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textures, and each texture of special bistological or 3. The pulmonary indusium, or pleura, limiting the morphological elements, Thus, the liver, which is a external configuration of the organ, and of the same secreting organ, has the following textures and elements
nature with its analogue in the liver; and althougha entering into its composition :
we may give to the indusium, or to the lobular indusia, 1. The hepatic parenchyma.-A brittle, slightly-co- l of one organ, one name, and to those of another herent, corpuscular texture, the elements of which are organ, other names, still it behoves us not to neglect cells, containing in their interior a yellow fluid, with the identity of their structural elements, nor their numerous molecules and globules of fatty matter, physiological and pathological relations. (together forming a kind of animal endochrome) | 4. The coats of the larger divisions of the blood-which, when set free by the dissolution of the cello | vessels and air-tubes. walls, constitutes the secretion termed the bile. The 5. The mucous texture of the interior of the aircells are congregated in small groups, termed lobules, | tubes. each lobule having its own vessels and ducts. . 6. The Abro-cartilaginous and cartilaginous textures
2. The areolar texture. A coberent elastic texture, l of the windpipe and larynx. interposed between the lobular sub-divisions of the In the leaves of plants, a coherent transparent nonhepatic parenchyma, and forming a cushion or bed secreting aëriferous texture, with air spaces and around the divisions and sub-divisions of the blood- stomata, and an incoberent, secreting, corpuscular, vessels and bile-ducts. This texture is diffused through- chlorophylle texture, with a supporting frame-work ont the whole organ, enters into all its recesses, l and spiral vessels. are conjoined, and co-exist: wbereas and with the blood vessels and bile-ducts, interposes it would appear, from the details of the structure of between the lobules. The elements of this texture the liver and long, that in animal bodies, the colierent are waved fibres and curled fibrils.
transparent, non-secreting, aëriferous parenchyma, with 3. The hepatic indusium, or peritoneum.Athin
its pecessary appendages of air-passages and air-tubes, membranous texture, which limits the external con
and the secreting, endochrome, corpuscular texture, figuration, and gives a smooth equable surface to each with its requisite ducts and outlets, are separated, and lobular sub-division, and to the whole organ. This form two distinct organs. texture is coherent cellular externally, and fibrous! In the lung, (V., p. 92,) the fibrous elements of beneath, where it is continuous, and blends with the the texture of the larger divisions of the blood-vessels areolar texture just described. . .
and air-tubes are continuous with, and terminate in, 4. The coats of the larger divisions of the blood
the coherent, non-secreting, celtalar parenchyma ; so dëssels and bile-ducts. This is a strong fibrous texture,
it appears in the liver, and probably in other secreting difering from areolar texture by the fibres. being
organs, that the fibrous textures of the blood-vessels straighter and condensed into layers, which cross each
and ducts are disseminated, (in the capillary channels, other at right angles, and inclose among them cell
among the secreting cells of the corpuscular parenlike bodies termed nuclei, numerous molecules, and
chyma. (IV., p. 92.) gradular or fatty particles. The elements of this
The analogous fact may be seen in the embryo texture therefore are fibres, nuclei, molecules, and
" chick, where the walls of the vessels of the respiratory gradules; and its nutrient vessels are technically
allantois are quite different from those of the nutritive called vasa vasorum.-(IV., p. 92.) , 5. The mucous texture of the interior of the bile
yolk-sac. ducts. The elements of this texture consist of cells
Of the several elements of the liver and lung bere
enumerated as typical of the composition of the organs and fibres; the cells at the free surface are denominated
of the human structure, it is to be observed, that some epithelial cells, and when detached from the texture
are general, some peculiar, and in all cases it is the in an early unmetamorphosed globular form, are
peculiar parenchymatous elements that constitute the called mucous cells, or mucous globules.
distinctive character and execute the special function. The lung is composed of the following textures and
The slightly coherent endochrome, and transient cells elements:
1. The pulmonary parenchyma.-An elastic, coherent, of the hepatic parenchyma are peculiar to the liver; cellular texture. The cells of this texture are com- the strongly coherent, vascular, permanent, aëriferous paratively very large, and incluse spaces filled with cells of the pulmonary parenchyma, peculiar bubbles or vesicles of air. The elementary membrane lungs; muscular fibrillæ, to muscles; and nerve-tubes forming the cell-walls is thin and transparent, but to nerves. But the fibrous elements of the coats of strong and elastic, and covered all over with a close the blood-vessels, and of the areolar texture, are network of non-secreting capillary blood-channels. general, so that no visible part of the body, however (IV. and V., p. 92.)
small, is without them. Hence, every perceptible 2. The areolar texture, with the same elements, alteration of structure involves not one only, but many and performing the same kind of office as the areolar textures,--the parenchymatous texture, the texture of texture of the liver,
I the coats of the blood-vessels, the areolar textures, &c.
