Discussion on the pathology of phthisis pulmonalis.

Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Discussion on the pathology of phthisis pulmonalis. Source: Wellcome Collection.

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    both ] ungs, both kidneys, both halves of the membranes of the brain, &c., are equally affected. In the individual organ also the tubercles are planted uniformly in every region of it. In the lung, for instance, there is no localization at the apex or elsewhere, but from apex to base there is a homogeneous distribution of the nodules. So is it in the liver; the tubercles here are mostly too small to be visible to the naked eye, but making a microscopic section of any part of the organ one is certain to meet with them. Now a lesion which has thus a symmetrical distribution, which occurs simultaneously in a great variety of organs, and which presents all the characters of an eruption, must be due to the presence of some poisonous agent in the blood. This is confirmed by the clinical characters of the disease, which are not entirely referrible to the local conditions. In a recent debate on syphilis in the Pathological Society of London, Jonathan Hutchinson insisted on the view that a symmetrical disease is a blood disease, and adduced the authority of Paget and Budd in support of this view. In the present case it seems impossible to escape the conclusion that there is some virus carried by the blood to these various organs and producing the lesions there. It may be important here to refer to the histological charac¬ ters of this lesion, the miliary tubercle. The structure is virtually identical in all situations. In the case of the lung, for instance, as appears in the sections which I have placed under the microscopes, the tubercles are seen as rounded solid tumours in the midst of perfectly vesicular tissue. So in the liver there are rounded bodies appearing in the midst of the hepatic tissue. The tubercles are situated in the connective tissue of the organs. In their finer structure they present giant cells in their central parts, and these giant cells contain multitudinous nuclei, largely distributed towards their margin. At their peripheral parts the giant cells present processes which form a reticulum, in the meshes of which are smaller cells, some of them epithelioid in size and appearance, some of them with the ordinary characters of small round cells. These characters are often obscure in their finer details on account of degenerations and the complications about to be referred to. While these small round tumours, the true tubercles, are present in the various organs mentioned, they are not the only pathological condition. It is important to observe that in almost every case there are evidences of concomitant inflam¬ mation. In the case of the lung the inflammation manifests itself in the form of a catarrhal exudation in the air vesicles,
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