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Sectio cadaveris twenty-four hours after death. The trivial, and receive no very great attention on the part body was ædematous over the entire surface; plentiful of the patient; nevertheless, a condition apparently serous exudation from every tissue as the knife passed so trifling, and accompanied by no great amount of through the abdomical and thoracic parietes; a mode. physical disturbance, may, by its tendency to recur rate amount of clear serum was present in the cavity of again and again, under favourable circumstances, and the abdomen. The lungs did not collapse on raising the often does, lead to serious inischief, and ultimately sternum, but were attached by firm bands of tissue to even to fatal consequences. According to the best the pleura costalis; no trace of recent plastic exuda authorities, in the earliest stage of acute catarrbal tion could be detected; the lungs on their anterior affection, distinct portions of the bronchial mucoas surface, and particularly about the middle lobe, pre membrane exhibit patches of a fine rose-red injection, sented many emphysematous patches, one or two of which are not circumscribed by a definite boundary. the size of a filbert; the margins of the inferior but gradually become diffused, and insensibly lost in lobes were also covered with emphysematous vesica the surrounding pale tissue. This increase of colour tion; the posterior and inferior portions of the lungs arises from the injection of the capillaries of the spot, were dense, with cadaveric infiltration, a plentiful san and expresses the condition of true, though limited, guinolent serum (frothy,) exuding freely on a section capillary hyperæmia. If the catarrbal irritation inbeing made. The mucous membrane of the bronchial creases, the patches extend and coalesce, and the coloar tubes was turgid and swollen, of an intense dark, of the affected part becomes darker; and when the madder-red colour, and from them into the lesser irritation has reached its maxinum of intensity, the series the colour passed into a purplish violet, and pre- membrane assumes a bright vermilion-red bue. At this sented the appearance as of intense venous hyperæmia; period there is a deficiency in the natural secretion of the the larger tubes were smeared over with a glutinous. membrane, and when the affection is seated bigh up in tenacious, and very adhesive secretion, and many of the the wind-pipe, or extends no farther than the larynx, smaller tubes seemed quite blocked up with this gelati- it is at this stage that hoarseness exists. It may be nous mucus. It was of a faint fawn-colour, and at no observed here that catarrhal irritation invariably propoint could any appearance of yellow muco-purulent ceeds from above downwards; and that, supposing secretion be detected. Under the microscope this the trachea to be the seat of the original catarrhal exudation had a Sibrinous appearance, and exhibited attack, there would be alınost a certainty, that if many granular cells; none could be found that pre- it extended, it would descend to the bifurcations of sented any of the characters of pus-globules. The heart the bronchi, rather than ascend to the larynx. This was much enlarged, but uniformly so; no valvular is more particularly noticed in epidemic catarrhs, thickening nor opacity; the walls were relatively thin where the original attack, commencing as coryza, and in respect to the increased capacity of the auricles and seated in the Schneideriun membrane, extends to the ventricles; it weighed twenty ounces. The liver was not pharynx, thence to the larynx, and if the attack be unhealthy in appearance, presented indications of a severe and neglected, continues to the trachea and large amount of portal congestion, and weighed forty bronchi, and ultimately extends to the minutest eight ounces; the kidneys were free from any morbid branches of the air-passages. But the reverse is never appearance, the right weighed six ounces, and the left observed, the catarrhal irritation never proceeds from five and a half. The brain was not examined.
