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Show DISEAJ ES OF THE ORGANS OF {ESI'IRATIOX. [Mac'riox III. TABLE VI. ctnnmencement of destruction of the parenchvma near a Flo. '1.--(hilfn‘rhfllpact/mm)in. .s-ulis-M/imnl in uterine. hepatic small bronchus; fig. 3. a number of cavities produced bV (Ii/(l splfinilfc MIN/ililwln'l‘fs. Thrombotic occlusion/137" flu? 1 the ulcerative corrosion of liquified 'aseous matter. (A); jut/nunmrf/ (Ir/cry (Ii/«l many of its larger branches. Suh- bronchial tube,(B); 'avitiesandulcers,((7). Themucous jtlcm'al lung tissue «ulccmz‘ml in. warn/.1] places. chemor- membrane of the bronchial tubes is very red, and in rhu‘r/[c infarct (Ill/1e lmsc of the lift lung. spots dark, and infiltrated with black pigment. (Asa-A woman :38 years of age. l'rimapar: . Fig. 4-. Portion of easeous lung near the hilum: (11.) .Ifisi‘orj/.-Ilard labor. artificial delivery. followed by 'aseous change obliterating all the structural peculiarities enormous hzemorrhage. \Vas taken with metritis on the of tln affected lung; no interlobular septa are noticeable second day after the birth; phlebitis of the uterine veins i in this region. appeared next day. Two days later. excessive pain in the ‘ Fig. 5. (i‘aseoils pseudo-tuberculous masses on the chest, and severe dyspnoea. Died in a collapse twcnty-. 1 outer surface of upper lobe. The interlobular septa are eight hours after the birth of the child. very much thickened and are very distinct. the lobules Post mortcm.-Abdo1nen. no sign of peritonitis. (There are very much contracted near the faseous portions; the was no 111icroscopic examination ot'the 111e1nbrane) Intespseudo-tubercles (solid caseous collections) are spheroidal tines very hyperaunic. Uterine, ovarian and hypogastric l in shape, and project above the pleu'al surface. They veins tl1r(.)n1botic. 'l‘hcyare hard and feel like cords. l vary in size; (41.) tubercles, (.li.) bronchial mucous The external iliac. the femoral veins and their branches. membrane, partly red, partly brown; enlarged and dilated also filled with compact. and adherent thrombi. but of l blood vessels run parallel to its long axis. more recent date; at the base of the left lung several Fig. (5. )Iiliary tubercles in a highly Congestsd porsmall abscesses filled with pus. They are circumscribed l tion of a lung; (13.) small bronchial tubes, partly filled by some, amemic tissue. and are superficiallysituated-sub- l with thrombi; (:I'.) pleural surface. pleural. Some are yellowish-white. others are red. Their Fig. 7. Portion of upper lobe of a lung infiltrated surrounding parenchyina has a mottled appearance. and l with cascous masses; the tissue is nearly solid and in a of several shades of red. At (F. S.) there is infarct into state of brown induration. the lung tissue. The posterior halves of both lower '3 Figs. 8. 9. 'J‘ubcrclcs in apex of a lung; the parenlobes are perfectly infiltrated with serum and unfit for chyma has lost its lobular arrangement. and 1n‘esents a breathing. Ineisions into different parts of the left lung nearly homogeneous appearance. Dilated blood vessels show the pulmonary artery and many of its branches to i and lymphatics cross the tissue in different directions; be filled with thrombi; red in the smaller. colorless they are situated outside the visce'al pleura, which is in the trunk and larger branches. \Vithin many clots firmly united with the lung. A. number of small and liquid pus was found. (11.1).) pulmonary artery. ((7. P.) large grayish-blue tuberculous masses, are situated partly collection of pus. (C. S. 1).) colorless thrombus. (.13.) sub-pleural. partly on top; they have a gelatinous con~ bronchus, (19.) superior lobe. sistence and are slightly transparent; they typify Laenec's Figs. 1. 2. 3. Softened caseous masses; fig. 2, shows gray tubercle in its primary stage. f t lung parenchyina. These particles are surrounded by grayish yel~ low masses with fringed edges, and consist of elastic, transparent, colorless substance, and contain very numerous fat molecules and other granular detritus, mingled with groups of black pigment. and crystals of fatty acids. Vast numbers of vibrioni are found in the sputa." Lei/(lea and Jafi'c have also discovered great numbers of vibrioni in the gangrenous sputa, as well as in the dilated bronchi themselves. The vibrioni were endowed with very lively motion resembling the amocboid. The 111icroorganisms are similar to those found on the teeth and the gums in putrid stomatitis. Large quan- tities of crystals and amorphous substances, usually to be met in organic substances undergoing putrefaction, such as lcucin, tyrosin, etc, were also found therein. Occasionally any of the forms of croupous pneumonia mayter- minate in the formation ofpulmonary abscesses. The older pathologists have confounded this mode of termination with the gangrenous, for some really good reason. In nearly every severe form of pneumonia there is mortifieation of the lung tissue, but to a vcrylimitcd cxtent,and the necrotic process passes so quickly into the reparative stages that no gangrenous manifestation becomes apparent. some sketchy description of its post Imortrm, appearance. "Very frequently,"he says,"cavities ofvarious dimensions are found in the lungs, filled with a thick, creamy pus. The cavitieshave different shapes; they may be single or multiple; they may intercommunicafe or not. At the height of the ulcerativc process, the walls are uneven, and covered with ragged portions of mortified tissue, of a grayish red, black or black-green. These project into the cavity and are covered with pus. Thecavity itself istillcd