layers of the thickened 
 capsule, which at the post-mortem contained 250 c.c. of thick yellow 
 pus. 
 
 The cut surface shows a dense cartilaginous, partly laminated 
 capsule of 0.5 cm. thickness (varying a httle). The cut surface of the 
 spleen is dark in colour and shows slightly enlarged Malpighian 
 bodies and prominent trabeculae. 
 
 D. 0., male, aged 35, admitted to the M.G.H. Feb. 27, 1909, 
 with history of daily rigors for past 15 days, and complaining of 
 pain in the stomach. Examination showed intense jaundice, chronic 
 bronchitis, arterio- sclerosis, enlarged heart ; hver and spleen enlarged 
 and hard. Fever, chills, and perspiration at irregular intervals 
 continued. On March 16 fluid developed in the abdomen. 
 
 Stained shdes from the blood showed organisms lesembling 
 Plasmodium malarise, but these were only found in specimens staine d 
 by Wright's triple method. Progressive anaemia and weakness, with 
 increased ascites. On July 1, 4,800 c.c. of fluid were withdrawn 
 from the abdomen ; spleen as before, but liver not palpable. Died 
 June 7, 1910. 
 
 P.M. Chronic suppurative cholecystitis and cholangitis ; 
 splenomegaly, with chronic perisplenitis and perisplenic abscess ; 
 chronic fibrous pleuritis ; cirrhosis of the Uver. 
 
 Micro. Exam. The capsule is greatly thickened by hyaUne- 
 looking fibrous tissue which is poor in nuclei. The trabeculae are 
 also greatly thickened, leaving very httle proper splenic tissue. 
 There are but few Malpighian bodies, and they are small in size and 
 contain few germ-centre ceUs. The reticulum of the pulp is con- 
 spicuous and red cells are relatively sparse. Few phagocytes or 
 endothehal cells or pigmented cells or eosinophiles are to be seen. 
 
 Ref. : E. 3895. M.G.H. 125.09. 
 
 Presented by Dr. Wolbach. 
 
 IV,I 
 
130 THE HEMOPOIETIC ORGANS 
 
 43.5132 Spleen in Banti's Disease. 
 
 A moderately enlarged spleen, measuring 17 X 11 X 4*5 cm., with 
 a smooth pale surface, save near the upper pole, which shows a few 
 tags of lymph. At the junction of the middle and upper half is an 
 irregular patch of hyaloserositis, 4-5x4 mm. across. The thickening 
 of the capsule here is 2 mm. The cut surface is very pale and just 
 shows a faint white mottling with Malpighian bodies. At the time 
 of removal the spleen was described as fibrosed. 
 
 C. B,, male, was ill for one year before death, but had symptoms 
 for three years. There were splenic enlargement, anaemia, weakness, 
 jaundice, ascites, and pain over the splenic region. There were 
 periods of improvement, but a progressive downhill course and 
 death from asthenia. 
 
 P.M. Diffuse fibrosis of spleen ; enlarged spleen ; cirrhosis of liver. 
 
 Micro. Exam. The capsule is considerably, and the trabeculse 
 moderately, thickened. A striking feature about the splenic tissue 
 is the abundance of pulp-cells (which are atypical in form) and the 
 abundance of interstitial deposit of fibrous material. The latter 
 contains many spindle-shaped cells. The endotheHum of the pulp 
 is not conspicuously altered, although in many cases the cells are 
 spindle-shaped in type. The blood-channels are dilated. There are 
 a few pigmented cells. The Malpighian bodies are almost entirely 
 lost ; a few areas of lymphoid-celled formation occur close to the 
 trabeculse, but are iU-defined in outline and very small in size. They 
 are enclosed in an excess of fibrous tissue. Eosinophiles are not seen. 
 
 Another section shows very great thickness of the capsule, and 
 the spleen substance immediately beneath it shows very conspicuous 
 dilatation of the blood-vessels, in which lie eosinophile cells along with 
 ordinary blood-cells. In this section there is a sprinkhng of brown 
 pigment, and the fibrosis of the pulp is even more marked. The 
 Malpighian bodies are easily seen, but they are scanty, small, and 
 iU-defined. 
 
 Ref. : Entry No. 3439. 
 
 Presented by Dr. Hamilton. 
 
 43.513^ Spleen in Banti's Disease. Hyaloserositis. 
 
 Half of a greatly enlarged spleen. The organ is marked on its 
 outer surface by a large irregular mass of thickened capsule, having 
 a bright ochre-yellow colour ; half-way from the two extremities 
 is a paler area in which spicules of calcified matter are present. 
 The outhnes of this area of hyaloserositis are for the most part 
 
PLATE XII 
 
 1 
 
 w>_ 
 
 lA- 
 
 (A 
 U 
 
 a. 
 
 t- ■ 
 
 UI 
 
 Z 
 
 z 
 u 
 
 i J 
 
 43.513^ SPLEEN IN BANTl'S DISEASE. HYALOSEROSITIS 
 
 Dr. Gruner 
 
 P. 130 
 
43. SPLEEN 131 
 
 clearly marked off by a bluish line of congestion ; but at the lower 
 end it blends imperceptibly with a generally opaque capsule, in 
 which, however, a few tiny irregular prominences are seen. There 
 is no notching and the outUnes are rounded ; attached to the upper 
 end is a broad tag of adhesions. 
 
 The cut surface originally had a deep maroon colour, and was 
 apparently homogeneous throughout (as it is now). No Malpighian 
 bodies can be seen. The fibrous trabeculse are slightly conspicuous. 
 
 A male ItaHan, aged 50, was admitted to R.V.H. August 16, 1912, 
 for ascites and epigastric pain ; had been ill for three weeks ; he had 
 been six years in Canada ; had a fever of some kind at 25 ; the 
 abdomen was tapped many times. The cUnical diagnosis was 
 atrophic cirrhosis. Died Oct. 18th. 
 
 P.M. Multilobular cirrhosis, partly bihary ; subperitoneal 
 haemorrhages ; muscle degeneration of heart ; focal atheroma of 
 aorta ; leucoblastic marrow. 
 
 Micro. Exam. A definite increase in the connective tissue 
 throughout the organ ; there is very marked fibrosis of the coats 
 of the central arteries of the Malpighian foUicles. 
 
 Ref. : E. 5341. R.V.H. 146.12. 
 
 Presented by Dr. Gruner. 
 
 43.513^° Gaucher's Splenomegaly. 
 
 A small slab of an enlarged spleen with a smooth capsule, showing 
 a number of pinhead-sized brownish-coloured spots on a pale back- 
 ground. The cut surface tends to bulge. The spots are evidently 
 altered Malpighian bodies, and recall the appearance of amyloid 
 disease. 
 
 From a boy, aged 4| years. Admitted to the Mount Sinai 
 Hospital on Feb. 26, 1912, because of an accident. Enlargement 
 of the spleen and liver was found as well as altered structures. The 
 blood examination showed : red cells, 2,208,000 ; white cells, 500 ; 
 Hb, 35%. No abnormal cells. Polynuclears, 70; large lympho- 
 cytes, 25; small lymphocytes, 3; mononuclears, 1; myelocytes, 1. 
 No normoblasts, sUght poikilocytosis and anisocjrtosis. Splenec- 
 tomy was performed on March 1, 1912, and death occurred within 
 24 hours. Other members of the family apparently had the same 
 disease. 
 
 P.M. Enlarged tracheo-bronchial nodes ; thymus weighed 
 0-8 grm. No ascites. Enlarged periportal nodes, and intestinal 
 foUicles. Enormous enlargement of all mesenteric and retroperi- 
 
 K2 
 
132 THE HiEMOPOIETIC ORGANS 
 
 toneal lymph-nodes. Marrow of tibia bright red with small white 
 dots. 
 
 Micro. Exam. Note presence of iron-containing pigment and 
 large multinuclear cells in a characteristic cytoplasm. In early 
 cases, large phagocytic cells arise from the germ-centre cells, and 
 become swollen and vacuolated. With the low power, one notices 
 many large, round, or oval spaces with well-defined outHnes. These 
 are the venous tissues, each of which is more or less distended with 
 blood. With the high power a peripheral layer of large cells is 
 seen closely united to the wall and apparently arising from the 
 endothehum of the sinus. Some of the cells are detached and are 
 seen lying free in the lumen of the sinus surrounded by blood cells. 
 The sections also contain a large number of similar alveolar spaces 
 filled with the same type of large cells, but without any endothelial 
 Uning. The Malpighian bodies are of enormous size. In many 
 the small deeply staining tingible bodies of Flemming are found. 
 These are contained in large cells, which resemble the other large 
 cells in size and shape. Many have nuclei and also contain the non- 
 stainable pigment granules described by Flemming. These cells 
 have all the appearances of phagocytes. Throughout the sections 
 are mononuclear cells with eosinophile granulations. These are 
 somewhat larger than the lymphoid cells, and the nucleus is often 
 small and compact. Others have a larger vesicular nucleus and 
 resemble typical myelocytes. 
 
 The reticulum encircles the Malpighian bodies in a very regular 
 and uniform manner, the individual fibres being short and delicate, 
 as a rule. Three or four layers of fibres, somewhat separated from 
 each other, are usually seen. Fibres are also found between the 
 lymphoid cells of the Malpighian body and in the germ-centre, 
 but always in small amount. The fibres do not appear to be con- 
 nected with either the peculiar cells described in the germ-centre, 
 or the large cells situated between the lymphoid cells, though it 
 must be admitted that such a relation is possible. 
 
 There are no areas of degeneration, necrosis, or haemorrhage 
 in the spleen, and no evidences of a tuberculous process. 
 
 Ref. : * The Pathology of Primary Splenomegaly,' Journ. of 
 Exper. Med., xvi, 1912, No. 6, p. 797. 
 
 Presented by Dr. Mandlebaum. 
 
43. SPLEEN 133 
 
 .514 Leukaemia. 
 43.514^ Enlargement of Spleen in Leukaemia. 
 
 A moderately enlarged organ, measuring 15x10x3 cm. in 
 diameter, of normal contour, the notches preserved, but shallow. 
 The surface is somewhat wrinkled and is pale in colour (action of 
 Sappey's fluid), with a few punctiform motthngs. A band of peri- 
 splenitis crosses over the lower third. The cut surface is homo- 
 geneous and shows nothing. There is no evidence of the accom- 
 panying leukaemia, and the organ is kept to show that a relatively 
 small spleen may occur in this disease. 
 
 Micro. Exam. Shows thickening of the trabeculae. The pulp 
 has a loose structure, but the tissue stains so poorly that no cellular 
 details can be made out. 
 
 Old Museum specimen. 
 
 Spleno-medullary Leukcemia. 
 43.514^ Splenomegaly in Spleno-medullary Leukaemia. 
 
 An enormously enlarged organ, measuring 26x15x9 cm., of very 
 firm consistency, normal contour preserved, notches distinct. The 
 organ is mottled by large ill-defined pale areas due to multiple 
 infarctions of varying size. The capsule is irregularly thickened 
 and bears a few adhesions. 
 
 A. S., male, aged 11. Leukaemia of two years' duration. Abdominal 
 swelling first noticed October 1897. Headaches, dizziness, epistaxis 
 followed, and increasing abdominal enlargement. Admitted Feb. 27, 
 1899, emaciated. P. 128, R. 38, T. 99-4°. Dyspnoea, slight cyanosis, 
 abdomen immensely distended. A large mass, having an edge with 
 four distinct notches, occupied the whole left half, being palpable 
 from ninth left costal cartilage to 2-5 inches to the right of umbihcus, 
 thence to pubes. Superficial glands slightly enlarged. Blood 
 examination March 21, 1899, was : Red blood cells, 2,080,000 ; leuco- 
 cytes, 284,000 ; Hb, 23%. On July 4, 1899, red cells, 955,000 ; 
 leucocytes, 460,000 ; Hb, 25%. Many myelocytes. 
 
 P.M. Superficial abdominal veins dilated. Spleen and Hver 
 almost filled abdominal cavity. Spleen firm, weight 2,783 grm. 
 Measured 31x18x9-5 cm. Irregularly congested, several large 
 white infarcts. Liver also much enlarged, pale, soft, and fatty. 
 Shght ascites. Enlarged retroperitoneal glands. 
 
134 THE HEMOPOIETIC ORGANS 
 
 Micro. Exam. Sections in this case are remarkable for the great 
 numbers of eosinophile myelocytes which are present everywhere in 
 the capillaries, vastly outnumbering other forms of leucocytes. 
 
 Ref. : R.V.H. 62.99. Entry No. 553. 
 
 Presented by Drs. Stewart and Adami. 
 
 43.514^ Splenomegaly in Leukaemia. 
 
 A greatly enlarged, elongated organ, of firm consistency, the 
 capsule irregularly thickened with tags of adhesions. On the outer 
 and upper surface there is a large fibrous infarct with cystic centre. 
 Other infarcts of smaller size are visible scattered over the surface of 
 the organ. 
 