within outwards from the smaller tubes upwards to This case explains to us many of the pathological the wind-pipe and larynx. conditions of pulmonary catarrh, bronchitis, and em I bare already observed, that in the earliest stage of physema. Pulinonary catarrh is one of the most fre- tbe affection, there is a diminution, even total absence quent and commonest precursors of the severer and of the ordinary lubricating secretion of the part. The more fatal forms of bronchitis. Pathologically it can air irritates the undefended and irritable surface, and be said to differ from bronchitis only in the amount excites a dry, frequent, and harrassing cough. In the and intensity of the preceding hyperæmia; the usual mildest cases, this state of capillary congestion and products of inflammatory action, pus, and plastic exne deficiency of secretion is soon followed by the pouring dations, being the result of the more intense morbid out of a ihin pituitary fluid, which soon presents many action; while in the milder affection, cpithelial cells, minute grey points or striæ, mixed with many granular corpuscles, and fuid mucus, are generated air-bubbles. Under the microscope, this secretion and expectorated to a greater cr less extent. To the is observed to be composed of epithelial cells-even latter the term catarrh, or pulmonary catarrhi, is layers of them-- in great abundance, suspended or usually applied; while, to express the former, we foating in a clear mucous fluid, and often mixed with employ the word bronchitis. I propose to examine the many granular corpuscles. Proportioned to the inpathological conditions of these affections somewhat tensity of the preceding capillary injection, changes minutely, as the case before us presents me with a take place in the secretion; it becomes thicker, favourable opportunity practically to illustrate these opaque, slate-coloured, greyish yellow, even yellow, morbid conditions,
and then assunes a more evident muco-purnlent Catairbul affections of the mucous membrane of the character. As the irritation subsides, this secretion trachea and larger bronchial tubes may be reckoned gradually diminishes in quantity and consistence; among the most frequent derangements of the system, epithelial cells in dimini-bed number are alone visible, and except in rare cases, are from the first treated as and the mucous membrane gradually and slowly
LECTURE ON CLINICAL MEDICINE.
returns to its normal and healthy condition, regular | we have some evidence in this case, which must not be epithelial layers being formed, as the more superficial omitted, and that is the presence of plastic exudation ;' are constantly and uniformly thrown off.
it is also known as fibrinous exudation, and is the In the more severe forms of bronchial catarrh, where inflammatory exudation of Vogel and other niodern a more extended surface of mucous membrane is from pathologists. The mucous membrane is as capable of the first the seat of morbid action, and where the generating this product of inflammatory action as capillary hyperæmia is not confined to the superficial other tissues, although it is certainly not so frequently mucous layer, but involves a more expanded series, observed as in the serous and cellular series. It would and injects even tbe vessels of the sub-mucous tissue, appear to be dependent on the amount of pre-existing the term bronchitis more usually applies. The several capillary hyperæmia, the intensity of which, instead of pathological conditions before noticed, are here much generating granular cells, which are rapidly converted aggravated. The mucous membrane is no longer of a | into pus-globules, and thus forming a true muco-parabright rose-red colour, but presents a deeper tint, lent secretion, is attended by the exudation of a plastic even madder red; in the case before is purple madder. lymph, which fills the binaller tubes and takes their Consequent on this large amount of turgescence of the form; and if the disease be fatal at this stage, this capillary vessels, (upon which this change of colour coagulated matter may be drawn out from the sinaller depends,) is tumefaction of the entire series of mucous branches, and in this case you witnessed its tenacity to tissues. A swollen turgid state of the mucous mein be sufficient to allow it to be drawn out. In cronp brane is now observed; the effect of this is a diminu this exudative product extends over a large portion of tion in the calibre of the air tubes,-a coarctation of the tubes, and explains the peculiarity of the stringy them,-a lessened diameter. An increased frequency shreds expectorated in this disease. In the adult, if in the respiratory movements now compensates, or life be prolonged, tliis infiammatory exudation soon is an effort to compensate, for the diminished capacity becomes purulent, pus-globules being very soon of the air-tubes; and we notice in the severer forms generated in it. This change facilitates its excretion, of the disease, a gasping effort during inspiration, rendering it more fluid, less tenacious, and conseattended by very distinct wheezing sounds on expira quently more easily expectorated. tion; these are distinctly heard, even without the aid | There can be no doubt, notwithstanding the imperof the stethoscope.
