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THE AUTHOR.
The Ovarian
Its Origin
T. M.
Cell
and Characteristics
DRYSD ALE,
A. M., M. D.
PHILADELPHIA, PA.
VII.
vnnSxttianS
1883
ITS ORIGIN
AND CHAR-
ACTERISTICS.
BY THOMAS M. DRYSDALE,
A. M., M. D.,
Philadelphia.
Abdomen,"
elements which are found in a " Myxoid Proliferous Cystoma," or multilocular ovarian tumor, he made the following
cal
statement
1
:
large
number
of free nuclei
The
some
of
scribed
cells.'
them
They
name
of
known
'
granular ovarian
(i,
number
e.,
of
They have no
Their
size ranges
the test with acetic acid as characteristic of them, but Lebert says he found these bodies in the peritoneum, in the
synovial
membrane
and metastatic
abscesses, and often mixed with common pus corpuscles,
1
1881, vol.
vi.,
p. 54.
THE OVARIAN
CELL.
themselves nuclei. These nuclei are in a state of fatty degeneration as seen by the clear, highly refracting globules
in their interior. They are never found in the quite
young,
microscopical cysts, developed in the wall of larger cysts,
while we seldom miss them in the latter. In Case XXXII.'
was able
to observe directly the identity of Drysdale's corpuscles, the colorless corpuscles with fine dark granules, and
I
showed
some
of
THOMAS
M.
DRYSDALE.
in the fluid.
corpuscles."
and
in a renal cyst,
in a vaginal cyst
made by
On
others.
abdomen by
may
proceed
This granular
but sometimes a
little
The
granules
is
granular
the
in ovarian fluid,
cell,
"
oval in form,
is
is
almost
is
cell."
generally round
number
of fine granules,
have a
clear,
but no nu-
well-defined
outline.
These cells differ greatly in size, but their structure is always the same. They may be seen as small as the one fivethousandth of an inch in diameter, and from this to the one
two-thousandth of an inch in some instances I have found
them much larger, but the size most commonly met with is
;
The
more
cell.
When
distinct,
ether
while the
is
Atlee, Diagnosis
of Ovarian Tumors,
clearly
ease,
the granular
named
of these cells
and when
apparent.
and
cells,
we
fre-
cell
tain a
any
of the cells
named
ble.
varying in
for
it will,
if
a pus
it is
on adding
Should the
have seldom
"
be
cell,
or
size,
cell,
this acid,
become very transparent, and nunumber from one to four, will become visi-
seen to increase in
clei,
above,
it
its
cell,
transpar-
This ovarian
consider as diagnostic of ovarian dropsy, and
failed to find
The compound
it
granular
distinctly.
in this fluid.
cell,
and others, or inflammation corpuscle of Gluge, is also occasionally present in these fluids, and might possibly be
mistaken for the ovarian granular cell but it is not difficult
to distinguish them from each other. Gluge's cell is usually
much larger and more opaque than the ovarian cell, and has
the appearance of an aggregation of minute oil globules,
sometimes inclosed in a cell wall, and at others deficient in
The granules are coarser and vary in size,
this respect.
while the granules of the ovarian cell are more uniform and
very small. Again, the behavior of these cells on the addi;
ovarian granular
most has
its
cell
granules
made
it,
Gluge
or at
loses
its
THOMAS
In another place
M.
DRYSDALE.
the ovarian
cell is
spoken of as "
A cell
seen in ovarian
lar cells
fluids,
heretofore given, of
little
value,
in
fluids
ac-
me
been discovered by
cal fluids."
may be
summarized as follows
I assert
r. That a cell, called the ovarian granular cell,
is almost invariably found in the fluid of ovarian cysts.
2. That this cell may be distinguished from the pus cell,
lymph corpuscle, white blood, and other cells which resemble them, both by the appearance of the cell and by its be:
That
it
has been
named the
p. 179-
THE OVARIAN
6
distinguish
from
CELL.
dropsical fluids
all
abdominal
cavity.
On
1.
in ovarian fluids,
cells,
and known as
That
in
of the body.
be perceived that the first and last of Dr. Garrigues' statements merely express a difference of opinion, but
the second and third amount to grave charges which I will
endeavor to refute.
Whilst our views are antagonistic on all these points, it
It will
will
in
common
He
says, 1
vi.,
p. 54.
THOMAS
large
number
of free nuclei,
The
DRYSDALE.
