Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

133/440 (page 117)

it is that impresses special features upon the disease and stamps the anatomical marks upon the affected organ. This, in typical cases of cirrhosis, is represented by a development of fibrillary connective tissue, which forces everything else into the background in consequence of its vast predominance and its results ; on the other hand, in the cases which are the farthest removed from this type, the new formation of connective tissue recedes into the background when contrasted with the cellular infiltration and the parenchymatous degene- ration of the epithelium. It is not the longer duration and the more tedious progress of the disease which are the primary and principal factors in the production of the cirrhotic type, for, as I have already mentioned, years may pass by without this type becoming developed, while in other cases it makes its appearance after a brief interval. A better opportunity is afforded us in the lungs than in any other organs, of watch- ing the development within a few months of a perfect state of cirrhosis, such as in other cases of chronic pneumonia is not a,ttained after an interval of several years. It is, there- fore, not the peculiarity of every chronic inflammation to induce cirrhosis ; for there are, for example, suppurations running a very chronic course, but the production of cirrhosis necessitates the antecedent occurrence of something or other that is peculiar, or its supervention in the course of the disease. The nature of this peculiarity does not fall within the scope of our present investigation. It would, moreover, appear that the diversity in the course of the two types is not dependent upon the renal affection alone. In addition to the fact that dropsy is as constant in the one type as it is rare in the other, the way in which this symptom makes its appearance is so peculiar that the idea suggests itself that some disease of the skin is concerned in its production. It is perfectly evident that the dropsical effusion cannot be referred to suppression or diminution of the urinary secretion, an explanation advanced by some observers. Even the complete interruption of the discharge of urine, which may originate from obstruction in the urinary passages, does not, i^cr so, produce dropsy as a consequence. Oohnheim (loo) very particularly refers to the fact that neither hydr£emia nor hydraemic plethora can be the cause of the dropsy in