Bed-side sketches : on the pathology, diagnosis, prevention, and treatment of thoracic consumption / by J.C. Hall.

  • Hall, John Charles, 1816-1876.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: Bed-side sketches : on the pathology, diagnosis, prevention, and treatment of thoracic consumption / by J.C. Hall. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    10/32 (page 20)
    often long permitted to exist: an attack of inflammation comes on, from some cause or other; they lose the little brightness they at first possessed, and become changed into that form of tu- bercle which Laennec first introduced to our notice. This change first takes place in the centre, which arises, as Dr. Williams supposes, from the fact that, being de- void of blood-vessels, the centre is fur ther removed from the vivifying influ- ence of the hlood. It was suggested by Dr. Elliotson, that the softening of tu- bercles is the result of a spontaneous chemical change, and the author already quoted agrees with him so far; but he also regards this chemical change to be promoted by the fluids of the surround- ing parts. So long as tubercles remain dry, this change does not take place; but, on an afflux of fluids around them, they soon become soft. Mr. Gulliver lias drawn attention to the very singular increase of fat globules in softened tu- bercle.* Although, as already stated, the tubercles may remain even for years in a state of rest, sooner or later, in the great majority of cases, inflammation is set up around them. This inflamma- tion is of the strumous type; thin pus is thrown out around the deposits, which become loosened, and at length the whole is expectorated. This is the way in which tubercles are got rid of; and, singular as the remark may ap- pear, it is nevertheless true, that it is by this process of nature to get rid of the extraneons matter the unfortunate patient is destroyed. There is nothing malignant in the nature of tubercle; and, if the quantity deposited in the first instance he small, even when this process takes place the patient may re- cover, provided no additional crop of tubercles be sown. This, unhappily, generally takes place: the constitu- tional taint remains; and no sooner has the jioor patient got rid of one lot of tubercles than the process is repeated, and at length, worn out and exhausted, he dies. Some years ago we saw a gentleman in whose lung a vomica most imdoubt- edly existed; but it had, liapj>ily for * Mr. Davy discovered oleine and margrarine in opaque exudation corpuscles from the lungs. Dr. Williams has so many times detected fat globules in deposits in the kidneys, and in the vegetations on the valves of the heart, that abun- dant proof is before us of the liability, in all de- graded plasmata, to the production of fat. himself and for his family, existed singly: it was in time completely emptied. It gradually contracted, and is now completely obliterated. We have examined one or two bodies in which this state of tilings was very beautifully demonstrated. When the sides of these cavities come together, a puckering takes place of the pleura on the surface of the lung; beneath this puckering will be found a collapsed vomica, the inner surface of which re- sembles cartilage; but, unfortunately, the result, at least hitherto, has been that the tubercular bodies continue to increase, inflammation is set up, the tu- bercles, becoming further degenerated, soften and are expelled, leaving larger or smaller caverns. We have seen them not bigger than the end of the finger, and sufficiently capacious to contain at least a pint of fluid. Some- times the whole of the upper part of the lung is excavated into a large cavern. We have the notes of the post-mortem examination of two bodies which we opened, the one on the 15th, and the other on the 16th of June, 1836, in tho presence of Mr. K. J. Pollock, of Ken- sington. In both were very large cavi- ties, more particularly in Mr. Khmer, set 40, a caipenter. There was a cavity in both lungs, but more especially hi the right, which was almost destroyed. This large vomica ajipeared the result of the amalgamation of several smaller ones. It was irregular in shape, and divided into compartments by bands, which crossed it in various directions. There were also, in both these cases, a good many pervious bronchial tubes opening into the cavities, and appear- ing as though they had beeu divided just before entering the excavations. No blood-vessels were found in these cavities, nor have we seen them hr tho great majority of the numerous subjects dying from phthisis that we have had an opportunity of examining. This would appear to arise from the yielding nature of the coats of the vessels per- mitting their being pushed out of the way and flattened Some are thus ren- dered impervious by pressure from without, and others are probably obli- terated by accumulations in their inte- rior. Sometimes a considerable blood- vessel does ge laid open in the forma- tion of a vomica. This happened to a young lady under our care, who was seen by Mr Chapman also, and whose death