 E. D., female, aged 25. First symptoms, low fever and chills, 
 set in in June 1897. * Growth in abdomen ' (enlarged spleen) was 
 noticed in July 1897, and increased steadily. Admitted June 27, 
 1898. The spleen was palpable at the brim of the pelvis, having 
 a distinct notch in its right margin. Laparotomy was performed 
 July 1, and revealed an enormously enlarged spleen, normal in 
 colour and of firm consistency. Death two days later. 
 
 P.M. Hyperplasia of bone-marrow. Slight hyperplasia of 
 cervical, axiUary, and inguinal glands. Spleen reached sUghtly 
 to right of median fine and to within 3 inches of pubes. Weight 
 2,065 grm. Measurements : 37-5 x 19-5 x 5-5 cm. On section, firm, 
 pale, with several infarcts. The splenic veins were very large. 
 
 Ref. : E. 4. R.V.H. 51.98. 
 
 Presented by Dr. Adami. 
 
 43.514* Spleen in Myelogenous Leukaemia with 
 Rupture of Softened Area. 
 
 The spleen is enormously enlarged, measuring 27x16x9 cm., 
 with a smooth surface, showing notches only to a shght extent : 
 the surface is mottled in an irregular fashion. At the lower pole is 
 a fluctuating mass, containing bloody fluid, and having a soft pulpy 
 substance. The upper half of the organ is hard and firm, showing 
 some white infarcts ; it has burst in two places. 
 
 Farmer's wife, aged 38, from north-west Ottawa. First noticed 
 swelhng four months before death, which kept growing upwards and 
 gave rise to labour-hke pains ; nausea and vomiting were present. 
 
43. SPLEEN 135 
 
 She had had several miscarriages. Was never further south than 
 Smith's Falls, Ontario. Father and mother both had paralysis ; 
 brother died of phthisis. Temperature normal on admission, but 
 rose later. Unconscious two days before death, with paralysis of face 
 on right side. There was blood in the stools. 
 
 Blood Exam. Red cells, 5,664,000 ; haemoglobin, 85% ; whites, 
 20,700. Differential : Polymorphonuclears, 60% ; lymphocytes, 
 0-8% ; large mononuclears, 1% ; eosinophiles, 4-8% ; mast-cells, 
 2-7% ; neutrophile myelocytes, 30% ; other myelocytes, 13%. 
 
 Micro. Report. Blood sinuses not visible. The pulp is made up 
 of closely aggregated large cells, with large, well-staining nuclei ; 
 occasional giant ceUs with several nuclei are seen ; small lympho- 
 cytes are only irregularly distributed about some of the vessels. 
 Bands of necrotic tissue stretch through the section, giving an appear- 
 ance of infarct ; there is slight congestion of the periphery of these 
 areas. With the low power the size of the cells in the non-infarcted 
 portion is most striking, and gives rise to an appearance not unhke 
 that of round-celled sarcoma. Evidence of blood destruction is not 
 seen ; the protoplasm of the large ceUs is not granular. There is 
 also a white infarct in the Uver. 
 
 Ref. : Entry No. 3088. 
 
 Presented by Dr. Mohr, Ottawa. 
 
 Lymphatic Leukcemia. 
 
 43.514^** Spleen in Acute Lymphaemia. 
 
 A very large spleen, weighing 900 grm. and measuring 20x15 
 X 8 cm. The edges are rounded ; there are four deep notches on the 
 anterior border. The surface is smooth and pale, and the capsule 
 is tense. The cut surface is very pale and fleshy in appearance. 
 The Malpighian bodies are invisible, as also the trabeculae. The pulp 
 is fleshy in appearance but rather diffluent. The organ is absolutely 
 normal exteriorly. 
 
 The patient was a dentist who had only been ill for two weeks 
 with pain in the abdomen and headache. Bruises appeared aU over 
 the sldn. 
 
 P.M. Hsemorrhagic purpura. Petechial haemorrhages : sub- 
 pleural, peritoneal, subepicardial, subendocardial, intramuscular, in 
 the papillaries of heart, omentum, and all along the track of bladder 
 and appendix. Enormously enlarged mesenteric and retroperi- 
 toneal glands. 
 
 Micro. Exam. Shows diffuse lymphadenoid change. There is 
 a hyaline change in the reticulum with desquamation of the 
 
136 THE HEMOPOIETIC ORGANS 
 
 endothelium lining the sinuses. The pulp-cords are ill defined, are 
 rich in cells, and contain megakaryocytes and eosinophiles. 
 
 See also Specimen No, 42.514. 
 
 Ref. : E. 4957. R.V.H. 47.12, 
 
 Presented by Dr. Gruner. 
 
 43.514^^ Giant Spleen in Acute Lymphatic Leukaemia. 
 
 An extremely large spleen, measuring 29 X 16 x 8 cm., and weigh- 
 ing 1,820 grm. Its surface is smooth, the edges are rounded, and the 
 consistence is firm. There are no adhesions. The capsule is tense, 
 and the organ pinkish in colour. The cut surface bulges and shows 
 apparent homogeneity and pale colouring. The Malpighian bodies 
 are not to be seen, nor are the trabeculae conspicuous. 
 
 D. B., male, aged 44. An Itahan labourer, admitted to the R.V.H, 
 for pain in the upper abdomen of 20 days' duration. There was 
 slight icterus. Glands everywhere large, hard, movable. Blood : 
 2,040,000 reds ; 334,000 leucocytes. Albuminuria. Temperature, 
 104°, Death from cerebral haemorrhage on July 17, 1912. 
 
 P.M. Acute lymphatic leukaemia with purpura haemorrhagica. 
 Haemorrhages : subepicardial, subendocardial, omental, renal, mes- 
 enteric, stomach, intestine, subpleural, haemolymph glands. 
 
 Micro. Exam. The normal structure is entirely lost. Differentiation 
 of Malpighian bodies cannot be made out. The whole tissue appeared 
 like pulp, but is rich in lymphoblastic cells of anomalous form. 
 
 See also Specimens Nos. 42.5142, 41.514^. 
 
 Ref. : E. 5207a. R.V.H. 100.12. 
 
 Presented by Dr. Gruner. 
 
 43.514^^ Spleen in Lymphatic Leukaemia. 
 
 An enormously enlarged spleen, measuring 26x16 cm., with 
 normal notchings and a perfectly smooth external surface of uniform 
 colour. The cut surface is dark red, mottled with the much enlarged 
 Malpighian corpuscles. One red infarct is seen. 
 
 Male, aged 35, was in hospital in 1904 with fever and enlarged 
 spleen, diagnosed as typhoid fever. In 1906 had a similar attack, 
 which proved to be lymphatic leukaemia, with a white-cell count 
 of 106,000. Before death in 1908 red cells were 1,120,000, whites 
 385,000, Hb 22%. 
 
43. SPLEEN 137 
 
 Micro. Exam. The capsule is only slightly thickened and the 
 trabeculae are inconspicuous. The normal structure of the spleen 
 is practically lost, owing to the replacement of the pulp-tissue by 
 cells with round trachychromatic pachychromatic nuclei of almost 
 regular size. They are intermingled with red blood-cells, and are 
 very similar in appearance to the cells composing the Malpighian 
 foUicles, within which there is active mitosis. Proliferating endo- 
 thelial cells are seen in the vicinity of these follicles. Few phago- 
 cytes occur. There is no evidence of red-cell formation. 
 
 See also Specimen No. 42.514^. 
 
 Ref. : M.G.H., A. 08.79. E. 3530b. 
 
 Presented by Dr. Finley. 
 
 43.514^^ Spleen in Lymphatic Leukaemia. 
 
 A massive spleen, measuring 24-5 X 16-5 X 5-5 cm., and weighing 
 1,510 grm., having a pale colour, very smooth surface, and very 
 rounded edges with three deep notches. The capsule is tense. There 
 is ill-defined motthng with purple. 
 
 The cut surface is about homogeneous in texture, pale purple in 
 colour. Follicles cannot be made out with certainty. 
 
 A. A., male, aged 33. Admitted to M.G.H. April 29, 1910, for 
 general weakness, shortness of breath, and swelling of legs and neck. 
 A swelling had been noted in the groin for 12 months. The left side 
 of face became swollen three months later, with pain and tenderness. 
 The swelling then became differentiable into separate glandular 
 masses. Six weeks ago had ' grippe '. Noticed shortness of breath 
 one month ago. 
 
 P.M. Marked general glandular enlargement. Enlarged spleen 
 and liver. Active bone-marrow. 
 
 Micro. Exam. Shows loss of differentiation of structure, the 
 whole tissue being composed of round cells of varying size with no 
 structural arrangement noticeable. They are the size of meso- 
 lymphocytes, myelocytes not being noticeable. A number of eosino- 
 philes and a large number of pigmentophages are present. 
 
 Ref. : E. 4467. M.G.H., A. 10.92. 
 
 Presented by Dr. Rhea. 
 
138 THE H.EMOPOIETIC ORGANS 
 
 .515 Hodgkin's Disease. 
 43.515^ Spleen in Malignant Granuloma. 
 
 A spleen of medium size, weighing 400 grm., and measuring 
 17'5x 11-5 X 4-5 cm., with rounded edges and smooth surface, 
 mottled with fine reticulation, purple-red in colour. The cut surface 
 is very dark red and granular owing to the diffluence of the pulp. 
 The Malpighian bodies are easily seen ; the trabeculse, however, 
 are not conspicuous. There are no tumour nodules. The organ is 
 diffluent. 
 
 N. J., male, aged 27. Admitted July 3, 1911, died Nov. 19, 
 1911, complaining of enlargement of glands in neck and axilla, which 
 began two years ago. X-ray treatment. History of gonorrhoea. 
 Blood, Hb, 22-4% ; polynuclears, 82-5% ; transitionals, 4% ; large 
 mononuclears, 10%; lymphocytes, 3%; mast-cells, 0-5%. 
 
 P.M. Malignant granuloma of superior mediastinal, cervical, 
 axillary, and lumbar glands (thymic in origin) ; Hodgkin's disease ; 
 invasion of dorsal spine and root of left lung ; compression of spinal 
 cord ; red diffluent bone-marrow ; hypostatic pneumonia. 
 
 Micro. Exam. The capsule is shghtly thickened and is adherent 
 to the underlying tissue. The trabeculae are conspicuous, and appear 
 as thickened bands throughout the section ; some of them have 
 a distinctly hyahne appearance. The Malpighian bodies are scanty 
 in number and small, their peripheries blending imperceptibly with 
 the surrounding pulp-tissue. The central vessels of these bodies are 
 thick- walled and slightly tortuous. In the wall of one a small hyahne 
 mass with serrated edges is seen ; some of them are filled with blood, 
 while others are quite empty. The surrounding cells are chiefly 
 of the large lymphoid type. Germ-centre cells are very scanty. 
 No evidence of polymorphonuclear or eosinophiles is seen. The 
 edges of these collections are aU invaded with red blood-cells. In the 
 pulp the sinuses are engorged with blood, in which may be seen, as 
 well as red cells, numerous polymorphonuclear leucocytes, eosino- 
 philes, and small lymphocytes, together with a few vacuolated and 
 swollen endothelial cells ; some of the endothehals are pigment 
 bearers. Germ-centres are more numerous here. Many macroplasma 
 cells occur in the pulp-tissue, especially in immediate proximity 
 to the smallest branches of the splenic artery. 
 
 Ref. : E. 4765. R.V.H. 162.11. 
 
 Presented by Dr. Gruner. 
 
43. SPLEEN 139 
 
 43.515^ Spleen in Hodgkin's Disease. 
 
 A slice of spleen, showing a few minute foci of disease scattered 
 through it. Two occur with a red Umiting Une. 
 
 Male, aged 27. Ill for nine months with fever and swollen 
 lymph-glands. 
 
 P.M. Combined tuberculosis and Hodgkin's disease. Changes 
 in Uver, spleen, pancreas, femur, and retroperitoneal lymph-glands. 
 
 See Specimens Nos. 41.515^, and 42.5 15^, and under Liver and 
 Pancreas. 
 
 Micro. Exam. Tubercles with giant cells and nodules of new- 
 formed tissue having structure of granuloma mahgnum. 
 
 Ref. : E. 5097. 
 
 Presented by Dr. de Josselin de Jong, Rotterdam. 
 
 43.515^ Spleen in Hodgkin's Disease. 
 
 A portion of a spleen containing numerous cream-coloured nodules 
 in its substance. The nodules have a deUcately lobulated contour, 
 are raised above the surface, and are traversed by reddish Hnes 
 in some instances ; others are breaking down in the centre. 
 
 No history. 
 
 See also Specimen No. 42.515^, and under Liver. 
 
 Micro. Exam. The Malpighian bodies are diffuse and large. 
 The pulp is loose in texture, and the blood-channels very large 
 in some places. The pulp and trabeculse have undergone a hyahne 
 change ; pigment granules are numerous. There are several foci 
 in the centres of the hyahne zones which are constructed very 
 similarly to the centres of tubercles. 
 
 Ref. : E. 4880b. 
 
 Presented by Dr. de Josselin de Jong, Rotterdam. 
 
 43.515* Spleen in Hodgkin's Disease. 
 
 Portion of spleen showing a number of white nodules of varying 
 size scattered through its substance. Some show slightly lobulated 
 edges and central softening. The others are quite round. They 
 stand out in marked contrast with the splenic pulp. 
 
