Aldred Scott Warthin

Heredity of Carcinoma in Man

Excerpt If one may judge from the literature, all of the animal experimental work on the heredity of cancer susceptibility has not made a very deep impression on the general medical mind, because i...

The Constitutional Entity of Exophthalmic Goiter and So-called Toxic Adenoma

Excerpt There is perhaps no more interesting chapter in Internal Medicine today than that dealing with disease of the thyroid, in so far as etiology, symptomatology and pathology are concerned. Thi...

A SILVER - STARCH - GELATINE METHOD FOR THE DEMONSTRATION OF SPIROCHETES IN SINGLE TISSUE SECTIONS

IN I920 and I92I, Warthin and Starry published their two silver-agar methods for the demonstrations of Spirochceta pallida in single tissue sections. Since I92I the second of these methods has been in constant use in this laboratory, where it has been considered a great improvement over all other existing methods in its great saving of time over the Levaditi and allied tissue-block methods, in the correlation of histologic lesion and spirochete localisation afforded by it, and in that in our hands we have been able to obtain by its use a much higher percentage of positive findings of spirochetes than by any other method. Nevertheless, we have not remained satisfied with this method, because of the fact that the results obtained by it are not always uniform, although the working conditions may have appeared to be identical. In certain material showing characteristic syphilitic lesions repeated staining would bring only negative results, or after repeated failures a given section might turn up filled with beautifully stained spirochetes. A rough calculation of our results might be given as 50 per cent. positive spirochete demonstration in histologic lesions of syphilis on first attempt. On repeated attempts and with slight variations of the method the positive correlation of spirochete and histologic lesion would be raised to 65-70 per cent. of cases. This is too far from being a perfect method, particularly when it is considered that our positive results run higher than those obtained by the same method in less expert hands. The apparently capricious results have been studied, and an attempt

The new-formation of hemal nodes in the omentum and mesentery of the dog after splenectomy and ligation of the splenic veins. (Preliminary report.)

The question of the new-formation of splenic or hemolymphnode tissue in the dog after splenectomy has been opened up again by Meyer, 1 who, as the result of the findings of eight dogs examined after splenectomy, at periods of 30, 41, 53, 77, 89, 98, 112 and 126 days after the operation, found no changes in the lymph-nodes, either of the nature of a hyperplasia or regeneration. Doubt was, therefore, cast upon the work of preceding investigators, notably that of Tizzoni. During the years 1910-13 several series of experimental investigations in regard to this point were carried out in my laboratory, with results as yet unpublished. These are now presented here in the form of a preliminary report. Results of SpZenectomy.–Nine dogs were splenectomized and examined as follows: Three one week after the operation; three two weeks after, and three one month after. In no dog was there the slightest change apparent in the lymph-nodes of any part of the body. Five dogs were splenectomized and examined eight months after the operation. In one dog the lymph-nodes and hemolymphnodes were larger than they had appeared to be at the time of operation when these nodes were examined as carefully as they could be. No new-formation of hernolymph-nodes was seen. Five dogs were splenectomized and examined eight and a half months after the operation. No hyperplasia and no new-formation of lymph-nodes was seen. Five dogs were splenectornized and examined nine and a half months after the operation. In one dog there was distinct enlargement of lymphatic and hemolymph-nodes, but no new-formation.

Improved methods for staining spirochaeta pallida in tissue.1

The two methods outlined here present the first satisfactory ones devised for the staining of spirochetes in single sections of tissue mounted upon cover-glasses. We consider them of great value for the following reasons: They are more certain than the Levaditi method of staining in bulk; the time required is shortened to hours, instead of the days required by that method; they have a much greater applicability to practical diagnostic work in that they can be used for single sections, thus permitting a closer control of histological findings. 1. Warthin And Starrys Cover-Glass Method. I. Fix tissues in 4 per cent. formol. 2. Wash thoroughly in distilled water. 3. Imbed in paraffin (alcohol, xylol, paraffin). 4. Cut; mount sections on cover-glasses with albumin fixative. 5. Remove paraffin from section (xylol, alcohol, water). 6. Place cover-glass in a saturated solution of ferric alum, or a 4 per cent. solution of ferrous ammonium sulphate, in incubator for I to 2 hours. 7. Wash in distilled water. 8. Rinse cover-glass with section in a 2 per cent. silver nitrate solution. Cover section with another perfectly clean cover-glass which has also been rinsed in the silver solution, so that the coverglasses are held together by capillary attraction. Then place them carefully on the bottom of a wide-mouthed dark bottle covered with black paper, and cover them with the silver nitrate solution. Cork tightly, and put into incubator for 3 to 24 hours. 9. After impregnation pour off the silver nitrate solution and rinse in distilled water without removing cover-glasses from bottle, by pouring the water into the bottle, shaking gently, and then pouring off. 10. Pour reducing fluid (pyrogallic acid, 4 grams; 40 per cent. formol, 5 cc.; distilled water, 100 cc.) into the bottle.

