Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 100

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189

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HISTORY OF CAT .*

CASE I .- The first case of lung flukes to come under our servation was that of a female cat. Early in the spring of 25% she with three other kittens was found under an old lumber pie The other kittens were taken away, but this one was kept & grew up as a family pet. After she had become somewhat mr than a year old, we noticed that she had a very peculiar cond This was not clear and free, but rather close and choking We at first thought little of the matter and permitted the cs to remain a pet. The cough gradually grew worse and the d' seemed to lose weight. As we did not deem it well to harel sick cat as a pet we concluded to dispose of her. During the Christmas holidays of 1908 the cat was chloroformed auf autopsied. The lungs at their apices were of normal color, ba at their bases colored nodular areas were to be seen, Tu cutting into one of these areas we were greatly surprised to tal two parasites contained therein. Upon opening the other cosa for now it was evident that these dark colored nodules vert such, other pairs of parasites were found. In all there nz have been 6 or 8 different cysts and each contained two parasite

CASE II .- The second case of lung parasites was also it female cat. The cat, a kitten of the cat in the first case, Wii born on March 25, 1908. When but a few months old she 's

. gave indications of a throat or lung trouble by a choking conga This gradually became more marked and the cat grew dx Finally she had several hemorrhages and then she was ch.om formed, and autopsied on Easter Sunday, 1909, in the Pathokg cal Laboratory of the Milwaukee County Hospital.

Anatomical Findings .- With the exception of the lungs t'y findings were negative.

Lung of Cat .- The upper lobe of the lung is of salmon rel color, crepitates and shows no infiltration except in the lower part where a few areas of induration can be seen which som what resemble tuberculosis nodules. The nodules vary in six In the lower lobe there are more of these areas, some of wax? are from 1 to 2 mm. or more in diameter. These have a Sez. translucent appearance, and are of an opaque grayish-white cok: Other areas in the lower part of the lower lobe are of a dal dirty brownish-gray with a yellowish-green tinge in the underlying tissues. Along the mediastinal portion there are more of thes grayish, dull, semitranslucent areas. In the lower part of :">

* History written by Edwin Hirsch, Wauwatosa, Wis.

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garance in the lung. On section one cuts into a definite cyst ch contains two lanceolate bodies somewhat coffee bean jed, but the blunter head end differs from the narrower end and thus to some extent destroys the analogy of the :e-bean. The fluke resembles the larva of the potato bug 'sal surface). The flukes each have a rounded dorsal and a ened ventral surface.t

ne flukes in this case measured 11 mm. long by 4 to 4.5 mm. and in the fresh live condition about the same in the dorso- ral diameter. On inspection one can see dark, blackish-blue s which, as I have found on further study, are the internal

For a detailed description of the parasite I will quote from trated Key to the Trematode Parasites of Man. Bulletin, 17, Hygienic Laboratory, Treasury Department, Washington, ·

'YPE SPECIES PARAGONIMUS WESTERMANII (KERBERT, 1878).

Asiatic Lung Fluke-PARAGONIMUS WESTERMANII-(Ker- คา

bert, 1878)-Stiles & Hassall-1900 of Man.

