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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    was afterwards called tuberculosis. We may call this the period of the recognition of tubercle as a distinct and probably specific morphological type, related in many ways to a great variety of previously well known diseases, and especially to phthisis pulraonalis. By thus defining and specifying tuljercle on the basis of anatomical facts observed in connection with clinical, and especially physical, diagnosis, Laennec unquestionablv gave an importance and a definiteness to the idea of tuber- culosis, which were entirely novel, and which became the starting point of a host of new observations and researches. Inheriting, as we do, the results of this movement as trans- mitted and carried on by Andral, Cruveilhier, Carswell, and, above all, by Louis, we are perhaps apt to ascribe to Laennec opinions about tubercle which he would probably not have stated without reservations; and errors which were the errors of others more than his. For example, although Laennec undoubtedly laid great sti-ess upon both miliary and crude tubercle as distinct anatomical forms, we are scarcely authorised in affirming that he regarded either of them as being essential to the idea of a tuberculous structure.* On the contrary, in the description he has given us of what he called tubei'culous infiltration, we can easily observe him to be grappling with the same difliculties that we now experience as to the connection of tubercular with inflammatory processes. [Dr. G. here showed a portion of lung which he had preserved for more than thirty years, as being a typical specimen of Laennec's infiltrated tubercle, but which now would probabl}' be designated as caseating pneumonia.] It is by no means to be too readily assumed that Laennec believed a tubercular condensation of the lung, or even what he would have regarded as a tubercular excavation, to be impos.sible without those definitely rounded forms, called more distinctively tubercles, occurring as a first stage in the process. All that his researches necessarily imply is the frequent presence of the miliary or of the crude form of tubercle, as a note or sign of the specific constitutional taint which leads, in so * La matiere tuberculeuse peut .se ilevelopper daus le poumou et daiis les autres organes sous deux formes principales, celles de corps isole's et (['{nfiltratio7is. . . ■ Quelle que .soit la forme sous laquelle se developpe la matiere tuberculeuse, elle pi'esente daus I'origine I'aspect d'une matiere giise et demi-transparente, qui peu a peu devient jaunc opaque et trcs- dense. Elle se ramollit ensuite, acquiert peu a peu une liquidite presque ucral a celle du pus ; et, expulsee par les bronclies, laisse a sa place de? cavites connues vulgairement sous le nora d'nlceres die poiimon, et que iious desio-neroiia sous le uom d'c.vcavaiio7i.<t tnhercuhuses.—Ausc. Med., 2ic;me edition, 182G. T. I, p. 534.
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