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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    even more unsatisfactoiy, excluding, as he stated it did, some- thing like one half of the cases regarded as phthisis by hospital physicians during life, and probably also so regarded after the inspection by many of them at least. These points, however. Dr. Finlayson would prefer to leave to professed pathologists, and they would no doubt receive attention that night. He must, however, protest, as a physician, against the definition given of phthisis pulmonalis, not merely on the etymological and historical grounds urged by Dr. Gairdner, but even on the narrower ground of its forming a distinction between local lesions which were thus unwarrantably separated from each other. [Dr. Finlayson here showed the lungs of a woman who had recently died with enormous irregular cavities in both, and with localised pneumo-thorax, as an illustration of what was deliberately excluded by Dr. Hamilton's definition of phthisis.] It might be asked why he ventured to take part in this discussion if he were not a professed pathologist. He did so with some diffidence, but he felt that the issues raised involved something more, something much greater, than mere questions of histology. Moreover, his attention had been somewhat specially directed to the subject soon after he entered on practice, and ever since 1868 he had been anxiously consider- ing the relationship between phthisis and tuberculosis. About that time his attention was first called to the allegation that in tuberculosis, with the well known grey granulations, there was always some pre-existing cheesy deposit or similar con- dition; and at the same period he had begun to try to discover whether careful thermometric observations might help the discrimination of cases of tubercular and non-tubercular phthisis. Since then, both by observation and reading, these objects of inquiry had been kept pretty steadily in view. In the eai'lier part of his experience in Manchester, his cases were almost exclusively those of children, in whom the evidence of miliary tuberculosis, when present in a pronounced form at least, was usually plain enough to the naked eye; in the latter part of his experience he had had the benefit, almost invari- ably, of Dr. Coats's presence at the post-mortem examinations. The conclusion arrived at was this, that although in the great pi'oportion of cases of miliary tuberculosis some cheesy mass or similar lesion could be found, there was a residuum of cases where no such thing was discovered even after a careful search ; and indeed in some of the cases where it was discovered the ma.ss was so small and apparently insignificant that it seemed hard to blame it for the tuberculosis, as many such lesions
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