 Female, aged 23. Became ill in September 1907, with fever and 
 cough. Von Pirquet negative. No tubercle bacilli in sputum. 
 Marked anaemia. Died August 1908. 
 
140 THE HEMOPOIETIC ORGANS 
 
 P.M. Many small and large tumours (Hodgkin's disease) in 
 lungs, Kver, spleen, lymph-glands, kidneys, and pancreas, Cavse 
 injected with tumour mass. No trace of tuberculosis. Hodgkin's 
 disease. 
 
 Micro. Exam. The section shows several granulomatous areas 
 in which fibrous tissue radiates from a centre. Eosinophiles infil- 
 trate between the fibres in large numbers. A few giant cells occur. 
 
 Note. The student wiU find it worth his while to compare the 
 sections of the preceding three of the .515 series with this. 
 
 See also Specimens Nos. 42.515*, and under the Lung, Liver, 
 Pancreas, and Kidney. 
 
 Ref. : E. 5096c. 
 
 Presented by Dr. de Josselin de Jong, Rotterdam. 
 
 43.515^ Spleen in Hodgkin's Disease. 
 Two portions of spleen showing several small nodules within 
 the substance. They are iU-defined in outline and of a yellowish 
 tinge. Foci of congestion seen here and there. 
 
 F. H., aged 48, married, 7 children, 1 abortion. Always healthy 
 previous to onset of present illness. December 1910 complained of 
 always feeling tired. Temperature elevated, liver and spleen 
 enlarged. Died March 20, 1911. 
 
 P.M. Hodgkin's disease ; granulomata in liver, spleen, kidneys, 
 pancreas, and retroperitoneal glands. Weight of liver 2,200 grm., 
 of spleen 600 grm. No nodules in lungs. 
 
 Micro. Exam. The Malpighian bodies are poorly shown. The 
 fibrous tissue is very scanty. The pulp is cedematous and very rich 
 in pigmentophages, as well as in free pigment, which appears in the 
 form of coarse flakes of varying size. There are several granuloma- 
 tous deposits containing large epithehoid cells. The pigment is 
 scattered irregularly through the deposits. 
 
 See also Specimen No. 42.515^, and under the Liver, Pancreas, 
 and Kidney. 
 
 Ref. : E. 5098b. 
 
 Presented by Dr. de Josselin de Jong, Rotterdam. 
 
43. SPLEEN 141 
 
 .516 Pernicious Anaemia. 
 43.516^ Spleen in Pernicious Anaemia. 
 
 Half a moderately large spleen, measuring 14.5 x 7.5 x 2.5 cm., 
 weighing 215 grm. It is pale and has a smooth capsule. There are 
 two notches. The cut surface is pale, and shows an abundance of 
 fibrous trabeculse. The Malpighian bodies are not easily seen. 
 
 A. T., female, aged 34. Admitted to the R.V.H. Nov. 27, 
 1912, with signs and symptoms of severe anaemia of six months' 
 duration. 
 
 Hb 20% 
 „ 10% 
 „ 10% 
 
 Nov. 30th, reds, 1,270,000 ; whites, 1,800 
 Dec. 8th, „ 780,000 ; „ 2,700 
 Dec. 16th, „ 970,000 ; „ 3,400 
 Died with multiple haemorrhages Dec. 16. 
 
 P.M. Cryptogenetic anaemia ; fatty degeneration of organs. 
 Haemosiderosis of liver. The spleen was moderately enlarged. Its 
 outer surface showed moderately conspicuous Malpighian folhcles 
 and a relative increase in the amount of fibrous tissue. The pulp 
 was rather soft. Notching was natural. 
 
 See also Specimens Nos. 42.516^, 37.63. 
 
 Micro. Exam. The chief change in this section is the overgrowth 
 of the stroma cells with hyaline inundation into the substance of 
 the pulp-cords. The result is a conspicuous prominence of the 
 blood-channels. Endothelial cells are met with here and there. 
 The Malpighian bodies are for the most part atrophied. 
 
 Ref. : E. 5375. R.V.H. 174.12. 
 
 Canadian Practitioner and Review, March 1912. 
 
 Presented by Dr. Gruner. 
 
 43.516^ Spleen in Aplastic Anaemia. 
 
 A greatly enlarged spleen, weighing 530 grm., and measuring 
 18-5 X 12-5x5 cm. The organ is dark red and fairly firm. It has 
 three shallow notches anteriorly ; the surface is smooth and the 
 capsule is wrinkled. It is perfectly normal exteriorly. Cut surface 
 presents a deep-red colour, mottled with pinhead-sized nodules. 
 One large greyish lymphoma was seen. There are one or two tiny 
 infarcts in the substance of the organ, and a large infarcted area 
 (about 2 cm. on surface) half-way along its length. The cut surface 
 is flat, tending to convexity, and the pulp is fairly firm. 
 
 H. W., male Jew, aged 28. Family and personal history good. 
 Gonorrhoea seven years ago. Five months before death he developed 
 
142 THE HEMOPOIETIC ORGANS 
 
 a few small pustules on fingers of left hand, which disappeared on 
 treatment. After a short holiday returned to work, but was easily 
 tired and not up to par. On Sept. 9, 1911, another small pustule 
 on one finger; temperature 99° to 100°; spleen palpable. Examined 
 by Dr. Hardisty on Sept. 14th, pale but weU nourished ; shotty 
 glands in groin ; heart somewhat enlarged with systolic murmur at 
 base; fiver palpable just below costal margin, spleen three to four 
 finger-breadths below margin ; very hungry ; constipated ; Widal 
 negative. Blood : Hb, 50% ; white blood cells, 5,300 ; red blood 
 cells, 4,340,000 ; lymphocytes, 86-6% ; polymorphonuclears, 12% ; 
 eosinophiles, 1-5%. Drenching night-sweats; rather dyspnoeic on 
 slight exertion. Sept. 30th, Hb, 33% ; white blood cells, 5,500 ; red 
 blood cells, 2,520,000 ; lymphocytes, 90-4% ; one nucleated red 
 cell seen. Admitted to R.V.H. ; temperature 102°, axillary glands 
 just palpable, sHghtly more so on left side (site of infection). Appe- 
 tite enormous; blood-culture negative. Oct. 14th, red cells 770,000; 
 improved slightly under arsacetin and cholesterin. Consolidation 
 of left lung. End of November, ascites, left pleurisy with effusion, 
 liver and spleen increased; white cells 9,800, 77% being lympho- 
 cytes. Signs of loss of compensation developed and small sub- 
 cutaneous ecchymoses appeared. He sank gradually and died 
 Jan. 16, 1912. 
 
 P.M. (Spleen, fiver, and rib only examined.) Multiple infarcts 
 and diffuse fibrosis of spleen. Fatty infiltration, intralobular 
 haemorrhages, and focal necrosis of liver. Bone-marrow atrophic 
 with some mucoid change of interstitial tissue; cellular elements 
 proper (chiefly lymphoid) varying fittle in size. Megakaryocytes 
 scanty, eosinophiles absent ; no evidence of erythroblastosis. 
 
 A full study of this case is published by Dr. Hardisty, R.V.H. 
 Bulletin, No. 2, 1912. 
 
 Micro. Exam. The trabeculse are unduly conspicuous and 
 present a hyafine appearance in some cases. The pulp is rather 
 atrophic. The Malpighian bodies are seen with difficulty, owing to 
 their small size, and to the degenerative changes present in many of 
 them. The central vessel is sometimes much thickened, sometimes 
 converted into a hyaline-looking structure. The differentiation of 
 the pulp is entirely lost in the necrotic areas which are of the nature 
 of infarction. In the other sections the pulp-tissue is fibrosed, the 
 sinuses being characterized by thickening of their walls, and swelling 
 of their lining epithefium. The pulp cells are chiefly small lymphoid 
 cells with swollen endothefial cells intermingled. Small infarctions 
 occur in section. Diagnosis : Multiple infarcts. Diffuse fibrosis. 
 Changes indicative of Banti's disease. 
 
 Ref. : E. 4871. R.V.H. 8.12. 
 
 Presented by Drs. Hardisty and Gruner. 
 
43. SPLEEN 143 
 
 43.516^ Spleen in Pernicious Anaemia. 
 
 The spleen measures 13 x 6-5 x 4 em., and weighs 175 grm. 
 The organ is sUghtly enlarged ; the edges show deep notches on the 
 anterior part, nearly spHtting a lobule off ; also a small notch 
 exists on the posterior surface. The organ was flabby. The siu:face 
 is mottled with tiny opaque pinhead-sized areas which are sub- 
 peritoneal. There are some shaggy adhesions behind. The cut 
 surface shows the Malpighian bodies clearly, and slight increase of 
 the trabecular tissue. 
 
 R. S., male, aged 42, was admitted to the R.V.H. in November 
 1910, suffering from weakness, anaemia, shortness of breath, &c., 
 which had existed 14 months. No tuberculosis, cancer, or rheu- 
 matism in the family. Blood : red cells, 940,000 ; white cells, 2,000 ; 
 Hb, 16% ; nucleated reds common ; poikilocytosis ; only 2 myelo- 
 blasts seen. Death was preceded by usual symptoms. 
 
 P.M. Haemorrhages in pericardium; fatty heart, liver, and 
 kidneys. The bone-marrow was pale. 
 
 Micro. Exam. Shows the capsule to be greatly thickened, 
 but the trabeculse are not thicker than normal. The Malpighian 
 bodies are numerous, are ill-defined and irregular in size and shape. 
 The central vessel is normal. There are many mitotic figures in the 
 germ-centres, but there are other places where there is hyaline 
 change. Eosinophile cells are numerous. The splenic channels are 
 conspicuous and contain many large exfohated endothehal cells 
 with large nuclei, many of which exhibit mitotic figures. The elastic 
 tissue is normal in amount. There are no nucleated red cells. 
 
 Ref. : E. 4480. R.V.H. 156.10. 
 
 Presented by Dr. Gruner. 
 
144 THE HEMOPOIETIC ORGANS 
 
 .53 Diseases due to Autochthonous Poisons of Organic 
 Nature. 
 .531 Acute Yellow Atrophy. 
 43.531^ Spleen from Acute Yellow Atrophy. 
 
 An organ of moderate size (10 x 3 cm.), of deep-red colour and 
 mottled appearance, not showing Malpighian bodies. The consis- 
 tence is very flabby. 
 
 From a girl aged 18, dying of acute yellow atrophy of the liver. 
 
 P.M. Acute yellow atrophy of liver ; fatty kidneys ; congestion 
 of spleen; subperitoneal, retroperitoneal, subepicardial, and sub- 
 endocardial haemorrhages, and haemorrhage into pelvis of kidney. 
 Spleen slightly enlarged, weight 120 grm. 
 
 Micro. Exam. The Malpighian bodies are few. Blood-channels 
 are enormously dilated and show desquamation of endothelium. 
 
 Ref. : E. 1474. M.G.H. 55.05. 
 
 Presented by Drs. Armstrong and Gillies. 
 
43. SPLEEN 145 
 
 .6 RETROGRESSIVE CHANGES. 
 .61 Atrophy. 
 43.61^ Atrophy of Spleen. 
 
 A small spleen presenting the normal outlme and surface. 
 There is a notch on either side. The capsule is smooth and tense. 
 The edges are sharp. 
 
 Ref. : A.M.M. 3184. E. 1924. 
 
 Presented by Army Medical Museum. 
 
 43. 6F Senile Atrophy of Spleen. 
 
 A very small organ, 7-5x5 cm. The cut surface shows excess 
 of fibrous tissue. The capsule is much wrinkled. 
 
 Old Museum specimen. 
 
 43.6F Atrophy of Spleen. 
 
 A small spleen of flattened shape, measuring 8x6-5x3 cm. 
 The capsule is greatly wrinkled and shows one or two tags of fibrin. 
 There is only one notch at the lower end. The cut surface has 
 a homogeneous appearance. The white colour is due to initial 
 preservation in bichloride. 
 
 Ref. : A.M.M. 2484. E. 1872. 
 
 Presented by the Army Medical Museum, Washington, D.C. 
 
 43.61* Atrophy of Spleen with Hyaloserositis. 
 
 A small thick spleen, measuring 6-6x4-5x4 cm., the surface of 
 which shows a large area of hyaloserositis (icing), having a raised 
 surface with scalloped edges and outlying small, round, flattened, 
 discrete patches of the same appearance. The rest of the surface 
 is quite rough with adherent lymph. The cut surface shows enlarged 
 
 IV.I 
 
146 THE HEMOPOIETIC ORGANS 
 
 Malpighian bodies. Fibrous trabeculae cannot be made out. The 
 white colour is due to preUminary hardening in HgClg. 
 
 From a white man, aged 72, dying of acute pericarditis. Had had 
 syphiHs years before. 
 
 P.M. Heart normal ; stomach congested ; some adhesions about 
 the liver. 
 
