Lectures on the principles and practice of physic : delivered at King's College, London / by Thomas Watson.

  • Sir Thomas Watson, 1st Baronet
Date:
1850
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Licence: Public Domain Mark

Credit: Lectures on the principles and practice of physic : delivered at King's College, London / by Thomas Watson. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    hand ulceration of the larynx, existed in one-fourth ; ulceration of the bowels, in five-sixths of the cases. In 180 cases in which tubercles of the lungs existed in children, Dr. Green found the brain to be affected with tubercles in one-ninth of the cases ; the bronchial glands, in 100 out of 112 ; the mesenteric glands were tuberculous, in one-half; the liver, in one-ninth ; the kidneys in one eighteenth of the cases ; but ulceration of the larynx occurred only once, and ulceration of the bowels, sixteen times in 112 cases. M. Cless, of Stuttgard, has also published the results obtained from the examination of up- wards of ISO bodies affected with tubercular disease. In 152 examinations of adults, M. Cless found the lungs free from tubercles six times. In 21 examinations of children, he only found the lungs free from tubercles once. This was in a boy eleven years of age, who, besides a considerable serous effusion into the ventricles of the brain, had two large masses of tubercle in the cerebellum, many small ones on the surace of the liver, and caries of the vertebra?. In 146 adults affected with tubercles in the lungs, there were only thirty-five in whom the disease was confined exclusively to the lungs. In children there were only three cases out of twenty in which all the other organs were free. M. Cless never found the bronchral glands in children affected with tubercular deposit without the existence of tubercles in the lungs also. In thirteen adults and one child there were tubercles in the pleura. In sixty-one adults, and four children, the tubercles were limited to the peritoneum eight times. The four chil dren were between six months and ten years of age. In 152 adults affected with tubercles, the small intestines were affected eighty-three times, and the large intestines thirty-seven times, and in twenty-one children, the small intestines were affected seven times, the large ones only once. Among 152 adults, thirty-two had tubercles of the mesenteric glands, while they occurred in these glands in seven out of twenty-one children. In all the cases tubercles were found in the other organs. Tubercles of the liver occurred once in an adult, twice in children, while other organs were also affected. In four adults, and twelve children, the spleen was affected with tubercles, these at the same time existing in other parts of the body. In children M. Cless remarks, the parenchyma of the spleen is often completely invaded by tubercles. In the kidneys, tubercles were met with four times in adults, and three times in children; of five children, aged from eight months to eleven years, in whom the membranes of the brain pre- sented tubercles, four died of acute hydrocephalus. In all these there were tubercles in the lungs and other organs also. The tubercular granulations had always their seat on the ex- ternal surface of the arachnoid, between this membrane and the pia mater, never within the cavity of the arachnoid. In twenty-seven children who died from tubercles, four had tubercles of the brain, as also in other organs; M. Cless never found any in the brain of adults. Be- sides their existence in the mesenteric and bronchial glands, M. Cless found tubercles in the glands of the neck in five adults, and one child. See Condie on Diseases of Children, 2d edition.—C] The question has been much and eagerly discussed, whether the deposition of tubercular matter be not, what I should call, an event of inflammation. Some persons have strenuously argued that the curd-like substance is nothing more than a parti- cular kind of vitiated lymph, and that it is never poured out except as a consequence of inflammation ; and they cite cases of persons who always had enjoyed good health, until inflammation was accidentally excited in their lungs, immediately after which the well-known signs of phthisis began to display themselves; and, after death, the lungs were found full of tubercles. But they forget to take into the account another fact equally well established, viz.: that tubercles are found, in great abundance, in the lungs of persons who were never known, in their lives, to have any functional disturbance of those organs; and whose lungs present, after death, no other traces of having been inflamed. We even find tubercles in the lungs of unborn children. Not that this is conclusive; for inflammation does sometimes attack thr foetus in utero, aud leave permanent and unequivocal traces of its action. Moreover, inflammation continually happens, in all the component textures of the lung, in the forms of bronchitis, pneumonia, and pleurisy, without the subsequenl development of tubercles. I admit that this fact, to be of weight, should be proved of persons who possess the scrofulous diathesis ; and I believe the proof might be found ; but the search for it would require much carefulness and candour. In my own opinion, there is not a shadow of evidence to show that the deposit ot tubercular matter is always and necessarily preceded by inflammation. Yet an undoubted and most important connection obtains between the occurrence of in- flammation and the occurrence of tubercles. Tubercles will cause inflammation, and inflammation will determine the development of tubercles. The enlarging tubercles excite inflammation in the surrounding textures by the pressure they exert upon Ihem; and probably in other ways; by mechanically interfering with the healthy
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