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

  • Da Costa, J. M. (Jacob Mendes), 1833-1900.
Date:
1855
Catalogue details

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.)

    8/22
    Now, as the engorgement was not cadaveric in any of these cases, this table proves a marked increase of fat in hypcrsemia of the lung occurring some time before death. My observations with reference to the increase of this substance, in the first stage of pneumonia, are as yet too limited to permit of my publishing here a comparative table; but tbe cases examined lead me to the belief, that the accumulation of fat occurs in this stage even to a much larger extent than in simply congested lungs. In one well-marked specimen; in which the portion of the lung analyzed had commenced to lose its spongy character, but still floated in water, although some parts in its vicinity were already markedly consolidated, the amount of fat present in 360 grains of wet tissue was 7.85 grains, bearing the proportion of 2.18 per cent, to the wet, and 15 per cent, to the dried structure; a much larger percentage than was obtained from any congested lung examined. A recognizable condition of the pulmonary tissue is stated, by a most dis- tinguished observer, to precede the stage of engorgement of Laennec. Dr. Stokes describes, as the true first stage, an irritation of the lung, in which the pulmonary tissue is drier, and of a bright vermilion colour. However convenient, in many respects, it might be to admit such a morbid condition, pathological demonstrations have not borne out this author's view. Nearly all eminent pathological anatomists of the day deny this stage as an antecedent of inflammation of the lung; nor does, indeed, Dr. Stokes himself seem to have based his assertion so much on anatomical as on clinical grounds.1 He states, it is true, that he has met with this condition in pathological specimens, and relates (pp. cit.) a case of an extensive burn in a child, where nearly the whole of the lung was in this state; but he fails to point out that this appear- ance is of necessity connected with inflammation. I have had recently an opportunity of examining the lung in a case similar to the one he describes. The organ, in this instance, was dry, and presented an unusually bright colour; yet nothing could be discerned in which it differed from ordinary con- gested lungs, nor did it, when minutely examined, afford any evidence of inflammatory action. Another morbid change which has been much dwelt upon by writers, as connected with this first stage, is splenization; but so varied are the descrip- tions given of this condition, and it has been associated with so many diseases, that there is no little difficulty in referring any characteristic ap- pearance to it, save that very general one of a resemblance to the spleen. 1 No one can doubt, be writes, that tbe crepitating is but tbe diminutive of tbe mucous rale : it is a phenomenon produced by tbe passage of air through a viscid fluid secreted by tbe irritated cells or terminal tubes, and its peculiar characters result from tbe bubbles being necessarily so minute. The existence of tins sign, then, points out that secretion has taken place into tbe cells ami minute tubes; so tbat Laennec's first is, in reality, tbe secretive stage of the inflammation, and every analogy favours tbe opinion that a stage of irritation has existed previous to tbe secretion which caused the crepitus.—Stokes on the Diseases of the Chest, Am. ed., p. 200.