A study of the various changes which occur in the tissues in acute diphtheritic toxaemia : more especially in reference to 'acute cardiac failure' / by Leonard S. Dudgeon.

  • Dudgeon, Leonard S., 1876-1938.
Date:
1906
Catalogue details

Licence: In copyright

Credit: A study of the various changes which occur in the tissues in acute diphtheritic toxaemia : more especially in reference to 'acute cardiac failure' / by Leonard S. Dudgeon. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    In 1891 Bolton [4] made an exhaustive examination of the neuro-mechanism of the heart in eleven fatal cases of diphtheria. In all instances he found acute degenerative changes in the medulla oblongata, both the sensory and motor nucleus of the vagus being affected. The change apparently begins round the nucleus of the cell in which there is evidence of chromatolysis. This process spreads in every direction throughout the cell, and finally affects the dendrites ; later stages are seen in which the whole cell is finely granular and has only a single layer of Nissl bodies arranged around the periphery. At this period the nucleus looks swollen and is usually excentric. At a still later stage there is a further change in the position of the nucleus, which now appears on one side of the wall of the cell, and frequently causes a local bulging of this wall as if it were about to be extended. In all the eleven cases there was extensive fatty degen- eration of the heart. The vagus nerve was normal in every example. Bolton considers that death in acute diphtheria is due to primary heart failure, which can be accounted for by the extensive fatty change which is found in the heart muscle, and the acute degeneration in the motor nucleus of the vagus. He considers that in the less toxic cases fatty degeneration of the cardiac muscle is absent, but that many fibres show cloudy swelling, although, as a whole, these fibres are very small in number in comparison with the normal fibres. The degree of degeneration in the medulla runs pari passu with that in the heart and all the acute degenerative changes which occur within the first few days of the disease. Technique. Histologxj.—I will first describe in detail the methods which I have employed in every instance for the purpose of identifying fat in the tissues. The portion of tissue to be examined was placed as soon as possible after death in 10 per cent, formalin in normal salt solution for twenty- four hours, (2) then in running water for twenty-four