fect history of this case antecedent to admission, that Now all these conditions were present in the case pulmonary catarrh had existed for some time, perhaps in under consideration; and the physical signs recorded in a chronic form, and that in all probability the patient the case book are very expressive of the conditions just had experienced repeated attacks for soine winters explained. There is no respiratory vesicular murmur to past. The enlarged condition of the heart strongly be beard, the only sound at first is a sor.orous rhon- | favours this view, for derangement in the structural chus, either accompanied or followed by a variety of condition of this organ is one of the most frequent irregular murmurs, sonetimes simulating the genile causes of the perpetuation of chronic catarrhal affeccooing of a pigeon, at others whistling and wheezing, tions of the pulmonary organg. A catarrhal predispoThe lessened diameter of the air-tubes from the tumefac-sition in the broncbind mucous membrane, and hearttion of the sub-mucous tissue, is the cause of these sounds. disease, tend to mutual aggravation. The catarrhal As secretion becomes established, the turgescence of the condition gives rise to frequent cough, often paroxysmembrane is relieved, but the air passing and re-passing mal and suffocative; venous turgescence results. The over and through the tenacious matters in the tubes, violent expiratory efforts of couglıing convey an improduces the bubbling sound, heard so soon as secre- pulse back on the right ventricle; in consequence of tion is accomplished, and to which the terın mucous the disturbance the current of blood suffers froin the rhonchus or mucous gurgling is applied. This sound circulation from the right side of the heart into the differs somewhat, according as it emanates from the lungs being iinpeded, dilatation of this cavity follows, larger or smaller tubes, and the study of that distinc with a corresponding increase in the general mass of tion is of much practical consequence. The mucous the organ. Increase of volume produces increase of gurgling of the small tubes was very palpably present power, and causes the blood to circulate in the pulmoin this case, and you had an opportunity of hear nary tissues with a force proportionate to the auge : ing its peculiarity. When the catarrhal irritation mented volume. A condition of passive hyperæmia is extends to the smaller tubes, a siinilar series of changes perpetually present, which promotes, if it does not takes place; the secretion at first scanty and thin, originate, the suscep:ibility to catarrhal irritation. accompanied by frequent, urgent, and almost suffoca- With such predisposing causes it is not to be wondered tive cough, becomes more abundant, opaque-a yel. 'that acute bronchitis should supervene, and should run a lowish mucus, tenacious and frothy, -and in urgent rapid and fatal course. Inflammatory exudation forms cases, assumes the qualities of a muco-purulent fluid, in the smaller bronchi; blood imperfectly oxygenated in some cases possessing an almost cream-like con circulates through the left side of the heart, and reaches sistence. This, as convalescence proceeds, becomes the great central organs of the frame; its action on the again thinner-more fluid, till in the stage of chronic brain is first to induce turpid senses, the countenance bronchitis it has become a perfectly white frothy Guid, becomes livid and purple, the surface becomes clemacolourless, and oftentimes extremely abundant. tous, the dyspnea becomes more and more urgent,
There is yet one other pathological condition in the coina supervenes, and death then closes the painful serere and more acute forms of bronchitis, and of which' and distressing struggle. The existence of empiiyeema on the inferior margins, and on the surface of the to the vessels (the protoplasma.) We are precluded lobes, must be taken as collateral proofs of the exist- from making this direct satisfactory and conclusive ence of some long-standing affection of the pulmonary
observation in the human body, because there is no organs, attended most probably by violent expiratory
accessible part sufficiently thin and transparent for efforts, as in coughing; but the subject and patho
| the purpose; but we have cogent reasons in the logical conditions of emphysema I propose to treat of
analogies of life and function—in the composition of on some other occasion.
the textures and the blood--for concluding, that ia man, analogous or similar irritants are followed by
similar results. This conclusion, drawn from analogy, THE LAW OF THE MORPHOLOGY OR META
is substantially corroborated by the fact, that in the MORPHOSIS OF THE TEXTURES OF THE
human body, colourless cells greatly abound in the HUMAN BODY.
blood drawn from vessels that are experiencing any (Fourth Series of Experimental Researches.)
irritative or inflammatory action. By WILLIAM Addison, M.D., F.R.S., Malvern. But the real nature or meaning of the phenomenon, (Continued from page 93.)
thus seen in the living vessels of animal structure, and VII. THE PROCESS OF NUTRITION, OR THE RE presumed from strong analogies to exist in the human
OCAL ACTION BETWEEN THE BLOOD AND | body also, must be interpreted by the result or proTAE SOLID TEXTURES.
