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Whenever possible, these have been omitted from filming/ II se peut que certaines pages blanches ajouttes lors d'une restauration apparaissent dans le texte, mais, lorsque cela etait possible, ces pages n'ont pas cte filmies. Q L'Institut a microfilm^ le meilleur exemplaire qu'il lui a Hi possible de se procurer. Les details de cet exemplaire qui sont peut-Ctre uniques du point de vue bibliographique, qui peuvent modifier una image reproduite. ou qui peuvent exiger une modification dans la mithode normale de f ilmage sont indiqu^ ci-dessous. □ Coloured pages/ Pages de couleur r~n Pagp< dr ^ned/ LUp .lagies □ Pe ) tu<.N TEST CHART (ANSI n. d ISO TEST CHART No. 2) 1.0 I.I 13.6 HO 2.0 1.8 1.25 iu 1.6 A /APPLIED IM/^GE I S^ 1653 Eost Moin Street S^S Rochester. New York 14609 USA '-SSr (716) 482 - 0300 - Phone ^S (^'6) 288 - 5989 - Fax ON A GIANT-CELLJD RHABDOMYO SARCOMA FROM THE TROUT. BY J. G. ADAMl, M.A., M.D., F.R.S. (From the Pathological Laboratory, Royal Vic*'(ria Hospital.) UNILATERAL CONGENITAL ABSENCE OF THE PAIRED GENITO-URINARY ORGANS. BY JOHN MCCRAE, M.B., M.R.C.P., Lecturer in Pathology, HcGill University, Montreal. EXFCRIMENT.AL " WORK-ARTERIOSCLEROSIS." AND TRYPANOSOMES IN MONTREAL RATS. BY OSKAR KLOTZ, M.D., (From the Pathological Laboratory, of the Royal Victoria Hospital. ) HK. BINTKD FROM THE MONTREAL MEDIt'AI. JOUBNAL, MARCIl, 1908. / ON A GIANT-CELLED RHABDOMYO SARCOMA FROM THE TROUT. BY J. G. Adami, M.A., M.D., F....S. (From the Pathological Laboratory, Rojal Victoria Hoipttal.) The subject of tumours derived from striated muscle is one that ii ■till involved in considerable uncertainty. French pathologists of the present time, more particularly, report numerous cases of sarcoma which they regard as directly derived from muscle tissue elements, but th's ▼lew 18 not by an^ moans universally accepted. It may be laid dov n as a general rule that the more highly differentiated a tissi' ■, the less is its tendency to afford neoplasms. When we encounter indubitable tumours, containing more or less imperfect but recognizable striated muscle elements, these, with the rare exceptions, are not in association with the ordinary muscles of the body, but are of the nature of mixed tumours, deiived, it would seem, by displacement of cells capable of giving rise to striated muscle elements during the course of develop- ment. Most often in such tumours there is an admixture of cells of other orders, cells of a sarcomatous type, gland cells and, it may be., bone and cartilage and other tissue elements. Another feature that we may lay down as characteristic of tumouis in general is that the cells composing those tumours represent more or less faithfully souie stage of development short of the perfect adult type. If we study the development of striated muscle, we find that there is a pre-existing stage in which the sarcoblasts, the embryonic tells giving rise to this particular tissue, bf tme multinucleate, become, in short, giant cells. In fact, the adult i ascle fibre is itself multinucleate. We should expect, therefore, were tumours derived from striated muscle at all common, to fiind giant-celled growths originating in association with the striated muscle in man. As a matter of fact, in the ordinary rhabdomyoma of man we encounter not infrequent multinucleate cells, but to my knowledge a tumour composed wholly of these, — what may - .-■* I be termed a pure piant-celled rhabdomyoiarcoma i« unknown, or, at least, hag so far failed to gain recognition as a separate entity. By great good fortune. I jun indebted to my colleague, Dr. Hamilton White, for an exquisite \ample of this very condition in a trout caught by him in OctolxT. The fish is the " i 1 trout," and was caught in Balsam Lake, Montfort district, in this ?)rovince. Save for tlio tumour, it was i well grown individual, 14 ii.ehes Ion?, and weighed about thiec- quartprs of .t pound. It will be seen that some 4 cm. behind the main dorsal fin and 1.5 cm. in front of the posterior dorsal fin, there is, on the left side, near the middle line, a very definite tumour. When brought to the laboratory, this was covered by a hoahhy unbroken skin, and projected some 1.5 cm. above the general surface. Oi. dissection, the tumour was found to be Omost spherical in shap and 3 cm. in diameter lying to the