An inquiry into the pathological anatomy of acute pneumonia / by J. Da Costa.

  • Da Costa, J. M. (Jacob Mendes), 1833-1900.
Date:
1855
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Licence: Public Domain Mark

Credit: An inquiry into the pathological anatomy of acute pneumonia / by J. Da Costa. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    clears them of their granules, and renders them almost transparent vesicles (Fig. 5, h) ; in some it shrivels up the cell-walls. Other elements met with, are flakes of albumen or fibrin, some containing small oil-globules; in exceptional cases, masses of pus-cells (Fig. 5, <?) predominate. The fibrous tissue in the walls of the air-vesicles is very indistinct, and more or less densely infiltrated with granules (Fig. 5, c), which are mostly soluble in ether. Epithelium is entirely absent; nor are compound granule-cells in advanced gray hepatization noticed in the same quantity, as in the stage of red hepatization, whilst free fat molecules and globules abound. The vessels are generally dark brown, and their walls (Fig. 5, d), coated with large masses of granules, destroyable by the caustic alkalies. These minute structural appearances, then, point conclusively to the fact, that gray hepatization is, certainly, in most instances, not a suppuration; but rather a gradual breaking up of the exudation (and, secondarily, of the lung- tissue), allied perhaps in its nature to fatty degeneration, such as we have stated to occur in other parts of the body, as a result of acute inflammation, and commencing with the earlier stages of the pneumonic process. In support of the latter assertion, besides the appearances presented by the microscope, may be cited the fact, that hepatized lungs yield a much larger quantity of fat than the normal organs, or even than such as are in a state of engorgement. Thus Natalis Guillot (Joe. cit.~) writes, that, in hepatized lungs, he finds from 18 to 40 per cent, of fat, whilst in engorged lungs, whether inflammatory or not, the fat, as we have above seen, rarely exceeds 10, or at the highest, 15 per cent. As he does not inform us in what stage of hepatization the lungs examined were, we cannot make any further use of his observations for ascertaining the relative amount of fat in the two stages. Yet there is a strong proba- bility that the organs were mostly in the third, or in a far advanced second stage, as pneumonic lungs in the earlier conditions are more rarely attainable for pathological researches. My own comparative analyses are as yet too few to justify a conclusion on purely chemical grounds; nor do I conceive that this—considering that we have proved the fatty metamorphosis to be a gradual one, and shown that a large amount of oil and granules are .visible in the epithelial cells, and in the exudation in the earlier stages of red hepatization— should be as decisive as the microscopic appearances. These last exhibit the exudation-cells much more oily, and further—what most concerns the propo- sition advanced—the fibrous tissue more indistinct, softer, broken up, and infiltrated with fat-granules, the nearer we approach to the yellowish-gray appearance of the third stage; which we thus can regard, in many respects, as simply a continuation of the second. The opinion expressed with regard to the non-suppurative nature of most cases of gray hepatization derives further support from a fact which every pathologist has admitted—the extreme rarity of pulmonary abscesses following pneumonia. In over 100 post-mortem examinations, extended over a space of 20 years, Laennec only met five or six times with a collection of pus in