the peritoneal cavity, on its great extent of lymphatic vessels and spaces on the perforations of the membrane limitans, and on the respiratory motion of the diaphragm. The force of gravity, intra-abdominal pressure and contact of fluids against the centrum tendineum, enhances the rapidity of the absorption of colored granules. For, if an animal is hung up by the hind legs the absorption is more rapid than if he be made to sit up. Also movements, manipulation, massage, kneading of the abdomen, etc., hasten the deposit of colored granules in the lymph spaces of the So far experiments centrum tendineum. 203 ient; the cat, dog, guinea-pig, rat, etc., The opened by snipping into them with do not indicate to me that starving the animal hastens absorption to any considerable extent. I can not observe in the experiments that tying one or both thoracic ducts (i. e., the two innominate veins) retards absorption of the colored granules into the centrum tendineum. But the experiments have shown that if the thoracic duct (i. e. the left innominate vein) be tied, the injected peritoneal fluids appear in the bladder about twenty minutes later than if the duct be left untied. The test is made by injecting fluids into the peritoneum containing two to six per cent of potassium ferrocyanid, subsequently every five minutes squeezing the urine out of the bladder, and adding ferric chlorid, producing a beautiful blue reaction if any potassium ferrocyanid be present. The test is so delicate that the blue reaction will occur at about one to thirty thousand. The vast and active absorptive capacity of the centrum tendineum, with the consequent fluid stream directed toward it, is a strong argument against peritoneal irrigation, as any fluid in the peritoneal cavity will quickly stream with its contained germs toward the diaphragmatic tendon, the dangerous grounds of peritonitis. I have frequently observed inflammatory products on the peritoneal serosa in pleuritis and pneumonia. Recklinghausen found violet inflammation on the peritoneal serosa of the centrum tendineum in septic puerperal cases. To demonstrate the lymphatics of the The most The lymphatics of the central tendon may be seen without brushing, but not as well. The lymphatics of the peritoneal side of the diaphragm are not so numerous nor so easy to demonstrate. The beginner may expect more failures than successes in demonstrating the lymphThe radiating atics of the peritoneum. intertendinous lymph spaces are prominent features in the microscopic specimens. To preserve the central tendon place in a five per cent solution of forma The blood vessels, and may be double, lying on each side of the blood vessels. blood vessels may even be invaginated in the lymph vessels, which, however, is nowhere so evident as in the turtle (amphibia). The most distinct lymphatics of the peritoneum, either lymph trunks (with valves) or interstitial spaces, are found in the centrum tendineum. The endothelia of the lymphatics of the central tendon is chiefly of two shapes, (a) elongated spindle-shape, and (b) sinuous bordered. The endothelia are elongated in the direction of the lymph stream. just as blood vessels have elongated endothelia in the direction of the stream. B lin, or seventy-five per cent solution of alcohol; these agents contract the tissues, however. To demonstrate the diaphragmatics lymphatics with Berlin blue, inject a solution of the colored granules in the rabbit's abdomen, and, if killed in forty-five minutes, by brushing and silvering, the radiating blue streak may be seen between the tendon and the particles of Berlin blue deposited in all the lymphatics of the diaphragm. The lymphatic trunks of the diaphragm are wide vessels, whose walls consist of a single layer of sinuous endothelial plates. They possess many valves, large sacculations and dilations corresponding to the FIG. 28 (Hand Book for Phys. Lab., Vol. II, 1873). Septum cisternæ lymphaticæ magnæ of frog, colored with silver. A. View of peritoneal surface. B. View of surface of lymph sac. The stomata, some of which are open, some collapsed, are surrounded by germinating endotheliam, which is ciliated if the subject is a female (Oc., 3; obj., 5). valves. The posterior portion of the diaphragm collects in two large trunks which empty into the thoracic duct just above the diaphragm. The anterior portion collects into two trunks, which accompany the internal mammary arteries. The sinuous endothelia of the many and wide interstitial spaces are easily seen. There are several planes of lymph vessels in the diaphragm united by vertical lymphatic channels. The nuclei of the endothelia may be stained with haematoxylin. The lymphatics may run in company with blood vessels, or separate, but, as a rule, lymphatics course parallel to the At the valves, duplicatures of the intima, the endothelia changes its direction to transverse, chiefly. In the lymphatics swim a number of round bodies, lymph corpuscles. In some vessels they are numerous. The peritoneum is a lymph sac, similar to the amphibian lymph sacs. It is lined by a single layer of peritoneal endothelia. The endothelia in some places lies on the lymph spaces with little intervening tissue between them, and the endothelia of the lymphatics. In other places the endothelia do not have lymphatic spaces immediately under them. The peritoneal cavity is in direct connection with the walls of the lymph sac, so far as I have made examination of the peritoneum. The order of localities where lymphatics highly abound are: (a) the tendinous portion of the diaphragm; (b) the ligamenta lata; (c) the omentum; (d) the ventral surface of the small intestines; (e) the liver