MORPHOLOGY OF THE TEXTURES.
A retrograde metamorpbosis in the parenchymatous gelatino-cellular, fibro-cellular, fibro-granulur, &c. In texture of the brain, lung, joints, and bones, cannot the egg of a bird we have an example of a gelatinous take place without sundry degrees of morphological protoplasma, derived from cells in the white, and of a transformation in the contiguous textures. In the lung slightly coherent, cellular, or corpuscular texture (the the fibrous texture of the coats of the blood-vessels, cells abounding in granular matter,) in the yolk. And the fibro-corpuscular secreting texture of the air. in all cases the normality or abnormality of the preya. tubes, the lobular indusia, the areolar fibrous tex. lent elements must be determined by the natural type ture between the lobules, and, finally, the pleura or standard, by their conformability or unconformaitself, all partake in the phenomenon. Thus, during bility to the law of the morphology, or the law of the the progress of consumption, there is an increased growth and nutrition of the structure. secretion frora the air-tubes ; a thickening of the inter-1 - It has been shewn in the blood-vessels ministering to lobular areolar textures ; destruction or thickening of the growth of the transparent textures of the human the coats of the blood-vessels; and, finally, adventitious embryo, that we are sometimes able to discriminate membranes and abnormal secretions on the pleura. If with the microscope the red blood in the centre of the ulceration of the mucous texture of the air-tubes vessel (a); a layer of protoplasma (1); the texture of occur, the fibrous texture beneath is thickened and the wall of the vessel (c); and the parenchyma (0.) consolidated ; and when the secreting texture of the (VII., Fig. I., p. 117.) And it is evident, if unconalimentary canal softens and ulcerates, pseudo-fibrous formable elements accumulate in the protoplasma membranes glue the convolutions of the bowel to each space (6), that they must, in the progress of nutrition, other, one texture retrograding into a fluid pus, whilst mingle with or supplant the normal elements of the adjacent ones, of a higher type and different order, are coats of the vessel (c), and thence enter into the combecoming tbicker and more consolidated, -scrofulous position of the parenchyma (d), ultimately appearing and inflammatory actions running on together, not in in the secretion (or excretion,) if the texture be a the same texture, but in the same organ.
secreting one, or being eliminated from a non-secreting Amidst the manifold phenomena, and the multitude (or non-excreting) one, they constitute an abnormal of qualities and textures produced, during the growth discharge. Unconformable and incoherent cells preof living bodies, and during the progress of scrofu. dominating, alter the physical properties of the cohelous and inflammatory diseases, by the agency of rent textures; and if they supplant the normal elecells, the following two events appear constant and ments, the texture is said to ulcerate. . . influential :
In the blood-vessels which traverse the transparent, 1. The enlargement of the capacity of some cells, / adult, fibrous, or areolar textures, we see no indicathe thickening and coalescence of their adjoining tion of a protoplasma space; nor do we find incoherent, walls, and their durability in sundry forms as persistent cellular, or corpuscular forms interposing between the elements of the fabric. .
red current and the walls of the vessels, and it is on 2. The transient existence of other cells, the thin,
this account inferred that nutrition and growth are not ning and dissolution of their walls, and the consequent going forward actively in such vessels. But when these discharge of their contents,-a gelatinous, fibrillating textures become inflamed, not only are the vessels protoplasma, or a limpid secretion.
multiplied in number, but their walls become thicker ; And as cells (I, and II.) are
uncomformable, cellular, and protoplasma elements 1. Incoherent and fluid, in blood, pus, &c.;
make their appearance between the blood-current and 2. Slightly coherent, forming soft and brittle solids, the texture, occupy the intervals between the normal in the brain, the hepatic parenchyma, and the corpus-fibrous elements, accumulate on the exterior of the cular secreting textures; or,
vessels, and are cast off in the excretions. Hence, 3. Strongly coherent, in the parenchyma of the lung,
then, we see the propriety of the terms protoplasma in the pith and leaves of plants, and in woody and and protuphasma ; for lymph, in the ordinary acceptaOsseous textures.