M.
some
of
known
" The
"
and again,
have found it really
'
diffi-
ovarian gran-
are thorn-apple or rosette-shaped red-blood corpuscles, the knobs on the surface of the latter, seen from
above, giving an appearance which is very like that of the
ular cell
'
ence of a peculiar body in ovarian fluids which can be readily identified as the one which I have described as the
ovarian
The
cell.
question, then,
body, but as to
its
is
my own
sary to give
be neces-
and charremarks
fully understood,
views
it
of Dr. Garrigues.
The reader
my former
of
take.
it
'
ovarian
'
the ordinary
properly called
'
compound granule
'
cell
or
'
formerly iminflammatory
1882, p. 24.
"
whatever
locality found,
and
An
ity."
it
misunderstood.
In taking up the subject again, after ten years of silence,
was correct
this paper,
it
will
in considering
it
cell.
its origin.
an
epithelial lining.
8 Ibid.,
*
p. 353.
1S82, p. 430.
April, 1882, p. 43 2 -
THOMAS
their
growth
in
most
M.
cases,
it
DRYSDALE.
will
they are possessed of an intense vital activity. The cell elements multiply rapidly, and are cast off, pari passu, with the
increase of the cyst. In this hurried growth a great number
of the epithelial cells do not come to maturity, but are thrown
being completely developed, or, in other words, before a nucleus has formed in them. This rapid growth and
shedding is, as is usual in such cases, attended by a partial
fatty degeneration of the cells, giving them their granular appearance. Being immediately immersed in the albuminous
off before
they acquire, by maceration in it, that delicacy and transparency so peculiar to them. In short, the ovarian cell is not claimed to be a new cell, but an epithelial cell
in an immature condition, produced in ovarian cysts by rea-
This
is
cell.
may be said, this is merely a theory of their formaWhat proof can be given to show the correctness of
tion.
The evidence may be found in a careful
this conclusion ?
But,
it
stages of development.
cell
fluid,
THE OVARIAN
IO
For many
of these years I
CELL.
ovarian cell
is
epithelial cell,
of
fatty degeneration.
when
it
is itself
a nucleus." 1
if
cells
p. 29.
THOMAS
1
cleus remains."
M.
DRYSDALE.
Spiegelberg, and
many
II
other observers,
its
we
is
we do
not desire
We
an elementary organism.
cell to
must
we
protoplasm."
little
in their struc-
more
cell,
proceeds
British.
Ibid., p. 29.
Ibid., p. 29.
"
But
'
THE OVARIAN
12
there
number of cases in which the cell shows ita form of much less complete development; the
a large
is
in
self
CELL.
elementary part being a corpuscle of protoplasm or germinal matter,' of which the exterior has undergone a slight
'
'
'
but in
'
'
cell contents,'
or nucleus.
This condition, which is characteristically exhibited by the nearly globular colorless cor'
common
of their
'
'
'
'
Am
not correct,
cell,
and that
such a body as
have correctly defined it, it will be
that there
is
why has
itself.
If
been called
an ovarian cell and described as having no nucleus ? This
question has been partially answered in my first paper. Believing this immature cell to be the one which is characterthis is
istic of
ovarian fluids,
to "distinguish
it
it
from
cell,
it
cell
it.
And,
as
it
an epithelial cell, for then a matured, nucleated epithelial cell would have been looked for, but as the
peculiar cell which I found only, with one exception, and almost invariably, in ovarian fluids, and which differs so
as
it
existed, not as
The Microscope,
P- 734-
etc.,
1875,
THOMAS
widely from the epithelial
M.
DRYSDALE.
13
appearance, and in
cell in size, in
following paragraphs
instead of examining old cysts, we direct our attention to the very beginning of the formation of a microscopic
"
If,
They are
minute cysts
of these
larger,
we
in diameter.
still
The
In another
which
of the
is
little
same kind,
here somewhat larger, either circular with a diameor oblong, measuring seven by eleven
eter of seven
One of them has a nucleolus. At the same time we notice
ies are
in the wall a
much
enlarged epithelial
cell
The
nuclei
may
later
eration,
1
1882, p. 28.
THE OVARIAN
14
CELL.
offered to
colloid
show
degeneration or melting.
statement
simply
Closely examined,
that
his
this,
same
is
overwhelming.
manner the
the
cell itself
cell
THOMAS
Again, does the
cell
DRYSDALE.
M.
15
eration,
here, for in
describing the process of fatty degeneration in the epithe" Usually, the nucleus is destroyed, but it
lial cells, he says,
may
I
still
be
visible."
Bennett's corpuscles. 2
Having shown
the liberation of the nucleus by colloid and fatty degeneration no proof can be found of the correctness of his conclu-
yellow-gray fluid."
"In
this
swam
flakes of epithe-
showed
still
Some
some
surrounding
fluid.
