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Show SECTION 111.] D1 SEA RES OF THE ORGANS ()Ir‘ HESPIRATI'ON. TABLE X1. 11 I‘I'olcm‘ (zip/'I‘Ntorg/ efforts in coughing. it, collapsed. The lungs were lighter than usual. and the bronchi contained but vcrv little serum. The liver was I infiltrated with fat. ("Asia-Man '76 years old. Fig. 4. Vesicular emphysema in the lungs of a BO-vear old woman. Suffered foryears from bronchial asthma. with Ficus. 1. 2.-Intr»rlolmlm' pulmonic mnphgsmnaproducctl by llistor3/.-.\fi'ected with atheroma of the large arteries and aortic valves. Died of apoplexy. 7 Fig. 1 represents the apex of one lung, and Fig. ‘2 a portion of the middle lobe of the other, in a state of interlobular emphysema. There were enormous dilatations of whole groups of lobiiles and destruction of air-cells. A part of the pulmonic tissue was indurated. Fig. 3. Vesicular (imply/scam of a lung of a woman of 49 years. She was attacked two years before her death with paraplegia of both lower limbs. from which she had partly recovered. Died suddenly. Post JIortmn.-Therc was found a large 'alcareous mass lodged between the inner and middle coats of the aorta, extremely violent cough, dyspnoez , and sense of suffocation. Tyinpanitic sound and bronchophony on both sides of chest. in front; purulent sputa. Two months before death attacks of vertigo and syncope. rep >atedly. Died of asphyxia. Past fife/tam.-Sudden protrusion of lungs 11'0111‘ opened thorax. The dilated cells formed groups of bluish and reddish color immediately beneath the pleurae, and had a generally congested appea 'ance. The bronchi were all softened and filled with mucous and pus. In many places they were dilated. The blood in the heart was liquid (as usual in asphyxia); the liver strongly infiltrated with fat. Other organs normal. Fig. 5. Two air-cells enlarged and thickened. Fig. 7. a largely dilated air-vesicle, opened at. (a) showing its iii- which was in a. state of partial aneurisin from its origin to side lined with a vascular layer. the end of the arch. natural size. Fig. 6, the same, magnified, showing coalescence of the alveoli and infundibula, and the broken down The inner coat was atheroniatous. Outside, the heart was covered with very thick layers of fat; the organ was softened. The lungs partly red and Fig. 8, dilated air-cells, partly g‘ayisli, pressed forward on opening the thoracic cavity. Larger and smaller sacs filled with air projected septa. (A. Figs. 6, 8, orifices of dilated bronchi.) (B. Figs. 7, 9. destroyed septa.) Fig. 10, a pseudo membranous cast of trachea and from its surface, and lifted the pleura in many places. bronchi cxpeeto 'ated by a child affected with pseudo meni- \thn one sac was opened. the others. communicating with branous angina. are never infected from them, whilst others are remarkably easy to be infected. The experiments of inocculation with tuberculous matter has f/t'llCI‘la‘, as R. Koch and his adherents claim, or not, is really imma- been carried on in a variety of ways. Some inocculate into the skin, others the abdominal cavity, the eye, the cavities of the joints; or feed the animals with food tainted with tuberculous substances, or such as contain easeous matter, etc. Atomized sputa mixed with watery or other vapors served to saturate the air to be inhaled by the animals. (Villcmtn, Gaz. hclhlmn. 1855, N}. 50. COIN/fl. rrml. LXI. 1866, (owl Elm/rs 8/17‘ [(1. Tubrrmtlosc, 1868.) (Le/)crt Bulletin (/0 lllcmlrmic XA'XII; Griz. JIM/[(7. tlc Parts, 1867, Was. 25-29; Lchrrt (out lVg/ss: Vtrch. Arch. 40 lr'TOl; qulr/cnboy, (lie. Taberculosc, 1869; fault/hails: (/fc Dix/Icrtm't/uMy, 1868; Klubs: th/"ch. Arch. Vols. 44, 49. 1'1l'r'lt.fllt'l‘(If/HT. 1'ut/mlo;/.Vol. ,1 Tut/Matt (/cr Natal)gfora'hcr, 1877; Con/Leon. uml From/wt: l'rr'rch. Arch. 45170L; Toppebzcr, Lyppl, .S'chzven[at/(r: Trrr/lzlutt r/rr h‘hturforschcr, 1877; Tuppeincr: WII‘C/Z.x'17‘f7lt. Vol. 74; ()rth: Vm-Iz. Arch. Vol. 76; Bolling/('1‘: ATP/hf. arpm'. Put/total]. Vol. 1.) However true it be that the anatomical mark of TuberculOsis lies in the presence of nodules in certain organs and tissues, yet not every nodular form nor every cellular congerie, although morbidly formed, is equivalent to true tubercles. For instance, when all sorts of substances (even the most harmless) be introduced into the tissues through the blood or otherwise, provided they are in a high state of division, they will produce, where the" are deposited, a cellular infiltration, anatomically resembling tubercles. The clin- ical conditions will, however, be either difi'erent from those con- nected with tuberculosis, or inflammation and suppuration will at once mark it as a distinctly non-tuberculous disease. Even spontaneously generated, tuberculous or rather nodular forms, such as are found in cutaneous lupus, or in the serous membranes diffused here and there, ‘21]111013 be considered tubercular. There are a number of conditions in the body where inflammatory granulations are produced, which are to be counted as tubercular, although tubercles be absent; for not only are the clinical course of the process and the dcveltqnnent of the inflammatory neoplasm indicative of tubercular peculiarities. but also eventually tubercles develop in those granulations. Such a condition in an organ like the lung very often obscures the diagnosis for simple inflammatory processes often hear the same progressively destructive char- acter as tuberculosis of the organ. As a rule, true tuberculosis manifests itself clinically and anatomically alike. Etiology of Tuberculosis. After the