Phthisis : its morbid anatomy, etiology, symptomatic events and complications, fatality and prognosis, treatment and physical diagnosis ... / by Austin Flint.

  • Flint, Austin, 1812-1886.
Date:
1875
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Licence: Public Domain Mark

Credit: Phthisis : its morbid anatomy, etiology, symptomatic events and complications, fatality and prognosis, treatment and physical diagnosis ... / by Austin Flint. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    which, if either, is antecedent to the other, and have they a causative connection with each other? In other words, do the grauulations precede and give rise to what has been known as tuberculous infiltration, or, on the other hand, are the former secondary to, and dependent on, an infection derived from the metamorphosis of cheesy morbid products in the lungs or else- where ? It is difficult to answer this question otherwise than by conjecture. It is a reasonable supposition that granulations precede and determine the occurrence of the exudation (which doubtless consists of inflammatory products) within the air cells, the ulterior results being softening, liquefaction, and cavities. When these products and results are found after death without the presence of either granulations or miliary tubercles, it may be reasonably supposed that the latter have existed and been lost by being merged in the lesions to which they give rise. It is a fact militating somewhat against this conjecture, that, in cases of acute tuberculosis, granulations exist in immense numbers without the occurrence of exudation within the air-cells. More- over, as in some of the cases which have been cited already, exudation and liquefied products may exist in one lung, the other lung being crammed with granulations or miliary tubercles with- out either exudation, liquefied products, or cavity. The other conjecture, namely, that granulations are secondary to, and de- pendent on, cheesy degeneration of morbid products either in the lungs or in some other part of the body, requires, of course, a constant coexistence of the latter with the former. In the cases of acute tuberculosis, the granulations, which accumulate in the lungs sufficiently to cause apncea, must, according to this conjecture, depend on an infection from morbid products else- where than in the pulmonary organs. Granting that the latter are not found, there is always room for the supposition of their being in some part of the body not examined with sufficient minuteness, or it may be supposed that they have existed and disappeared before death. But in the cases in which morbid use the expression liquefied morbid products to denote this exudation liquefied, considered heretofore as liquefied tuberculous matter, and constituting so-called tuberculous abscesses, the evacuation of this matter leaving cavities. I use these terms on account of their not involving any pathological views respecting the character of the exudation ot products. I suppose, however, as 1 have stated, the exudation to be the result of an inflammatory process.