Let us examine
this description.
"
Some
Ibid., p. 27.
American Journal of
Obstetrics, p. 31.
of the flakes,"
1882, p. 28.
THE OVARIAN
i6
CELL.
He
us,
but
How
did he
know
is,
it."
it,
To
peculiar.
in
It
simply impossible.
of
it is
epithe-
cells
p. 54-
THOMAS
M.
DRYSDALE.
17
show
that I
am
rian cells,
are nuclei
is
ment, which
without foundation,
next state-
that " in
membrane
of the knee, in
common
pus and its varieties, he says 1 " The element by far the
most important is the one to which we have given the name
of pyoid globules, and that we regard as a variety of pus
globules, with which one often finds them mixed, but from
which notwithstanding they differ by several of their chemical and physical characters." He then gives the size, which
" They are spheris almost the same as that of the pus cell.
ical and composed of two elements, of a substance tolerably transparent, of a consistence rather solid than liquid,
and of molecular granules varying from four to ten, and beyond, irregularly distributed in their substance but they
never show any nuclei, and the acetic acid above all, in rendering them a little more transparent, never changes them."
If we stopped here the quotation would certainly confirm what has been said by Dr. Garrigues, but we will read
on " They are larger and more spherical than the globules
of tubercle, smaller and more granular in their substance
than the white globules of blood, from which they differ by
:
I.,
THE OVARIAN
i8
CELL.
another essential character, their yellowish tint." 1 Is this entirely like the ovarian cell in appearance ?
Is not Lebert's
statement clear, that they can be distinguished from the
white blood
cell
by
why
blood
cell,
cell,
which
Dr. Garrigues appears to have overlooked, is that these bodies are only discovered in pus.
Never are they alluded to
as being found alone, or apart from pus
and
in the false
membranes
of the
mucous
the acid causes the pus cell to become transparent and reveal its multiple nucleus, while the pyoid body is only made
a
little
nuclei,
is its
yellow
color.
statements, founded on an imperfect quotation from Lebert, are disproved by Lebert's own
Nothing is found in his writings to support Dr.
words.
Garrigues' assertions, for the mere fact that Lebert discovsont plus grands et plus sphdriques que les globules du tubercule, plus petits et plus granuleux dans leur substance que les globules
blancs du sang, dont ils different par un autre caractere essentiel, leur
1
"
lis
teinte jaundtre."
Paris, 1845.
Lebert
i.,
p. 46.
THOMAS
M.
DRYSDALE.
19
dale's so-called
'
'
pus, certainly
seems disingenuous.
it
may be
well to
bodies of Lebert.
This
is
many
Lebert
American Journal, of
of these pyoid
i.,
mere
fact of the
p. 47.
THE OVARIAN
20
CELL.
That there
2.
is
its
the
granules are not distinct, their outlines are not sharply defined.
Acetic acid has very little influence on it. But its
it
cell,
white blood
my
cell,
etc.
have
"
paper on
Dropsical Fluids of
words 1 " Specimens of
ascitic fluid are occasionally met with containing objects
which, in size and appearance, resemble the pus cell, but
which show no nuclei on adding acetic acid. Their surface
is generally granular, but occasionally is finely wrinkled.
They differ from the ovarian granular cell in being semiopaque, in their not presenting the clearly defined granules
of the ovarian cell, and in their being of an uniform size,
one two-thousandth of an inch in diameter. These cells
are here described particularly, not that they are believed
to be peculiar to this fluid, but in order to guard against an
error in diagnosis, as they have been mistaken for the ovarian cells." But, as I have shown, there is but little risk of
an observer who has an eye well trained to this kind of rethe
Abdomen,"
in the following
cell for
the other.
is
To
my
first
paper.
W.
L. Atlee, p. 451.
188 1, vol.
vi., p.
55.
THOMAS
M.
DRYSDALE.
21
1
on the Principles and Practice of Medicine,'
Bennett draws both large granular cells with or without a
nucleus, and small bodies invariably without a nucleus, which
latter are entirely like Drysdale's corpuscles. Fig. 1 72 on page
cal lectures
172 shows very distinctly Drysdale's corpuscles, after addition of acetic acid [the italics are Dr. Garrigues'] without
nucleus. The text describes them as pale, round, and oval
'
same
cell is referred to in
the drawing at
91,
What
this,
cell,
graph
is
entirely misleading,
and
is
The
para-
two entirely
to
In regard to
this,
know
cells
proof,
it is
The
1
2
a mere assertion.
p. 38.
