The pathology, diagnosis and treatment of intra-cranial growths.

  • Knapp, Philip Coombs, 1858-1920.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: The pathology, diagnosis and treatment of intra-cranial growths. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    they may attain a considerable size, a diameter of three or four centimetres or more. These are the so-called solitary tubercles, an ill-chosen name, for, as the tables show, such growths are often multiple, and the individual tumour is in many cases formed by the agglomeration of several smaller nodules. Tubercular disease of the dura is rare, except in combination with similar disease in the pia or the skull. These solitary growths arise most commonly from the pia, or some penetrating fold thereof; and, when they occur within the brain apart from the pia, they probably spring •from a blood-vessel, through which the bacilli have been carried to the affected spot. These growths are usually irregular in shape, with various projections, indicating the agglomeration of several distinct nodules. The surrounding brain-substance may be softened or sclerosed about the growth, but sometimes the periphery becomes fibrous, forming a capsule to the tumour. In long- standing cases this capsule may become calcified. On section the growth is found to have a grayish-red, translucent peri- phery and a yellowish centre, which is sometimes cheesy, and occasionally shows a concentric marking. The growth extends along the lymphatic sheaths, and, when blood- vessels are met with, it causes thrombosis. Sometimes, however, the growth may penetrate a vessel, and the blood may become re-infected with bacilli, and thus give rise to a fresh and more acute infection of the brain, a secondary tubercular meningitis. Under the microscope we find in the periphery of these growths an abundance of newly-formed round cells, nuclei, giant cells with many nuclei, and epithelioid cells. Here, too, may usually be found a certain number of bacilli. The exact origin of these cells, whether from endothelium in the serous cavities, lymph cavities, or adventitia, or from con- nective tissue or lymph corpuscles is still uncertain. Occas-