394 ri:tro(:ri:s><i\ i: cjLwaES 



quantitatively in the urine. -^^ Bradley -^^ calls attention to the fact 

 that atrophy occurs commonly under conditions of reduced blood 

 supply, Avhich implies i^artial asphyxia and a resulting tendency to 

 local excess of H-ions, which would favor autoh^sis. Conversely, 

 hypertrophy is observed with abundant blood supply which tends to 

 keep the reaction of the tissues so low in Il-ions that autolysis is held 

 at a niiiiinniiii. 



CLOUDY SWELLING ^^< 



The characteristic appearance of organs the seat of cloudy swell- 

 ing, which is frequently likened to a "scalded" appearance, sug- 

 gests that the change consists in a coagulation of the cell proteins, 

 which idea is supported by the similarity of the microscopic changes 

 observed in the cells and the earliest microscopic changes observed in 

 cells after heating gently to about their maximum thermal point. 

 On the other hand, the granules in cloudy swelling are generally de- 

 scribed as being soluble in dilute acetic acid and dilute KOH, which 

 indicates that they are not the result of ordinary heat coagulation. 

 If we bear in mind, liowever, that cloudy swelling probably does not 

 represent one single change, it may be possible to arrive at some 

 understanding of the chemical changes that occur in the process. 

 Albrecht ^° considers, with good reason, that we may have a granular 

 appearance of cells which is simply an exaggeration of the normal 

 granular structure, and, although it may be observed in tissues mod- 

 erately affected by toxins, or in starvation, or in transitory anemia, 

 the change is still to be looked upon as little more than physiological 

 in response to stimuli and overwork. Such a ' ' cloudy swelling ' ' may 

 also occur in cells in. the beginning of autolysis, or simply under the 

 influence of salt solution. If the injury is greater, however, as in 

 profound sepsis, or extreme local anemia, the granules become coarser, 

 less soluble in acetic acid and KOH, and droplets resembling "myelin'' 

 make their appearance. If the injury is still more severe, true coag- 

 ulation of the granules occurs, and they become insoluble, the fatty 

 droplets become more prominent, and the cell reaches a condition 

 that may with propriety be termed necrosis or fatty degeneration, or 

 both. There is no very sharp line separating necrosis and cloudy 

 swelling, especially if we consider only the changes in the cytoplasm. 

 In the earliest stages the granules are jierhaps due. in some cases, to 

 simple aggregation of the colloids, without the development of a true 

 coagulation, and so the granules are still soluble. Possibly bacterial 

 toxins may also cause soluble precipitates, but this does not appear 

 to have been established. Halliburton has shown that temperatures 

 that iiuiy be reached in high fevei's can cause turl)idity in solutions 



2»fSloni<>ns, Bull. .Toliiis Hopkins llosp., 1914 (25). l!)."). 



2RKjour. Biol. Chcni.. lltlfi (25), 2(51. 



20 Review of ^enoral features bv Landstcinev, Zic-^lcr's T^cilr.. 1!)0:? iX]). 2'M . 



30 Verb. Deut. Patb. Ccsoll., 100.3 (6), (>:{. 