and the spleen. The lymphatics might be considered the drainage of the B FIG. 29 (Author). Gastro-hepatic omentum of a woman of forty-five. Two vacuolated cells which are widely expanded, almost sufficiently to be called a lymph sinus. A has five stomata vera. B has two stomata vera, 2, 2, 3, another vacuolated cell begins (Oc. 2, ob. 3a, R.). Ag. NO, applied. One of the best places to study vacuolation is on the adult human omentum, especially along the large trabeculæ; 4, 4, 4, are very brown spots. In these germinal tracts the endothelia are of all sizes and shapes. This was taken from a region where numer ous vacuolated cells existed of all sizes. peritoneum. The lymph channels of the peritoneum stand in open connection with the peritoneal cavity by means of vertical canals mined with granular cells. The lymph channels of the peritoneum are viewed with the microscope in two ways, viz: (a) after staining the free peritoneal surface with Ag. NO,, a small bit is snipped off, mounted in glycerine, and the lymphatics viewed by looking through the transparent endothelia of the free peritoneal serosa. Vast lymph channels and wide tracts of capillary lymphatic vessels may be seen, especially in the zona tendinea of the diaphragm. (b) By brushing off the peritoneal endothelia and then staining with Ag. NO,, and mounting in glycerine, one can view the lymph vessels and capillaries directly. Another method might be mentioned, which is to inject the lymph vessels, either by physiologic or mechanical method. The location of the lymphatics of the peritoneum in general may be placed immediately beneath the free peritoneal serosa. The microscope may reveal one or several layers of lymph vessels. The signification of the lymphatics of the peritoneum is that of nutrition and drainage. The lymph fluid passes out of the blood vessels into the spaces of the sub-endothelial tissue, in which are found lymph channels. The channels, after the tissue has been bathed by the lymph fluid, conduct it back to the blood vessels, finally subclavian veins. The origin of the lymphatics of the peritoneum lies within the subserous connective tissue. In the subserous tissue may be seen cells, with branching stellate cells, with various kinds of projections. The branched or projecting processes of these cells communicate with and join each other in such a manner as to form tubes or channels through which flows the fluid lymph. Also, in these spaces are found the lymphoid cells. The spaces thus formed are the so-called "juice canals, saftkanalchen," of Von Recklinghausen, or what medical literature terms the lymphatic canalicular system. In this lymph canalicular system lies the fixed connective tissue corpuscle, and the wandering, or lymph corpuscle. The fixed connective tissue corpuscle is simply a blood (white) corpuscle, which has passed out of the blood vessels, and entered the lymph channels. The lymph canalicular system communicates with the so-called lymph capillaries, and in good specimens one can plainly observe the transition from the lymph capillaries into the lymph channels. The peritoneal lymph capillary is easily distinguished by being lined with endothelia with a very sinuous margin. The lymph capillaries are simply larger than blood capillaries. The lymph channel, which collects the fluid, generally lies in the middle of the capillary space which coalesces A FIG. 30 (Gegenbaur). A. Perivascular lymphatics of the turtle's aorta. B. Cross section of an artery from the brain showing perivascular lymph spaces divided. It is known as the perivascular space of His. The Virchow-Robin space is the lymph space in the advetitia of blood-vessel wall. The turtle is the type of all animals, so far as known to the author, to show the typical lymphatic spaces of the peritoneum and perivascular spaces. toward the channel. The means by which the blood reaches the capillary lymph space is not fully settled. It is assumed that there are temporary or permanent openings in the walls of the blood vessels. These openings we have so far in this work designated stomata spuria and vera. J. Arnold designates the larger apertures in the blood vessel walls as stomata, and smaller ones stigma. The stomata (spuria or vera) occur at common junction of several of the endothelia which compose the wall along the single endothelial line. The fluid which passes out of the blood vessels into the tissue nourishes it, i. e., the tissue appropriates the part of the fluid required for its assimilation, and the effete matter passes on in the lymph streams, through the lymph capillaries, lymph channels, through the lymph glands, through the thoracic duct to the subclavian vein. The method of propelling the lymph fluid is a matter not yet fully decided, but blood pressure and muscular action have much to do with it. The connective tissue corpuscles may aid by relaxing and imbibing the fluid and then contracting and expelling it, thus inducing movement in the stream. The lymph corpuscles, leucocytes, we know pass onward from the blood vessels through the lymph capillaries, channels, glands, and, finally, through the thoracic duct, because by impregnating them with coloring matter they pass to various portions of the body. Leucocytes wander through the lymph spaces and pass into the lymph channels. For example, experiments show that finely divided coloring matter held in liquid suspension, injected into the peritoneal cavity is quickly and first found in the vast lymphatics of the diaphragm. From considerable observation and experiments show that white blood corpuscles (leucocytes) will pass through the stomata or blood vessels and blood capillaries as a normal