Volume 1

Text-book of the principles and practice of medicine / by the late Charles Hilton Fagge and Philip Henry Pye-Smith.

  • Charles Hilton Fagge
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Text-book of the principles and practice of medicine / by the late Charles Hilton Fagge and Philip Henry Pye-Smith. Source: Wellcome Collection.

    1120/1212 (page 1098)
    organ. One of the points on which Virchow insisted when he upheld the view that the discoloration was due to a pigment derived from altered haimatin, was that even in children the development of phthisis was some- times attended with a blackening of the tissue Avhich at their age could only be regarded as exceptional. The experiments of von Jus, referred to above (p. 1095), enable us to understand why the foreign material should accumu- late in newly-formed fibroid tissue, and even in fibroid tubercles of a diseased lung, just as it does in the connective-tissue tracts of the healthy organ rather than in its alveoli. The complete identity of the pulmonary affections to which so many different classes of operatives are liable is in itself sufficient to show that a common pathological process is concerned in producing them. Since the irritants M'hich excite these several diseases act upon all parts of the lungs alike, the resulting lesions might be expected to be uniformly diffused. But, as a matter of fact, it is found that in most cases they attack one lung before the other ; they almost invariably begin in the upper lobe, and spread gradually downwards through the oigan towards its base—that is, they follow the characteristic distribution of phthisis. vii. Cold and tvet.—No idea is more firmly rooted in the public mind than that consumption is often the result of accidental causes, such as getting chilled by remaining in wet clothes, or by exposure to a draught when heated in dancing, or by sleeping in damp sheets; and generally that there is danger, especially in those who are hereditarily predisposed to the disease, of its supervening upon a cold, or a succession of colds. But the weight of medical opinion has in our day tended against such notions.* The considerations which led pathologists to reject the idea that phthisis could arise out of a common catarrh were probably in the main identical with those which induced them to regard as necessarily non-tubercular the cases due to dust-inhalation. And such theoretical opinions were greatly strengthened by the practical observation that many persons, even of deli- cate aspect, suffer for years from an extreme liability to bx'onchial attacks without ever becoming consumptive. Indeed, Eokitansky believed that pulmonary emphysema and dilatation of the bronchial tubes, if carried far enough to cause venosity of the blood and cyanosis, afford exemption from the liability to pulmonary tuberculosis (cf. p. 1106). But, apart from the crucial instance of congenital disease of the heart, there are striking exceptions to Eokitansky's rule. In 1864, for example, a girl of seventeen was admitted into Guy's Hospital with extreme dyspncea and dropsy, and with clubbing of the fingers and toes. The bronchial tubes were found widened out into great sinous passages, so that the cut surfaces of the lungs showed hollow spaces as extensive as the remains of the pul- monary tissue. Yet there were scattered yellow tubercles, especially in the left lung, spreading from the apex downwards. In 1874 a woman, aged thirty, died, who had long been more or less subject to cough, which for nine months before had become continuous. There was extreme emphysema of the bases and anterior parts of the lungs, and the tubes contained a large * The only statistical facts which are in favour of the popular view are those given by Dr Theodore Williams in vol. liv of the ' Med.-Chir. Transactions.' Out of 1000 cases of phthisis he found that no fewer than 149 had originated in, or been closely preceded by, pleurisy and pleuro-pneunionia, and 118 by bronchitis; but probably this tabulation must have generally rested on the unsupported assertions of the ]iatients themselves, who doubtless consiilted him or his father, Dr C. J. B. Williams, at variable periods after their illness had begun, and often when a considerable time had elapsed.