brilliant and much promising discovery of the Bacillus Tuberculow's by Robert Koch, and the manifold confirmations of the actual existence of the fungus in tubercles and kindred morbid tbrmations, it was reasonable to expect the question of T/Ihc/‘c/Ildr Etiology settled; yet such is not the case. In the latest medical literary publications quite a passionate war of words is carried on between the schools of Berlin and Vienna, on the very subject of the bacillus. which threatens to unsettle the whole question once more. Until the right of the one or the other side in the controversy is decided by further research, it is necessary to hold on to such facts as are beyond cavil. The cardinal facts about tubercular etiology are: (t. Trachea.) (l). Bron/chi.) terial. The fact is sufficient that tuberculosis is an infectious disease of a parasitory origin Very importantis the question, whether other forms of phthisis pulmonalis resulting, for instance, from caseous pneumonia and ln'oncho-pneumonia, scrofula, and kindred pulmonary lesions, owe also their origin to the same bacillus or not. If, as R. Koch states (in Etiologz'e (lcr thbcrcztlosc, Berlin, Kl/n. llr'ochrnsr-ha andubcrTuberculoxc;Archf.Anatom.(yPhg/siololz/q1).1110). the bacillus can only exist in a tempo ‘ature of from 30° C. to 42° (1., and is necessarily developed in the animal body and can s tarccly develop outside, what is the etiology of tuberculosis derived from scrofula or rather developed from inequality of venous circulation in the lungs and bronchi, with irregular respiration, inadequate nutrition, cellular emigration, and partly tedomatous infiltration into the tissues; in fact, that condition of the body described as scrophulosis? All of these morbid manifestations are produced by faulty hygiene, in the animal and human body. Practically, the remote cause is of lesser importance than the immediate, and here the clinical phenomena can lead far easier to the solution of the problem of tubercular etiology than the anatomical. Gmrral Physical Sv/27zpt07iis (if BronClio-Pneumonia, Bronchitis, and the scacraljbrms of Pneumonia. 1. Diseases of the bronchi, even after they have existed for some time and have become a source of anxiety and annoyance to the patient, may still be very difficult to diagnose. ‘VllCll, for instance. the seat of the bronchial trouble be at their origin and close to the place of their bifurcation, there will be violent cough. a constant sensation of tickling, and soreness in the lungs, without any other objective signs. The same is the case when the disease is situated in the middle of the lung and surrounded 011 all sides by parenehyma containing air. In such cases, only the sputa would positively indicate, to a certain extent, the nature of the lesion. :l'atients will sometimes cxpcctorate large quantities of sputa without manifesting any other physical symptoms, as \Vintrich has noticed it. Here, too, only the sputa will indicate the existence and the nature of the lesion. Constant absence of tissue-elements of the lung in the expectorate points to a bronchial disease. ‘Vhen the expcctorate is very copious, but comes at long intervals, dilatation of the bronchi will be indicated; when it has a bad odor, and contains mycotic bronchial coagula, especially if it is inclined to separate in layers, putrid bronchitis may be well presumed to exist. in peripheral and readily reeognizabl . alterations of the bronchi are conditions which lead to enormous accumulations of liquid in their cavities, and give rise to rules, or moist rattling. According to the viseid condition of the liquid are rules different. Very viscid liquids give rise to dry ralcs or Thom-has, which, if they exist in the larger bronchi, produce a snoring; if in the finer bronchi, produce a whistling or sibilating rhonelius. \Vherc. the secretion is not at all viscid and more flowing, moist rales or mucous rattles are produced. The wider the bronchi the coarser will the vesicular rales be. of reactive processes carried on by the body to overcon'ie the effects of infectious or contagious bodies of a- special kind. \Vhere there is much secretion accun'iulated in the smaller and smallest bronchi, the sound will be of the crepitating, crackling kind. The intmm‘fy of the rale will indi iatc the seat of the disease. its extent. the diffusion of the disease process. in alterations existing 2. No substances or bodies, except miero-organisnis, are able to onlv in the. bronchi no click or metallic ring exists; this always produce in the body and to call forth therein such definite morbid phenomena and specific morbid anatomical products as are found in tubercular conditions of the tissues predicates a condensation or imluration of the adjacent lung-tissue. recognizable by a dull, or dull-tympanitic resonance. \Vlicthcrtlie accumulated liquid in the bronchial cavity be purulent. mucous. or bloody, the sputa alone can decide. _ 1. Real tubercles do not develop spontaneously. but are products 53. That the tubercle itself. and almost all of its transforuiations. provided these contain tl.es1'>eeific virus proper to them, are capa- 2. "Then laru‘e quantities of liquids or secretions are so accumuble of rcprm‘lucing the phenomena peculiar to tubercle. when lated in the bronchi as to close them u] the physical symptoms will soon indicate it. only it must not always be taken lor granted intioduced into other parts of the same individual or into others. Whether the tubercular bacillus constitutes a parasitic fungussu/ ' that an obstructed bronchus is always tilled with liquid. it might |
