by the greenish color of its surface and by the more or less distinct fluctuation. When the abscess is opened it may be found of various size, so large even that the muscle itself may be completely destroyed, in which case the abscess is surrounded only by the thickened perimysium and surrounding connective tissue. The walls are usually uneven, ragged (remnants of muscle), and frequently of a slaty color. The pus, especially in case of caries, of the pelvis, contains more or less numerous bits of bone, which suggest the admixture of sand, and indicate the origin of the trouble. The abscess may sometimes be traced into the true pelvis and as far as the hip-joint, which may be perforated secondarily and suppurate. On the other hand it may extend upwards for a considerable distance, especially when the bones of the upper part of tlie trunk are affected ; still the track is not always easily followed, as the seat of the caries is frequently connected with the abscess only by a very narrow and tortuous fistula. Perforation of the descending colon may take place from the abscess, and faecal matter may then be discharged into the latter ; if the abscess should also discharge through the skin an indirect faecal fistula would result. Secondary tumors are quite often formed in the ilio-psoas, owing to its proximity to numerous organs ; the nature of the primary affection determines the composition of such secondary growths.
<Callout type="warning" title="Be cautious with abscesses">Abscesses can spread and perforate critical structures like the colon, leading to severe complications.</Callout>
Secondary tumors are quite often formed in the ilio-psoas, owing to its proximity to numerous organs ; the nature of the primary affection determines the composition of such secondary growths. 15. THE FEONT OF THE SPINE, (a.) Crerieral Characteristics. * Alterations in shape are among the most noticeable pathological changes in the vertebral column, and are most marked in the dorsal portion. The different varieties are scoliosis, or lateral curvature (usually to the right side in the dorsal portion), kyphosis, or curvature backwards, and lordosis, or curvature towards the front. Very frequently scoliosis is combined with one of the other forms, occurring especially as THE FRONT OF THE SPINE. 383
<Callout type="important" title="Count vertebrae accurately">When examining spinal deformities, count the spinous processes to determine the number of destroyed vertebral bodies.</Callout>
In order to determine accurately the number of the bodies of the vertebræ which have been destroyed, the spinous processes, which usually remain intact, are to be counted. In making a careful examination it is necessary to remove the affected portion completely, and saw through it longitudinally, otherwise pathological changes in the bodies of the vertebrae, or intervertebral substance, may be easily overlooked.
384 DIAGNOSIS IN PATHOLOGICAL ANATOMY. (5.) Special Morbid Conditions. Fractures of the spinal column may be transverse or longitudinal, and are frequently comminuted or combined with a crushing of a portion of the bodies. Both the fractures and dislocations, the latter being necessarily partial, are liable to produce deformities of the spine, like the carious affections, and a longitudinal section is also best adapted for their examination.
<Callout type="risk" title="Fractures can lead to severe deformities">Spinal fractures can result in significant spinal deformities if not properly managed.</Callout>
The inflammatory processes in the vertebræ usually manifest themselves as caries, and are included under the name of spondylarthroeace. Two forms, however, must be distinguished, the simple carious (purulent) and the cheesy inflammation. The first may occur at any time of life, sometimes being primary in the vertebrae (at times of traumatic origin), and again extending from neighboring abscesses. As a rule, a great quantity of pus is formed Q prevertebral abscess')., which by constantly extending into the connective tissue of remote parts, especially of the psoas muscle, produces a large abscess which may finally discharge outwardly (cold abscess). The second form occurs almost exclusively in scrofulous and tuberculous children, and is chiefly produced by a cheesy osteomyelitis. When a section is made through the bodies of the vertebræ, the cancellated tissue is found to be filled with cheesy material, in the vicinity of which small tubercles may often be plainly recognized.
The bodies of the vertebrae are destroyed as in simple caries, and prevertebral abscesses are formed, which extend in the manner above described. A minute description of the process will be given in considering the bones of the extremities.
Cartilaginous, and especially bony new formations are very common, particularly in the form of supracartilaginous exostoses., which will be hereafter described (with the bones of the extremities). These sometimes originate from the contiguous sides of two vertebræ and then become fused, thus forming a bridge over the intervertebral substance.