duct-and this clearly proves it to be a phenomenon of The growth and preservation of all parts of the nutrition, for the irritated animal textures become human body, and the renewal of its textures and thicker, and new layers and new matter appears; secretions, whether healthy or diseased, depend upon so in the human body where textures are becoming a reciprocal action between the blood and the solid / thickened, where new products and new results are parts, termed the process of nutrition, in which certain appearing in pimples, boils and vesications,-in the elements or forms of matter withdrawn from the cir- skin in scarlet fever and erysipelas,-colourless cells culating current, become portions of the fixed solid. are exceedingly abundant in the nutrient vessels, someU the newly withdrawn matter assume the form of the times equalling in amount the number of the red cells. pre-existing elements of the solid, and the quality of Hence, therefore, it appears, from proofs accumulated the pre-existing secretion, the process is said to be on all sides, that the separation of the colourless cells normal or healthy; but if the elements of the solid be and protoplasma or lymph of blood, from the red cells, changed, or the quality of its secretion altered, in con- and their distribution in a stationary form over the sequence of any unusual change or unconformable interior surface of the nutrient vessels are phenomena transformation which the new matter undergoes, then of nutrition; and it would farther appear from the the process is said to be abnormal or unhealthy. cellular or corpuscular nature of pus, and from the If the circulation of the blood be observed with the ready healing by pressure of wounds discharging pus,
roscope in the nutrient ressels of a transparent that if the colourless elements withdrawn from the texture in the living animal, without any previous rude blood fail to undergo a conformable metamorphosis, bandling or irritation, the stream is seen rapid and or the cells to deliver up their contents, they change uniform, and it is impossible, from the rapidity of the the character of the walls of the vessels, alter the current, to discriminate its cellular or corpuscular anatomical type of the texture, and subsequently elements, except that here and there colourless cells appear in the discharges or secretions, in which case are seen clinging to the walls of the vessels, slowly the whole thickness and the whole of the matter in the gliding along in close contact with them. If the part walls of the vessels experience a progressive alteration under observation be irritated, the regularity of the from within, there being no membranous septum or stream is immediately disturbed in a very remarkable structureless membrane under these altered conditions, manner, and, as if in consequence thereof, colourless standing as a barrier to the retrograde morphology. . cells, in increasing numbers, are observed separating The process of nutrition here described from observa. themselves from the red current, and becoming fixed tion and experiment, comprises three intelligible and to the walls of the vessels. Soon afterwards, a clear visible stages :-First, the separation of the colourless colourless material appears between the stream of red cells and protoplasma of the blood from the red current; blood and the solid texture, in which the colourless secondly, the metamorphoses of these colourless elecells seem to be embedded; so that the irritating wents in their progress through the walls of the cause, of whatsover nature it may be, is productive of vessels; and thirdly, the ultimate product which an actual and visible separation between the colourless constitutes the permanent form or textural type. The and the red elements of the blood, which is seen to first stage takes place within the vessels, along their Lake place within the vessels, the red flowing onward, | interior boundary; the second takes place in, and gives sometimes with the utmost rapidity, whilst the colour the form of, the elements of the walls of the vessels ; less remain stationary, and form a new interior coating and the third, or ultimate product, appears at the outer
, MORPHOLOGY OF THE TEXTURES.
margin and is in fact an extension, of the vascular linear. The dark portion, a, is one half of the column wall.
of red blood lying in the centre of the vessel ; the red These stages of nutrition will be more readily com- cells are many of them aucleated, and larger than in prehended by referring to the wood engraving, which the blood of an adult, and lying obscurely amongst represents one half of the diameter of a small blood. them are several colourless-cells-various in dimea vessel in the transparent membrane of a human embryo, sions-some very large and filled with a colourless at two months, that is to say, in a texture in a state of matter mixed with molecules. Atb is a transparent layer rapid growth or active metamorphosis. It was copied of colourless matter or protoplasma, lying between the from the microscope, and is magnified 750 diameters column of the red blood and the wall of the vessel ;
Fig. 1.-Half the diameter of a small blood vessel in the transparent membrane of the human embryo at two months. a, column of red blood, b, layer of colourless matter, with cell:, granules, and molecules, between the red blood and the coherent wall of the vessel. c, a texture composed of fibres, cells, and nuclei, forming the wall of the ressel. d, the coherent cellular texture forming the membrane.
Fig. II.- A section of the same vessel perpendicular tot he axis, shewing the same series, blood, protoplasma, texture, (Epuroy vodoua,) and ceilular parenchyma. Itappears to me, that the subject of secretion, the growth of the embryo structures, and the phenomena of inflammation, would be more intelligible were we to use terms expressing more accurately the stages of nutrition, as revealed by the microscope:-(a) blood-6) protoplasma-(c) prot-uphasma
-(d) parencehyma. I well remember the late Dr. George Pearson, five and twenty years ago, insisting upon the distinctions between coagulable and coagulated lympb.
