The diseases of infancy and childhood : for the use of students and practitioners of medicine / by L. Emmett Holt and John Howland.
- Luther Emmett Holt
- Date:
- 1911
Licence: Public Domain Mark
Credit: The diseases of infancy and childhood : for the use of students and practitioners of medicine / by L. Emmett Holt and John Howland. Source: Wellcome Collection.
Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.
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![blood-vessel, iuul partly or entirely ()bslructiu<^ i(s juineii. Sortciiinj^ may take })laee and the contents he discharged into the hi'onchus or hlnod- vessel. Ahout this focus other cliang(;s of an infianunatory character occur, as a result of which each cheesy nodule is surrounded hy a zone of simple broncho-jmeumonia which tends, in a measure at least, to limit the tuberculous process. The lHr<i;('r caseous areas are formed by an extension of this process to the zone of pneumonia which surrounds it; but in its further growth it is still pi-eceded by a simple pneumonia. The rapidity with which the lesions advance differs much in the different cases; in infants the progi-ess is apt to be continuous until the dcjith of the patient; in older children it is usually slowei', and interrupted by intervals of arrest and even of partial retrogression. Not infrequently one sees in the post-mortem room one or two caseous, or less frequently calcareous, nodules encapsulated by firm, organised con- nective tissue when a most careful search fails to show any other tuber- culous lesion in the lung. If, however, the nodules are widely scattered through the lung, such an arrest of the process is not to be cx])ecte(l. 3. Chronic Pulmonary Tuberculosis, Chronic Phthisis.—In children who have passed the seventh or eighth year the pathological i)roc('ss re- sembles that seen in adults; but in younger children, and especially in infants, nothing corresponding to it is met with. At this period the nearest approach to this condition is seen in the cases of tuberculous broncho-pneumonia, which run a slow, irregular, and somewhat chronic course. The essential features of the process in these patients is a chronic interstitial broncho-pneumonia with tuber- culous nodules which rarely undergo softening, but usually become en- capsulated. The gross lesions closely resemble those of simple chronic broncho- pneumonia. There are the same generalised pleuritic adhesions and the shrunken cicatricial condition of the part of the lung most affected, with bronchiectasis, compensatory emphysema, etc. The tuberculous nodules are old and for the most part converted into dense fibrous tissue, in the centre of which, however, some softened, caseous areas are often seen. Bronchial Lymph Nodes (bronchial glands).—The prominence of the lesions of the lymph nodes is one of the most striking features of tuber- culosis in infancy and early childhood. Those which are most frequently affected are connected with the bronchi. The lymph nodes, to which the term bronchial glands is generally applied, consist of three groups: the first of which surrounds the trachea; the second is situated at the bifurcation of the trachea and surrounds the primary bronchi; while the third follows the course of the bronchi into the lung, being found, ac- cording to anatomists, as far as the fourth division. The anatomical relation of the different groups should be borne in mind, since upon them the symptoms principally depend. The first group, or the peri-tracheal](https://iiif.wellcomecollection.org/image/b21218407_1087.jp2/full/800%2C/0/default.jpg)