tion of the term, is only one of the forms of the So the protoplasma may be
nascent, nutrient, metamorphosing matter; and the 1. Incoherent, gelatinous, and Auid, in lymph, liquor walls of capillary vessels ditter in sanguinis, mucus, saliva, and other secretions ; differ in the same place in the embryo and growing
2. Slightly coherent and granular, in the Aakes and from the adult texture, and are subject to sundry clots of pus, tubercle, tuberculous matter, &c.; or,- | alterations in inflammatory and scrofulous diseases. 3. Strongly coherent and fibrous, in coagulated fibrin,
(To be continued.) in the areolar and ligamentous textures, and in false or adrentitious membranes.
Combinations of these cellular and protoplasma elements give rise to textures of sundry kinds, and of various degrees of cohesion,--to gelatino-corpuscular, or
ON THE PATHOLOGY AND TREATMENT OP to become epidemic. From the repeated observation of PERTUSSIS.
| this fact, I feel called upon to admit the accuracy of By GEORGE FIFE, M.D., Newcastle-on Tyne. Cullen's definition, with the qualification of the term On po disease of common occurrence, has a greater contagious" being used synonymously with infections. diversity of opinion apparently existed as to its true It is only necessary to add, that this affords fartber pathology or seat, than, even at this time, prevails in re-proof of the “specific" nature of the disease, as a gard to that of booping cough, If, in support of this state- disease to be capable of propagation in such a manner, ment, any evidence should be required, such is abund- must have a specific character. In this respect, antly afforded by a consideration of the very numerous hooping cough follows the known laws of most diseases and 'diverse remedies which have been recommended
which prevail epidemically, and all of which, I believe, for its mitigation or cure. Hence, no apology seems can and do occasionally assume the property of extension requisite for the obtrusion of the present remarks on by infection. this peculiar and interesting disease upon the attention The definition of the cough could not well be more of the Association. To enter into a full enumeration accurate, as, brief as it is, when taken in connection of the various causes to which it has been assigned, with its generic position, it embraces all save one would occupy more of time and space, than the limits characteristic, viz., its occurrence in paroxysms, which of this paper permit, consequently, for the present, I will demand our especial notice hereafter. The term will restrict myself to the consideration of what may “convulsive" here may be taken as expressive of be termed the two principal doctrines which modern “spasmodic, and can therefore be subject to do practitioners hold on the subject.
objection; its "suffocative" character is equally unOne of these parties may be said to maintaju the questionable; whilst its being accompanied by sonorous inflammatory nature of hooping cough, and to consider and repeated loud inspirations, is the cause of the it as essentially a form of bronchitis; the other name "booping" being given to the disease, and regards it as a peculiar nervous and spasmodic disease, must therefore carry with it the assent of all. The and specific in its character.
last-mentioned phenomenon-" vomiting"--also deThe former opinion I believe to be advocated by the mands particular attention, as it forms one of the majority of the profession, whilst to the latter, for main diagnostics of the disease, as will be presently reasons which will be apparent in the sequel, I, after shown. The only omission of consequence in the extensive practical observation, and the most mature above otherwise very concise and truthful definition, consideration, am disposed to give my support. is that of its occurrence in paroxysms, with an interval * Fashionable as it now is to impugn and even to of health between them. When the above is comridicule the nosological division of diseases by the pared with the symptoms of bronchial inflammation, illustrious Cullen, I am free to admit, that in his defini- we shall very readily perceive that the analogy is but tion of pertussis, he bas not only been most bappy, remote, and that the disease under consideration, but has also rested his views on what is perfectly however frequently complicated with bronchitis, is compatible with the most recent pathology. His essentially distinct from it. Another circumstance definition I will now therefore give, prior to entering requiring notice is the occurrence of hooping cough upon the the more particular consideration of the but once in a life-time, whilst bronchitis may and Ĩ
does repeatedly attack the same individual, hooping “Morbus contagiosus; tussis convulsiva, strangulans, cough also, for the most part, happening in tb cum inspiratione sonora, iterata ; sæpe vomitus." The first proposition in the above, as it has but little
years of infancy and childhood. reference to the actual nature of the morbid action
Let us now take a glance at the symptoms charactergoing on, may be passed over with comparative
istic of inflammation of the mucous membrane lining brevity. Of the epidemic prevalence of hooping