left of u. dorsal spines and not attached to these. A layer of muscle appeared to (wss over it, and it had a semi-fluctuuting feel. It was well defined, and was easily separ- ated from the surrounding tissue. On section, the tumour is found to be composed almost wholly of giant cells, varying, it is true, greatly in size and shape. The smdlest cells may contain but two or three nuclei, tlie largest, without exag- geration, many hundred. There is no definite capsule, but at the peri- phery there is a zone exhibiting a moderate grade of small-celled infil- tration, in which the tumour cells proper infiltrate between stiil recog- nizable striated muscle elements. This infiltration, it is noted, extends between the dorsal spines to the right side to a slight extent. These more normal muscle fibres are easily distinguishable; while shrunken, they exhibit regular striation and well marked longitudinal fibrillation. The interesting part is that in making a careful study of these remark- able giant cells certain of them are of very great length as compared with their breadth, and the nuclei are gathered more particularly at one pole. Such cells recall in a very striking manner the buds or processes projecting from the muscle fibre of a mamma', in the process of regeneration after injury and in not a few of them the part of the cell furthest from the grouped nuclei shows well-marked longitudinal fibrillation, while here and there irregular but distinct transverse stri- ation is to be made out. Studyiiifr the various transitional stages, there can be no aoubt that here we are dealing with a rhabdomyosar- coma, and, as I have already indicated, we have encountered a new form of muscle tumour, but one, which from embryological consider- ations, is also to be termed " natural " and to be expected. We have found this in one of the lower animals, and it now remains to be seen whether this form occu™ alio in man, and whether ia niun we have to add to the list of giant-celled tumours, u type jfaining its origin from voluntary muscle. Tunioura in fish an- not unknown. Some twelve years ago, I received from Dr. Decks a relatively large myxofibroma, which he had remove*! post mortem from a cod, caught in the (iulf. If I mistako not, I brought the case before the .Society. Recently, in connexion with the study of the distribution of malignant growths throughout the animal kingdom, there has been an increased interest in the siibji et, and several cases ha\e been reported of tumours of different orders fouud in fn The majority of these cases, curiously enough, are of ailenoniatous and even of definitely carcinomatous type (Scott, (Jilruth, I'lehn, I'i' k, and Bashford's tirst case). Judging from Dr. Marianne Plehn and Pick, and Poll's cases, their most common situation in the Kiilmonid is below the lower jaw in the floor of the mouth. Thia position m their histological structure suggests strongly an oiigin from th\ A tissue. Bashford records a malignant adenoma o' the peritoneal cavity of the Gurnard. The only sarcomatous tumour to which I have found reference is Bashford's second case, thai of a spindle-celled sarcoma of the codfish, the figure given by him, with its loose arrangement of cells, shows some similarity to our own specimen of my.xoflbroma in the same fish. So far, I have been unable to come across the description of any case of a fish tumour at all resembling that here described. BIBLIOGRAPHY. Bai "iford — lleport of the Imperial Cancer Renoarch Fund, No. 1, London, 1904. BaMhford and Murrd.y — Proc. Royal Sopf<^ty London, 73, p. «e, 1904. Ollruth — Annual Report Dlv. of Veterln.iry Science, New Zealand Depart- ment of Agriculture, No, 1, 1902. Pick and Poll— Berliner Kiln. Wochenschr. 