516 



CELLULAR TISSUE. 



to escape but imperfectly on a puncture being 

 made ; and in other cases, as in the diffused 

 swelling so often occurring in bad constitutions 

 after serious local injury, compound fractures, 

 poisoned wounds, &c. the effused fluid is of 

 an acrid character. The effusion is often 

 restricted to a particular region, (oedema ;) 

 at other times it is more extensive, and 

 may even occur in all parts of the body 

 (anasarca). In all instances in which effusion 

 takes place, it ought to be regarded simply as 

 an effect, resulting from some previous change 

 in the vessels of the cellular tissue, which 

 stands in the relation of a cause. This change 

 consists, I believe, in the great majority of 

 cases, if not in all, in a preternatural con- 

 gestion of the bloodvessels, which may be 

 induced by inflammation, debility, mechanical 

 obstruction to the free return of the venous 

 blood, or the suspension of any of the great 

 secretions of the body. 



c. Air. Emphysema, in its usual form, 

 arises from an unnatural communication being 

 formed between some part of the air-passages 

 and the cellular tissue (traumatic emphysema) : 

 it is thus an occasional consequence of fracture 

 of the ribs, in which the neighbouring portion 

 of the lung is lacerated ; of penetrating wounds 

 of the chest; of rupture of the air-cells by 

 violent exertions ; of ulceration of the air- 

 cells ; of rupture of the membrane of the larynx, 

 and even of the lachrymal sac and windpipe, 

 and of fractures in the vicinity of the frontal 

 sinuses, causing a laceration of their mucous 

 membrane. Emphysema has been likewise 

 known to arise spontaneously, the air appear- 

 ing to be secreted from the bloodvessels ; and 

 it is also a frequent attendant on gangrene, in 

 which case the effused air is the result of the 

 decomposition of the fluids previously col- 

 lected. 



d. Urine. Effusion of urine may arise from 

 a wound or ulceration of any of the organs 

 through which the urine passes ; usually, how- 

 ever, it is a consequence of an injury of the 

 bladder or urethra. The accident particularly 

 demands notice on account of the destructive 

 effects which result from it. These effects are 

 extensive mortification of the cellular tissue, 

 and, in a somewhat less degree, of the skin, 

 followed by profuse suppuration, attended with 

 constitutional symptoms of so serious a nature 

 as often to cause the death of the patient. 



III. INDURATION. Induration occurs as a 

 special disease in new-born infants, and in a 

 large proportion of those who are attacked, 

 there is a fatal termination from the sixth 

 to the thirtieth day ; in very severe cases, 

 and in infants prematurely born, death may 

 take place in two, three, or four days. Some 

 idea of the mortality in this disease may be 

 formed from the following facts : in the 

 Foundling Hospital in Paris, the mortality of 

 late years has been one in three ; out of twenty- 

 seven cases occurring in 1809, at La Charite" 

 in Berlin, only two were saved; in fifteen 

 cases seen by Lobstein, four recovered. 



The disease is very prevalent in the large 

 foundling hospitals on the continent, as many 



as 240 cases occurring in one year in the Hos- 

 pice des Enfans Trouv6s of Paris, out of 

 5392 received into the institution. In this 

 country, where, fortunately for humanity, no 

 such establishments exist, and where conse- 

 quently new-born infants are but rarely deserted 

 by the mother, the disease is very rare. Dr. 

 Copland states that he has not met with an 

 instance of it in the Queen's Lying-in Hospital, 

 and that even in the Infirmary for Children, 

 such cases are very rarely presented. I have 

 made inquiries of several very extensive prac- 

 titioners of midwifery, some of whom are con- 

 nected with public institutions, and they have 

 very rarely or never seen the disease. 



The parts which are attacked, usually the 

 legs, hands, and face, are more or less swollen, 

 hard, and rigid to the touch ; and the skin 

 assumes a red or violet colour in consequence 

 of the respiration being imperfectly performed. 

 The affection consists of an cedematous state of 

 the cellular tissue, the areolae being loaded 

 with a concrete albuminous matter and a sero- 

 sanguineous fluid, which oozes out when a 

 section is made and quickly coagulates ; it is 

 this infiltration that is the cause of the peculiar 

 hardness, for according to M. Billard, who has 

 carefully investigated the characters of the dis- 

 ease, the cellular fibres and layers preserve all 

 their flexibility, and present no signs of having 

 undergone any organic change. According to 

 M. Chevreul, in this disease the serum of the 

 blood contains an abundant quantity of a matter 

 distinct from fibrin, but which spontaneously 

 coagulates ; this substance is perfectly identical 

 with the material to which the cellular tissue 

 owes its apparent induration. 



The history of this disease, and the results 

 obtained by dissection, prove that venous con- 

 gestion is a very constant morbid appearance ; 

 and it is a question that has not hitherto been 

 decided, how far this congestion is the exciting 

 cause of the disease. 



IV. MORBID GROWTHS. These are of 

 very common occurrence and of very various 

 characters ; some consisting of the trans- 

 formation of the cellular membrane into other 

 tissues, the fibrous and osseous for example; 

 whilst others are entirely new productions, and 

 occasionally prove of a malignant nature, such 

 as cysts, vascular sarcoma, scirrhus, melanosis, 

 &,c. We do not often meet with bony or 

 fibrous formations in the common cellular 

 structure, although I have occasionally seen 

 growths with these characters. From an ex- 

 amination of many specimens, I am induced 

 to believe that the ossific deposits not unfre- 

 quently observed in connection with the fibrous 

 and serous membranes, as the dura mater, 

 pleura, &c. are formed in the cellular tissue of 

 these structures. 



V. FOREIGN BODIES are sometimes intro- 

 duced into the cellular tissue from without, 

 such as bullets, needles, &c. Certain para- 

 sitic animals, the origin and characters of 

 which are very obscure, are also occasionally 

 met with in the substance of the human body, 

 and especially in the cellular tissue. At the 

 present day it is generally admitted that by- 



