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Show DISEASES ()F Tl IE ORGAN S OF RESPIRATION. TABLE X. lf/‘(HlellI-l‘ts' (ll/1'] Per/brunch(ifs. Fios. 1. 2. .3. -l.-1)l"1‘IIID Buoxcnii‘is. The bronchial branch (\l has been partly obliterated by ulceration. ,Its color is purplish, and shows that. only a, portion of its mucous membrane remains unaffected. The lung-tissue is dark gr: y and indurated. showing some very dark spots and stripes mingled with it. Figs. 2 and 3 rep- resent the pleural covering of that lung; shining. black little tumors, being iiielaiiotic, infiltrated lobules projecting upon the surface of the lung immediately beneath the membrane. Fig. 3 shows an cmphysematous state of the lung" Fig. 4 a hiU‘hlv dilated bronchus with I ‘ t i" . )ortioiis of cmphysematous lung-tissue. Fig. 5. A horizontal section of a large bronchus. A portion of peribronchial tissue (1A.) is nearly normal. while (B) shows enormous dilatation of the lung cells. and infiltration with tubercular matter in the infuinlilnilar septa. The bronchial glands (C) are exceedingly enlarged. filled with dark pigment, and in a. partly ulcerated state. Fig. 6 shows a small portion of a bronchus filled with a great number ofcrystals ofcholesterine and some phosphatic masses, colored red by haemoglobin and other blood-pig- ment (magnified). Figs. 7, 8. Portions of lung-tissue near the involved organism are brought about. As in the greatest number of infectious granulations, so also in tuberculosis is the morbid process propagated upon other or foreign organisms, as innumerable examples have proven its hereditary as well as its infectious transference upon other individuals besides the one primarily infected with it. Very seldom is the primary stage of tuberculosis in any organ ever met in anatomical examination. Usually the advanced stages are found, and the pareiichyinatous structures have already undergone great inmlifications. Only in experimental pathology are the initial states to be observed, and that only in animals. Once, in a great while, by the side of a compactly infiltrated portion of tissue, a caseous nodule in its earliest phases may be observed. It will then be found to consist of the. elements above described, and will have a fairly transparent look, and will resemble a portion of ordinary granulation on the surface of the skin when epithelial cells are developing in large quantities. In its later stages, as usually met with, the 1iarenchyniatous organs contain easeous nodular foci, which are either thoroughly compact or already softened in their centers. In superficially situated tissues ulcers are formed in the softened excavations. The edges and fundus ofthose cavities are caseous; surrounding these is a gray or grayish-red slightly transparent zone of structures, resembling very much ordinary granulating tissue. This same class of tissue is to be found in different portions of the affected organ in greater or lesser patches; they usually contain small gray or yellowishwhite opaque nodules. Likewise are there small grayish little knots in that class of tissue. They are surrounded sometimes by hyper- temic portions; some by apparently unaltered structures. The first are usually plainly visible to the naked eye. The grayish-red or the gray t‘ansparcnt masses, which surround the caseous por- tions, or form the fundus of an ulcer, or constitute solitary centers are nothing else but granular infilt‘atcd tissue. The yellow nodules enclosed within those are either fresh giant cells containing tubercles, or older ones already in a caseous state. The differential diagnosis between granulating tissue and tubercular masses is readily effected by tinction of the. tissue with two or more colors. The epithelioid and giant cells are not nearly as readily stained as the small spheroid ones. In a tubercle three different zones are produced by the coloring process. The innermost portion is formed of nuclear parts of the giant cells, which assume a darker color than the Zone immediately surrounding them, which consists of the epithelioid, and is much lighter. The most external are_the splieroid cells; they are more intensely colored than the rest ot the \Vheii in the center of a tubercle caseous granulating cells. alterationhas taken place, giant cells are superposed here and there. Sooner or later the lymph-glands nearest to a tubercular center become involved, and a tubercular eruption near the old center is formed. From the nearest lymph-glands a progressive spread of tubercular formation is extended into larger lymphatics and eventually are carried into the thoracic duct, and thence into [Siic'riox III. bronchi in which all traces of normal lung-structure are obliterated. In both they present nearlv homogeneoUs textures. Fig. 8 a closed large l)ronchns.'f<irnii110'aishallow 'avity filled with partly organized connective tissi-ie. Some traces of a former caseous/stat . are still left here and there. indicated by slight depressions in the level ofthe tissue. , Figs. 9. 10. The apex of a lung in a state of vesicular emphysema. The bronchi are partly filled up and partly ulcerated; the peribronchial tissue is nearly destroyed. and in its place 'avities filled with dark purulent masses are to be found. Fig. 10 is a magnified view of the bronchial and peribronchial alterations (.\.,.\. A.) emphysematous tissues, showing enlarged lobnles surrounded by highly infiltrated septa. whilst very much dilated bloodvessels form a net-work upon the face of the visceral pleura. The bronchi (B) are nearlyr denuded of their i epithelial coverings. Figs. 11, 12. in the lungs. right Two very large cal "areous masses. found and left upper lobes of tuberculosed Perfectly altered bronchus (A), indicated by a somewhat lighter color than the rest of the mass. cned pleura (C). Thick- Fig. 12 has a distinctly fibrous texture. and is of more recent origin than Fig.