with a creamy pus of a whitish, greenish, reddishor brownish color. In the later stages of ulceration the walls become smooth, and are lined with a pyogenic membrane, of slate color, and covered with pus. The membrane is sometimes very dense, or even cartilaginous, or very thin and fragile. Occasionally partly closed cavities, by cicatricial contraction, are to be met with. Of course such cicatrices cause total obliteration of function of the lung tissue." " When in later stages of acute pneumonia no absorption takes place, there is formed a chronic interstitial inflammation, which readily passes into cascous pneumonia. " I11 croupous pneumonia the cellular elements fill only the air cells, the intercellular septa remain unaffected. In the chronic caseous form the intercellular septa become affected. They appear Whilst formerly pulmonarj abscess was thought to be a very like large bands between the alveoli, for they are filled with emi- common termination of fibrinous pneumonia, so that even Lainec mentions very numerous examples of the kind, at presentits exist- grated colorless blood corpuscles, and fusiform connective tissue cells, from cell proliferation between the fibres. Aslong asthe i11- ence is altogether denied. Thctruth is that it occurs very seldom, yet well authenticated cases have been reported by Fischl, Loydrn tlannnation lasts, the vessels of the. septa remain perfectly turgid, until the retrog 'essivc process sets in. This begins in the center of the air cells, and spreads externally into the septa, and converts the whole part thus affected (usually a lobule) into a finely granular, half dry, caseous inass."-( Tlif(‘/f(‘l(l(")'.) "Under such circum- stances the physician will wait for a long while for the resolution of the pneumonic focus, but in vain. For he will find that he has to deal with a case of caseous pneumonia, which will differ in nothing in its consequences, from ordinary broncho-pneumonie phthisis.-( Iliml/lcisch.) and other very competent and trustworthy authors. Traube has established the differential diagnosis between abscess of the lung and gangrene. This is to be found in the character- istic sputa, in abscess, that is, the constantly present elastic shred.»- of the parcnrliyma of the lung in abscess, which are always absent'fn gan- grenous sputa. Leg/dew ( Ucbcr Limgenabsccss, Klinisch llr'oclzrnbl.) presents a characteristic description of abscess of the lungs, which he says resembles in many features acute easeous pneumonia. far more than gangrene, although he advises to avoid 111istaking abscess ("(Ltarrlml Pacmaunia. for gangrene. IIc places abscess of the lung under two heads: Radically different from the fibrinous is the catarrhal form of 1. Perforating, (such as Stokes describes under the same name, inflammation of the lungs. As l'z'rrlm'w has defined it, the fibrin and "realm under the name of latent abscess.) Such are hepatic and peritoneal abscesses situated beneath the diaphragm, or exist- l ous partakcs more of the haimorrhagic nature, forthe 'Z‘( 'I- only are primarily involved in the disease. whilst the catarrhal is celluing in the vertebrae or in the bronchial glands. All of them may perforate the thoracic wall, or penetrate into the lungs, and from l lar, for the air cells are at once infiltrated with smallcells and the there be discharged by expectoration. 1 alveolar walls are soon affected. The tibrinous gives rise to yellow 2. Pulmonary abscesses proper. Those are abscesses following ‘ hepatization, the catarrhal to a variety of hepatizations. The fibrin- ous follows a typical course, the catarrhal an irregular, atypical. pneumonia, embolic and metastatic, also local inflammations pro- duced by lodgement of foreign irritant bodiesin the lungs. The lat- } 111 all forms of catarrhal pneumonia there is bronchial inflain- mation, only in some the bronchial affection is primary, in others ter class of abscesses are met in the course of acute pneumonia with crisis on the seventh or ninth day, but which do not lead to con- i simultaneous or consecutive. There are two distinct forms of the disease, the hemp/unwilrr and the sir/(fly (‘tlllll(1)'. ioth may pass valescence. Fora few days after the, crisis, the fever will return into the easeous, degenerative state. and cxpcctoration will almost cease for several weeks, But sud- llntil verv latelv all forms of catarrhal inflammation of the, lungs, denly, after a certain lapse of time, an exceedingly copious dis» both acute and chronic. were thrown togctherunderthehead of ca. charge of pus will take place, which, as a rule, relieves the patient tarrhal pneumonia. or broncho-l>11eu111onia.until Bil/ll established and causes a return to health. The characteristic sputum from the fact that one form of catarrhal inflammation was really a seppuhnonic abscess is this: It has a sweetish, insipid taste, a slightly arate disease. specific in its nature, and having a pathology alto- pungent odor, and contains shreds of lung-tissue, which are of a getherits own. He designated it in his work "I.uny/ruruumtlu111/ yellow or grayish black color, and surrounded by thick pus : initl Til/u rriilos: ." [)r'sun/u/ri/frw I'urltmoufo. fatty acid crystals, ha-matoidin and bilirubin, micrococci different Since then the best clinicists have fully corroborated hi.s state- from the very lively moving bacilli found in gangrenous sputa; ments. The main characteristic of this lesion is the filling up of epithelial lining of the bronchi and air cells, etc. Lei/(lea g1ves . the air cells with infiltrated endothclial cells in a very early stage Its pathological anatomy is yet to be studied. |