Ipecific Diagnosis .- Paragonimus: 8 to 16 mm. long (after cott 15 to 20 mm.), 4 to 8 mm. broad, 2 to 5 mm. thick; p pinkish to reddish-brown (alive), slate color when pre- d; live specimens are depressed and with a variable out- preserved specimens often oval to elongate pyriform, trans- . section round or nearly so, anterior end bluntly rounded, rior end less blunt. Oral sucker 0.53 to nearly 0.75 mm. kart) or more; 0.864 by 1.017 mm. or 1 to 1.4 mm. (Ward) ; 10 to 1.12 by 0.83 mm. (Stiles and Hassall) ; 0.78 mm. (Ker- in diameter, terminal or subterminal in different speci- from the same lung. Ventral acetabulum 0.6 to at most mm. (Leuckart); 0.78 mm. (Kerbert); 0.75 to 1.017 mm. d) ; 0.88 to 1.2 by 0.86 to 1.44 mm. (Stiles and Hassall) very ly larger than oral sucker. Skin provided with broad scale- pines. Pharynx elongate; esophagus very short so that the :ation of the intestines is considerably anterior of the al acetabulum; intestinal ceaca usually somewhat zigzag distance from each other run irregularly to posterior end. il pore, often indistinct, close to caudal margin of ventral ulum, may be in the median line or immediately to right : of it. Male organs: Cirrus or cirrus pouch absent; ductus atorius is straight; testicles tubular, ramifled, one slightly ior of the other on each side of the median line. Female : Ovary branched lateral, right or left of medial line, hat posterior of acetabulum and anteroventral of trans- vitello-duct; on the opposite side of median line and at the same height is situated a lobate shell gland and a short massed uterus: in some specimens the latter may across the median line and partially cover the ovary; f uterus extend ventrally of shell gland; vitellaria mar- highly developed, extending anterior to posterior ex- , often leaving but a small portion of the dorsal and median fold uncovered; transverse vitello-ducts dorsal; e reservoir large; Laurer's canal present. Eggs oval, 00 # long by 56 u broad (Leuckart); 96 to 118 u long by 3 p broad (Ward); 68 to 96 long by 48 to 60 u broad and Hassall); yellow shell. Miracidium ciliated, de- after eggs leave host. Sporocyst, redia, cercaria, and diate host undetermined.

itat .- Lungs and brain (occasionally in other parts of !), royal tiger (Felis tigris), domesticated cat (Felis catus cata), domesticated dog (Canis familiaris), swine (Sus omesticata) and man (Homo sapiens).

raphic Distribution .- China, Japan, Formosa, occasional [ cases in Europe, some cases of endemic infection in the States."

organs such as uterus and intestines. One of the flukes was cut accidentally and as a result secreted a dark biliary, viscid- looking fluid substance. Color of flukes, a reddish-brown. On section of the lung one finds a more or less infiltrated appear- ance, with nodules of varying size. The cut surface in such areas has a yellowish appearance and smears from these areas reveal a large number of eggs with a chitinous yellow shell. The smears are obtained by simply drawing a slide across the fresh lung surface. These eggs are oval, one end blunter than the other, the blunter end has a definite operculum. Within the eggs are found varying pictures. Some seem to be simply an empty shell while others have a definite yolk or nuclear structure in the center of the egg mass. The eggs with the yolk mass also contain some cells which have the appearance of endothelial cells, but have a very granular protoplasm, almost resembling the granules of the Herzfehlerzellen.

Microscopic Findings .- Section, stained with hæmotoxylin and eosin, taken through the fibrous cyst with some of the surround- ing lung tissue. In the gross this shows a fibrous capsule about the parasites, about 1 mm. thick with a dense surrounding in- filtrated tissue. Microscopically this is found to be composed of whorls of fibrous tissue with some round, spindle and fibro- blastic cellular infiltration. The picture is that of a chronic inflammation resembling a fibrous pneumonia. In the center of this cyst there are some organizing blood clots and an accumu- lation of round cells, other leucocytic cells, and here and there an occasional egg. Outside of this cyst wall one sees a dense pneumonic infiltration, of endothelial, round and polymorpho- nuclear cells, also giant cells. Within the eggs one finds in many instances a nuclear cleavage, probably the beginning develop- ment of the egg. Such a theory has already been advanced by one writer and discredited by others. Nevertheless such is the picture which is found in the eggs in the sections from this case. The section also shows empty shells of eggs. The significance of this cannot be definitely stated. The eggs of other flukes are not known to develop and liberate their ciliated embryos in the tissues.