 Micro. Exam. The fibrous tissue is conspicuously increased ; 
 the remainder is very oedematous. The Malpighian bodies are small 
 and rather ill defined. There are numerous pigment-bearing phago- 
 cytes in the pulp. The capsule is enormously thickened, fibriUated, 
 and hyaline, with a broad zone of pigment cells separating it from 
 the spleen. 
 
 Ref. : E. 1913. A.M.M. 1829. 
 
 Presented by the Army Medical Museum, Washington, D.C. 
 
 43.6P Senile Atrophy of Spleen. 
 
 A small spleen, measuring 7- 1 x 3-4 X 2-6 cm. Part of the capsule 
 is missing ; the rest is opaque, wrinkled, and portions are conspicu- 
 ously thickened. There are no notches. The organ is moderately 
 thick. There is no perisplenitis. 
 
 The spleen weighed 30 grm. 
 
 H. W., male, aged 80, suffered from symptoms of vesical trouble 
 for ten years, due to a papilloma in the bladder. 
 
 P.M. Papilloma of bladder, cystotomy; acute cystitis, senile 
 atrophy of all organs ; fibrosis of pancreas. 
 
 Micro. Exam. Spleen atrophic ; trabeculae prominent. No 
 Malpighian bodies were to be made out. 
 
 Ref. : R.V.H. 41.08. E. 3353. 
 
 Presented by Dr. Adami. 
 
 43.6r Atrophy of Spleen. 
 
 An unduly small spleen, measuring 9x7x3 cm., weighing 
 65 grm., of reddish colour. There are two notches. The capsule 
 is a little wrinkled. The cut surface is a Httle congested, with firm 
 pulp, abundant trabecular network and large follicles. 
 
 The spleen appears to have shrunk in size, not from senility (the 
 follicles are not atrophic). 
 
 S. C, female, aged 65. Admitted to the R.V.H. on Jan. 22, 
 
43. SPLEEN 147 
 
 1913, with gastric pain and diarrhoea and pronounced thirst. She 
 had no children. No family history of cancer. 18,000 white cells 
 per c.mm. Urine contained pus. Vagina full of new growth. 
 
 P.M. Carcinoma simplex of cervix (ulcerative form) with local 
 extension ; bilateral hydronephrosis ; atrophy of organs. 
 
 Micro. Exam. The Malpighian bodies are numerous. Many 
 showed necrosis in the centre, and thick hyaline change in the central 
 vessels. The trabeculae are hyahne. The pulp is rich in fibrous 
 tissue and contains a number of pigment ophages. The vascular 
 channels and pulp ends are very conspicuous, but the number of 
 ceUs present is small. 
 
 Ref. : E. 5402. R.V.H. 9.13. 
 
 See Specimen No. 63.79i. 
 
 Presented by Dr. Gruner. 
 
 43. 6r Senile Atrophy of the Spleen. 
 
 A spleen of small size, measuring 8-5x 5x2-6 cm., with sulcus 
 half-way along the posterior border. The edges are rounded, the 
 organ flattened, and the capsule is slightly wrinkled, producing a 
 finely nodular surface. The colour is rather dark, with lighter bands 
 at each end. The cut surface shows a dark pulp rich in trabeculse. 
 The Malpighian bodies are not easily seen, 
 
 Ref. : P.H.I., Verdun. E. 3135a. 
 
 Presented by Dr. Kaufmann. 
 
 43.6P Atrophy of Spleen. 
 
 A small spleen, measuring 7 X 4-5 X 2-5, and weighing 15 grm. 
 There are three notches. The organ is firm, bulky, with a smooth 
 surface. There is a little white calcified nodule of pinhead size 
 near the upper end. The colour is dark red. The trabeculae are 
 rather conspicuous, and the Malpighian bodies are very minute. 
 
 J. D., male, aged 51, was admitted to the R.V.H. Jan. 23, 1913, 
 with obscure symptoms. The existence of adhesions round the 
 gall-bladder was the only definite finding. There was extreme 
 wasting. 
 
 P.M. Qironic pericholecystitis ; obstruction to the thoracic 
 duct ; chronic ulceration of the transverse colon ; atrophy of all 
 
 L2 
 
148 THE HEMOPOIETIC ORGANS 
 
 the organs ; persistent thymus ; renal calculus ; purpura ; en- 
 larged mesenteric glands. 
 
 Micro. Exam. The section shows fibrosis. The Malpighian 
 bodies are small, numerous, and contain only lymphoid elements. 
 The central vessels can be clearly seen. The trabeculse are very 
 conspicuous ; the pulp shows a diffuse increase of fibre ceUs. The 
 blood-channels are everywhere engorged with red blood ceUs. 
 Numerous pigmentophages are to be seen. 
 
 Ref. : E. 5428. R.V.H. 17.13. 
 
 Presented by Dr. Gruner. 
 
43. SPLEEN 149 
 
 .62 Degenerations. 
 .625 Amyloid Degeneration. 
 43.625^ Spleen. Early Amyloid Disease of Sago Type. 
 
 The organ is large and tense, pale-coloured with exaggerated 
 notches. Four small white infarcts (two wedge-shaped) occur along 
 the edges, and the cut surface shows motthng with semi-translucent 
 whitish spots which correspond to the Malpighian bodies. 
 
 I. N., male, aged 19. A case of hip- joint disease (suppurative 
 arthritis), which had lasted on and off for ten years, following a fall 
 while skating. 
 
 Micro. Exam. Recent white infarct. Amyloid disease about 
 the Malpighian corpuscles. 
 
 Ref. : R.V.H. 54.07. E. 3392. 
 
 Presented by Dr. Adami. 
 
 43.625- ' Sago Spleen ' in Amyloid Disease. 
 
 A shghtly enlarged organ with the normal contour preserved. 
 The cut surface is conspicuously mottled from the presence of small, 
 round, semi-translucent areas the size of a pin's head and smaller. 
 They appear dark in contrast to the pale bands which separate them. 
 They correspond in part to the Malpighian bodies. 
 
 Ref. : R.V.H. 1896. E. No. 770. 
 
 43.625^ Sago Spleen. Amyloid Disease. 
 
 Half of a moderately enlarged spleen, measuring 10-5x8 cm. 
 The Malpighian bodies are visible as semi-translucent pinhead-sized 
 spots scattered throughout the splenic substance. The intermediate 
 pulp is pale in contrast. The notches are indistinct, but present. 
 
 From a woman, aged 28, who died of tuberculosis. 
 
 Micro. Exam. The Malpighian bodies are replaced by large 
 rounded masses of hyaUne material which shows irregular cleavage, 
 the clefts being occupied by small round cells in small numbers. 
 The centre of each mass shows the remains of the central vessel 
 infiltrated with a few lymphoid elements. At the periphery of each 
 mass is a zone in which there is much dark-brown pigment within 
 
150 THE HEMOPOIETIC ORGANS 
 
 the leucoc3rtes. The spleen-pulp is very rich in cells, many of which 
 contain pigment granules, while very few blood-vessels can be seen. 
 The trabeculse are rather prominent. 
 Ref. : St. Bart's. Hosp. E. 3077. 
 
 Presented by Dr. Martin. 
 
 43.625* Spleen. Amyloid Disease. 
 
 A portion of spleen showing well-marked amyloid change (sago 
 spleen). The capsule is not thickened, but is shaggy with firm 
 shreds of lymph. The cut surface shows numerous discrete brownish- 
 coloured nodules of pinhead size or smaller. Each corresponds to 
 a Malpighian follicle. The intermediate pulp is pale. The disease is 
 uniformly distributed. 
 
 Ref. : M.G.H. 8.03. E. 1049. 
 
 Presented by Dr. McCrae. 
 
43. SPLEEN 151 
 
 .7 PROGRESSIVE CHANGES. 
 .72 Hypertrophy. 
 43.72^ Enlargement of Spleen in Cirrhosis of Liver. 
 
 An enlarged spleen, measuring 14-2 X 12x6-5 cm. The surface 
 is opaque over an irregular area, and elsewhere shows fine motthng, 
 with pale spots ; the internal surfaces are roughened with recent 
 lymph. There is an accessory spleen at the lower end of the hilum. 
 No notches are seen. The cut surface presents no particular feature. 
 
 Old Museum specimen. 
 
 Presented by Dr. Howard. 
 
 43.72^ Spleen. Hypertrophy. 
 
 From a coloured child aged 17 days. Died with abdominal 
 cramps. 
 
 P.M. Fluid Uke curdled milk in the stomach, the walls of 
 which were thin and softened, and had two rents. Hypostatic con- 
 gestion of lungs. 
 
 Ref. : A.M.M. 3184. 
 
 Presented by Army Medical Museum. 
 
 43.72^ Enlargement of Spleen in Cirrhosis of the Liver. 
 
 A greatly enlarged spleen, measuring 7 x 17x0-5 cm., cut open 
 lengthways. On the outer surface are general short shaggy adhesions, 
 and towards the upper end are several flat, discrete, nodular, ochre- 
 yellow opacities, with a dififuse grey opacity between them. Half- 
 way down the posterior border is a shghtly depressed flattened 
 quadrangular area of sclerosed appearance, with one or two ochre- 
 yellow foci visible within it. The cut surface has a uniform grey 
 colour, and shows no differentiation of structure. The texture is 
 very dense, as if there were imiform hypertrophy of the trabecular 
 tissue. 
 
 Ref. : E. 4002c. 
 
 See also Specimens No. 37.39, 42.3612. 
 
 Presented by Dr. Klotz. 
 
162 THE H.EMOPOIETIC ORGANS 
 
 43.72* Enlarged Spleen in Cirrhosis of Liver. Syphi- 
 litic History. 
 
 A greatly enlarged spleen, 18x4-5 cm. on the cut surface, having 
 a wrinkled capsule, devoid of abnormaHties and with normal notch- 
 ing. The cut surface is bright red with deeper red hning, and shows 
 much increase of fibrous tissue. The Malpighian bodies are readily 
 visible but normal. 
 
 J. D., male, aged 54, had syphilis 23 years ago for a year ; he also 
 was accustomed to drink spirits heavily. His abdomen was swollen 
 with ascites, and there was jaundice ; bile-stained fluid was twice 
 removed by tapping. There was tuberculous peritonitis. There 
 were gummata in the calvarium and cirrhosis of the hver. 
 
 Ref. : E. 4103. M.G.H. 10.43. 
 
 Presented by Dr. Rhea. 
 
 43.72^ Hypertrophied and Fibrotic Spleen. 
 
 A large spleen, measuring 17-5 x 11-5 x 4-8 cm. and weighing 
 550 grm. The edges are rounded, the natural shape is preserved, the 
 sm-face smooth, and the capsule wrinkled. The cut surface is very 
 firm and flat ; the trabecular tissue is conspicuous, as also the Mal- 
 pighian bodies. 
 
 L.F., a Chinese male, aged 43, was admitted to the R.V.H. on 
 April 19, 1911, for swelling of the feet and shortness of breath. The 
 case was one of advanced interstitial nephritis. Death occurred 
 from sudden convulsions and coma (uraemia). 
 
 P.M. Chronic mixed nephritis with cysts ; tuberculous pleurisy ; 
 marked oedema of lungs ; hypertrophied heart ; hydropericardium ; 
 ascites ; fatty liver ; passive congestion of organs ; adrenal 
 hyperplasia ; anasarca. 
 
 Micro. Exam. The capsule is thickened slightly. The trabeculae 
 are hyaline here and there. The splenic channels are well seen, and 
 there is yellow pigment throughout the pulp. 
 
 Ref.: E. 4722a. R.V.H. 58.11. 
 
 Presented by Dr. Gruner. 
 
43. SPLEEN 153 
 
 43.72^ Movable Giant Spleen. Splenectomy. 
 
 Enormously enlarged spleen, measuring 23 X 12 X 8, removed by 
 operation. Weight 1,408 grm. 
 
 The organ is very dark in colour, and shows an irregularly 
 bossed surface produced by cicatricial contractions of white colour 
 here and there. A smaU area of peritoneal adhesions is seen, with 
 a few petechial haemorrhages in the splenic capsule at their attach- 
 ment. Just below this, near the middle of the length of the spleen, 
 is a large white infarct projecting considerably above the surface, 
 having a reddish centre on section, and enclosed in a broad zone 
 of deep-red hsemorrhagic infiltration. The cut surface of the spleen 
 is very dark in colour, mottled with haemorrhages, and showing 
 a decided increase of fibrous tissue. 
 
 Female, aged 32, born in Sparta, Greece, and lived there until 
 July 1905 (six months before operation), when she came to Canada. 
 History of malaria fifteen years previously, with attacks occurring 
 at irregular intervals for three years. Pain in the left side set in also 
 about this time and a mass was noticed in the left abdomen, 
 which remained about the same size and gave no further trouble 
 until recently. In August 1905, dragging pain in the left side set 
 in and grew gradually worse. Admitted to Royal Victoria Hospital, 
 October 7, 1905, and had an attack of chills and fever ; temperature 
 104° soon after admission, November 1905 blood-count showed : 
 red cells, 2,500,000; white cells, 4,200; 35% lymphocytes in 
 excess. January 10, 1906 : red cells, 3,500,000 ; white cells, 4,000. 
 Splenectomy was performed January 12, 1906. There were a few 
 peritoneal adhesions. The hilum of the spleen contained verj^ 
 large vessels, and there were large tortuous veins in the adherent 
 omentum. On January 15 : red cells, 3,000,000 ; white cells, 
 20,000. February 25 : white cells, 12,000 ; Hb, 25% ; lympho- 
 cytes, 35%. The patient made a good recovery and was still alive 
 in November, 1914. 
 
