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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    felt on coming back to the physical examination some weeks afterwards, on discovering the metallic sounds characteristic of a considerable excavation over the upper lobe, where immediately after the haemoptysis the respiratory murmur had been abun¬ dant and the percussion good. There was no reasonable doubt of these facts; so that it was perfectly clear to me, that while this lad was walking about the ward with pulse, temperature, and respiration normal, with scarcely any appreciable expec¬ toration, and no pain, a cavity had developed, of size sufficient produce the most marked physical signs, in the upper part of the lung. Briefly, the rest of the case may be said to be as follows: from this time, by exceedingly slow stages, the patient still making no complaint, hardly a patient at all, going home and coming back again, for he was three times in the Infirmary, the disease gravitated into a case of very chronic ordinary phthisis, and came to be undistinguishable in character from an average case of very slowly developed tuberculosis ; and ultimately the lad died. At the rpost-mortem examination the left lung was found firmly adherent, and an enormous cavity was found in the upper lobe, into which several large bronchial tubes opened; the tissue was condensed throughout in the lower lobe with smaller cavities. The right lung was free from adhesions, and there was no considerable condensation, much less any cavities, but it was dotted over with frequent dark nodules, which the microscope showed to be undoubted miliary tubercles. Miliary tubercles were also found, though not very abundantly, in the liver and spleen. It was certainly a case where one would have been strongly inclined to doubt the tubercular nature of the disease, as observed without the microscope, for it had a good many of the characters of cirrhosis of the lung, but from the microscopic sections from the right lung, some of which are shown by Dr. Coats to-night, there was no doubt as to its tubercular nature. This lung was very adherent. In the right lung there was an entire absence of adhesions. The tubercular character of the disease ultimately is thus clearly established, and the question is, With what pathology of tubercle does this case best agree ? It seems to be one of the cases that comes nearest to the general doctrine of Virchow, the doctrine of a secondary tuberculosis, of a “ phthisis ab haemoptoe,” as expounded by Niemeyer; but if it is to be accepted as such, it differs from Niemeyer’s description in details, especially as regards the inflammatory changes and symptoms usually following a haemoptysis. He says, the
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