Among other flukes which occur and may be pathogenic for man are the following: Liver flukes (Fasciola hepatica, Fasciola gigantica), and the Venal Distoma (Schistosoma hæmatobium), the latter is also known as Bilharzin, the disease, Bilharziosis or Egyptian Hæmaturia. The Schistosoma is a very rare parasite in this country and not more than six or seven cases have been reported. The last of these reports which I have seen is " Para- sites Found in New York City, Archives of Internal Medicine, September 15, 1908, Vol. 2, No. 2, by H. S. Patterson." Other flukes have also been reported, e. g., Ward in 1895 reported " The European Cat Fluke, Opisthorchis felineus," from cats in Ne- braska. This fluke, however, infests the gall ducts of the do- mesticated cat, and is not found in the lungs.

Clinical Diagnosis .- Diagnosis of lung fluke infection can be made by examining unstained specimens of sputum from sus- pected cases. The finding of large, yellowish, oval eggs should at once make the diagnosis. There are no other eggs the size and shape of the lung fluke eggs which are likely to be found in the sputum. "The eggs are always present and constitute the only constant specific character." Stiles (Osler's Modern Medicine) estimates that as many as 12,000 eggs may be ex- pectorated in a single day. The cough is at first a hard, dry, chronic cough. The sputum is said to have a peculiar odor, probably due to the blood which it contains, and is of a rusty color.

"The lethality has not been determined but probably varies with the intensity of the infection." (Stiles, I. c.)

The lesson to be drawn from finding this parasite in this vicinity and other parts of the country is that there may be

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more of them in persons suffering from vague pulmonary symptoms, and that the physicians should always be on the lookout for them, especially where the parasite is now posi- tively known to exist. All efforts should be made to deter- mine, if possible, the mode of infection. So far the secondary host for these lung parasites has not been determined. All the writers upon this subject discredit the theory of direct transmissibility from one animal to the other of the same species. It would be contrary to all analogy. In the cases in question, where the mother cat had the infection and both of her kittens later developed the infection, one can explain the transmission by the fact that the mother and kittens ate of the same food.

In connection with the discovery of this case, the query, are we in danger of the spread of the infection among human beings? is a pertinent one. What danger are we in from eat- ing raw vegetables in infected districts? May not some of our obscure pulmonary cases which have been diagnosed as

tuberculosis be, truly, lung fluke infection, especially where symptoms are not severe and where one is unable to find tx tubercle bacilli in the stained sputum.

REFERENCES.

1. Stiles, C. W .: Hygienic Laboratory. Bulletin No. 11, A; 1904. Illustrated Key to Trematode Parasites of Man, p. 14-18.

2. Stiles, C. W .: U. S. Department of Agriculture, Bureau Animal Industry. Notes on Parasites, 50-52. (Reprint fnc 16th Annual Report of the Bureau of Animal Indast" (1899). Issued Dec. 31. 1900.)

3. Ward, H. B .: Ueber das Vorkommen von Distoma Wese manii in den Vereinigten Staaten. Centralbl. f. Bakteri :. u. Parasitenk., 1894, XV, 362-364.

4. Ward, H. B .: The Asiatic lung-distome in the United Stutz Med. News, Phila., 1895, LXVI, 236-239.

5. Ward, H. B .: A second case of Distoma Westermanit in the United States. Vet. Mag., Phila., 1895, II, 87-89.

6. Lazell, E. W .: Cysticercus cellulose and Distomum Palmoca lis in Brain. Denver Med. Times, 1908.9, XXVIII, 43243;

BLOOD PLATELETS AND MEGALOKARYOCYTES IN HODGKIN'S DISEASE.'

By C. H. BUNTING, M. D.

(From the Pathological Laboratory of the University of Wisconsin.)

