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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    of cheese, which the above pathologists called Crude Tubercle. They supposed that these two varieties of tubercular matter were closely allied to one another ; that the gray semitransparent mat- ter, in beginning to soften, necessarily passed into the yellow,—a process which, according to them, commenced in the centre of each mass; and that the yellow matter was never deposited primarily without passing through the previous stage of gray ness and semitransparency. Many recent pathologists, however, are now of opinion that these two forms of tubercular matter, though frequently found associated, and the one even springing up in the centre of the other, yet for the most part are independent of one another. Laennec* himself, from the following passage, seems to have been quite aware that cases do occur where the yellow matter is found without any trace of the gray : “ The conversion of the gray and gelatinous infiltration into yellow tuberculous matter is sometimes so rapid, that in examining lungs containing large masses of the latter (yellow,) we sometimes find no trace of the former (gray,) although there can be no doubt that the one origi- nated in the other.11 He was, however, so wedded to his favourite theory of the conversion of the one into the other, that he endea- voured to account for the absence of the gray matter by its rapid conversion into the yellow. It will afterwards be seen, that a si- milar yellow tubercular deposit was found in several of the cases, without any of the gray matter being anywhere visible ; that in all of them the symptoms during life indicated that an acute ac- tion had been going on in the lungs ; and that its presence in these organs was always associated with appearances known to be the result of inflammation. It appears to me that both these varieties of tubercular matter are generally the result of inflammatory action ; and that the great difference between them consists in the yellow being the result of an inflammatory action, acute at the commencement, but very liable, in some constitutions, to degenerate into a chronic form ; whereas the gray semitransparent matter is the result of an inflammatory action, which is chronic from the beginning. Tubercular matter, whichever of these two forms it assumes, it may now be concluded, from the 1 abours of recent pathologists, am ong whom the name of Dr Carswell f stands pre-eminent, is situated, for the most part, in the air-cells, and in the smaller branches of the bronchi. On this idea, I think it may be called, 1. Simple Tubercle, when situated in single air-cells; 2. Aggregate Tu- bercle, when deposited in several contiguous air-cells, or the whole of those constituting a lobule; and, 3. Diffused Tuberculation, when occupying several contiguous lobules, a whole lobe, or an * On Diseases of the Chest, Forbes’ Translation, p. 277, t Cyclopaedia of Med., Art. Tubercle.