I'AI llOlAXiKWL FAT ACCUMULATION 405 



is niuc'li jiTeatiT in the cholesterol esters than in the free cholesterol. 

 Cholesterol compounds stain differently from neutral fats, beino; more 

 yellow than red with Sudan III, and iirayish rather than black with 

 osinie acid. Path()l()j.iically the anisotropic drojjlets are also found 

 especially in the above-named tissues, but also in tissues the site of 

 chronic inflammation, including: the mucosa of the gall bladder where 

 they may be of importance in the formation of cholesterol concre- 

 tions. They are also f(mnd in tlie alveolar epithelium in pulmonary 

 intianmiation, in atheromatous patches in arteries, in many tumors, 

 in most cells,"^ and occasionally in varied patholog-ical tissues.-^'^ Per- 

 haps the most conspicuous deposits are in the epithelium of the ''large 

 white kidneys," and in xanthomas. In Gaucher 's disease there is also 

 a remarkable lipoid accumulation in the foamy phagocytic cells. -^'' 

 According to ]\[unk -" true lipoid degeneration always means a serious 

 injury to the cell, but there seem to be many exceptions to this. In- 

 deed, according to Anitschkow and Chalatow {loc. cit.) the feeding of 

 foods rich in cholesterol may cause the appearance in the liver of great 

 quantities of anisotropic droplets, lipoid deposits in the aorta, enlarge- 

 ment of the adrenal cortex, and the presence in practically all tissues 

 of semifluid, doubly refracting crystalline structures {cholesterol 

 steatosis) .'^^'^ 



In cells undergoing autolysis the fat-like "myelin" droplets which 

 appear, differ from the above in not being anisotropic, but are un- 

 doubtedly closely related to them in composition. These "myelin" 

 droplets are also found in cells showing cloudy swelling, presumably 

 representing cell lipoids set free through changes in the cell proteins. 

 They are characterized by staining with osmic acid but not by sudan 

 III, which shows them not to be simple fats nor yet lipoids, but they 

 are undoubtedly precursors of true fatty degeneration ; " they prob- 

 ably consist chiefly of lecithin, with more or less free fatty acids and 

 relatively little cholesterol (Aschoff). 



It is possible to distinguish the lipoids of cells, whether normal or 

 pathological, from the neutral fats by means of Ciaccio's method.-* 

 This consists in a preliminary treatment with bichromate, which ren- 

 ders the lipoids insoluble ; the tissues can then be hardened and im- 

 bedded by the usual methods which remove the unchromated fats, 

 leaving the lipoids stainable by Sudan III. By this method Bell -^ 



25Ciaccio, Cent. f. Path., 1013 (24), .'50. 



25a Patholotrical deereape in lipoids may also ho ohscrved, especially in the adrenal 

 cortex, usnally under the influence of toxic ajients; e. g., Hirsch found a marked 

 decrease in delirium tremens (Jour. Amer. Med. Assoc., 1014 (fi.S), 2186). 



25b See Wahl and Richardson. Arch. Int. Med., 1016 (17), 2.38. 



20Virchow's Arch.. 1008 (104), 527. 



2CaSee also Anitschkow. Dent. med. Woch., 101.3 (30), 741; ^Yosselkin. Vir- 

 ehow's Arch., 1013 (212). 22-5. 



27 Hess and Saxl, Virchow's Arch., 1010 (202), 140. 



28 Cent. f. Path.. 1000 (20), 771; Arch. f. Zellf., 1010 (5), 235. 



29 .Jour. Med. Pes.. 1011 (24), 530. 



