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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    caseated matter can be found; bow do they arise ? It may be in persons with strongly pronounced heredity, from the absorption of tuberculous matter in the atmosphere, when near some phthisical person while coughing, or that the blood in such persons spontaneously acquires the condition which is generated by the introduction into it of caseous matter in ordinary cases. I stated at the outset my belief that Laennec’s theory had exerted an evil influence on practice. Being of opinion that the state of the blood is the primary and chief morbid condi¬ tion, and holding the disease in the lungs to be a mere local expression of that condition, practitioners, it is to be feared, have been led in many instances to give almost all their care to the former, and little heed to the latter. But when the physician considers phthisis to be a consequent on inflam¬ mation, the local morbid process receives his assiduous atten¬ tion, and unquestionably in many cases a great deal of good can be effected by local treatment. At the same time, being well aware that heredity and a feeble constitution are present in most cases, he neglects no measure which is likely to strengthen the system, and obviate, as far as possible, the influence of the morbid disposition which has been inherited. Dr. Barr said—Assuming that acute miliary tuberculosis might be due to the absorption of inflammatory products which have undergone caseous metamorphosis, he would suggest that, in many cases, the source of this infective material might be caseous accumulation in the osseous cavities of the ear, known as the mastoid cells. In chronic inflammations of the middle ear, we have these cells filled with purulent secretion and epithelial debris. These purulent diseases go on for years, and in time this secretion and debris become dry, and undergo, undoubtedly, a caseous change, and often after the otorrhoea has stopped for some time, on ex¬ amining these spaces this caseous material is found. Now, the veins may convey the effete matters from the mucous membrane lining these cells, and as they pass into the sinuses of the skull, a connection is thus formed with the pulmonary tissue through the jugular vein; so that, if it is made out that tubercle may arise from caseous material, this is a probable source of it. Von Troltsch related three cases of acute miliary tuberculosis, and in all three he found, on examining these cells, that they were filled with this caseous accumula¬ tion, all being due to long continued chronic inflammation of the middle ear.