The toxic action of dichlorethylsulphide (“mustard gas”)

The investigations recorded in these two papers are founded upon numerous series of animal experimentations and also clinical observations of human mustard gassing. 1. Local Action: Skin.—Dichlorethylsulphide (“mustard gas”), in liquid or in vapor form, even in very low concentrations, is an escharotic poison for the animal tissues (skin, conjunctivæ, cornea, mucous membranes of respiratory and gastrointestinal tracts) with which it comes in direct contact. The degree of the injury is proportionate to the concentration of the gas, the time of exposure, individual susceptibility, and local physical conditions, such as moisture, sweating, warmth, pressure and friction. The escharotic action is, for the greater part, painless, the anesthetic effect being especially notable upon the skin; while upon the mucous membranes its action may be more irritant, probably chiefly reflex in character. The cutaneous surfaces most susceptible are those with thinner, more delicate skin, well supplied with sweat glands and hair follicles, where sweat may collect, and which are exposed to friction or pressure, such as the axillæ, flexor surfaces, genitals, inner surface of arms and corresponding surface of trunk, inner surfaces of thighs, between the fingers, etc. There is a penetration of the gas into the sweat and sebaceous glands, and a re-solution of mustard gas vapor into the sweat or sebum occurs. The injuries are particularly striking in their insidious, slowly progressive development, becoming first apparent only some hours after the exposure. Upon human skin the lesion appears as a hyperemia, followed by vesication, eschar formation, sloughing and slow healing, with more or less pigmentation. Depilation may occur; in severe cases the eschar may extend entirely through the corium into the subcutaneous tissues. Secondary infection and gangrene of the eschars occur invariably in cases not properly treated. Milder lesions may show only the earlier stages of hyperemia, vesication or pigmentation. In general the injuries may be classed as burns of first, second or third degree.

A study of the lipin-content of the liver in two cases of pituitary dystrophy. (Preliminary report.)

Studies of the lipins in the curious obesity characteristic of hypopituitarism have not as yet been made. In the case of two autopsies upon bodies showing this condition microchemical studies have been carried out by the writer. One case was a boy of eighteen showing infantilism, obesity and loss of sight (dystrophia adiposo-genitalis). Died after attempted removal of pituitary neoplasm (adamantino-carcinoma); the second case was a man of 29 years, with loss of vision, staggering gait and disturbed mentality. Acromegalic symptoms with secondary hypopituitarism. Round-cell sarcoma of base of skull destroying a hypophysis adenoma. Both bodies showed very marked post-mortem increase of temperature; the source of the heat-production apparently being localized in the panniculi and fatty livers. Gross Appearances of the Fat.-Panniculi thick, in large coarse lobules; when first cut it was glistening, translucent, very firm and light buffy yellow in color. As it cooled it became more buff in color, opaque and very hard. The livers of both cases were large, mottled red and yellow, with fatty shine. Microscopical.-Frozen sections examined optically showed the presence of numerous small anisotropic droplets in liver, adrenals, panniculi, intima of aorta, and elsewhere. In the liver the fine anisotropic droplets are chiefly in the central and midzonal regions. They are present also in a narrow border of preserved liver cells in the peripheral zone. Larger isotropic droplets are scattered irregularly through the lobule, usually occurring in groups. There is in both cases a peculiar necrosis of the inner portion of the peripheral zone (intra-peripheral necrosis). Staining with osmic acid gives a pale gray tint to the fine anisotropic droplets, while the larger fat-drops stain a deep brownblack. Sudan III stains the fine fat droplets a peculiar brownish red; while the larger fat droplets take a deep brick-red to a yellow or pale buff color.

Experimental ligation of splenic and portal veins, with the aim of producing a form of splenic anemia

From the pathological study of four cases of splenic anemia showing partial or complete obstruction of splenic or portal veins due to old thrombophlebitis, the writer was led to believe that the splenic enlargement (fibrosis) and the clinical picture of splenic anemia might be produced experimentally in animals. During the last two years he has carried on a series of observations upon dogs whose splenic veins had been ligated at varying distances from that organ. Briefly, the results have been as follows: In dogs examined from one week to three months after the operation the spleen was found greatly enlarged, firm and dark in color. This enlargement reached its extreme about four weeks after the ligation. In dogs examined after three months the spleen was found to be diminished in size, paler and firmer. In those examined one year after ligation of the splenic veins the organ was found to be greatly atrophic and fibroid, in two cases completely separated into small islands or lobes of splenic tissue, each lobe having a separate vein running into the gastro-splenic omentum, and anastomosing with veins from the stomach. Such a collateral circulation was found established in all cases. All animals with splenic atrophy become very fat. Hyperplasia of the prevertebral hemolymph nodes was noted. There was a slight anemia, the hemoglobin being reduced to a greater degree than the red blood cells. No lasting changes in the white cells were observed. Microscopically the spleen showed a lymphoid atrophy, relative increase of stroma and excessive pigmentation. These experiments would indicate that obstruction of the splenic veins of dogs by ligation is not followed by a fibroid hyperplasia of the spleen but by a partial atrophy. A more or less complete venous collateral circulation is always produced.