Discussion on the pathology of phthisis pulmonalis.

  • Gairdner W. T. (William Tennant), Sir, 1824-1907.
Date:
1881
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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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    words. They are employed so loosely, and with such wide and diverse significations, that any argument about them will surely end in confusion unless we settle what lesion we are to call phthisis pulmonalis, and unless we can give something like a rational definition of Avhat a tubercle is. I presume that the members of the Society will agree with me that the body which we generally understand as tubercle is typically seen in the different organs in genci-al tuberculosis of children and adolescents, consecutive to the cheesy soften- ing, say, of an enlarged lymphatic gland of the neck. Such tubercles are found in the lung, liver, spleen, kidney, peri- toneum, pleura, meninges, and elsewhere. Granting, therefore, that these bodies are typical instances of tubercle, what I propose to do is to take the structure of one of these as oui- model, and to call bodies similarly constituted by the name of tubercles, and to discard all other bodies from this nomen- clature which do not possess such a composition. In this course I believe I am thoroughly justified from the fact, which in my experience has never failed, that, if properly examined, all the nodules occurring in such cases have identi- cally the same histological structure and mode of origin. It may happen that the develoj^ment of this structure might approach perfection more in some organs, or in particular nodules in a certain organ, than in others, but, nevertheless, . if a series of the nodules in any organ be systematically examined, essentially the same composition and mode of growth can be observed in each. A question has been raised of late as to whether the mere histological features of a tubercle can be taken as a test of identity. My reply to that is that if we can define histologically what a cancer, a sar- coma, a fibrous tumour, or a myoma is, then the same applies with even more force to the detection of a tubercle. The appearance of the body, which I will call tubercle, is, that it is rounded in shape, about the size of a mustard seed, grey or yellow in the centre, somewhat fibrous or even cartila- ginous in texture, and when examined microscopically it is found to be an isolated and sharply demarcated mass of new formed tissue. In its centre or at its sides are invariably, if the tubercle is not too old or too young, one or more giant cells. From their periphery processes of fibrous tissue are o-iven off, which, by dividing and subdividing, form a surround- ing reticulum. Within the meshes of this reticulum, or lying flatly upon it, are connective tissue corpuscles, which bear the same relationship to the fibrous wall of the reticulum on which they lie, that they bear to a bundle of ordinary fibrous tissue.
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