THE PELVIC BONES. 385 Heteroplastic growths, especially sarcoma and cancer, sometimes occur by extending from neighboring parts, and the former also occur primarily. 16. THE PELVIC BONES, (ffi.) General Characteristics. The most important pathological conditions of the bony pelvis are the deformities and the resulting alterations of the internal dimensions. In order to examine these thoroughly the entire pelvis should be completely removed from the body, and freed, as thoroughly as possible, from the muscular tissue.
<Callout type="tip" title="Pelvic examination is crucial">A thorough pelvic examination can reveal critical deformities that may affect childbirth or other life-threatening conditions.</Callout>
In the majority of cases, however, it is sufficient to observe the general shape and to take accurate measurements of the inlet ; and in most cases it is customary to take no further steps. It would require too much space were all the deformities described, as they are fully treated of in all the current text-books upon obstetrics ; certain general points only may be now stated. The pelvis is seldom widened in all directions (large pelvis), though very frequently narrowed (contracted pelvis). It is either uniformly narrowed, or only in the direction of certain diameters, while the others are of normal or increased length ; the narrowing upon the two sides is either about equal (symmetrical pelvis) or it may be unequal (unsymmetrical pelvis).
The cause of the deformities lies in the pelvis itself, or in pathological changes in the vertebral column, or hip-joints. In the latter case the deformity is usually unilateral (unsymmetrical pelvis) and results from inflammation in childhood, anchylosis, or dislocation (coxalgic pelvis). The spinal curvatures produce a compensatory displacement of the sacrum, and the pelvis becomes consequently distorted (kyphotic pelvis).
The pathological changes of the pelvis itself, which result in deformity, are tumors, the rare synostosis of the sacro-iliac synchondrosis (synostotic pelvis, usually unsymmetrical), osteomalacia, and lastly, rickets, which is extremely common. In cases of osteomalacia the pelvis has a very characteristic 25 386 DIAGNOSIS IN PATHOLOGICAL ANATOMY. shape (heart-shaped), due to the pressure of the thigh bones upon the acetabula, in consequence of which the latter are approximated, the pubic bones become pointed, and the sacrum projects forwards into the pelvis.
Rickets does not always produce the same alterations ; the most common deformity consists in the sacrum being depressed and pushed forwards more than in the normal condition, so that the antero-posterior diameter is diminished, while the transverse is sometimes even increased. The projection of the sacrum is due to the rachitic changes in the sacro-iliac synchondrosis and the accompanying extreme softness and mobility which will be more fully described hereafter.
When a similar pressure is exercised upon the ilio-pubic synchondrosis, the resulting deformity may resemble that due to osteomalacia. Besides these alterations in the shape of the true pelvis, a diminution in size and flattening of the hip bones also results from rickets.
(5.) Special Morbid Conditions. Fractures of the pelvis are produced only by great violence, and are usually associated with great injury to very important organs, so that death soon results, often preceded by extensive gangrenous inflammation and necrosis of the bones. Separation of the synchondroses is sometimes observed in connection with fractures.
The inflammatory, carious processes., when not caused by injury, usually proceed from the hip-joint or a psoas abscess ; still any and all other processes in the neighboring parts, which are characterized by suppuration, may by extending produce caries of the pelvis. Caries is thus very commonly found on the posterior surface of the sacrum as a result of decubitus (bed-sore). In addition to the formations of bone which results from processes originating in the hip-joint, small exostoses sometimes occur, seated on the ilio-pectineal line, or symphysis pubis ; they project like spines into the pelvis, and may cause lacerations during childbirth.
The other tumors which occur here are enchondroma., osteoma., sarcoma., and carcinoma. The latter is said to occur as a primary growth of great softness, and is often infiltrated throughout all the bones, so that the shape of the softened pelvis may resemble that affected with osteomalacia.
