Puerperal Fever

Abstract

of cells, and was a replica of the surface epiderm. Thus, those parts of the follicle which lay closer to the surface exhibited a most sharply and fully developed stratum granulosum ; if anything, a basal layer was better indicated here than on the surface. However, no prickle cells could be made out. In deeper portions of the follicle, there was a delicate, threadlike, hyaloid (but doubtless keratinous, chemically) zone lining the lumen of the hair follicle. Its wavy contour reminded one of the elastic membrane in arteries and perhaps of the cuticle-like lining of sweat ducts. It is regretted that none of the bulbs of follicles were included in these sections.Sebaceous Glands : These were most inconspicuous for a position like the scalp, although they might have been more fully represented if deeper portions had been available for study. As it was, only small groups of cells adjacent to the hair follicle could be found. Those that were exhibited appeared normal.Sweat Glands : Again, since the examination was restricted to the upper portions of the scalp, the deeper parts, such as the secreting coils, were not represented. Ducts, however, were numerous.The lumina were narrow and their lining cells plump and of normal appearance. Comment and Summary : No exceptions could be taken against the epiderm ; if anything, it appeared to be biologically more active than normal. The important changes were those of the hair shaft, together with the assumption of epiderm-1 ike qualities on the part of the sheath. The second significant feature was the hyperplasia of the capillaries and of the spin¬ dle cells around them ; but there was nothing to indicate whether this was a primary or secondary factor in the case. The same was true of the scarcity of sebaceous glands, but in this case the explanation was at hand in the form of the secondary atrophy of disuse.Supplementary Note : In subsequently cut sections, the lowermost portions of some hair follicles were presented for study. Now the whole follicle was less than half the size of those elsewhere, and easily overlooked. The peripheral parts of the sheath merged with the surrounding loose fibrous tissue by reason of an edema, which affected both of these members. The sheath consisted of only two or three layers of cells, the basal ones not being recognizable as such. The center of the follicle consisted of some pink, probably keratinous substance, enclosing numerous epithelial nuclei. The latter were degenerate-some were swollen and pale, while others were shriveled, solid and almost black. Small numbers of lymphocytes and one or two polymorphonuclears appeared in the neighborhood of these follicles. The appear¬ ance was not that of an inflammation and fibrosis which was inducing an atrophy of the follicle, but more that of a primary atrophy. The surrounding loose fibrous tissue and minor cellular infiltrate might be interpreted as reactions to disin¬ tegration products of the hair shaft that were once present.The histologie diagnosis was atrophy of the hair follicle and seba...