30, 1903, Pp. 518, 546 and 678. Plehn (Frl.) — AIl?em. Flschcre! Zeituner. No. 7, 1903. Scott— Transactions New Zealand Institute, 1891. ,^*1." UNILAli.. AL COX(i 'T.aL AUSKXCE OF THK PAIRED OENll miNARY ORGANS. BT IomV McCrab. M.B., M.R.C.P., Lei"tur«r >■ Pfttaologry, .McOlll I'nivcralty, Montreal. Thi • cimrn shu » an abflcci>g of tlu; gt-nital and urinary structures of the loft side, in hi fni- u- ttiosc stnittuns wliieli are bilateral are con- fcmi'd. Till' woman wag forty-nino years old, and had homo one child and had one miscarriage. There was no kidney, ureter, renal artery, ovary. Fallopian tube or broad ligament on 'he left side, and the uterus consisted really of hut half a uterus— the right half; the organ was finger-shaped, and pointed to the right at about au angle of 30 degrees from the sagittal plane, which is the usual position and appearance of a uterus which has but one coinu. The vagina and urethra were ap- parently normal ; the bladder was median and showed no sign of 1 ;'t ureteral opening. The right kidney was a little larger than usual .id was in the noni.al position. The body of the uterus measured Cuii\2x2 (in. The right ovary was very small and •■ rinkled, but the right tube appeared normal. The anomaly has arisen from the fact that on this side there has boon no WollFian body or duct formed, nor any Miillerian duct, and the entire series of structures whi/.: arise from them, kidney, uretor, ovary, parovarium, tube and uterine cornu, is missing. I cannot find how uncommon this combination is; the abeence of each one of the structures concerned is noted in nearly all works, and unilateral absence "f the genital organs is commented upon; the only case at all parallel that I have fnimd is in the Transactions of the Pathological Society-, 1883-4, whciv Mr. Carrington recorded a cai>e somewhat similar, in which the same abnormality of the genital organs was accompanied by a misplaced left kidney. EXPERIMENTAL "WORK-ARTERIOSCLEROSIS." BY OsKAR Klotz, M.D., (From the Pathological Laboratory of the Royal Victoria Hospital.) The experimental work in arteriosclerosis has, up to the present, been mainly of the nature of ineohanically injuring the vesself, or else by introducing foreign loxic substances into the animal body. Of the latter type much has been written in the last four years, and it has been shown that substances like adrenalin chloride, barium chloride, digitalin and nicotine, all of which produce high pressure in the arterial Bystem, are capable of bringing about definite arterial lesions. It has also been shown that certain bacterial toxins act on the vessel walls, either by producing degenerative changes, or else in stimulating the proliferation of certain cells. ^ There has been a considerable controversy as to the nature of these arterial lesions, whether they were the result of the toxic substances, actinjr directly upon the tissue cells, or whether their mechanical effect of increasing the blood pressure was capable of bringing about these changes. Clinically, it has been noted that in the adult, the vessels of thd more active organs show hypertrophy and. sclerosis earlier than in the lees active parts. In right-handed persons the radial arteries are con- siderably more sclerosed than those on the left side, and the reverse is true in left-handed people. Similarly, those whose occupation re- quires them to be constantly walking around and on their feet show the most advanced arterial changes in the vessels of the legs. These facta point to the prominent part that is played by work, in the production of arteriosclerosis, but still the question arises whether in a healthy vessel increased work alone can bring about sclerotic changes, or whether it is necessary to couple the factor with the effect of toxic agents. It was my endeavour to throw some light on this question by experi- mental means. I chose healthy, nine months old rabbits to carry on the experiments. The first animal was treated for one hundred and thirty days, by suspending him by the hind legs for three minutes each day. The endeavour was to increase the pressure and the mechanical stress in the arteries, without employing any drugs. By inverting the animal, the pressure in the thoracic carta and in the arch is decidedly increased over that which normally exists in the animal. At the begin- ning, the animal did not seem to be worried by treatment, but later mmm on it showed aigns of dyspnoea, and the heart beat waa accelerated. Towards the end it was noted that the animal waa much fatigued after each treatment. At autopsy the following was noted: — There were no lesions in the vessels of the brain and no haemorrhages had occurred in this organ. The carotid vessels had a remarkable appearance; the arteries were enlarged to about twice their size, and looked like sclerosed radials. There were distinct headings n the vessels, which were most marked just above their origin from the aorta. These headings were white in colour