IV. THE EXTREMITIES. In the majority of cases, when the examination of the abdominal cavity is finished, the autopsy may be considered completed ; but in others the extremities must still be examined. In these parts the lymphatic glands and vessels, the blood-vessels, nerves, muscles, joints, and bones deserve special consideration. The examination, of course, is limited to those parts only where in certain cases pathological changes are known to exist, or at least are suspected.
- THE LYMPHATIC GLANDS. The lymphatic glands of the extremities usually examined are those which lie nearest the trunk. These include the axillary and inguinal glands, both of which are not only connected with the lymphatic vessels of the extremities, but with other important parts. The axillary glands receive the lymph-vessels of the breasts also, and the inguinal glands those of the generative apparatus, so that they are liable to become involved when disease exists in either of these regions.
Results of primary acute inflammation of these glands are rarely met with at the autopsy, though sometimes accidentally found ; evidences of secondary inflammation in cases of extensive inflammatory processes in the subcutaneous and intermuscular connective tissue, etc., are more common. The glands are swollen, more or less reddened, and sometimes contain pus (lymphadenitis apostematosa). The surrounding tissue is often inflamed and infiltrated with pus (peri-adenitis). The pus corpuscles are distinguished from lymph corpuscles by their size and several small nuclei, while only a single large nucleus exists in the lymph corpuscle.
Chronic inflammation is manifested either by induration, combined with a diminution in the size of the glands, in which case the reticulum is thickened and the cells of the gland are less numerous, or by hypertrophy, in which alteration the reticulum is also found to be thickened, but the meshes are still filled with cells. Cheesy (tuberculous ?) inflammation occurs less frequently in these peripheral glands than in those already described, and when present is most likely to be seated in the cervical glands.
The specific syphilitic affection (indolent buboes), on the contrary, is very common, especially in the inguinal glands, which become enlarged and hard, presenting a gray color on section, and are filled with cells. Leucemia and lymphosarcoma give rise to enlargements, which sometimes may be very great.
Primary tumors are not rare, but secondary ones are more common, especially cancer. As has already been suggested, when the axillary glands are affected, the primary cancer is usually seated in the breast, while the inguinal glands become secondarily cancerous from the external genitals (cancroid of the penis or clitoris), or from the internal (cancer of the uterus).
THE LYMPHATIC VESSELS. The lymphatic vessels are sometimes dilated (in central obstruction), owing to induration and atrophy of the glands (elephantiasis'). They may also present inflammatory changes (lymphangitis'), which are usually secondary to perilymphangitis (phlegmasia alba dolens). Portions of new formations are sometimes found in their interior, especially of those near or among the axillary glands. They may also contain blood when haemorrhage has taken place in the region from which they came, and the blood is then found also in the lymphatic glands, at an early stage in the sinuses surrounding the follicles.
THE BLOOD-VESSELS. The pathological changes occurring in the blood-vessels have already been described in connection with the aorta and vena cava; it is only necessary to add, that in examining the vessels of the extremities the incision is always to be made along the course of the main branches, since it is important to determine exactly their relation when changes in the larger vessels are continued from those of the extremities.
THE NERVES. The most important pathological change in the peripheral nerves is atrophy, which may often be roughly determined by their small size ; when teased preparations are examined with the microscope, the nerve fibres are found to have disappeared, usually in consequence of fatty degeneration. Acute inflammatory changes have been described by Virchow under the term neuritis interstialis proliferans. They are characterized by an abundant cell proliferation between the nerve fibres and atrophy of the latter. Chronic inflammatory changes are manifested by a fibrous thickening of the perineurium, and frequently occur in stumps after amputations (false neuroma'). The first to be considered among the tumors are the neuromata, which may be defined as enlargements occurring in the course of a nerve, or at its termination in an amputated stump ; they are usually somewhat fusiform, varying from the size of a pea to that of a hen's egg, and are composed of nerve fibres. If the tumor contains white substance it is termed neuroma myelinieum, if not it is designated as neuroma amyelinicum. Formerly, many other tumors of a similar shape occurring along the course of nerves were incorrectly called neuromata. Among these may be mentioned fibromata, myxomata, and sarcomata. The latter are occasionally developed in the course of many different nerves at the same time. Carcinoma is very rare.