 The size of the spleen on removal was 25 x 17 x 11 cm. 
 
 Micro. Examination. Fibroid hyperplasia ; swelling and prolifera- 
 tion of endothelial cells of vessels and trabeculae ; lymphocytes rela- 
 tively decreased ; no multinuclear cells seen. Extracellular pigment 
 present. Necrosis of cells and extravasated blood in infarcted area. 
 
 Ref. : Surg. 15.06. R.V.H. E. 1141. 
 
 Presented by Dr. Garrow. 
 
154 THE HiEMOPOIETIC ORGANS 
 
 .78 Sarcoma. 
 43.78^ Sarcoma of Spleen. 
 
 Half of a spleen whose substance is occupied by a large spherical 
 mass of tumour which is well encapsuled. The peripheral portions 
 are dark coloured, the central portions show early softening, more 
 or less in radial lines ; minute rounded spaces are thus produced. 
 The splenic substance is reduced to a minimal amount, but presents 
 no other abnormahty. The capsule is wrinkled. 
 
 Ref. : St. Bart's. 68. E. 2301. 
 
 Presented by Dr. Martin. 
 
43. SPLEEN 155 
 
 .786 Lymphosarcoma. 
 43.786^ Splenomegaly in Generalized Lymphosarcoma 
 of Spleen, Lymphatic Glands, Liver, Kidneys, 
 and Serous Surfaces. Chylous Ascites. Chy- 
 lous Pleurisy. 
 
 An enormously enlarged spleen, measuring 31|x 17x11 cm. 
 The surface is thickened over large areas in many places : the rest 
 of it is opaque and slightly puckered. There are several areas 
 roughened from perisplenitis. The cut surface shows large nodules 
 of ill-defined new growth infiltrating the pulp, which is so small in 
 bulk as to be almost negligible. Wherever the organ has been cut 
 into the same diffuse infiltration is met with. The edges are round, 
 and there are no notches. 
 
 From a man, aged 45. Onset of symptoms several years before 
 death after injury in falling from a street car ; four weeks after this 
 accident some swelling in the neck and left side of abdomen was 
 observed, with dragging sensation in the latter region, and some pain 
 and occasional vomiting ; a month later suppuration of left inguinal 
 gland necessitating operation, progressive asthenia, and moderate 
 anaemia. 
 
 Admitted R.V.H. some two years later with superficial and peri- 
 bronchial lymph-glands enlarged, spleen much enlarged, Uver 
 palpable. Red blood cells, 2,170,000 ; white cells, 10,000 ; Hb, 52% ; 
 polynuclears and lymphocytes predominating. Two weeks later 
 white cells 32,000, relative increase of large lymphocytes and eosino- 
 philes and a few nucleated reds present. 
 
 Readmitted a year later, a few weeks before death. The spleen 
 and glands were now enormously enlarged, the abdomen was much 
 distended, and there was chylous ascites and bilateral chylous 'pleurisy, 
 great and progressive asthenia. 
 
 P.M. Lymphosarcomatosis of cervical, axillary, inguinal, 
 mediastinal, peribronchial and retroperitoneal glands, pleurae, 
 peritoneum, spleen, fiver, and kidneys. Receptaculum chyh em- 
 bedded in enlarged glands and dense adhesions. Abdomen and 
 pleurae full of milky fluid with pinkish tinge. The spleen measured 
 34x17x11 cm. and weighed 3,540 grm. The pleurae and peri- 
 toneum were covered with a fine villous growth so closely arranged 
 and so fine in character as to resemble coarse velvet, which consisted, 
 on microscopic examination, of lymphoid cells in a fine reticulum. 
 
 See also Specimens Nos. 42.7862, 36.786, 37.786. 
 
 Ref. : R.V.H. 73.99. Entry No. 566. 
 
 Reported Journ. Med. Research, 1901, ii. 249-57. 
 
 Presented by Drs. Martin and Adami. 
 
156 THE HiEMOPOIETIC ORGANS 
 
 43.786^ Secondary Lymphosarcoma of Spleen. 
 
 A greatly enlarged organ, weighing 630 grm. and measuring 
 18x10-5x4 cm. The edges are rounded, and there is no sign of 
 any notch ; the surface is mottled with small, round, yellowish-white 
 nodules, some of which are of the size of normal Malpighian bodies, 
 others larger (pinhead size). The larger nodules are foci of new 
 growth. The cut surface shows a generalized diffuse distribution 
 of small, white, closely packed nodules similar to those visible through 
 the capsule. 
 
 J. H., female, aged 35. Occupied in heavy field work until 
 January 1895, then began to lose flesh ; during the last fortnight 
 before death suffered from complete anorexia and pain in the upper 
 abdomen. On May 4th purpuric patches developed on the forearm, 
 and there was oozing of blood from the gums. On May 5th hsemat- 
 emesis occurred, and the purpura was increasing rapidly. Admitted 
 to the R.V.H. May 6th. Petechial haemorrhages everywhere ; teeth 
 loosened and very tender ; great thirst ; leucocytosis ; vomited in all 
 50 oz. of bloody fluid. Died May 16th. 
 
 P.M. Generalized purpura hsemorrhagica. Haemorrhage into 
 thyroid. Primary sarcoma of cervix uteri. Multiple secondary 
 sarcomata of ovaries. Fallopian tubes, stomach (34.786), peritoneum, 
 spleen, kidneys, Uver, lungs, suprarenals, and skin. The spleen 
 was coarsely mottled, deep carmine-red, with firm yellowish areas 
 scattered abundantly throughout the tissue. 
 
 Micro. Exam. ' The spleen showed great over-development of 
 small round cells, along the trabeculse and along the vessels, evidently 
 lymphosarcoma ; and as it was most extensive in the spleen, this, 
 not improbably, was the seat of primary growth. In parts the growth 
 was so extensive that the splenic sinuses were collapsed and bloodless, 
 in others the small round cells could be well seen infiltrating in fines 
 in the splenic stroma. The trabeculae near the surface were repre- 
 sented by irregularly defined walls or columns of lymphoid tissue, 
 and the same tissue was in parts spread out beneath the capsule. 
 To this subcapsular growth was evidently due the mottled appear- 
 ance of the surface of the organ. The growth had further invaded 
 the splenic veins ; certain sections showing weU an infiltration 
 beneath the intima. In parts the endothelium could stiU be seen 
 covering it in others ; the growth had come to project into the 
 lumina.' 
 
 Ref. : R.V.H. 36.95. Entry No. 1576. 
 
 See Drs. Martin and Hamilton, Journ. Exp. Med., vol. i, 1895. 
 
 Presented by Drs. Stewart and Adami. 
 
43. SPLEEN 157 
 
 .79 Carcinoma. 
 43.79^ Secondary Cancerous Nodule of Spleen. 
 
 A portion of large spleen with well-marked notching of a smooth 
 surface. The capsule is wrinkled. The cut surface shows several 
 large round nodules, 2x7 cm, in diameter ; well-defined, but appear- 
 ing slightly to infiltrate. The cut surface is granular, and shows a 
 faintly radiating appearance. 
 
 Micro. Exam. The nodule of tumour is made up of elongated 
 oval acini separated by narrow bands of fibrous tissue. The lumen 
 of the acinus is in many cases swollen out with necrotic cells. The 
 lining is made up of successive layers of spheroidal cells, which 
 break loose from each other as one passes to the centre of the lobule. 
 The tumour is a spheroidal-celled carcinoma of acinous type. 
 
 Ref. : E. 4970. 
 
 Presented by Dr. Muir, Dissecting Room. 
 
 43.79^ Secondary Carcinoma of the Spleen. 
 
 Two slabs of spleen. The larger measures 40 cm. long and 4 cm. 
 wide, the smaller 17x4 cm. In the larger piece are three large 
 nodules of growth 4, 3-5, and 1-5 cm. in diameter respectively. They 
 are well-defined, subcapsular, and Hmited above by a thin grey line 
 of pinkish colour. There is a suggestion of whorled arrangement. 
 Besides these, there are seventeen smaller nodules about 0-5 cm. or 
 less in diameter. They have a similar appearance to the larger ones, 
 but show no breaking down in the centre. 
 
 The cut surface is not fibrous, and shows few Malpighian bodies. 
 The dark-contoured line 6 mm. from the edge is due to artefact. 
 
 The smaller specimen shows eight similar nodules, two of which 
 are subcapsular. 
 
 Ref. : E. 4338. 
 
 Presented by Prof. W. G. MacCallum. 
 
158 THE HEMOPOIETIC ORGANS 
 
 43.79^ Adenocarcinoma of Spleen (Secondary to Gall- 
 Bladder). 
 
 A very small spleen with a rather granular surface mottled with 
 minute grey spots. The surface is generally dark red, and there is 
 one deep incised notch. There are adhesions on the inner side. At 
 the hilum is a small round, brownish-yellow, cloudy, well-defined, 
 fine, homogeneous nodule about 0-6 cm. in diameter. There is a trace 
 of splenic tissue over its surface, so that it is just subcapsular in 
 position. The trabeculse are prominent and the Malpighian bodies 
 very numerous, distinct, and sand-grain-like. 
 
 From a case of obstruction of intestine following kinking by 
 appendicular adhesions. 
 
 P.M. Mesenteric glands, large, hard, and appeared caseous in 
 spots. Kidney and coronaries arterio-sclerotic. 
 
 Micro. Exam. The nodule is clearly defined and composed of 
 small narrow cleft-like acini of new growth, the lining being formed 
 of very low, almost cubical columnar cells, and they are rather widely 
 separated by structureless fibrous tissue. A broad capsule limits 
 the tumour from the splenic tissue. The spleen capsule is small, 
 as also are the trabeculse. The arteries in the Malpighian bodies were 
 atheromatous. The tumour tissue is much infiltrated with small 
 round cells. 
 
 Ref. : E. 5571. 
 
 Presented by Dr. Kaufmann, P.H.I. 
 
43. SPLEEN 159 
 
 ,70 Cyst Formation. 
 43. 70^ Cyst of Spleen. 
 
 A spleen of moderate size (13x7x3 cm., weighing 140 grm.) 
 laid open to show two small cysts near its lower pole (upper in jar). 
 The larger cyst is 1-25 cm. in diameter, completely enclosed by 
 .splenic substance, and shows slight loculation of its cavity. The 
 lining is smooth and glistening. Adjacent to it is a smaller cyst 
 which reached the surface, being bounded by a slightly opaque 
 capsule. The cyst walls are glistening, but much more irregular 
 than those of the larger cavity. The contents were clear. 
 
 A. H., female Austrian, aged 44. Admitted to the R.V.H. on 
 April 9, 1907, having had symptoms pointing to cancer of the stomach 
 for five months. The condition was found to be inoperable. 
 
 P.M. Scirrhus cancer of anterior wall of stomach. No meta- 
 stases, suppurative peritonitis (streptococcic). 
 
 Ref. : E. 3134a. R.V.H. 46.07. 
 
 Presented by Dr. Klotz. 
 
 43.70- Spleen, Multiple Small Cysts. 
 
 Part of a moderately large spleen, showing a number of minute 
 cysts along the border ; the largest measures 4 mm. in diameter, 
 and is well raised above the surface ; it is rounded in shape ; there 
 is no congestion at the border. The walls are translucent. A 
 number of very small cysts occur in the vicinity. 
 
 Mrs. E. M., aged 27. Death from cerebral haemorrhage. 
 
 P.M. Cerebral haemorrhage ; chronic nephritis ; arterio- 
 sclerosis ; chronic myocarditis ; fat-necrosis of liver ; hsemorrhagic 
 pleurisy ; haemorrhages into skin. 
 
 Micro. Exam. The fibrous tissue is moderately abundant. 
 The splenic tissue is apparently normal. A cyst is shown \vith 
 a lining of a single layer of endothelial cells. It contains coagulated 
 matter and desquamated, highly vacuolated cells. It bears no rela- 
 tion to the ordinary splenic structures. 
 
 Ref. E. 4629. M.G.H., A. 10.197. 
 
 Presented by Drs. Finley and Curry. 
 
160 THE HEMOPOIETIC ORGANS 
 
 .8 TRAUMATA, OR RESULTS OF TRAUMATA, FROM 
 MECHANICAL, CHEMICAL, OR PHYSICAL CAUSES. 
 .819 Rupture. 
 43.819^ Rupture of Spleen. Splenectomy with Recovery. 
 
 A spleen of moderate size which has been torn into two pieces. 
 The larger piece measures 7 x 8-5 X 4-3 cm. ; the smaller 4-6 x 7-5 X 
 3 cm. ; so that the total organ measured 10-6 x 8-5 X 4-3 cm. A 
 fissure runs along the upper segment parallel to the torn border. 
 There are three contusion marks at the posterior border, and one 
 at the interior. The capsule is tense. The organ is pale, save at 
 the region of the tear, where it is blackened. The lower extremity is 
 quite black, and its capsule is tense. The cut surface of the lower end 
 is very deeply coloured, while the upper one is pale. A portion of 
 deeply congested omentum is mounted beside the organ in the jar. 
 
