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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    which we are informed that the difference between the two affections consists in pneumonia occupying the deeper portion of the lung, pleurisy generally the more superficial, and the pleura.1 Thus, notwithstanding the many observations made, and the time that had been spent on the study of pneumonia, the present century found the exact pathology in a very unsettled condition, and it required some of the master minds of this age to cut through the knot, tightened by medical controversy, and point out the true path on which observers were to proceed. Amongst the first who clearly distinguished pneumonia from pleurisy, we find Bichat leading the way by his auatomical researches. Yet to Laennec—great in pathology as in diagnosis—belongs the credit of having most clearly and satis- factorily investigated the pathological lesions, and, by careful anatomical exa- minations, as well as by a comparison of the results thus obtained with the stethoscopic signs, of having detached pneumonia, as a separate disease, from the other affections with which it had up to then been classed. Laennec divided pneumonia iuto three principal stages: the stage of engorgement— lung of livid hue, heavier, but still crepitant; the stage of red hepatization—■ marked by loss of crepitous feel, with increased consistence and weight; and, lastly, purulent infiltration, or the formation of pus in the inflamed lung. Besides these most prevalent anatomical conditions, we find in his work de- scriptions of rarer forms of the disease : as of chronic pneumonia; camification of the lung; aud even allusions to lobular pneumonia, the true nature of which, and its connection with bronchitis and collapse of the air-cells, form part of those important subjects which modern pathological research is now so brilliantly elucidating.8 To inquire more minutely than this into the further historical development of the exact anatomy of pneumonia, would be here out of place, and is, indeed, in so far unnecessary, as the terms and distinctions of Laennec (if we substitute gray hepatization for purulent infiltration) are the ones still most generally adopted; and as, further, the opinions of the more distinguished pathologists of the day, and the additions made by them to our knowledge of the affection, will have to be considered in discussing the subject of this paper—the changes which take place in the lung in acute lobar pneumonia. First Stage, or Eiujoryemevt.—We have, then, following Laennec, to admit, as the first stage of pneumonia, the eugouement or engorgement. A lung in this condition is of a livid hue, less cohesive, less elastic, and less crepitous; it has lost its spongy character, and from it transudes, when pressed, a frothy serum. If a portion be subjected to a minute examination, the following 1 Vera autem pleuritis sedem suam habet in ipsa pleura, quae intus thoracis cavi- tatem investit, et plerumque in consensum trahit annexos subinde pulmones, et peri- pneumonia ipsani pulmonum substantias occupat.—Hoffmann, Op. Omn., torn. i. cap. iii. p. 201; Geneva?, 1748. 2 See especially the valuable contributions of Dr. Gairdner, in the British and Foreign Medico- Ckiruryical Review, 1853 and 1854, on Collapse of the Lung, Emphysema, etc.