Statistical and pathological report of the Royal Infirmary of Edinburgh, for the years 1833, 34, 35, 36, and half of 1837 / by John Home.

Date:
[1837?]
Catalogue details

Licence: Public Domain Mark

Credit: Statistical and pathological report of the Royal Infirmary of Edinburgh, for the years 1833, 34, 35, 36, and half of 1837 / by John Home. 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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    they are composed, cannot be distinguished even on the most at- tentive examination. They give in most cases a crenated form to the circumference of each aggregate tubercle. I apprehend that they have an exactly similar origin to the simple gray tuber- cles or miliary granulations. /3. Yellow Aggregate Tubercle.—Those, like the former, vary much in size and shape. When recently deposited, as we occasional- ly see them, in the lungs of children after acute inflammation, fol- lowing the febrile exanthemata, they often assume a star-like form, or an arboresceflt appearance, arising from the tubercular matter having filled a few only of the terminal branches of a bronchial tube. This arrangement is well seen in Dr Carswell’s plates. * When the whole cells of a lobule are filled with this yellow tubercular mat- ter, the aggregate mass assumes the shape of the lobule in which it is formed. This is seldom at first round, but angular and lo- zenge shaped. The round form, I believe, of these tubercles is afterwards assumed when they have been for some time deposited, and is owing to the pressure being equal on all sides. This has the effect also of making their texture, which was at first soft and friable, hard and compact. I conceive them to arise from acuteinflam- mation of the lining membranes of several contiguous air-cells, or those of a whole lobule. When soft and recently deposited, they are generally associated with other known effects of inflammation, such as red hepatization of the surrounding pulmonary tissue, lymph on the neighbouring pleura, which, as observed by Dr Ali- son,-!* in all respects resembles the matter effused into the sub- stance of the lung. But if they should be found, as occasionally they are, in their soft recent state, without their being accompanied with any marks of surrounding inflammation, I do not consider this as an argument against their havinghad an inflammatory origin. Lobular peripneumonies are often seen surrounded by perfectly healthy tissue. In the same way wTe can conceive the inflamma- tion giving rise to these tubercles, limited to the single lobules in which they are formed. There is a great analogy between this kind of tubercle when recent and lobular peripneumonies ; indeed it appears to me the only difference is, that the latter go on more rapidly to suppuration forming abscess. I have had numerous op- portunities of witnessing them in the lungs of those who have died after capital operations. They are often mistaken by surgeons for tubercles, and are supposed to have existed previous to the ope- ration. I agree with M. Bland in]; in thinking that they are the only source of the purulent deposits that so often take place in the lungs after operations. Aggregate tubercles of both kinds being formed by the filling up of several or of the whole air-cells of a lobule by tubercular * Fascie. i. p). 1. fig. 1. f Journal Hebdomudaire. -|- Ed. Med. Cliirurg. Trans. Vol. i. 1824, p. 410.