and encircled the vessels in transverse rings. Similar appear- ances were also present on the subclavian and brachial vessels. The headings were distinctly palpable, while the vessels in general were firmer than normal. The amount of change in these arteries diminished after the bifurcation of the common carotids, though it waa still ap- parent in some of the smaller branches. Thorax and Abdomen. — The lungs were healthy and without change. The heart showed an enlargement of, at least, one and one-half times its normal size. The ascending aorta had its walls thickened, and waa larger than normal. This increased size was apparent as far as the middle of the arch, or just beyond the opening of the left brachial. The wall felt firm and nodular, and did not collapse when its contents were removed. < )pposite the 6th ri the vessel again dilated to twice its size, forming a fusiform aneurys i as far as the diaphragm. This aneurysmal dilatation had firm and brittle walls, in which concentric rings could be distinguished passing about the vessel. Below the diaphragm the aorta again became smaller, but showed thickening of its coat, which was visible as far as the right renal artery. The begin- ning of the cceliac axis was also sclerosed, though no changes were noted in the branches of this vessel. The renal arteries were normal in appearance, and below them the aorta, too, waa without change. There waa no change, to be noted in the iliac arteries, nor the vessels of the legs, nor did the viscera of the abdomen exhibit any microscopical lesions. We have, therefore, produced macroscopical changes in the aorta and its branches above the renal vessels. In these changes the aorta is chiefly involved, while the carotids and the vessels of tlie neck are also sclerosed. Consequent upon the weakening of the lortic wall by sclerosis, a fusiform aneurysm developed in the thoracic a^. ta. -MiCEOSCOPICAIi. Ascending Aorta. — The aortic wall was hypertrophied, the thickening occurring in the intima and possibly in the media. The media, where it waa apparently thickened, waa normal in structure and showed the 3 alternating layers of elaatic fibres and muscle tissue. The intima. where thickened, showed the hypertrophy to be in the muscle elements (of the musculo-elastic layer). There was no connective tissue pro- liferation to be found. With the intimal thickening there was every- where a process of degeneration accompanying it. This degeneration in the mildest form occurred close to the internal elastic lamina, and, in the more advanced types, extended closer to the endothelial surface. The muscle cells themselves were degenerating and disintegrating, leav- ing areas of non-cellular debris. These areas showed many spicules of crystals like those of calcium salts. Many of the cells were vacuo- lated as if containing drops of fat. In one area the media, too, showed degeneration where the muscle cells were entirely wanting, while the elastic bands were thrown into prominence by a darker blue staining, due to a calcification. Fractures were occasionally seen in the elastic lamins. Eemarkable cells were found between these calcified elastic bands. These cells were large with a spherical media and lay in a homogeneous looking matrix with vacuities about them. One was re- minded of the appearance of cartilage cells, though definite cartilage was not to be made out A study of these sections convinces one that the muscular changes are primary. The rupture and changes in the elastic fibres are secondary. Descending aorta just above diaphragm. — The vessel wall was in its greatest extent narrowed. Only short stretches of normal looking aortic wall were seen. The rest of the wall showed a hypertrophied intima, in which the musculo-elastic layer was thickened, while the media was much narrowed. The middle zone of the media showed a band of calcification almost encircling the vessel. There was a narrow strip of media on both sides of the calcified band, which showed the muscle cells wanting to a great extent, while the elastic fibres lay more closely together. The advehtitia nowhere showed change. In the calcified band of the media no cells were to be made out. This degenerative change in the descending aorta resembled that produced in the aorta by adrenalin chloride. Carotids. — In the carotids the changes found were principally located