The bacillus tuberculosis and the etiology of tuberculosis : is consumption contagious? : second communication, read, by invitation, before the Philadelphia County Medical Society, November 14, 1883 / by H.F. Formad.

  • H. F. Formad
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: The bacillus tuberculosis and the etiology of tuberculosis : is consumption contagious? : second communication, read, by invitation, before the Philadelphia County Medical Society, November 14, 1883 / by H.F. Formad. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    6/38 (page 4)
    3. Tuberculosis without predisposition, due to inflammation of serous membranes. 4. Question of contagiousness ; clinical aspect. 5. The bacillus tuberculosis. 6. Experiments “ pro” and “contra;” traumatic tuberculosis. Conclusions. All these considerations will have to be of necessity very brief. l.— THE DEFINITION, THE ANATOMICAL CHAR- ACTER, AND THE ETIOLOGY OF TUBER- CULAR LESIONS, INCLUDING PULMONARY PHTHISIS. No definite understanding concerning a disease can be arrived at unless some fixed conception of the anatomical characters and various expressions of the lesions of that disease is formed. Thus, as regards the question of tuberculosis and pulmo- nary phthisis, the matter would be much simpler if a general understanding could be arrived at as to the definition of tuber- culosis and phthisis in its different anatom- ical manifestations. The pivot of the question is what to call a tubercle or a tubercular lesion. The traditional conception of a tubercle being a miliary node, the belief is that nothing is tuberculosis unless expressed by nodes, and that everything is tuberculosis that appears to the eye as containing nodes. These misconceptions are what bring the confusion and prevent the set- tlement of the question of tuberculosis, both at the post-mortem table and in the hands of the experimenter. One of the results of this confusion is that some clinicians divide pulmonary phthisis into catarrhal, cheesy, fibroid, and tubercular proper, because they do not see tubercle-nodules in some of these forms of phthisis. They seem not to be aware of the fact that miliary tubercles do not belong necessarily to the picture of pulmonary phthisis; and, on the other hand, that those nodes which occasionally appear as miliary tubercles are not miliary tubercles at all, but are only miliary foci of broncho-pneumonia, due to aspiration, as will be explained later. Miliary tuber- cles, if at all present, usually form a part of a general disease, a tuberculosis of the whole body. In rare instances, when the miliary eruption takes its departure from the lung, the miliary nodules may be lim- ited to the lung. A more serious matter is the mistake that experimenters make of interpreting as tubercles the so-called inhalation tubercu- losis, artificially produced in animals by means of a spray with tuberculous and other matter. The nodules produced in the lung under these circumstances are not miliary tubercles,—in fact, no tubercles at all. They are simply miliary broncho- pneumonic foci, limited to those terminal collections of air-vesicles, called acini, in which some of the inhaled irritative ma- terial became lodged. The natural round boundaries of these acini correspond ex- actly to the usual size of miliary tubercles, and appear as such even under the micro- scope, although filled merely with an un- organized inflammatory exudate. The uni- form distribution of these foci is due to the fact that the inhaled irritating particles are distributed only to individual and the most accessible bronchioles and acini, thus simulating a true miliary tuberculosis of the lung. Similar broncho-pneumonic foci occur in the human lung from self- aspiration of tuberculous material from a primary focus to some other portion of the lung or throughout the whole lung. This was proved long ago, but the inhalation experimenters appear not to be aware of that fact. Careful personal observations and experiments, to be recorded in my forthcoming report, have convinced me that such inhalation experiments prove nothing, either for or against the contagi- ousness of tuberculosis, in connection with which they have been brought forward as the strongest affirmative proofs. Further- more, it must also be remembered that the so-called experimental inhalation tubercles, as a rule, remain local. On the other hand, miliary nodes or tubercles are met with, not only in tuber- cular lesions, but also in a variety of sim- ilar and dissimilar lesions, such as pearl- disease or bovine tuberculosis, lupus, lep- rosy, glanders, actinomycosis, chancre and gummata, cancer, typhoid infiltration, lymphomatous and leukaemic lesions. All these lesions, even cancer (“ miliary car- cinosis”), are able to give rise to exquisite miliary disseminations, or eruptions, al- though these are most frequently observed in tuberculosis. We already recognize leprous, lupous, glanderous, syphilitic, and other tubercles, in contradistinction to tuberculous or scrofulous tubercles. To the above nodular formations may be added a variety of minute inflammatory