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to have been caused by a contraction of the delicate muscular
fibres encircling the small vessel. If this be the true cause,
the contraction must have occurred before death, or during the
act itself. The most interesting phenomenon regarding these
minute vessels, venules as well as arterioles, is the fatty de-
generation of the nuclei in their walls, observed in almost all
the cases thus far examined, a condition which I had pre-
dicted some time before. In many vessels, therefore, the nu-
clei have disappeared, leaving a number of fat-globules in
their places. At the same time, however, others are met
with in which an increase of the mere trace of protoplasm,
surrounding the nucleus in the normal condition, has taken
place, causing a thickening of the wall of the vessels, and
giving rise, as I have described and pictured on a previous
occasion, to minute aneurisms and to a final rupture of the
vessel. The small hsemorrhagic effusions observed in the pia
mater in the cases under discussion may have depended on
this cause. The opacity of the arachnoid membrane, found
in almost all the cases examined, is caused by the exudation
of a finely granular matter into the subarachnoid space, fill-
ing up at the same time the fibrous meshes of the pia mater. .
The granules of this matter are quite distinct but pale ; they
measure about -j-sVir mm. in diameter. Here and there, chief-
ly in the close vicinity of a vessel, or in contact with a hem-
orrhagic effusion, smaller or larger brownish-looking granu-
lar masses of irregular forms are observed. The granules
of these masses are identical with those of the exudate above
described, though they appear more distinct ; this exceptional
character, however, I suppose to be caused by the presence of
free haemoglobin imparting the color to the mass. As far as
I am able to judge at present, these masses are derived from
the blood ; they may represent portions of the liquor sanguinis
impregnated with free haemoglobin, rendered granular by the
action of the bichromate of potassa. Smaller colorless masses,
however, of the same material, situated between the vessels,
are also observed throughout the pia mater. With the excep-
tion of one, all the specimens of pia mater thus far examined
exhibited the changes above described.
The microscopical examinations of the substance of the
brain which I have recently made extend to only a small num-
ber of cases. The most prominent observation thus far made
is the existence of fatty degeneration of the blood-vessels of
the cortex cerebri, similar to that observed in the vessels of the
pia mater, together with degeneration of the ganglionic bodies
of the cortex.
As Lanoxin 125 regards the spinal marrow, it has already been men-
tioned that in a number of cases the vessels of the pia mater
were found congested in the lumbar and cervical portion, par-
ticularly in the former. For the want of time no microscop-
ical examinations have as yet been made.
The sketch which, in the preceding pages, I have drawn
of the principal pathological changes occurring in various
organs of the body during the course of yellow fever, short
and imperfect as it is, will nevertheless serve as a guide in
forming some idea of the nature of this disease; while, at the
same time, it will furnish sufficient material for discussion.
But, as my object in writing this article is only to render a
short account of the results of my microscopical examinations,
I can not here enlarge upon the true pathology of the disease,
though I will point in a few words to its probable nature.
In reflecting upon the degenerative processes observed to
take place in a number of important organs, and in the course
of only a few days, it is obvious that the disturbance of nutri-
tion preceding such changes must have been quite severe ;
and, on inquiring into the original cause of these changes, we
are naturally directed at once to the mysterious yellow-fever
poison. But here Cheap Lanoxin the difficulty commences; for, though it is
evident that all these changes were caused by the noxious in-
fluence of some unknown poison, the exact manner in which
they occurred still remains to be determined — in other words,
whether the poison first affects the nervous centers, and sub-
sequently through their medium the nutrition of the organs,
or whether the poisonous effects arc first experienced by the
blood, and through its medium communicated to the other
organs, including the nervous system. I am as yet not pre-
pared to give a satisfactory explanation of this subject, but it
is possible that the Lanoxin Price cause producing the different phenomena
operates in two directions upon different organs, which on their
part act reciprocally upon each other. Thus it may be that,
on Order Lanoxin the one hand, the direct deleterious effect of the poison
upon the blood affects the integrity of this fluid, Lanoxin Pg and in con
sequence indirectly deranges the normal nutrition of the
nervous centers, together with that of the secretory organs,
and, inducing thus a derangement of function, finally leads
to the febrile process ; on the other hand, the poison, without
primarily affecting the blood, may make its direct impression
upon the nervous centers, and, by the irritation which it causes
upon the nervous tissues, induce directly a derangement of
function, Buy Lanoxin Purchase Lanoxin experienced by all the organs of the body, and event-
ually giving rise to the fever. Judging from the premonitory
symptoms of the disease, it would appear that the poison leaves
its first impression upon the nervous system, which in its turn
reacts more or less upon the other organs. But, in consider-
ing the known fact that the poison requires a certain time, the
so-called " period of incubation," before being able to manifest
its presence in the system, it appears more probable that its
first impression is upon the blood. Not only this, but it seems
also that the pathological changes, to which its presence in
the blood gives rise, Lanoxin Online must have extended to a certain degree
before they can manifest themselves by those phenomena
known as the premonitory symptoms of the disease. For these
reasons we may presume that the first impression of the poison
is directly made upon the blood. And, judging from the
observations I made on the liver and some other organs, stated
in the preceding pages, and relating to the escape of free
haemoglobin through the walls of the minute blood-vessels and
its absorption by the neighboring cells, it would almost seem
that one of the first effects of the poison upon the blood
consisted in a disturbance of the mutual relations existing
between the haemoglobin and the protoplasm of the colored
It is true, no free haemoglobin could be detected in the
blood by microscopical examination in those cases of yellow
fever, before mentioned, in which it was taken from the living-
patients. But this fact explains itself by the large quantity
of free haemoglobin which would be required in order to be
detected in a layer of blood so exceedingly thin as that pre-
pared for microscopical examination, and contained between
the glass slip and the covering glass ; in fact, such a quantity
would be more than too large to be consistent with life. Free
haemoglobin, therefore, may be present in the circulating blood
without being detected by the microscope. The faintly yel-
lowish tint, appearing in a number of cases, and often as early
as the third day of the disease, in the conjunctiva and the skin,
corroborates this assertion. This yellowish tint, however, is
not produced by the Buy Lanoxin Online free haemoglobin still contained in the
circulating blood ; on the contrary, its presence is not per-
ceived until it has escaped from this fluid into the fluids of
the surrounding tissues, to be absorbed by the cells forming
the, lowest stratum of the epidermis of the skin.
I have already remarked that, of all the organs affected

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