in the intima. The media showed no changes in any part, save such as is produced by the compression of the thickened intima and slightly fatty degeneration along the border of the internal elastic lamina. The intima was in parts normal, consisting of a single layer of endo- thelium lying upon the internal • istic lamina. In other parts thi" • was a thickening of this membrane to that exceeding the thickness > the media. This thickened portion of the intima was made up of a rt^ roperficial and circularly dispoaed layer of connective tissue (poMibly of endothelial origin), while beneath this was a thick layer of lonin. tudinally disposed muscle fibres, with extensive fatty degeneration in them. In this deeper layer of the intima many of the muscle cells had entirely disappeared, leaving behind a granular debris mixed with mmute fatty granules. In somt places this thickened intinm occupied one-half the circumference of the vessel. We have, therefore, in this experiment been able to reproduce bv physical means two kinds of changes in the arterial walls The one iii isolated in the media without intimal change and consists of a pureW degenerative process, with death of the muscular elements and calcifi'- cation of the involved areas, including the elastic fibres. The other change 18 isolated to the intima, and consists mainly of a proliferation of the tissue while a secclary fatty degeneration has occurred in the newly formed tissue. In the lesions of the first type involving the media there has also occurmJ ihe production of aneuiysm. This, as we havB previously pomted out, IS the common result of severe degenerative changes in the I believe, therefore, that we may conclude from these experiments that work pkys a very important role in the production of arterio- sclerosis of different characters, and that even in vessels of different histological structare sclerotic changes can be brought about by increas- mg the work of the artery. And further, as a consequence to certain changes, degenerative in character, taking place as the result of in- creased work m the media of the vessels, aneurysms may result. We understand from Professor J. J. Mackenzie that Dr. Harvey of Toronto, working at Cambridge, has by different methods of increasing arterial pressure obtained marked changes in the arteries. As to the character of these changes, we have no information beyond that f y are arteriosclero^,ic. We gather from Professor Mackenzie's letter tha^ this paper has just been presented to the Koyal Society of London J TRYPANOSOMES IX MONTREAI RATS. BT 0!>itAR, KM)TZ, M.D. (From the Pathological Laboratory of the Roy.! Victoria Hospital.) After Dr Todd's extensive report before this Society on the Trypano- soir.es ox Central Africa Sleeping Sickness, we arc apt to associate this organism with d! .eases in far off lands. There are, however, many vari-«es of trypanosomes, and it would appear that some of the p. imil parasites not 'yet fully worked out will yet be classified amongL„ the trypanosomes. During the winter of 1006-07, Dr. xlaliah and I ex- amined for trypanosomes some forty rats, all obtained in the same locality in Montreal. These examinations all proved negative. Re- cently I examined two rats from a down-town grocery, and found both of them to harbour trypanoeomt>8 in their blood in large numbers^ Subaequent to this, Dr. Rankm found trypanosomes in a rat obtained at the Royal Victoria Hospital. No doubt, if a- ex =ve search were made, *ese trypanosomes would be found in a larg. 3entage of the rats of this city. •, • xl This organism, the T. liewisi, is a ver, common paraaite in the ordinary house rat, some even claim that it is as widely distributed as the rat itself. Kovy, of Ana A-bor, was t'.e first to recognize the T Lewisi in America. Since then, I learn that it has been found in Detroit, San Francisco, Philadelphia, New York, Lincoln, Seattle. Chicago and Ottawa. ^ • 'ii. ( THE MONTREAL MEDICAL JOURNAL A MONTHLY RECORD OF THE PflOGRCSS OF . . . Medical and 5urj|i:icai Sc'ence EDITED av J. GEORGE ADAMI, GEO. E. ARMSTRONG A. D. BLACKADER, G. GORDON CAMPBELL, F. G. FINLEY, WILLIAM GARDNER, H. A. LAFLEUR, JOHN MoCRAE, F. J. SHEPHERD, J. W. STIRLING, ANDREW MACPHAIL, Managing Editor. Subscription price, $3.00 per annum. ADDRESS Che m«iitr<4l mtikai 3oHm4i Co. P O. BOX 273 PUBLISHERS MONTREAL, Can. ■■I