CLOUDY fiWEIJAM} 395 



of cell i)r()t(Miis, and luMice heat j^reeipitation may hv partly responsi- 

 ble for the tui'hidity of eells in cloudy swi'lling, l)ut it is d()ul)tful if 

 the o-raimles thus formed would be soluble in acetic acid. A careful 

 discussion of the character and characteristics of this process is given 

 by Hell,^"" who concludes that the term cloudy swelling is sound only 

 as a gross description, since microscopically the cells may be found to 

 show albuminous »>i-anules, or fatty metamorpliosis or simple edema. 

 "When present, the granules are of unknown nature — tiiey are not 

 identical with Altmann's granules, although Aschoff and Ernst ^"^ 

 both consider that many of them are derived from the mitochondria. 

 An enormous number of granules may be present in the renal cells 

 without demonstrable impairment of function.'"'' They may disap- 

 pear during acute infections, and they bear no constant relation to 

 fatty changes. 



We may si)eak with more assurance concerning the swelling of the 

 cell, and attribute it to an edema of the cell contents, it having been 

 shown that in cloudy swelling the water content of the organs is in- 

 creased.^^ This might be produced by a rise in osmotic pressure due 

 to abnormally rapid splitting of proteins with incomplete oxidation 

 of the substances formed, which results in formation of many crys- 

 talloid molecules with high total osmotic pressure, from a smaller num- 

 ber of colloid molecules with almost no osmotic pressure. It has fre- 

 quently been shown that the cell-walls do not lose their semipermea- 

 ble character until the death of the cell occurs ; hence in cloudy swell- 

 ing water diffuses in much more rapidly than the crystalloids can 

 ditfuse out,^- causing a hydropic swelling. This hypothesis is sup- 

 ported by the observations of Cesaris Demel,^^ who found that by 

 modifying the osmotic conditions of the cells, particularly epithelial 

 cells, he could closely reproduce many of the characteristic features 

 of parenchymatous degeneration. It is possible, also, that too high 

 concentration of crystalloids within the cells may be a factor in the 

 precipitation of the cell colloids. In view of the fact that in the 

 earliest stages of autolysis histologic and microscopic changes closely 

 resembling those of cloudy swelling are pronounced, and that 

 organs the seat of cloudy swelling notoriously undergo autolysis 

 with extreme rapidity after death, ^^"^ we may also consider that this 

 process is possibly in part responsible for the change of ordinary in- 

 tra vitani cloudy sw^elling. The appearance of fine granules of lipoid 

 substance ^^ (myelin or "protagon" (?)) in cells during autolysis 



30a .Tour. Amer. Med. Assoc, 1013 (61), 4.5.5. 



30b Verb. Dent. Path. Gesellsch., 1914 (17), 43 and 103. 



'oc Shannon, Jour. Lab. Clin. :\red., 1916 (1), 541. 



31 Sc'hwenkenbecber and Tnpaki, Arch. exp. Patli. u. Pbarm.. 1906 (55). 203. 



32 See introdiu'torv oliapter conoerninu osmosis: also discussion of edema. 



33 Lo Sperimentale. 1905: Cent. f. Path., 1905 (16), 613. 

 33a See MedisTeceanu. Jour. Exp. :\Ied.. 1914 (19). 309. 



34 0rgler, Virchow's Arch., 1904 (176), 413; Hess and Saxl, ibid.. 1910 (202), 

 149. 