THE MUSCLES. (a). General Characteristics. In examining the muscles of the extremities their size is first to be noticed. All the muscles or single groups only may present variations in this respect, and atrophy is more common than hypertrophy. In general atrophy their size can, of course, be only approximately determined, but when the atrophy is circumscribed, it is possible to estimate exactly the diminution in size, by comparing the affected part with the opposite side. The color of muscles varies from a bright grayish-red to the darkest shade of red, according to the amount of blood contained in them (color of smoked goose-breast in typhoid fever and cholera) ; they become yellowish-red (fatty degeneration or infiltration) or brownish-red (brown atrophy), in consequence of changes taking place in the substance of the muscles ; in the vicinity of ichorous abscesses, and generally when putrefaction is present, they assume a dirty grayish-green or dark green color. The consistence depends principally upon the degree of post-mortem rigidity ; it is diminished in most diseased conditions, especially in atrophy and acute inflammation, and the tissue is then often perfectly soft, brittle, and even pulpy. The consistency may be increased, on the other hand, for instance, in chronic interstitial inflammation.
(5.) Special Morbid Conditions. 1. Hypertrophy. True hypertrophy seldom occurs, and when it does, it is always confined to single groups, and is usually the result of excessive use. The term false hypertrophy has been applied to a condition in which the belly of the muscles appears to be enlarged, although the actual muscle is not increased in size. The enlargement is due to an interstitial development of fat (fatty infiltration), which may very easily be distinguished by the eye, by the wide and narrow, yellowish-white lines which penetrate the muscular substance in all directions.
- Atrophy. One form of atrophy (atrophy due to fatty infiltration) essentially agrees with the previous condition, and is very frequently found when the muscles are no longer used, whether owing to affections of the joints or nerves. The gross appearances are similar to those above described, except that the muscular tissue is less strongly contrasted with the fat the longer the process has continued, while the circumference of the muscle is actually lessened. When examined microscopically, not only are fat cells found between the muscular fibres, as in the first case, but the fibres themselves are diminished in size, of course very irregularly ; the transverse striae are very obscure, apparently broken into separate pieces, and the picture is thus presented of the most extreme degree of atrophy. The muscles are sometimes found
Key Takeaways
- Recognize signs of abscesses and their potential to spread, especially in the pelvis.
- Understand the importance of accurate counting of vertebrae during spinal examinations.
- Be aware that fractures can lead to significant deformities if not properly managed.
- Know how to identify and manage pathological conditions affecting the pelvic bones and spine.
- Examine lymphatic glands for signs of inflammation, infection, or cancer.
Practical Tips
- Regularly check your body for unusual lumps or changes in muscle size that could indicate underlying issues like abscesses or tumors.
- Use a mirror to examine your back for any visible deformities or asymmetry that might suggest spinal problems.
- Keep an eye on lymph nodes, especially after injuries or infections, as they can swell due to inflammation or cancer.
- Stay active and maintain good posture to prevent muscle atrophy and promote overall musculoskeletal health.
- In case of severe trauma, seek immediate medical attention to avoid complications like spinal fractures.
Warnings & Risks
- Be cautious when handling abscesses as they can rupture and cause infection or spread to other areas.
- Do not attempt to self-diagnose or treat complex spinal deformities without professional medical advice.
- Avoid ignoring persistent pain or swelling in the pelvic area, as it could indicate serious conditions like cancer.
- Be wary of using unproven remedies for muscle atrophy or inflammation; always consult a healthcare provider.
Modern Application
While many of the techniques described here are outdated, understanding the signs and symptoms of abscesses, fractures, and tumors can still be valuable in modern survival situations. Proper hygiene, early detection, and prompt medical attention remain crucial for preventing severe complications from these conditions.
Frequently Asked Questions
Q: How can I recognize an abscess on my body?
Abscesses often appear as a painful, red, swollen area with a fluctuant (spongy) consistency. They may also be accompanied by fever or chills. If you suspect an abscess, seek medical attention promptly to avoid complications.
**Q: What are the signs of spinal deformities that I should look