During the progress of a clinical and pathological study of Hodgkin's disease, which has been undertaken by the author in conjunction with Dr. J. L. Yates, of Milwaukee, certain features of the blood picture have been observed which seem worthy of note. They are of constant occurrence in the disease and appear characteristic of it. Before describing them it seems best to define the condition designated Hodgkin's disease so that there may be no confusion regarding the cases in the mind of the reader. The term is used in the sense of Reed, Longcope and Simmons to denote a non-tuberculous disease most common in young males (though by no means confined to them) characterized by a progressive enlargement of the lymph-glands, by a tendency to an anæmic state, by cer- tain pressure symptoms and by a fatal termination, usually within a period of from three to five years. The lesion in the lymph-glands shows a progression from a hyperplastic cellular stage to a final condition of sclerosis. According to the terse and accurate description by Longcope' there is "an early in- crease in the lymphadenoid tissue with later proliferation of endothelioid cells, formation of uninuclear and multinuclear giant cells, thickening of the reticulum and a final overgrowth of connective tissue. Eosinophiles, though not specific, are frequently found in great abundance." To this might be added the fact that the architecture of the gland is early de- stroyed.

My first opportunity to study the blood of a Hodgkin's

1 Paper read before the Association of Pathologists and Bacteri- ologists, May 3, 1910.

'Bull. Aver Clin. Lab .. 1903, No. 1, p. 4.

patient came at a time when I was engaged in an experiment study of the origin and of the relations of blood platelets &z. my attention was attracted by the remarkable platelet pictrx in the blood smears from the patient (Case I). The bios. platelets of the smear were very well preserved and, stain -! by Wright's stain, showed the characteristic clear blue pr: toplasm with sharply cut border and with the central group metachromatic purplish granules. The platelets were e ceedingly numerous. In fact I could not recall having **: any blood smear in which the number of platelets equal .. that seen in this. In addition to this increase in numbe: there was a striking variation in their size and shape. Mas; were round and approached the size of a red blood corpus .. Oval forms also were found, from 15 to 20 p in length sz! from 7 to 10 p in width. Others took the form of pseudopod .. of about 4 µ in width and from 20 to 30 p in length. Frem the sharpness of outline of these forms and the arrangemes; of their granules there was no question of their being due " the fusion of platelets. The picture was entirely different

At a subsequent visit from the patient, who had in the it- tervening four months been under treatment with the X-ray. the same striking picture was present in the blood smear, E. a count of the platelets by the Pratt method showed their number to be 1,140,000 per cmm.

Since seeing this case I have had opportunity to examine blood smears from eight other cases and to count the plate- lets in two of them. It does not seem necessary to report tie cases in detail at this time, as clinical reports of the majority of them will be made in a subsequent paper. In addition to

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with one exception (Case VII) the clinical diagnosis of Hodgkin's disease has been confirmed by the examination of a gland removed for that purpose. The cases are briefly as follows :

CASE I .- Nov. 20, '08 (Dr. Yates). Male, white, 21 yrs. Onset in July, '08. Cervical and axillary glands involved. Oct. 30, '08, gland removed for diagnosis showed early Hodgkin's changes.

Nov. 20-08. R. b. c., 5,304,000; w. b. c., 7500.

Mar. 4-09. R. b. c., 4,968,000; w. b. c., 4800; platelets, 1,140,000.

June 11-09. R. b. c., 5,600,000; w. b. c., 7000; platelets, 475,000. Feb. 16-10. R. b. c., 5,800,000; w. b. c., 7000.

CASE II .- Nov. 10, '08 (Dr. Yates). Male, white, 10 yrs. Large mass of discrete glands in left cervical region of at least one year's duration. Test gland showed well-marked Hodgkin's picture. Glands removed at operation Nov. 10, '08.

Apr. 1-09. R. b. c., 4,712,000; w. b. c., 9500; platelets, 750,000.

Jan. 22-10. R. b. c., 5,250,000; w. b. c., 9600.

Oct. 8-10. R. b. c., 4,960,000; w. b. c., 9800; Von Pirquet test neg.

CASE III .- Apr. 1, '09. Male, white, 30 yrs. Seen two weeks after second operation for enlarged glands of neck. First opera- tion six months previous at Rochester. Diagnosis Hodgkin's disease.