‘1'l.. It shows a depression made in its upper portion by the first rib. The individual in whose lungs these masses were found was old and decrepid; had led a very dissolute life. ranging from that of a mustard seed to four or five times its volume. The smaller ones are grayish, jelly-like, and translucent; the larger are opaque and yellow. The latter are usually ‘ascous in the center. \Vhen single organs are attceted, they offer very near] v the same morbid appearance. In the early stages oftheir development they are made up of small spheroid cells, and directly derived from the blood, as can be proven experimentally. Some tubercles retain their cellular character to the last; they only increase in volume as they develop farther. epithelioid. Some contain giant cells and All terminate in caseous degeneracy. ‘ They are very seldom converted into fibroid tissue o ' are absorbed. . Connected with eruption oftubereles are always very diffuse and extensive inflammatory derangeinents of the circulation. In the lungs they are also associated with extensive exudatious. Miliary tubercles are invariably developed from emigrated blood eoi'puscles. Occasionally the fixed cells ass‘t in their formation. \Vhen tuberculous rim/.9 enters directly into a. blood vessel, it ‘auscs destruction of the vascular walls by formation of tubercles in its several coats. Sections of' tubercular lung tissue show Very numerous tubercles in the walls of its vessels. That all tissues of the body are not alike affected by tuberculosis, or like the skin not at all, is no doubt due to inequality of distribution of the blood in them, ainl partly to peculiarities of the. tissues themselves. Miliary tuberculosis is not necessarily the result of organic tuberculosis. As a rule, the tuberculous process does not pass the limits of the primarily affected organs and their accessory lymphatics. Decay of easeous tubercle of lymph-glands leads soonest to infection of the blood. Mucous surfaces are, at times, also the propagators of tubercles, and extend them to surfaces of and into other mucous tissues, with which they are in anatomical or even physiological connection. Thus do, for instance, tubercular lung tissues infect the tracheal, laryngeal, pharyngeal, and sometimes even the upper intestinal mucous membranes with tubercles. The serous membranes are even better carriers of tubercular infection than mucous membranes. The same as the parencliyiiiatous organs are some mucous membranes more liable to be infected than others. That of the mouth, the pharynx, and the :esophagus are far less liable to become involved than that of the larynx and trachea. The stomach, the duodenum, ainl the biliary ducts, also the urethra, are hardly ever affected with tuberculosis. Pathology of 'I'u/a‘rru/osi‘s. The above described morbid processes, which are all comprised in what is named 'l‘uberculosis, are anatomically characterized by by infiltration into or swelling of the tissue surrounding the formation of nodules, and clinically by their successive invasion of one or several organs, or of the whole organism; farther by producing progressive destruction, not only of the parts which are primarily affected, but also of those which become involved by infection from the former, in the different modes of propagation. It is also characterized by a more or less continuous process of inflam- mation in the (lifi'erent organs involved, the peculiarity of this form of inflammation consisting in the production of anatomically wellcharacterized morbid structures, the tubercles (-r/lu/zo' (out urnsculr/r )HH/IIqui‘. icsides the above pathological features there is also a dis- tinct mark belonging to it that it is transfi-rable to other individuals, both animals and men, as Villcmin and Klebs have at first clearly \Vhen this process goes on for a while, there is formed shown by experiment, and has been confirmed by very numerous new connective tissue in the place of the tubercular eruption. The, termination of the secondary tubercles is case-ation and decay; other investigators (\Valdenbui‘g. (‘oiiheinn llolliiiger, etc). The tubercular agency is both inocculablc and transferable, in its fresh state as Well as in the cascons condition, and produces the same characteristic anatomical, and to a great extent clinical peculiarities as the ones existing in the individual from which the infection is derived. It is, in fact, an infectious disease. That iiot all animals are alike infected by inocculation is true: also that not in every kind of animal are tubereulcs reproduced is also a fact. This only confirms its infections nature. that it attacks certain kinds and classes the blood circulation. Within the lymph-gland tubercular eruption is most abundantly developed, and wheneve‘ any favorable con- ditions will be present tubercles will form. \Vith the eruption of tubercles there is always associated a more or less intense inflammation of its surroundings, recognizable either by hyperaunia, or tubercle. very seldom do they turn into connective tissue, more seldom does abscrption of tubercles take place. \Vlien' tubercle-1iroducmg agencies, from a decaying tuberculous mass existing in a lymphatic gland, or in a tubercular ulcer in the thoracic duct, enter into the blood-current thev disseminate in the several organs of the body. The same disseiniiiatiou is brought about by tuberculous infectious Such blood matter entering directlv intoithe blood vessels. infection will be followed by eruptions oftuberclcs in single organs of the bodv. or in all the internal organs, or. at least, in most of them, i-onstitnting a Txllirrcalas/s,"' condition medically called "JIITZ/ary The nodules are found in the organs, of a Size of animals. and of these kinds only certain individuals. in man clinical experience has proven that members of one family are not, all alike atfccted by what is called an inherited tubercular fut/Ii. Also that some persons cohabiting with tulu-rculons individulas |