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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    and also by an inflammatory infiltration of the connective tissue of the lung. Around each tubercle there is commonly an inflammatory zone, and the tubercle as seen by the naked eye includes inflammatory products along with the true tuber¬ cular growth. In the case of the pia mater the inflammatory manifestations are highly developed, and the tubercles are so concealed by the inflammatory exudation as to be usually rather difficult of detection by an inexperienced person. An important question comes up here as to the relation of the inflammation to the tubercles. Is the inflammation produced by and secondary to the tubercles, or are they both due to the same poisonous agent ? This question will come up after¬ wards and need not be fully dealt with here. Turning now to a case of local tuberculosis, we have to consider what the exact pathological processes are in an undoubted case of this kind. Local tuberculosis of the kidney, sometimes called phthisis renalis, affords a good example. In this disease there is, let us say, first in a single calex, a tuber¬ culosis of the apex of one of the pyramids of the kidney, that is to say, tubercles are formed in this situation. These tubercles, of essentially the same structure as those in acute miliary tuberculosis, have a tendency like most tubercles to undergo caseous metamorphosis. Caseous metamorphosis means death or necrosis of structures, and here as the caseous material is at the surface, it is carried away and an irregular ulcer forms. This ulceration increases by a repetition of the same process. Tubercles are formed in successive crops outside the ulcer in the neighbouring kidney tissue, and the ulceration spreads by the successive disintegration of the tubercles and tissue involved. But this disease advances not only in this direction. It progresses down the ureter, causing ulceration of its mucous membrane, the caseous material sometimes forming a continuous layer on the surface of the prolonged ulcer. In this way the entire ureter may be converted into an ulcerated tube with a caseous lining. The bladder is also affected, and we have again ulcers produced by the formation of tubercles in the mucous membrane, and extending by the formation of successive tubercles peripherally, and their disintegration. The formation of tubercular ulcers may extend to the other ureter, but the process apparently finds some, difficulty in ascending against the current of the urine, but it may spread to the vesiculse seminales and vasa defferentia. Now in such a case as this we have a local disease present¬ ing characters exactly parallel to what we find in acute general tuberculosis. We have here a virus not conveyed by the
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