in it are seen several colourless cells of various sizes, onward in new directions, must find themselves at last filled with molecules, also smaller granular particles; | protecting shadows in the rear. and numerous isolated molecules. At c is the wall or In bringing my observations for verification to the coat of the vessel, (the prot-uphasma or first texture,) test of the microscope, I would rain remark, that composed of numerous colourless cells or nuclei the observer should bear in mind the minuteness. embedded in a mass of nascent fibrils, which have, in and delicacy of those portions of structure that can this example, hardly more coherency than the fibrils alone be submitted to high microscopic power, and the of a tough mucus. Granular particles and molecules unavoidable disturbances that necessarily ensue when are seen within these colourless cells or nuclei, and the it is requisite to take very thin sections, and therefore fibrils pass around and between them. Numerous that decisions pro or con should be based not so much red cells of irregular shape are seen mingled with the upon the isolated results of one or two hasty trials, colourless elements,-cells, nuclei, and fibrils,- of the but rather on the tenor of the indications derived from vessel's wall, or coat; but these have all the appearance a greater number. of being accidental and due to the manipulation neces- In any departure from the law of the nutrition of a sary to render the texture a microscopic object. At d is a texture,- from the law of the morphology-it must be a portion of the transparent cellular membrane itself-the very difficult question to determine where the first parenchyma ; it is evidently an extension or expansion or unconformable step commences, whether in the blood the wall of the vessel, and no unalterable barrier exists a,-in the lymph or protoplasma 6,-in the wall of to separate it from the protoplasma-every element is the vessel c,-or in the texture d? It is very comin progress of change.
mon to read about diseases of the blood, yet all must If a section of this vessel were made across it, per- be dark and unsatisfactory to any one that has observed pendicular to its axis, we should bave a column of | the relations between the blood and the textures by blood in the centre (a), consisting of red and colour- | means of adequate power through the microscope ; and less incoherent cells, suspended in the blood-duid; certain it is, that no practical conclusions can be next to it will be a layer of colourless lymph or pro-established respecting health and disease until the toplasma (6), consisting of a viscous inatter, mixed stages of nutrition, the reciprocal actions between the with molecules and colourless cells ; next to that is blood and the solid textures, be established. At the proper coat of the vessel (c), the first texture present the notorious fact of red blood, administering varying with the morphology, and consisting in this to the rapid increase or deposition of colourless texcase of delicate fibres, intermingled with molecules, tures, lymph, mucus, and pus, remains, in respect of granules, and colourless cells or nuclei ; and lastly, as any well-directed scientific investigation, a glaring an extension of the vascular wall, the proper texture instance of theory, hypothesis, and conjecture. Critical or parenchyma (d),--this texture shewing what the physiologists seem afraid of using tbeir eyes, though morphology has been, and the existing vascular wall they battle boldly with assertions. indicating what it is or will be. A similar section of
VIII. INFLAMMATION. a vessel that has been irritated in the frog's foot,
When the growth and nutrition of a texture of any would exhibit the same thing. Hence, then, the kind, whether animal or vegetable, is normal, its conclusion stated in the "First Series of Researches," I elements are reproduced or multiplied, its form erolved, p. 30, respecting the analogies between active growth and its characteristic qualities and secretions established and inflammation, is fully borne out by these subse- by a metamorphosis of the nutritive elements, supplied quent investigations.
from without, in accordance with the law originally These things, let it be observed, are not matters of in force in the primary conformation of the parent surmise and conjecture, but of demonstration, and organism from which it sprung. Every change, cannot, therefore, be set aside because they do not every metamorphosis,-every action,-and every proequare with received and bypothetical notions. It is duct, yielding or conforming to the law, is an integral very easy to throw discredit upon microscopical facts element of the complex phenomenon termed health; and copclusions by a flourish of the critical pen, and a and erery action or product deviating from it, is an flippant style of remark, little suited to the occasion ; | element of disease. but Nature marches on, although the critics write, and It is not my intention now to enter upon the multiis ever ready with intelligible answers to those who plied details of inflammation or inflammatory products; faithfully interrogate. A forid appeal to existiog bereafter we shall have occasion to return to the sympathies may be for a time successful. Warm-hearted subject, and examine more particularly the nature of spirits contead stoutly for their convictions; and set its manifold results. ted opinions are difficult out-works to carry, though! We have seen that any irritation of a vascular Nature herself be battering at the walls. But those texture, is productive of an increased amount of wbo, in the ardour of their defence, merely uphold their nutritive matter, which is deposited from the circulating own opinions, when truth and science are rolling blood, upon the walls or inner boundary of the vesselo.