Apr. 1-09. R. b. c., 4,560,000; w. b. c., 10,000; platelets, 720,000.

CASE IV .- Feb. 5, '10 (Dr. Tupper, Eau Claire, Wis.). Female, white, 40 yrs. Eight months previously right inguinal glands began to enlarge. Two months later left inguinal and left axillary glands; four months later left cervical glands and one in right cervical region. Test gland showed advanced Hodkgin's lesion.

CASE V .- Nov. 9, '09 (Dr. Yates). Male, white, 8 yrs. Swelling of cervical glands began five months ago; on date left inguinal glands also enlarged. Test gland showed early hyperplastic stage of lesion.

Nov. 9-09. W. b. c., 9900.

Jan. '10. Left cervical group of glands removed.

Feb. 26-10. R. b. c., 5,000,000; w. b. c., 5000.

Oct. 8-10. Von Pirquet test negative.

CASE VI .- Mar. 10, '10 (Dr. Sullivan, Madison). Male, white, 16 yrs. Marked involvement of left cervical glands. Had been noted for only one month. Examination of test gland suggested greater duration, from the sclerosis and advanced condition of the lesion. Mar. 10-10. W. b. c., 18,000.

CASE VII .- Jan. 5, '10 (Dr. Bennet, Oregon, Wis.). Female, white, 64 yrs. Onset in inguinal glands, March, 1909.

Oct. 24-09. General glandular enlargement with clinical diag- nosis of Hodgkin's disease.

Jan. 5-10. R. b. c., 3,200,000; w. b. c., 4450.

June 30-10. Death from exhaustion and anæmia.

CASE VIII .- (Dr. Yates). Male, white, 33 yrs. Onset in March, '07 with supraclavicular glandular enlargement.

Sept., '08. Left supraclavicular and left axillary glands most enlarged. Some enlargement in right cervical, axillary and inguinal region.

Oct. 30-08. Excised gland shows typical and advanced Hodgkin's lesion.

Jan., '09. Blood smears examined.

May 20-09. Patient died.

CASE IX .- Oct. 3, '10 (Dr. Yates). Male, white, 5 yrs. Left cer- ical glands markedly enlarged. Five months duration. Test ;land shows marked Hodgkin's changes.

Oct. 3-10. R. b. c., 4,800,000; w. b. c., 4200.

In the two cases in which the platelet count was made (Cases II and III) the counts were as noted, 750,000 and 720,000 respectively, numbers which are well above the limits ordinarily given as normal. While three counts form a limited number on which to base a statement that the plate- lets are increased in Hodgkin's, I am relying also on the appearance of the stained smears from the six cases un- counted. Comparison of these six with blood smears from the three cases counted and with smears from normal individuals shows that in the Hodgkin's cases there is a definite increase in the platelets. There was no exception to this finding in the series. Furthermore, as constant as this finding, is that of platelets of unusual size and of the pseudopodia-like masses. These latter have varied much in size and shape, the longest approximating 50 u in length. Their staining is identical with that of the platelets. The distribution of granules and the sharp borders preclude the possibility of their being fused platelets. Their general character can best be indicated by reference to the camera lucida drawings of a few specimens shown in Figures 1-4. My experience with these cases leads me to believe that these masses and pseudopodia are so fre- quent that one can scarcely fail to find them in any smear from an active case of Hodgkin's disease. On the other hand, in searching for them in the blood of normal individuals, I have found but one small pseudopodium in a careful examina- tion of blood smears from fifteen individuals.

The question naturally arises: What is the nature of these masses which take the platelet stain? I have spoken of them as pseudopodia as I find they are identical in form and stain- ing reactions with the specimens of Wright and with the figures published in his demonstration of the origin of plate- lets from the megalokaryocyte pseudopodia.' Further, as I have indicated in a previous paper,‘ I have been able to con- firm Wright's findings in the rabbit and have found similar pseudopodial masses in the capillaries of the bone marrow and of the lung. I think it can be stated definitely, therefore, that these masses of platelet nature observed in cases of Hodgkin's disease are masses of megalokaryocyte protoplasm and of unconstricted pseudopodia of the same.