physiologic process, it is natural to assume that cellular elements may pass from blood vessels and capillaries into the spaces of origin of lymph capillaries as a normal physiologic process. Granular coloring material will pass from the blood into the cells within the lymph spaces. If the granular coloring matter is excessive it will accumulate in the lymph canalicular spaces. Again, there may be considered the subject, perivascular origin of the lymph vessels. It is early demonstrated that the turtle has especially typical perivascular lymph spaces. The blood vessels in this case lie inside of a large lymphatic tube. I have found the same perivascular conditions in the frog's mesentery. The space extending between the external wall of the blood vessel and the surrounding lymphatic tube, is known as the perivascular space of His. The space is divided into departments by radiating partitions. In the peritoneum where the perivascular spaces accompany blood vessels, the passage of blood and lymph Gegencorpuscles is highly facilitated. baur claims that the perivascular spaces in the turtle are visible to the naked eye. But the perivascular spaces of the peritoneum of all animals which I have examined, from the frog upwards, are microscopic, and, besides, are neither typical nor easy to make out in every case. I have examined several turtles, and the peritoneum shows typical lymphatic lacunæ, wide interstitial and perivascular spaces. (To be continued.) [Written for the MEDICAL BRIEF.] Impaired Virility and Its Treatment. BY CHARLES W. MCINTYRE, M. D., Medical Department, McGill University, Montreal, 1864; Medical Department, University of Louisville, 1883. New Albany, Ind. By the term “impaired virility," I mean not the total loss of sexual power, but an impairment of that power. This, as we shall see later, owes its origin to a multiplicity of causes. Impaired virile power is a source of great unrest and misery, and many patients who suffer in this way destroy themselves, rather than live deprived of the exercise of this function. To enlarged prostate we may safely ascribe the greatest number of cases of impaired virility and positive impotence, yet there are many cases which do not owe their origin to this cause. Neurasthenia is a prevalent condition in this busy era, and to it we can attribute many cases. In fact, I have found in a large practice, covering a considerable period, that as many cases are attributable to this cause as to any other. A general atonic state of the reproductive organs is responsible for the impairment of this power. This is an atonic state of the organs of generation, and as a result they do not respond to the stimulus, as is the case when these organs are in what may be termed a strictly normal condition. The treatment which has been relied upon by many practitioners to cure enlarged prostate, has been by the introduction of sounds and other means of a similar nature. A large experience with measures of this kind has forced me to regard them as entirely worthless, and I may say, also, that they often are very prejudicial. In fact, I have often seen the most untoward results follow this means. For the last five years I have depended entirely upon medicinal measures to overcome enlarged prostate, and my success has been so great that I now take hold of a case with a measure of confidence, whereas in former times I held out no encouragement to my patient. Those cases of impaired virility which are a consequence of an atonic state of the organs of generation, I have found to yield to such an agent as was a general systemic tonic, and which at the same time exerted a special tonic and nutritive action on the organs of generation. In these cases, some physicians introduce cold sounds. These have never been productive of good results, but have often in the experience of many physicians done the most substantial harm. In the cure of enlarged prostate, no remedy can be said to compare with Sanmetto. In fact, so far as I am informed, it is the only remedy that will successfully combat enlarged prostate. It has brought me the most happy results in the treatment of enlarged prostate, but I have failed to get results from the substitutes for this remedy that are becoming plentiful on the market. In that type of impaired virility due to neurasthenia, and to an atonic state of the sexual organs, Sanmetto is the most rational remedy, and results prove it to be of substantial worth. It is a tonic and nutrient to the reproductive organs, and after it has been taken for a sufficient time, the sexual powers take on a degree of vigor that is normal. A man aged forty-nine years came to my office some months ago, and asked me to give him a remedy that would increase his "powers." He now rarely felt the presence of an erection after the usual stimulus, and in most instances the act was feebly consummated, and often it was a failure. This patient had had gonorrhea in his early manhood, and had a prostate that was appreciably enlarged, and somewhat tender. He was put on Sanmettotwo teaspoonfuls after each meal and on going to bed. This patient reported two weeks later, saying he felt a great deal better every way, and his "powers" were materially strengthened. He continued the Sanmetto two months longer, and at the end of this time had no enlargement of the prostate, and his powers were as vigorous as any man in good health. Another patient came to the office saying he was "all run down," and had not been able to exercise virile powers for two months. This was due to a neurasthenic state of his system, consequent upon imperfect recovery from influenza. He was given Sanmetto in doses of two |