THE OVARIAN
22
CELL.
his
own words
"
The
fluid
removed by
tap-
Fleming," he says, " contained flocculi which, when examined with the microscope,
were found to be composed of numerous cells varying in
size
of Jessie
in diameter.
a millimeter.
dis-
about the one hundred and fortieth of a millimeter in diameter (see Fig. 170)," 1 the very one alluded to
by Dr. Garrigues in support of his assertion. These were
nucleated cells, and are the only ones he refers to, which
tinct nucleus
cells,
which
p. 700.
THOMAS
feet as the description
M.
DRYSDALE.
clear
is, it is
enough
23
to enable us to
this,
have
in this
is
the
first
cells,
drawing.
The
dif-
cell.
" Fig.
without nucleus.
The
text describes
like
weak
Sometimes
this
matter
is
structureless, at others
it
jelly.
may be
(Fig.
172).
on Medicine, by
York, 1858, p. 172.
Clinical Lectures
edition,
New
J.
THE OVARIAN
24
To
CELL.
Paget
of colloid matter.
depicts
them thus
show
little
to
this
The
first
'
Principles
and Prac-
tice
of
Medicine
Museum,
']
am
Surgical Pathology,
Ibid., p. 38.
p. 775.
1882, p. 38.
p. 182.
vol. xxiv.,
THOMAS
guish
it
M. DRYSDALE.
cells.
25
Thus
all
of Dr.
Gar-
Bennett described
cells,
either in 1852 or at
That these bodies are not pathognomonic of ovarian nor any other cyst, as they may be found
in various parts of the body," and " That there is no pathognomonic morphological element in the fluids of ovarian
tion, his conclusions,
cell, but,
it,
the objection
is
groundless.
is
never
cell is suffi-
But
it
may
THE OVARIAN
26
CELL.
them
show
will
distinguish
them
besides,
it is
Generally, a sufficient
all
number
The
test
which
recommended
cells.
In another place I have stated that " the ovarian granular cell remains nearly unaffected by it, or, at most, has
its granules made paler, while the cell of Gluge loses its
granular appearance, and sometimes entirely disappears
THOMAS
M. DRYSDALE.
27
1
To
through the solution of its contents by the ether."
He says, "When
this statement, Dr. Garrigues objects.
ether is added we see some of Bennett's corpuscles almost
dissolved, but other corpuscles of the same kind are not
at
all,
my
is
can be readily settled by the further examination of the matter by other observers.
The last statement of Dr. Garrigues which I shall notice
is, that "Drysdale's corpuscles seem to have a little more
value than Bennett's, but they are by no means pathognomonic, not even of the presence of any kind of cyst, and
still less of an ovarian cyst." 3
"I have," he says, "found
correct, but this question
p. 181.
2
8 Ibid.,
1882, p. 24.
vol- xxiv.,
THE OVARIAN
28
CELL.
them
in
in
The
ovarian
how he
make
it
evident
American Journal of
2 Ibid.,
8
January, 1882,
p. 37.
THOMAS
M.
DRYSDALE.
columnar epithelium
else,
is
ovarian,
29
The
test, then, is
not
conclusive.
of
the
sertions
may be
is
own
words.
moved by
He
states
which were
He
re-
further
30
THOMAS
M.
DRYSDALE.
31
Dr. Garrigues tells us that he has also met with a cell resembling the ovarian cell in cysts of the kidney. This agrees
my own
experience.
brown color.
was alkaline.
was
it
Its reaction
1.020.
was seen
to contain
plates of cholesterin, coagulated fibrin, blood-cells, oil globules, and great quantities of granular cells, which, in ap-
Another
is
diagnostic of ovarian
fluid.
In the examination of these fluids for the purpose of diBut, foragnosis this exception must be borne in mind.
tunately, the exception
is
first
sight
granular
cell.
The
if
any
it
from that of
fluid,
or
if,
as in the
These were
all
met with
in accumulations of pus,
and
THE OVARIAN
32
The
CELL.
fluid in
cell.
all of
these
tion occupies
is illustrated
sent
facts
1881, vol.
vi.,
p. 85.
THOMAS
M.
DRYSDALE.
33
if
me
in cysts
met with
it is
note
cell
New York
City, 42
West 35TH
St.,
'81.
5, 5,
The
fluid
following
is
me
doubts about
my
you permit
me
to
its
being
lent
my
copy
to
THE OVARIAN
34
CELL.
My
dear Doctor,
If I did not mention the fact that the tumor in question came from the abdomen, it was because I thought
you knew that I am a specialist, only dealing with matters connected with the female genital organs.
Truly yours,
E.
Noeggerath.
Comment
is
unnecessary.