Researches on phthisis: anatomical, pathological and therapeutical / by P. C. A. Louis.

  • Pierre Charles Alexandre Louis
Date:
1844
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Licence: Public Domain Mark

Credit: Researches on phthisis: anatomical, pathological and therapeutical / by P. C. A. Louis. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    The existence of these bands is an actual proof of the de- struction of some portion of the surrounding tissue, and would in itself suffice to show that the disappearance of some amount of pulmonary tissue is a necessary condition for the generation of large cavities. The open orifices of bronchi at the periphery of the cavities, the obliteration of vessels near their walls, as well as the direction pursued by the remnants of those vessels, plainly indicating their previous passage through the now empty space, are so many additional proofs of the fact. Laennec^s opinion that the gray granulation originates in the interstices of the pulmonary parenchyma may be correct; but when these bodies are placed in more or less close proximity, and have given rise to the development of gray semi-transparent matter forming a bond of union between them, there is here too, in a very evident manner, destruction of tissue; the pa- renchyma originally comprised between the granulations has disappeared. Hence the inference, that the existence of caAdties of small size, as well as of those of considerable dimensions, in- volves the destruction of pulmonary tissue. The large tuberculous excavations of the upper lobe were closer to the posterior than the anterior surface of the lung ; and in many cases I have found their posterior wall formed almost solely of a semi-cartilaginous pseudo-membrane, one line or one line and a half [2 or 3 millimeters] thick, investing the apex of the organ. Inferiorly, a thin stratum of diseased pulmonary tissue sometimes alone separated them from the pleura of the interlobular fissure (Case li) ; or their walls were even de- stroyed in this direction, and they themselves conmiunicated with another cavity situated in the posterior part of the lower lobe. It is worthy of note, that in no instance did I meet with large cavities in the centre of the inferior lobe. The following case supplies a very remarkable example of the state of things just referred to, as also of the magnitude sometimes attained by tuberculous excavations. Case I. A girl, aged 20, of rather delicate constitution, but generally enjoying good health, was admitted into the Hospital of La Charite, the 24.th August, 1824. She was still growing, and had had a favorable confinement upwards of eight months before.