In an attempt to explain why these pseudopodia should be found in the peripheral blood stream in such numbers, while they are very infrequent in the peripheral blood of normal individuals. mv attention was directed by previous experi- mental work to the lungs. Investigations carried on upon the rabbit had shown that when platelets are being rapidly pro- duced megalokaryocytes in considerable numbers leave the bone marrow. A majority of these are held up in the lung capillaries where their nuclei form thrombi, while their pro- toplasm is stripped off and forms the pseudopodial masses and the large forms of platelets found in the rabbit in this condi- tion of rapid platelet production. Other megalokaryocytes slip through the lung and may be found in other organs, particularly in the spleen and in the liver.

3 J. Morph., 1910, XXI, 2.

J. Exp. Med., 1909, XI, 541.

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Through the kindness of Dr. W. H. Welch and of Dr. W. T. Longcope I have been able to examine the lungs of four cases of Hodgkin's disease from the pathological collection of the Johns Hopkins Hospital, and the tissues, including the lungs, from seven autopsy cases from the Pennsylvania Hospital. In none of these eleven lungs, in sections taken from parts unin- volved by the disease, were megalokaryocyte nuclei lacking. In four of the eleven cases they were much more numerous than ever found to be in the human lung in cases of marked leucocytosis, in which their presence to some degree is con- stant. It is impossible to give exact mathematical values to the numbers in the various lungs because of the varying alveolar expansion in the different specimens. An idea of their frequency may be gained, however, from the statement that in one lung, that of autopsy A-324 (Penn.), no field of moderate magnification (Zeiss : obj., 8; oc., 8) showed absence of megalokaryocytes and the number in such fields varied from three to twelve. Examination. of sections of other organs re- vealed an occasional megalokaryocyte nucleus in the capilla- ries of liver and spleen-but in no case were they numerous.

That these megalokaryocytes in the lung capillaries come from the bone marrow seems to me certain. There is but one other remote possibility. Examination of a considerable series of gland sections from cases of Hodgkin's disease from a variety of sources, shows that in well advanced cases there is present in the glands, besides the endothelioid giant cells, a type of giant cell indistinguishable from the bone marrow megalokaryocyte. Whether these giant cells are formed in situ or are bone marrow giant cells is undetermined. If they should escape into the lymphatics they would also be held up in the lungs. Yet they are so soon enclosed in a fibrous network that their escape in any such numbers as indicated by the lung sections appears improbable. Furthermore a study of bone marrow sections from five of the Pennsylvania series of autopsies seemed to show a definite increase in megaloka-

ryocytes in three. In one was noted an unusual number of small megalokaryocytes, the young forms, showing an activity in this type of tissue in the marrow. All these features with the analogy of the rabbit findings leave, I think, no question as to the origin of the giant cells found in the lungs.

One other bone marrow feature was of interest. In addition to a more extensive pyknosis of giant cell nuclei than is com- monly seen, in four of the five marrows was found karyolygis in these cells. This was most marked in a marrow in which there was necrosis of other marrow elements (Penn. Aut. 523). but occurred in the other three marrows where no necrosis of other elements was noted.

In conclusion the findings here presented would seem to indicate that in Hodgkin's disease there is a special activity of the platelet-producing elements resulting in the production of large numbers of platelets and in the emigration of megalo- karyocytes in large numbers from the bone marrow. In the lung capillaries these latter are stripped of their protoplasm. which appears in the peripheral blood stream in the form of the masses and pseudopodia described. What part this in- creased platelet production plays in the disease, I am unable to say. There is in the findings a suggestion that the toxin of the disease acts as sharply upon the megalokaryocytes si upon the lymphoid elements, leading eventually to their necrosis.

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Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 100

Author: Jacob Anthony Kimmell Publication date: 1910 Publisher: Number of Pages: 1189

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189