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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    blood being in the parenchyma of the lungs or in the alveoli leads first to an inflammation ; and that he has often witnessed a development of high fever and pain, with symptoms of inflammation, after such a bleeding as we had in this case. In the patient whose lung is now before us, it would perhaps be too much to say that the bleeding took place without any inflammation; but this at least may be safely said, that whether the tubercular tendency preceded or followed the haemoptysis, it seems to have come on without anything of the characters of the inflammation as gauged by the symptoms. It may here be suggested that cases of haemoptysis like this one are not the only cases in which it is known that blood is poured out into the lung ; and it always appeared to me a difficult point to meet, on the modern theory of haemop¬ tysis giving rise to tubercle, that cases are very numerous where haemoptysis and also haemorrhagic condensations take place, but where it is very rare for tubercles to follow. Haemoptysis as the result of mitral disease, “ apoplexy of the lung ” as Laennec called it, is the very type of a case where one would expect, on this theory, the blood stagnating in the air cells of the lung to caseate, and thus give rise to secondary or miliary tubercles; and yet it is very rare to find mitral disease associated with tubercular disease. Then, again, haemorrhage often occurs into other organs or parts in which tubercle never follows, as in bruises, in scurv}', in embolism, even pulmonary embolisms, &c., or in haemorrhage into the brain, where the rupture of a blood-vessel and the formation and organisation of a blood-clot is often survived for many years, and where caseation hardly ever does result as a consequence, and tubercle is still more rare. Certainly neither inflammation in the ordinary sense of the word, e. g., abscess, nor caseation, nor tubercular meningitis, nor general miliary tuberculosis, can be said to be at all a common result of an old apoplectic clot becoming encysted ; and yet, on the theory that extravasated blood per se is apt to caseate and give rise to tubercular disease, one would expect tubercle in one form or another to be among the well known and familiar pathological incidents of cases where an apoplectic clot has remained for years, has undergone gradual fatty degeneration, and has by slow degrees become to a great extent removed. So also it is not rare, though not, perhaps, so common, as in the case of the brain, to find haemorrhagic condensation in the lungs, from cardiac disease or embolism, undergoing a great variety of chronic changes, more or less allied to inflammation, and even to ulcer-
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