On artificial tuberculosis, and its relation to cellular pathology and the growth of tumours / by James F. Goodhart.

  • Goodhart, James Frederic, 1845-1916.
Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: On artificial tuberculosis, and its relation to cellular pathology and the growth of tumours / by James F. Goodhart. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    depend for its production mainly on two conditions—the tendency to cell-change in the patient, and the chronicity or otherwise of the first stao-e. If the cell-growth is active, a general tuberculosis will probably be established ; while, if the exciting causes alone are suf- ficiently persistent, adenoid formation will also take place to a more limited extent, but without probably any additional stimulus form a constitutional state; I say probably, because it would be impos- sible to demonstrate with certainty the absence of such a state, the strongest evidence that could possibly be brought forward being no more than the negative test, that the disease had not hitherto shown itself. My belief is, then, that all chronic pneumonic changes consist in part of adenoid formation. This view requires corroboration. The only evidence that I shall here offer on the point is, that in five such cases I found extensive thickening of the alveolar walls, with lym- phoid tissue, a condition precisely analogous to that of tuberculosis, either natural or artificial, except that the round millet-like grains were absent; and this is probably not a difference of kind, but only of degree. We must also remember that the ordinary result of a long-stand- ing pneumonia is a permanent induration of' the lung from increase of its fibrous tissue, and in connexion with this state, the undoubted fact that miners, stone-masons, or any people living in dusty atmos- pheres, are frequently affected with chest disease, while after death is found, not a tubercular, but a fibroid, condition of lung. If, in such cases, the earlier condition is, as I say, one of growth in the alveolar walls, the excess of fibre-tissue found post mortem must be regarded as lymphoid tissue become fibrous, the corpuscles having all been utilized by the proper tissue of the wall for its own repair and growth. This is the very termination one might expect from a chronic irritation proceeding continually in hardy men. It may be said by those who blame the diathesis rather than local conditions, that tuberculosis is but rarely associated with chronic bronchitis—a class of cases in which, according to the views expressed, it ought never to be absent. That the two are so rarely found together is because the effects of the irritation are neutralized by the emphy- sema. The ill-aerated blood, and the semi-stagnation in the lungs, .are conditions unfavourable to cell-life, and thus when tubercle does occur, it is small in quantity and shrivelled, instead of being succu- lent and translucent. It is, therefore, named by Dr Moxon starved tubercle.''1 For the same reason is it, probably, that tuberculosis and heart-disease are but seldom associated.1 • _ The third stage of the disease, that of spreading to neighbouring tissues, is well illustrated by the following short note of a post- mortem, made a few months back. The case was one of phthisis. The right lung had its upper lobe stuffed with tubercle; at the outer 1 Chronic bronchitis does occasionally,produce phthisis. Four such cases were lately brought before the Medical Society of London by Dr Andrew Clarke, but they are certainly exceptional. » i