Discussion on the pathology of phthisis pulmonalis.

  • Gairdner W. T. (William Tennant), Sir, 1824-1907.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Discussion on the pathology of phthisis pulmonalis. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    In the other form of phthisis the anatomical conditions are very different from these, and we have an example of it in the case which was the immediate occasion of this discussion and which I again bring before the Society. The condition which is most pronounced here is that commonly designated cirrhosis of the lungs, and in its more immediate anatomical features it consists in a new formation of connective tissue in the lung, with the usual contraction of the connective tissue—it is in fact an interstitial inflammation of the lung. We may take the description of the anatomical conditions in this case as indicating the usual appearances in an advanced stage of this disease. The report book contains the folloAving account of the state of the lungs and heart:— There is great shrinking of the left lung, so that the medias- tinum is drawn greatly to the left, and the edge of the right lung passes in some parts fully an inch and a half to the left of the middle line, and the heart is drawn considerably to the left. The heart is moderate in size, but the right ventricle is con- siderably enlarged, forming the apex of the heart. The valves are normal, but the tricuspid orifice admits four fingei's. The right lung is adherent almost throughout, but especially over the upper lobe. Here the adhesion is exceedingly firm, and the coalesced layers of pleura are greatly thickened. In this upper lobe there are numerous cavities, all of them smooth walled and with more or less of the sacculated form, without any distinct projecting trabeculse. These cavities ai-e sometimes quite distinctly in the form of bulbous dilatations of the bronchi, and are always directly continuous with one or more bronchi. [On examining the walls of the cavities there is found a great preponderance of inflammatory tissue, but with ciliated epithelium in abundance. The presence of this ciliated epithelium is determined in some of the most typical of the cavities.] Outside the cavities the upper lobe presents dense pigmented connective tissue, and there is not a trace in this lobe of normal air vesicles, nor is there any caseous material present in any part. The left lung is firmly adherent throughout, there being the same excessive adhesion over the uppei- lobe as in the other lung, and a still greater thickening of the pleura, which here reaches about half an inch in thickness. In the upper lobe there are also cavities distinctly bronchiectatic and dense pigmented tissue outside them. It is noted that the pigmenta- tion does not pass into the thickened pleura, but stops short by an abrupt line at the sub-pleural tissue.
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