 On Feb. 28, 1912, in the afternoon, a Jewish boy was tobogganing 
 on Fletcher's Field, when he encountered a tree, but failed to jump 
 off and avoid it. He was struck in the side, and lay where he fell for 
 a little while before proceeding home, which was a few hundred yards 
 away. The pain increased so much that a doctor was called in five 
 hours later, and he was removed to the hospital. The operation 
 revealed the tear in the spleen, and that the abdomen was full of 
 blood. The whole organ was removed. The only event was a slight 
 rise in temperature for three weeks, and delayed heaUng. The patient 
 was alive and well on March 11, 1913. 
 
 Micro. Exam. The section through the area of haemorrhage 
 shows almost entire loss of differentiation owing to infiltration with 
 blood. The parts adjoining show oedematous pulp- tissue and folHcles, 
 alternating with irregular and almost discrete focal haemorrhages. 
 In both cases the effused blood has become a homogeneous, almost 
 structureless, mass. 
 
 Ref. : E. 4874. R.V.H. 512.12. 
 
 Presented by Dr. Garrow. 
 
43. SPLEEN 161 
 
 IV. I 
 
162 THE HiEMOPOIETIC ORGAN^ 
 
43. SPLEEN 163 
 
 M 2 
 
164 THE HEMOPOIETIC ORGANS 
 
43. SPLEEN 166 
 
166 THE H.EMOPOIETIC ORGANS 
 
43. SPLEEN 167 
 
168 THE HEMOPOIETIC ORGANS 
 
43. SPLEEN 169 
 
170 THE HEMOPOIETIC ORGANS 
 
431. SPLENIC CAPSULE 
 
 CATALOGUE * 
 
 .1 ANOMALIES. 
 
 None in this series. 
 
 .2 CIRCULATORY DISTURBANCES. 
 
 None in this series. 
 
 .3 INFLAMMATIONS. 
 
 .325 Purulent Inflammation. 
 431.325^ Suppurative Perisplenitis. 
 
 The spleen is small and its surface marked with perisplenitis 
 in large patches of yellowish-grey exudate corresponding to the sites 
 of non-contact with adjoining viscera. The capsule was a little 
 wrinkled. The cut surface is red, the Malpighian bodies small, and 
 the pulp soft. 
 
 Mrs. Annie M., aged 44, was admitted to the R.V.H. (March 
 1911) with symptoms of carcinoma uteri which had existed six months. 
 She had had six children. A panhysterectomy was done. 
 
 P.M. Purulent peritonitis, infarct of right lung, perisplenitis, 
 chronic interstitial keratitis. No secondary deposits. 
 
 Micro. Exam. Malpighian bodies small and poorly defined. 
 There is desquamation of the endothelium of the splenic channels. 
 The pulp contains many eosinophile cells. 
 
 Ref. : R.V.H. 46.11. E. 4684. 
 
 Presented by Dr. Adami. 
 
 * For abbreviations used in this Catalogue, see p. xviii. 
 
172 THE HEMOPOIETIC ORGANS 
 
 .36 Inflammations due to Acid-fast Bacilli. 
 .361 Tuberculous Inflammation. 
 431.361^ Tuberculosis of Spleen. Involving Capsule. 
 
 A smaU spleen (10x6-5x2-5 cm., weighing 110 grm.), whose 
 surface is intimately adherent with the diaphragm on the one side, 
 and is covered with rather large creamy nodules on the other. These 
 nodules are rounded, sHghtly lobate, sharply defined, and show no 
 adjacent congestion. The cut surface of the spleen shows its sub- 
 stance riddled with small tubercles which are almost of a size and 
 present sHght peripheral congestion. There is little pulp-tissue left. 
 There is no evidence of breaking down within the nodules. 
 
 D. R., male, aged 11, was admitted to R.V.H. Sept. 26, 1911, 
 for general weakness. Von Pirquet negative. No tuberculosis in 
 family. Was very emaciated. Glands not enlarged. Abscess in 
 umbilicus. Temperature remittent. Died Dec. 7, 1911. 
 
 P.M. Caseous tuberculous peritonitis. Tuberculous perihepatitis, 
 perisplenitis, multiple abscesses in abdomen. Mihary tuberculosis 
 of liver, spleen, and kidney. Accessory spleen. 
 
 Micro. Exam. The capsule is much thickened by caseous 
 matter. The pulp is congested. There are caseous areas enclosed 
 in fibrous connective tissue, but no epithehoid cells. The follicles 
 are few in number. A few giant cells occur at the edge of some of the 
 caseous areas. In another section a number of caseating tubercles 
 of large size are present. 
 
 Ref. : E. 4785a. R.V.H. 173.11. 
 
 Presented by Dr. Gruner. 
 
 431.36P Hyaloserositis and Capsular Tubercles of 
 Spleen. 
 
 A moderately large spleen whose surface is completely hidden 
 by general adhesions in which are embedded numerous caseating 
 tubercles. The anterior surface shows thickening of the capsule 
 over a large area. The cut surface is dark coloured and homogeneous, 
 and presents but few Malpighian bodies of moderately large size. 
 
 From a case of generalized conglomerate tuberculous peritonitis, 
 commencing in the mesenteric lymph-nodes. There was no tuber- 
 culosis in the thorax. 
 
 There is no microscopic evidence of tuberculosis in the spleen 
 substance proper, except where invaded from the capsule. 
 
 Ref. : E. 5475. P.H.I., Ap. 7.13. 
 
 Presented by Dr. Kaufmann. 
 
431. SPLENIC CAPSULE 173 
 
 .39 Productive or Proliferative Inflammation. 
 
 Chronic Perisplenitis. 
 
 431.39^ Chronic Perisplenitis. Old Adhesions and 
 recent Acute Inflammation. 
 
 The spleen is small, measuring 11-2 x 5-6 x 3-8, and has a very- 
 rough surface from old perisplenitis ; there is a layer of recent 
 yellow lymph over the anterior surface, and adhesions at the lower 
 end. The cut surface is concave and mottled with pale irregular 
 areas running into each other. The Malpighian bodies are not con- 
 spicuous. The consistence was much increased. 
 
 Mrs. M., aged 32, was admitted to the R.V.H. December 1910 
 sujffering from a pyosalpinx which had led to pelvic celluhtis and 
 general suppurative peritonitis. She had only had symptoms for 
 two weeks. 
 
 P.M. Recent abortion ; general peritonitis ; enlarged lumbar 
 and mesenteric glands ; double salpingitis (gonococcic). 
 
 Micro. Exam. The capsule is thickened and the reticulum is 
 conspicuous. The Malpighian bodies are well defined, but the central 
 vessel is hyaUne. The channels are dilated and engorged. 
 
 Ref. : R.V.H. 176.10. E. 4550b. 
 
 Presented by Dr. Adami. 
 
 431.39^ Chronic Perisplenitis. 
 
 The major portion of a moderately large spleen, measuring 
 11x8x4 cm. Its surface is concealed by very dense adhesions to 
 the diaphragm. At each extremity the membranous and stringy 
 deposit is transparent enough to enable the splenic capsule to be seen 
 beneath. 
 
 The cut surface is mottled with rather large, dark-red, ill-defined 
 areas. There is no increase of the trabecular tissue. The weight 
 was 100 grm., the consistence was hard. 
 
 J. S., male, aged 72. Admitted to M.G.H. March 25, 1913, for 
 cancer of the oesophagus. He took alcohol to excess. 
 
 P.M. Carcinoma of oesophagus, secondary in larynx, lymph- 
 glands,' and Hver. Chronic interstitial nephritis. Old perisplenitis. 
 Aortitis. 
 
 Micro. Exam. The capsule is much thickened. The fibres of 
 
174 THE HiEMOPOIETIC ORGANS 
 
 which it is composed are not laminated, or parallel to the surface of 
 the viscus, but pass out radially. There are but few nuclei present. 
 The splenic pulp is very rich in specific cells. 
 Ref. : E. 5552. M.G.H. 13.55. 
 
 Presented by Drs. Finley and Burgess. 
 
 Hyaloserositis. 
 
 431.39^° Spleen with Hyaloserositis. 
 
 A moderately enlarged spleen showing an opaque whitish capsule 
 Uke ' icing ' of moderate thickness, without localized thickenings. 
 A hne of bright ochre mottling can be seen in one place. Ths spleen 
 pulp is apparently normal. 
 
 J. McG., male, aged 60, was the subject of gonorrhoeal stricture 
 and was a hard drinker. He died of cirrhosis of the Uver, and had 
 vesical calcuU and an enlarged prostate. 
 
 Micro. Exam. Concentric layers of fibrous tissue, showing few 
 nuclei. The trabeculae were prominent and fibroid. The tissue was 
 markedly congested. 
 
 Ref. : R.V.H. 115.08. E. 3441. 
 
 Presented by Dr. Adami. 
 
 431.39^^ Hyaloserositis of Spleen. 
 
 A spleen of approximately normal size, measuring 1 1 X 7-5 x 4 cm., 
 whose surface is very much roughened, irregular, and opaque. 
 The lower part of the opaque area in front is quite smooth over a small 
 distance, and has the appearance typical of hyaloserositis. The cut 
 surface shows thickening of the capsule to the extent of 4 mm. 
 There is a reddish-brown colouration of the inner edge, which is 
 sUghtly scalloped. The pulp is fibrous. Malpighian bodies are hardly 
 visible. 
 
 The splenic artery is moderately sclerosed. 
 
 C. K., male, aged 76. No cHnical notes available. A case of 
 carcinoma of the tongue, associated with well-marked arterio-sclerosis 
 and obsolescent tubercles of the lungs and granular kidney, 
 
 Ref. : R.V.H. 68.96. E. 764c. 
 
 Presented by Dr. Martin. ^ 
 
431. SPLENIC CAPSULE 175 
 
 431.39^2 Hyaloserositis of Spleen. 
 
 A small spleen, 8-5 x 6-5x3 cm., showing irregular plaque-like 
 thickenings of its capsule, giving it a rough whitish surface. There 
 is a Httle recent lymph at one pole. The cut surface is dark red and 
 homogeneous. The Malpighian bodies are normal in size and not 
 very distinct. The capsular thickening is only shght, but universal. 
 
 Henry P., male, aged 76, was in hospital eight days before death 
 and had been ill a month. He was operated on for hypertrophied 
 prostate. There was chronic interstitial nephritis with large cysts 
 in the kidney. (See Specimen No. 51.39.) 
 
 Micro. Exam. The lymphoid tissue was very diffuse. There 
 was some debris of broken-down red blood cells present. 
 
 Ref. : R.V.H. 118.07. E. 3103b. 
 
 Presented by Dr. Adami. 
 
 431.39^^ Hyaloserositis of Spleen. 
 
 A rather small spleen with a very puckered and opaque capsule. 
 The upper two-thirds show a uniform thickening, characteristic of 
 hyaloserositis, which is sharply defined from the remainder, rather 
 yellow over the capsule. Tags of lymph are adherent all over the 
 surface. The cut surface is pale and shows new structure. 
 
 Ref. : A.M.M. 2482. E. 1921. 
 
 Presented by Army Medical Museum. 
 
 431.39^* Hyaloserositis of Capsule of Spleen. 
 
 A small spleen. The capsule is slightly thickened, and is raised 
 in irregular hemispherical plaques almost simulating bhsters, having 
 a translucent bluish appearance. Near the border, which is free 
 from notches, the plaques come to be larger and more resemble icing. 
 
 F. G., male, aged 21. Death from gangrenous appendicitis 
 with perforation and retroperitoneal suppuration extending up to 
 the diaphragm. Chronic thickening of capsule of right kidney. 
 LocaUzed necrosis of pancreas ; locaUzed peritonitis round wound. 
 Hsemosiderosis of Hver. 
 
 Ref. : R.V.H. 69.95. 
 
 Presented by Drs. Bell and Adami. 
 
176 THE HEMOPOIETIC ORGANS 
 
 Localized Hyaloserositis. Lamellar Fibroma. 
 431.39^*^ Hyaloserositis and Infarct of Spleen. 
 
 A small spleen, measuring 9 X 6-5 X 2-5 cm. The outer surface 
 shows an oblong area of cream-coloured thickening, considerably 
 raised above the surface in some parts. The edges are clearly defined, 
 and are sUghtly lobated. The capsule is wrinkled. The cut surface is 
 deeply engorged, showing punctate mottling. A wedge-shaped 
 infarct of grey colour is seen. This is marked out by a dehcate vivid 
 red hne. 
 
 T. S., male, aged 85, was admitted to asylum for epilepsy. He 
 died of tuberculous broncho-pneumonia and thrombosis of aorta 
 extending into the iliacs. 
 
 Ref. : E. 5304b. P.H.I., Verdun. 
 
 Presented by Dr. Sims, 
 
 431.39^^ Lamellar Fibroma of Spleen. 
 
