8. The kidney, for signs of interstitial rather than tubular nephritis, adherent capsule, and blood-stained exudate.
9. If paresis of any sort has been present during the illness, examination of the cord and brain should be made with especial care, and in addition the nerves on the affected side supplying the affected muscles should also be examined. In the brain definite small but coarse hæmorrhages may be occasionally observed, but as a rule the only signs to be found are injection of the cortical vessels, frequently over certain definite areas, and not involving the whole of the vascular system of the brain. Minute hæmorrhages may be also found in the spinal cord.
For the purposes of histological examination, a portion of the following organs should be removed and placed in a 5 per cent. formalin solution at once: Liver, spleen, kidney, intestine, the last-named specimen being selected from any area which shows injection, or ulceration, or dark staining.
Smears may also be made from the bone-marrow, as in prolonged anæmia of saturnine origin definite changes may at times be found in the bone-marrow cells.
Where paresis has existed, a portion of the particular nerve supplying the muscles should be obtained, and histological examination made, as well as a portion of the cord above the lesion, and where cerebral symptoms have been present, a portion of the brain, the portions taken being part of that showing engorgement of the vessels. For the nervous tissue generally, it is better to place some of the specimens in Müller’s solution, and others in spirit. Equal parts of Müller’s solution and formalin may be used if desired.
Material for Chemical Examination.
—For the purposes of chemical examination, any of the organs which appear to be mainly affected by chronic inflammation may serve, but it is usually important to examine the brain, kidney, and liver. If any dark staining exist in the intestine, a portion of this, together with the contained fæces, should be removed. It is better to tie ligatures round the intestine, and divide the coat between the ligatures, and place the whole of the specimen in dilute formalin. Specimens thus obtained should be sent off for examination at once. The whole of the organ need not necessarily be despatched for examination in every case, but if only a portion is sent, it is essential that the weight of the whole organ be accurately taken before any portion is removed, and the total weight noted with the specimen when sent.
REFERENCES.
[ [1] Tanquerel: Traité des Maladies de Plomb ou Saturnines. Paris, 1839.
[ [2] Lancereaux: Gaz. Méd., 1862; Tribune Méd., 1896.