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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    brain, or into the ventricles, and thus cause sudden, and often ur- gent cerebral symptoms. Tumours on the serous membranes, the result of chronic inflammation, occasionally give rise also to sudden effusions of serum into the cavities lined by them. Most of the above five cases, which have been given as examples of miliary tubercles, had lasted for some time previous to the coming on of the urgent symptoms. The tubercles were in all probability formed during this period. In the interesting case of the lad cited by Dr Alison * in his excellent paper on the formation of Tubercles, it is probable, that the tubercles were formed duringthe attack for which he was first brought into the hospital. From this he recovered, went out and exposed himself to cold, and was re- admitted with urgent symptoms, caused in all probability by the morbid action going on in the pulmonary tissue surrounding the tubercles, which we are told was of a redder colour than usual, much loaded with serum, and in parts condensed. The diagnosis of this kind of tubercles during life is allowed by Louis and Dr Clarke to be very difficult. Percussion general- ly causes a dull sound if the pulmonary tissue is much condensed or loaded with serum. It often, however, retains so much air from the previous dilated state of the air-cells, that little dulness of sound is produced by percussion. The stethoscope generally indicates the existence of different rales from the accompanying bronchitis. I have noticed in two of the cases a very peculiar mo- dification of the crepitous rale, much resembling the creaking of Russia leather, occurring principally during expiration. I was so struck with it in the case of Stewart (112,) that when I again heard it in the case of Crawfurd (242,) I was led to give the diag- nosis, which I did, to Dr Craigie, that miliary tubercles would be found diffused through the lungs, along with engorgement of the surrounding pulmonary tissue. I conceive this rale to be pro- duced in the same way as the crepitous rale, so satisfactorily ex- plained by Dr Williams, modified by the different nature of the fluid contained in the bronchial tubes. 8. Yellow Simple Tubercle, called by Laennec Crude Mili- ary Tubercle.—These are more rarely diffused singly over the lungs than the gray variety. More commonly they are associated in groups. They are, however, occasionally seen disseminated through the lungs of children who have died of pectoral affections, follow- ing some of the febrile exanthemata, as small-pox and measles, the surrounding lung being generally in the state of red hepati- zation. I have seen them also in the lungs of adults, affected with pneumonia which had reached the third stage or that of suppura- tion. They are distinguished in this situation from the surround- ing parts by their bright yellow colour; and they have generally a