Bauhaus-Universität Weimar

Titel:
The Cyclopaedia of Anatomy and Physiology, vol. 4: Pla [corr.: Ple] - Wri
Person:
Todd, Robert Bentley
PURL:
https://digitalesammlungen.uni-weimar.de/viewer/image/lit29465/115/
PRODUCTS, ADVENTITIOUS. 
(2.) Infiltrated tubercle has been described 
rincipally in the lung, and is here said to ex- 
ibit two kinds of appearance ; (a) the grey, 
and (b) the gelatiniform. (a) There are oc¬ 
casionally found in the lungs irregular masses 
of variable and, it may be, considerable size 
(five inches in diameter even) of greyish semi¬ 
transparent aspect, homogeneous, shining, and 
without distinct structure ; such appearances 
are generally seen towards the apex of the 
organ, and may exist in very rare cases inde¬ 
pendently of any acknowledged form of tuber¬ 
culous deposit ; slices of texture thus affected 
sink in vrater, are moist on the surface, dense, 
and compact. In the midst of such masses it 
is sufficiently usual to discover a number of 
small specks of yellow opaque tuberculous 
matter ; these increase in number and size, 
and thereby gradually cause the disappear¬ 
ance of the grey matter. Now it is admitted 
on all hands that the characters of this alleged 
tuberculous infiltration are extremely like 
those of chronic pneumonia; and in our mind 
it is extremely doubtful whether the morbid 
state be anything more than a particular form 
of that inflammation. M. Louis draws at¬ 
tention to the following points as distinctive 
of chronic pneumonic induration:—1. Instead 
of being transparent, the affected tissue is 
opaque ; 2. instead of being homogeneous, it 
is traversed by thick white septa ; 3. the in¬ 
durated parts are more compact than in the 
presumed tuberculous infiltration. But in ac¬ 
knowledged chronic pneumonia all these cha¬ 
racters are subject to a great variation in 
amount; and the formation of yellow tu¬ 
bercle proves nothing in either direction, as 
there is no reason why such formation should 
not occur in a tissue infiltrated with indu¬ 
ration-matter. (b) Of the gelatiniform tuber¬ 
culous infiltration of Laennec, it is sufficient 
to say that no doubt can be entertained as 
to the fact of his having described, under 
this name, infiltration of common exudation 
matter with excess of serosity, sanguineous 
or not. Tubercle does, however, occur in the 
endosteal texture of bone in the infiltrated 
form. 
The microscopical constitution of yellow 
tubercle may be described as follows, at least 
according to the observations we have our¬ 
selves made. (1.) Granular substance exists 
in abundance in tuberculous matter ; large 
masses of soft consistence sometimes consist 
almost solely of it ; and, as the process of 
softening advances, it abounds likewise; when 
of well-defined characters and abundant, it 
constitutes a very distinctive element of tu¬ 
bercle. The granules are dark, of yellowish 
brown tint, heaped up in masses, varying in 
size from about l-4th or l-5th of that of the 
red blood corpuscle (say or Tsioo °f an 
inch) to the merest points. Some of them, 
undissolved by acids, alkalies, or ether, are of 
modified protein-basis ; others, soluble in hot 
ether, are of fatty nature : the latter are 
sometimes, though rarely, absent altogether. 
(2.) Cells.—Cells, though probably always ex¬ 
istent in tubercle at some stage of its develop- 
105 
ment, are not always to be found, or to be found 
in very minute proportion only, in specimens 
examined. In some cases they apparently con¬ 
stitute the entire tuberculous mass. We have 
found them sometimes of circular form, and 
rather flattish ; sometimes irregular in shape 
and with rounded angles, never caudate, and 
nearly averaging in size that of the white blood- 
corpuscle. They contain a variable number of 
granules scattered without order through their 
substance, but generally leaving a free circlet 
at the periphery. We have never seen a dis¬ 
tinctly defined nucleus within them ; acetic 
acid simply renders the cell-wall more trans¬ 
parent, and exhibits the granules more clearly. 
(3.) Irregular particles. Shapeless particles, 
flat, pale, and on an average of less size than 
the cells, are sometimes seen. These are pro¬ 
bably, in part at least, the walls of disinte¬ 
grating cells ; whether they eventually go to 
form granular matter is a point, open to 
inquiry, but appears to us probable. With 
these the substantial constituents of tubercle, 
are sometimes accidentally associated. (4.) 
large fat globules; (5.) plates of choiesterin ; 
(6.) amorphous saline particles ; (7.) melanic 
cells and granules. 
Nothing having the attributes of a stroma can 
be detected in tuberculous matter; but a semi¬ 
transparent substance, more or less solid, slowly 
soluble in acetic acid, absolutely structureless 
and amorphous, holds its elements together. 
Neither does tubercle ever contain vessels of 
new formation ; and the imprisonment by tu¬ 
berculous deposit of natural capillary vessels, 
still pervious, is comparatively rare and acci¬ 
dental ; there is a tendency, constant in action, 
and eventually irresistible, to obliteration of the 
vessels around and amid which the blastema 
of tubercle is thrown out. A new vascular 
system, we are aware, has been found to 
originate in the vicinity of tubercle ; but this 
development takes place within common in¬ 
flammatory exudation matter. In the same 
way there may be found on the confines of 
tuberculous matter compound granule-cor¬ 
puscles, pus-corpuscles, with, of course, the 
ultimate elements of the tissues implicated. 
In the same natural texture with such tuber¬ 
culous matter as we have now described, are 
very frequently found certain small bodies vary¬ 
ing in size from that of a pin’s head to a very 
small pea, of greyish-white or greyish tint and 
glistening aspect. These bodies are known as 
the semi-transparent grey granulation ; and 
their affinities to yellow tuberculous matter 
have been a theme of constant disputation 
from the period at which tubercle first became 
the subject of close study. While some regard 
them as products of common inflammation 
(Schroeder van der Kolk, Andral) ; while 
visionaries are found (Kuhn*) to maintain 
that their relationship is closest to the Nema- 
zoa of Gaillou (a class of beings forming a link 
between vegetable and animal existences) ; 
while a reasoner habitually most cautious 
(Carswell) regards them in some situations — 
the lung — as an admixture of mucus and true 
* Gaz. Mdd. de Paris, t. ii. p. 342. 1834.
        

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