 A small spleen, showing a locaHzed area of hyaloserositis, fully 
 1 cm. in thickness, whose edges are scalloped and project prominently 
 above the general surface of the wrinkled capsule ; it thus has the 
 appearance of icing, and it is of the consistence of cartilage. The 
 cut surface shows some evidence of lamination and is semi-translucent. 
 The capsule can be seen to be continued beneath it. The spleen-pulp 
 is fibrous and Malpighian bodies are normal. 
 
 G. R., male, aged 43, Cough with profuse expectoration, weakness 
 and loss of appetite set in in the end of March 1907, The patient 
 became much emaciated and died May 11, 1907, 
 
 P,M. Acute broncho-pneumonia ; bronchiectasis ; chronic 
 nephritis, pleuritis, and pericarditis ; chronic perisplenitis. 
 
 Ref. : M,G,H., A, 07,87, E, 3022, 
 
 Presented by Dr. Duval, 
 
431. SPLENIC CAPSULE 177 
 
 431.38-^ Hyaloserositis of Capsule of Spleen. Lamellar 
 Fibroma. 
 
 A very small spleen laid open. The capsule is everywhere 
 thickened, but near the hilum is a locaHzed hard mass, 1-2 cm. 
 thick, of translucent pink colour, laminated structure, and 
 cartilaginous hardness. The outer surface is regular in outline, 
 the inner is irregularly scalloped. This portion corresponds to the 
 ' lamellar fibroma '. The spleen-pulp itself shows no abnormaUty. 
 
 Mrs. M. M., aged 48. Died within 20 minutes of admission to 
 the hospital. She had been ill for two years with weakness, short- 
 ness of breath, palpitation of the heart, and extreme anasarca. 
 
 P.M. Obliterative pleurisy, ' icing ' under lower lobe of each 
 lung, adherent pericardium, ascites ; shortening and thickening of the 
 omentum, parietal peritoneum, and Uver. Duodenal ulcer ; sclerosis 
 of renal, mesenteric, and other abdominal arteries. 
 
 Micro. Exam. The spleen is atrophied, the trabeculae being 
 relatively more numerous than usual ; the capsule is irregularly 
 thickened and covered with tags of old adhesions. The thickening 
 of the capsule is due to a proliferation of the fibrous tissue, but 
 is more cellular than in the case of the pleura and the Glisson's 
 capsule. The Malpighian bodies and spleen-pulp show no abnor- 
 mahty. In the blood-vessels are great numbers of organisms, but 
 the pulp is free. 
 
 Agar-cultures gave a baciUus of the colon group. 
 
 Ref . : R.V.H. ' On a Somewhat Rare Form of Chronic Inflamma- 
 tion of the Serous Membranes (Multiple Progressive Hyaloserositis),' 
 by A. G. Nicholls, M.A., M.D., R.V.H. Bulletin, vol. i. No. 3. E. 43. 
 
 See also Specimen No. 25.39. 
 
 Presented by Drs. Hamilton and Nicholls. 
 
 431.39-^ Localized Hyaloserositis of Capsule of Spleen. 
 
 A small spleen (10-4 x 6-2x2-8 cm.), showing two-thirds of its 
 surface covered by a thick cartilaginous ' icing ' of absolutely smooth 
 surface, and sUghtly lobate contour. There are a few deep, round, 
 punched-out holes here and there. The remainder of the surface of 
 the spleen shows no change. The capsule is very tense. The cut 
 surface is rather dark and quite homogeneous. The Malpighian 
 bodies are not visible, and the trabecular tissue is not increased. 
 The inner surface of the capsule at the thickened part is perfectly 
 smooth and clearly defined from the splenic tissue. 
 
 IV. I J^ 
 
178 THE ILEMOPOIETIC ORGANS 
 
 J. S., male, aged 72. Admitted to M.G.H. from P.H.I,, Verdun, 
 Dec. 29, 1908, with a hard irregular tumour on right side of neck 
 behind angle of jaw, extending from the mastoid to mid-hne of neck, 
 fixed to deep structures. No other glandular enlargement. History 
 of onset of sweUing five months previous. Died under operation for 
 removal of glandular sweUing Jan. 5, 1909. 
 
 P.M. Chronic pericarditis, myocarditis, endocarditis, nephritis, 
 bronchitis, hepatitis, and pancreatitis ; broncho-pneumonia, calculus 
 of common duct, hyaloserositis of liver and spleen. 
 
 The spleen weighed 175 grm., capsule white and of cartilaginous 
 consistency, and about 0-5 cm. thick, except over small area at each 
 pole. Pulp dark red and friable. Malpighian bodies and trabeculse 
 poorly distinguished. 
 
 Ref. : E. 4821. M.G.H., A. 09.3. 
 
 Presented by Dr. Rhea. 
 
431. SPLENIC CAPSULE 17^ 
 
 .70 Cyst Formation. 
 
 431.70^ Cysts of Splenic Capsule. 
 
 Spleen, measuring 9-7 X 1-7x2 cm., shows collections of small 
 cysts along the anterior border for a length of 5 cm., and a breadth 
 of 1-2 cm. in the widest part. They are capsular. There is no other 
 noteworthy point in the organ. 
 
 Mrs. M. S., aged 44, was admitted to the R.V.H. July 2, 1913, 
 for a large chronic caUous gastric ulcer. The chnical history has no 
 bearing on this specimen. 
 
 P.M. Chronic caUous gastric ulcer with erosion of blood-vessel 
 and death from haemorrhage ; acute necrosis of hver ; cavitation 
 of adrenal ; granular kidneys. 
 
 Micro. Exam. The cysts are dilatations of the lymphatics ; 
 they are Kned by flat endothelium and contain slightly coagulable 
 material. The pulp- tissue is very loose. The Malpighian bodies are 
 very smaU. 
 
 Ref. : E. 5610. R.V.H., S. 107.13. 
 
 Presented by Dr. Gruner. 
 
 N 2 
 
180 THE HEMOPOIETIC ORGANS 
 
 .7 PROGRESSIVE CHANGES. 
 .79 Malignant Tumours. Carcinoma. 
 .796 Adenocarcinoma. 
 431.796^ Peritoneal Cancer of Spleen. 
 
 A portion of spleen, a large part of the surface of which shows 
 moderate thickening, of pinkish colour and irregular outhne. On 
 the cut surface the thickening is seen to be 2 mm. deep and resting 
 upon a normal capsule. The spleen-pulp is dark in colour, and the 
 Malpighian bodies are normal ; no evidence of fibrosis. The surface 
 is roughened here and there in parts other than the diseased area 
 by tags of lymph. (Contrast with this the appearance of hyaloserositis 
 in Specimens No. 431.39io-23.) 
 
 G. M., male, aged 19. Abdominal pain began in July 1909, 
 six months before death, and abdominal swelhng was noticed 
 a little later with some epistaxis and hsematuria. On Oct. 4th 
 194 oz. of fluid were removed from the abdomen by paracentesis. 
 An irregular nodular mass in the upper quadrant was then made out, 
 a,nd a large mass was also detected in the rectum. Paracentesis 
 of the abdomen was performed again on Oct. 12th. Died Dec. 25, 
 1909. 
 
 P.M. Cancer of transverse colon with extension into great 
 omentum and metastases into parietal peritoneum, diaphragm, 
 pleura, abdominal, pelvic and thoracic glands, liver, adrenals, and 
 left ureter. Caseous tuberculosis of left lung. 
 
 This was an unusual case of cancer of the transverse colon with 
 remarkable cancer en cuirasse of the parietal peritoneum, simulating 
 chronic hyaloserositis. 
 
 Micro. Exam. There was no secondary cancer within the organ, 
 but the siuiace formed thick layers of growth composed of adeno- 
 matous masses in a relatively abundant fibrous stroma. The 
 alveoli were sharply defined, and gave the impression of having 
 a distinct basement membrane on which was placed a layer of cells, 
 sometimes one, sometimes two or three cells in thickness, the cells 
 being elongate or irregularly columnar. These alveoh had a 
 moderately long lumen containing cell debris. 
 
 Ref. : R.V.H. 140.09. E. 4048. 
 
 Presented by Dr. Adami. 
 
431. SPLENIC CAPSULE 181 
 
182 THE H.EMOPOIETIC ORGANS 
 
431. SPLENIC CAPSULE 183 
 
184 THE HiEMOPOIETIC ORGANS 
 
431. SPLENIC CAPSULE 185 
 
186 THE HEMOPOIETIC ORGANS 
 
44. THYMUS GLAND 
 
 INTRODUCTION* 
 
 Anatomy. A two-lobed organ situate partly in the thorax 
 and partly in the neck. It arises in the same manner as the tonsil, 
 from a thickening of the hypoblast in the third cleft recess. The 
 thickened area pouches out and undergoes subdivision into small 
 buds or acini. Lymphoid cells come to be associated with these 
 buds, and the supporting tissue is derived from the surrounding 
 mesoblast. Two lateral lobes are completely separated off from the 
 original single mass. They come together anteriorly and below, 
 while their upper ends are found to pass under the thyroid at the 
 time of birth. The maximum development of the organ is attained 
 by the end of the second year, after which time it gradually dimin- 
 ishes in size, undergoing a replacement of lymphoid by fat cells. 
 
 Histologically, the thymus is found to consist of a cortical 
 and a medullary portion, broken up into polygonal lobes by narrow 
 bands of connective tissue. The whole is enclosed in a firm fibrous 
 capsule. The gland-substance proper is composed of lymphoid 
 cells, which possess very intensely staining nuclei. The cells of the 
 cortical portion differ somewhat in appearance from those of the 
 medullary portion. There is some evidence for beheving that these 
 cells are not true lymphocytes. 
 
 Scattered amongst the lymphoid cells are small nests of epithehal 
 cells, known as Hassall corpuscles. These are considered to be 
 reUcs of the gill-cleft epitheUum. Some authors have regarded their 
 relation to the production of the lymphoid cells around as being very 
 intimate. 
 
 Physiology. The gland is generally beUeved to be a blood- 
 forming organ, of great importance for foetal life and early childhood. 
 The fact that its presence bears a definite relation to the develop- 
 ment of the body as a whole, points to the suggestion that its real 
 function is of far-reaching importance. At the present time, the 
 student should preserve an open mind about this question. 
 
 The Museum Collection. Almost the only feature of pathological 
 interest that can be exhibited in a museum preparation of the 
 thymus gland refers to the existence of variations in size at different 
 ages. The anatomist, as above mentioned, regards the maximum 
 
188 THE HEMOPOIETIC ORGANS 
 
 size to be attained at the age of 2 years. Our series shows that the 
 bulk of the thymus may be considerable even at the age of 17 
 (44.72^). Even up to the years of 30 or 60 quite a large gland 
 may be found, in the experience of autopsy work. 
 
 The average size natural to the new-born child is shown in the 
 anatomical specimen 44^. 
 
 Enlargement of the gland in association with increased lymphoid 
 tissue throughout the body (so-called status lymphaticus), is ex- 
 emplified by 42.526i'2. 
 
 The only other feature of pathological interest illustrated in this 
 series is the occurrence of sarcomatous development in the thymus. 
 The specimen 42.786^ affords a very good example of a case in 
 which the thymus has undergone lymphosarcomatous change and 
 grown upwards into the neck and towards the axilla, producing 
 a very large mass with the clinical features of Hodgkin's disease. 
 Such a change is usually aptly described for clinical purposes as 
 ' mediastinal tumour ', and the student is advised to consult the 
 section of mediastinal tumours for comparison with this particular 
 specimen (01.78). 
 
 0. C. G. 
 
DETAILED TABLE OF CONTENTS 
 
 44. THYMUS GLAND 
 
 Ages, Size at dififerent : 
 
 
 Birth 
 
 . 44.721. 
 
 1 year 
 
 . 44.5262. 
 
 7 years 
 
 . 44.72*. 
 
 17 years . 
 
 . 44.722. 
 
 35 years . 
 
 . 44.723. 
 
 Hypertrophy of 
 
 . 44.721-5. 
 
 Lymphosarcoma of 
 
 . 42.7861. 
 
 ? Persistent, quoted in . 
 
 . 41.71'; 43.618. 
 
 Status lymphaticus, Thyi 
 
 musin 44.5261 -2. 
 
 Tuberculosis, Thymus in 
 
 . 44.5261; 44.72^ 
 
 Typhoid, Thymus in 
 
 . 44.72^ 
 
44. THYMUS GLAND 
 
 CATALOGUE * 
 
 .1 ANOMALIES. 
 See under 44.526. 
 
 .2 CIRCULATORY DISTURBANCES. 
 
 None in this series. 
 
 .3 INFLAMMATIONS. 
 
 None in this series. 
 
 .4 INFECTIONS. 
 
 None in this series. 
 
 * For abbreviations used in this Catalogue, see foot of page xviii. 
 
44. THYMUS GLAND 191 
 
 .5 GENERAL OR CONSTITUTIONAL DISEASES. 
 .52 Diseases of Ductless Glands. 
 .526 Status Lymphaticus. 
 44.526^ Thymus Gland, Enlargement at 14 Months 
 in Status Lymphaticus. 
 
