Report on the etiology and prevention of yellow fever / by George M. Sternberg.

  • Sternberg, George Miller, 1838-1915.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Report on the etiology and prevention of yellow fever / by George M. Sternberg. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    tins. When the necrotic masses were found iu the liver cells they were nearly always at the periphery of the cell nest to the capillary. Aithongh these necrotic masses were generally found in the heani-work of liver cells, careful examination showed them frequently to he in the hepatic veins and iu the capillaries. It would have heeu interesting to have examined sections of the Inngs to determine what part thej' might play in the formation of emholi. The other changes of the liver consisted in intiltration of round granulation cells aroTind the portal vessels. The fatty degeneration and the necrosis was much less marked in this place; e^en in the most advanced cases a certain numhcr of normal liver cells were .always found here. Some of the liver cells, particularly around the portal spaces and adjoining the portions most degeneraled, contained several nuclei, generally oval, and loss vesicular in appearance than the normal nucleus. Rows of smaller cells with similar nuclei were also found, and appeared to indicate an attempt at regeneration. A few of the specimens from autopsies very shortly after death and which were at once placed in alcohol showed rather ill-defined nuclear figures. In the kidneys the changes were generally those indicating an intense parenchy- matous degeneration. They were most marked in the tubules of the labyrinth. The glomeruli in the most cases were atfected. The capsular space was dilated and filled with a granular exudation coagulated hy the alcohol, and frequently in this, round hyaline masses were found. The epithelial cells of the convoluted tubules were very much swollen and the tubules often dilated. The cells often contained larger and smaller fat drops shown by the clear sjiaces remaining after this was dissolved out by the alcohol, but the principal change was a hyaline degeneration of the cells. The cells contained an immense number of clear hyaline granules which stained more brightly with eosin. In many cases there appeared to be a well-defined margin to the cells, and over this what appeared to be a row of cilia. Examination with high- power objectives showed this to be composed of oblong granules of the same hyaline material as that within the cells, and apparently represented an exudation. In the dilated tubules there were large and smaller, generally round, masses of similar hya- line material. The most peculiar change in the kidneys in some cases was the presence of masses of colloid material aud crystals in the tubules. This colloid material was found iu the loops of Henle and in the collecting tubules. It was sometimes in the form of round masses and sometimes in irregular clumps, apparently formed from aggrega- tion of the round masses. These were sometimes united to each other to form long chains. When these bodies are seen singly the center appears depressed and some- times stained more deeply than the periphery. They stained with nearly all of the nuclear stains, but particularly with Bismarck brown and hfematoxylin. They were highly refractive, and either perfectly hy.aline or composed of numerous laminoe, like starch granules. They were generally found iu the lumen of the tubules, but in one case there was a large aggregation between the epithelium and the wall of the tube. The crystalline masses were found in every case examined, aud differed in all respects from the material just described. They were of a yellowish or yellowish- green color, with sharp edges, very highly refractive, and with numerous radiating lines and fractures running from the periphery to the center. They did not stain with any of the reagents used. In addition to these bodies, in some cases the tubules contained beaded strings of a substance evidently derived from the blood, and which stained intensely with both eosin and picric acid. Cnstsboth epithelial and hyaline were found, the latter apparently composed of aggregations of the same hyaline material which was fouud in the epithelium. In some of the tubules considerable numbers of leucocytes were found, but in general it was remarkable, in view of the extent of the parenchymatous degeneration, how little cellular infiltration f hei-e was. The changes in both the liver and kidney appear to be due to a general toxemia rather than to the local presence of infectious agents. They are diffuse, affecting the whole of the organs, aud not small areas.