An Atlas of the pathological anatomy of the lungs / by the late Wilson Fox.

  • Fox, Wilson, 1831-1887.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: An Atlas of the pathological anatomy of the lungs / by the late Wilson Fox. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    nipple, the right being It was absolutely dull below the 3rd rib in front, throughout the axilla, and below the upper third of the scapula posteriorly. Respiration, vocal fremitus, and vocal resonance were all weakened at the upper conbnes of the dulness, sup- pressed below ; segopbony existed at the level of the dulness in the back. The right apex was resonant: the base was dull belov' the 5tli rib in front, 6tb rib, axilla, and below the apex of the scapula posteriorly. On the next day this bad increased to the middle third of the scapula. In the right back there was bronchial breathing, with coarse rales over the upper part of the dull area, diminished breath-sound in the lower part, and coarse friction over the right front. The heart beat at the ensiform cartilage : not to right of sternum : could not be felt on left side. Sounds weak. No murmur. The urine was free from albumen. No oedema of extremities. His temperature on admission was 101'4°, pulse 20, re- spiration 48. On the fifth day after admission the temperature fell to normal, and the dulness at the right base diminished. The dyspnoea also improved, and he appeared better for a few hours. The dys- pnoea, however, increased suddenly and rapidly, and he died on November 8. Post-mortem.—Large effusion of clear serosity in left pleura. Right lung adherent. Larynx.—Slight superficial ulceration on under surface of epiglottis; rest of larynx and trachea healthy. Lungs.—Bronchus of right filled with tenacious mucus. Tissue of lung loaded with serosity ; base excessively hyperiumic. Liings emphysematous. At the posterior part of the apex are nodules of in- duration of fibro-cartilaginous hardness. Near them is a cheesy mass the size of a walnut, wliich, wlien removed, leads into an irregular cavity. Below this the lung-tissue is tilled with sottish white granu- lations, forming, for the most part, racemose groups which have not undergone caseous change. In other places, small caseous granulations are connected by bands and strings of fibrous tissue which ramify between them. Tlie granulations are all very much pigmented, as is also the pulmonary tissue surround- ing them. They are scattered in groups in all parts, from the apex to the base, and the amount of lung occirpied by them is very considerable. Fibroid change tends to occur in strings and bands, passing not only between groups of granulations, but between single granulations scattered througli the pulmonary tissue. Some of the larger granulations, the size of a hemp-seed, where isolated, have a caseous and cup-shaped depression in their centre, and when cut into are found to communicate directly with the bronchi, as in the case of Oocrall (Case 27). Tlie appearances in this lung so exactly correspond with tliose of Overall {see X. 8, 0, 10, ami description) that I have omitted a drawing made to illustrate them. Left limj adherent at apex : collapsed tlirough- out, except at apex, which is still crepitant. It is studded throughout witli granulations precisely similar to those found in the opposite lung. The bronchial glands are large, indurated, and pigmented. They are filled with small granulations thickly scattered through the tissue. The granulations are firm and have a whitish look. Heart large, weighs 13 oz. Large adherent clots, formed shortly before death, are found in both right auricle aird ventricle. Some thickening of mitral valve. Wall of left ventricle is § of an inch thick. Muscular tissue softer than natiiral. Liver weighs G7 oz., capsule separates easily. Tissue mottled with granulations, which are irregu- larly dispersed throughout its substance. They vary in size from a hemp-seed to the minutest specks. The smallest are semi-transparent ; the largest are opaque, not cheesy. In some places they coalesce into tracts of some size. They are evidently situated between the acini, but press very irregularly upon these. Kidneys.—Indurated : present a few small granu- lations, grey and semi-transparent. Spleen soft; no enlargement of Malpighian bodies. Stomach.—Mucous membrane more opaque than natural ; contains a few follicular ulcerations. Intesti)ics.—Much congested. Solitary glands enlarged throughout both small and large intestine , no ulceration. Microscopic Characters.— The appearances found in these lungs are the following :— A. Areas of caseous pneumonia. B. Areas of suppurative pneumonia mingled with the former. C. Diffuse infiltrations of small-celled growth. D. Nodules of small-celled reticular growth. E. Nodules of intermingled small-celled and epithelial growth, passing in some cases into induia- tion, in otliers inio caseation. F. Some peribronchial and perivascular thicken- ing. § A. The areas of caseous pneumonia are net numerous or extensive. They are diffuse in some places, in others circumscribed by thickened inter- lobular septa. They originate in processes of thicken- ing of the alveolar walls by a small-celled growth, in the manner described in Griffin {Case 19), and Lloyd (Case 23). § B. Portions are found in the areas of caseous pneumonia where all structure has disappeared except the framework of elastic tissue, and where the final result is an appearance similar to XXXV. 5 {Smith), but where all appearance of suppuration is absent. It may, therefore, be questioned whether, in some instances, destructive changes of this nature may not occur without suppuration, and be caused solely by the disintegration of the cellular elements. §' C. Diffuse infiltrations of small-celled growth occur, either like XXXVTII. 8 (Hall), XL. 2 (Heath), or more commonly in the form of alveolar thicken- ings like XXXVil. 2, 6, and 7, and XXXVI. 2 {Griffin). The latter are found adjacent to, and meruino' into, masses of caseation, which theretore probably proceed from them. § I). Nodules of small-celled growth, without admixture of other elements, are occasionally found. Ill many cases they commence purely in the alveolar texture. § E. Nodules of intermingled small-celled and epitiielial growth, in various stages of transforma- tion, are the most common objects in these lungs. They occur either singly or in groups, and may, in the latter form, occupy large areas. Their most common tyjie is seen in XXXIX. 7. Single nodules, like a in this figure vary, from to or even J of an inch. The most common size is about inch. In their earlier stages they commence with a variable amount of epithelial growth, like XXXVII. 5 (Griffin).