 Heart of child with thymus in situ above it. The gland is about 
 the same size as the heart itself, measuring 4x5 cm. It has two 
 distinct lobes. 
 
 E. v., female, aged 14 months. The child was well developed 
 but anaemic, with enlarged tuberculous cervical glands. Died on the 
 table during operation for removal of the glands. 
 
 P.M. Tuberculosis of cervical glands ; hyperplasia of mesenteric 
 glands and of thymus. 
 
 Ref. : R.V.H. 72.98. Entry No. 653. 
 
 Presented by Dr. Adami. 
 
 44.526" Thymus, Tonsils, Lymphoid Elements of 
 Intestine and Mesenteric Glands in Status 
 Lymphaticus. 
 
 The tonsils are about the size of the thumb, and the papiUse 
 circumvallatae at the base of the tongue are very prominent. The 
 thymus (mounted just below) is enlarged, about the size normal 
 in a child of 1 year, measuring 9x4 cm. The mesenteric glands 
 (below) vary in size from a pea to a marble. There is a long strip 
 of small intestine in the jar, and throughout its whole length the 
 soHtary follicles and Peyer's patches are much enlarged. 
 
 F. C, male, aged 7. Sudden death after compound fracture 
 of right tibia and fibula. 
 
 P.M. All the lymphatic structures were hypertrophied. 
 Ref. : R.V.H. 149.03. Entry No. 948. 
 
 Presented by Dr. McCrae. 
 
192 THE HEMOPOIETIC ORGANS 
 
 .7 PROGRESSIVE CHANGES. 
 .72 Hypertrophy. 
 44.72^ Thymus. Enlargement at Birth. 
 
 The specimen consists of neck and thoracic organs, showing 
 a bilobed thymus of large size. The lobes are fiat and leaf-Uke, 
 and have a larger surface area than the heart. 
 
 The thyroid is also enlarged. 
 
 Infant K., new-born, male ; case of status lymphaticus. 
 
 P.M. Showed the thymus enlarged so much as to encroach upon 
 the greater part of the pleural cavities. The mesenteric glands were 
 not enlarged. There was a fat deposit beneath the pleura (see 
 Specimen No. 25.622^). There was also a hypospadias (see Specimen 
 No. 58.1). 
 
 Ref. : Mat. 81.08. Entry No. 3113. 
 
 Presented by Dr. Klotz. 
 
 44.72^ Thymus at 17 Years. 
 
 The gland consists of two long, fiat, narrow lobes, each measuring 
 10 X 2 cm. at the widest part. 
 
 R. L., male, aged 17. Death was due to severe scalding by falUng 
 into a tank of boiling water. 
 
 P.M. Enlarged pelvic and abdominal lymph-glands and spleen ; 
 hydrothorax. 
 
 Ref. : R.V.H. 121.04. Entry No. 1286. 
 
 Presented by Dr. Klotz. 
 
 44.72^ Thymus in Adult. 
 
 The specimen shows a bilobed thymus attached to the larynx. 
 Each lobe of the thymus measures 4x 1-5 cm. The lobes are well 
 formed and their lower extremities thick. 
 
 From a married woman, aged 35, admitted to this hospital 
 Sept. 24, 1904, for tuberculous stricture of the rectum. There 
 was tuberculosis also of the ileum and colon. The spleen was 
 lardaceous. 
 
 The specimen is of interest because it shows how large the thymus 
 may be in an adult. 
 
 Ref. : E. 1425. R.V.H. 134.04. 
 
 Presented by Dr. Klotz. 
 
44. THYMUS GLAND 193 
 
 44.72* Thymus in a Child of 7 Years. 
 
 The specimen consists of the thoracic viscera of a child, dissected 
 to show a flat leaf -like thymus, in which there are indications of the 
 two lobes. It measures 5-5 x 1-5 cm. The cut surface of the gland 
 shows the typical fawn-coloured homogeneous appearance of active 
 tissue. 
 
 From a boy aged 7|, dying of typhoid fever with perforation. 
 There was a history of three days' illness before admission, and death 
 occurred on the 22nd day. The symptoms were of the toxic type. 
 
 P.M. Typhoid ulceration of the intestine with perforation; 
 proliferative plastic pelvic peritonitis; caseous tuberculosis of the 
 glands ; ulceration of the transverse colon. 
 
 Ref. : E. 4365a. R.V.H. 116.10. 
 
 Presented by Dr. Gruner. 
 
 44.72^ Enlargement of Thymus and Hyperplasia of 
 Cervical Lymph-nodes. 
 
 The specimen shows a cluster of enlarged glands with a lobulated 
 surface and slightly mottled with congestion. They are only partly 
 discrete. 
 
 The larynx, tonsils, tongue, and upper end of the oesophagus are 
 mounted with the glands to show the upper circle of enlarged 
 lymphoid foUicles about the rfest of the tongue. 
 
 H. H., female, aged 3 years. Admitted to the M.G.H. on Feb. 18th 
 suffering from burns. Died two hours after admission. 
 
 P.M. Enlarged thymus and tonsils, burns of upper and lower 
 extremities (first and second degree). General lymphoid hyperplasia. 
 
 E. 4803. M.G.H., A. 11.10. 
 
 Presented by Dr. Rhea. 
 
 IT. I 
 
194 THE H.EMOPOIETIC ORGANS 
 
 .78 Sarcoma. 
 .786 Lymphosarcoma. 
 42.786^ Lymphosarcoma of Thymus. 
 
 A large mass of tumour of irregular form. The lower end is 
 thin and of the shape of the lobes of the thymus gland. From this 
 situation it passes upwards, enveloping the trachea, oesophagus, and 
 main vessels of the neck. The mass is more bulky on the left side, 
 where it forms lobulated masses corresponding to individual glands. 
 These are very closely adherent to each other. The portions of 
 tumour between these and the main growth are ossifying and 
 contain numerous sharp spicules in their substance. The bulk 
 of the mass includes the bronchial glands and all the tissues around 
 the hilum of the left lung. 
 
 At autopsy the tumour was found to be growing directly into 
 the dorsal vertebral column and spinal canal, spreading out in the 
 form of a flattened mass between the dura and the bone for the 
 distance of 3-5 cm. The main air- trunks were very firmly enveloped. 
 
 N. J., male, aged 27, was admitted to R.V.H. July 3, 1911, 
 for enlargement of the glands of the neck and axilla ; this had 
 lasted for two years. The condition began as a small tumour, the size 
 of a marble, on the left side of the neck just above the clavicle. It 
 gradually enlarged on both sides of the neck up to behind the ear. 
 Six months ago, the axillary glands began to swell. A week before 
 admission one of the nodules was removed, and was said to be not 
 tuberculous. Two weeks before admission, he noticed numbness in the 
 legs, commencing in the big toe and reaching up to the knees. The 
 legs were weak and stiff. For eight weeks he had been having X-ray 
 treatment, as well as arsenic, which caused the glands to consider- 
 ably diminish in size. Four months ago pain developed in the left 
 elbow and in the back about the third and fourth dorsal vertebrae. It 
 was worse at night. 
 
 On admission the blood-count gauged : reds, 5,320,000; whites, 
 5,470 ; Hb, 72%. The glands were removed on each side of the 
 neck ; tenderness was noted over the fourth dorsal spine ; increased 
 knee-jerks on both sides. 
 
 Nov. 3rd: Polynuclears 69, transitionals 5, large mononuclears 12, 
 small mononuclears 13, eosinophiles 1. Oct. 6th : Hard mass of 
 glands like stone above the left clavicle. Axillary glands on left 
 side shotty. Dullness over sternum and other costal spaces, also 
 between the scapulae. Left limb almost completely paralysed. 
 Nov. 19th : High temperature with delirium. Loss of sensation in 
 legs and back. Diagnosis : Hodgkin's disease, with metastases in 
 spinal cord, intradural, Math pressure on cord. 
 
44. THYMUS GLAND 195 
 
 P.M. Lymphosarcomatosis of superior mediastinum and cer- 
 vical, axillary, and lumbar glands. Invasion of dorsal spine, enlarged 
 lymph follicles of duodenum, enlarged diffluent spleen, red diffluent 
 bone-marrow, obsolescent apical phthisis, hypostatic pneumonia, 
 multiple bed-sores. 
 
 Micro. Exam. The first noteworthy feature is the variable 
 character of the changes. Some glands present excessive fibrosis 
 of the capsule and inter-trabecular tissue as the sole lesion, apart 
 from the necessarily induced atrophy of the original folUcles. There 
 is here no intimation of cells of abnormal type, no eosinophilia, 
 and no obvious endothelial proliferation. Other glands, however, 
 present characters which pass very well for those labelled ' Hodg- 
 kin's disease ' — that is to say, endothelial hyperplasia with marked 
 local eosinophilia and appearance of cells of giant size. Other glands 
 again show a great preponderance of the giant cells which give 
 a very characteristic appearance to the section. These giant cells, 
 and the heterogeneous medley of small uninucleate cells of different 
 form show that we have before us something quite different from 
 what we conceive to be the character of Hodgkin's disease, wliich, 
 as the trend of modern study goes to show, is an infective granuloma 
 of unknown causation. The present case is granulomatous in 
 character, but very atypical, and is distinguishable by the suffix 
 ' sarcoma '. 
 
 A brief review of the cell types found in Hodgkin's disease as 
 contrasted with those found in the present case may be found 
 useful. In Hodgkin's we have (1) Small lymphocytes, which tend 
 to diminish in number as the disease progresses, besides showing 
 degenerative changes in shrinkage of nucleus and fragmentation 
 of the nucleus into sickle-shaped or spherical particles. (2) Plasma 
 cells, which have been derived from some of the lymphocytes ; fre- 
 quently we can see fusion of these cells into miniature plasmodial 
 masses containing two or three nuclei. Such cells are quite charac- 
 teristic in the present case, constituting one of the varieties of giant 
 cells seen, and are associated with small clusters of plasma cells, 
 so that here we have scattered small plasmomata. That such 
 tumours can arise in lymphatic glands has been demonstrated from 
 a study of many of the ordinary lymphatic glands met with at 
 autopsy here in the R.V.H. (3) Mast-cells occur in small numbers, 
 especially near the capsule. (4) Reticular cells. (5) Endothelial 
 cells. (6) Connective-tissue cells. These three last-named types of 
 cells undergo marked proUferation, and come to be so similar in 
 appearance and so inextricably intermingled that it is difficult 
 to pick out the different forms from one another. Without going 
 into the cytological details which will enable the differentiation to 
 be made, we may point out the presence in this case of the epi- 
 thelioid cells which are derived from the endotheUal cells (5), and 
 which appear as very large cells with solitary nucleus. These are 
 very conspicuous also in Hodgkin's disease, but especially so here. 
 Many of these cells show active but atypical mitosis, so that many 
 examples of multinucleate cells, otherwise conforming to this type, 
 are met with. These cells are entirely different from the epithelioid 
 
 o 2 
 
196 THE HEMOPOIETIC ORGANS 
 
 cells met with in tuberculous granulomata, as shown by the intensely 
 staining chromosomes, the wide interval between the separated 
 clumps of chromatic material, and the close resemblance to the 
 basket-nucleus-bearing megakaryocyte of the bone-marrow. Not 
 a few of these cells in the case under consideration present characters 
 like those shown by the bone-marrow. 
 
 As regards the connective- tissue cells (cell-type 6), we find these 
 definitely increased in certain areas, as would be expected to occur 
 as a replacement process in tissue which has become abnormal ; 
 however, it cannot be doubted that we have here an active process 
 by which these fibroblastic cells are actually invading the diseased 
 tissues. The questions arise whether these cells are derived from 
 the adventitia of the vessels of the lymph-gland (or thymus), and 
 whether they play any part in the appearance of some of the abnormal 
 mononuclear elements characteristic of these tissues. 
 
 (7) Neutrophile leucocytes are few. (8) Eosinophiles form perhaps 
 the most striking feature, and we here come upon the hotbed of 
 discussion as to the significance of these cells in a tissue where there 
 is no associated blood-eosinophilia. This discussion we do not 
 propose to enter into here, but merely point out that the cells are 
 so closely clustered along the trabeculae, and along the zones of 
 fibroblastic hyperplasia, that they may be looked on as related to 
 the position of whatever abnormal (toxic) substance is present in the 
 foci of unduly active cell-prohferation. The association of eosino- 
 philes with the normal intestinal mucosa where there is constant 
 absorption of breaking-down products of proteid digestion seems 
 profoundly suggestive of this view. (9) Russell bodies, and Charcot- 
 Leyden crystals. These were not noted in the present case. 
 (10) Necrotic areas. These also were conspicuously absent in the 
 present case. 
 
44. THYMUS GLAND 197 
 
198 THE HEMOPOIETIC ORGANS 
 
44. THYMUS GLAND 199 
 
200 THE HEMOPOIETIC ORGANS 
 
44. THYMUS GLAND 201 
 
202 THE HEMOPOIETIC ORGANS 
 
44. THYMUS GLAND 203 
 
FEINTED IN ENGLAND 
 AT THE UNIVEESITY PRESS, OXVOS.D 
 
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