the air passages, and then compare them with their cough every practitioner of any experience must be
concomitant physical signs-with those met with in, perfectly satisfied, and but few will be found to deny,
and generally admitted as pathognomonic of, pertussis. that if the term contagious be used as synonymous
Here again the definition given by Cullen, though with infectious, even on this point the definition of
under the term of catarrh, is sufficient to indicate the Cullen is correct, and it is more than probable, that
difference, which recent pathology confirms, as existing
between the two diseases, as does also the position such is the sense in which it has been used, bow. erer objectionable it may be to confound infection,
which be has given to it in his classification. properly so called, with contagion, laken in its strict “Pyrexia sæpe contagiosa ; muci ex glandulis and literal sense of its infectious character I could membranæ narium, faucium, vel bronchioram, excretio adduce ample evidence, but it may suffice to state, that aucta; saltem hujus excretionis molimina.” in many cases I have known it carried from places Again, his division into species :where the disease prevailed, to others in which no Sp. 1. Catarrhus à frigore. instance of it had previously occurred, and in the latter' Sp. 2. Catarrhus à contagio.
Under the first of these may be included common facilitating the comparison which must now be instior accidental attacks of bronchitis; whilst the latter, tuted between the two diseases, and for such end may as obriously applies to wbat has now received the prove sufficient. One other remark only is at present appellation of “Influenza." The above definition necessary, riz., these symptoms and physical signs, is somewliat imperfect as applied to bronchitis, as is although they vary in duration and intensity according also its position objectionable, as in it the primary to the progress and duration of the disease, are constage of the disease, which is truly inflammatory, / tinuous,-.e., unattended by any real remission or seems to have eluded observation, and the second only interval of health. to have arrested attention. Without dwelling longer If we compare the symptoms of the two diseases, on the imperfections of such definition, I will, as we shall readily, and by very unequivocal evidence, see briefly as possible, endeavour to make good the de- that they are not only distinct in their nature, but ficiency or error, and thereby indicate more clearly also, on farther examination, find that they cannot the difference between bronchitis and pertussis, merely co-exist. To such comparision I will now proceed :observing that, like other inflammatory affections, In bronchitis the fever corresponds with the exçent bronchitis should have been placed under the head and severity of the attack, and continues with little "Phelgmasia."
or no remission so long as the inflammatory action perBronchitis, like pneumonia, may, by careful observa- | sists. The pulse is generally in a proportionate degree, tion, be very properly divided into stages, and it is in accelerated and hard ; the face is flushed; the eyes fact of the greatest importance to its successful treat. suffused; the cough is at first hard, dry, and though ment, more especially in infancy and childhood, to casual in its occurrence, distressing from its connote such stages, as the therapeutic indications are stancy; it is also seldoin, if ever, terminated by seriously influenced by the pathological condition vomiting; it finally becomes loose and less harsh, and peculiar to them. In the commencement of an attack is attended by expectoration; whilst the auscultatory of bronchitis, the symptoms are the following, modified sounds already described are always present, and graduby the severity of the disease, and the extent of lung ally disappear as the inflammation subsides. Broninvolved, as also by age and temperament, acceleration chitis occurs sporadically, and is peculiar to no period of breathing, with (in most cases,) pain on a full of life. Nor does the patient who has once suffered inspiration being made, which is also almost always from it obtain any exemption from future attacks, but productive of cough. The cough, which is generally on the contrary rather acquires a greater tendency to it. present from the very commencement of the disease, Hooping cough is generally met with during infancy in a greater or less degree, is at first dry, short, and and childhood. It seldoın assails the same individual bard, being unattended at this period by any expectora- more than once in a lifetime. It most generally pretion; as the disease advances, expectoration of a vails in the epidemic form, and is capable of propagafrothy tenacious mucus takes place, which, as it tion by infection. The cougt occurs in paroxysms, is becomes more free and easy, is accompanied by a very spasmodic in its character, and is generally terminated marked remission of all the symptoms. The cough by vomiting. Between the paroxysms there is an througbout the whole course of bronchitis is casual interval of apparent health, during which, even when in its occurrence, although repeated efforts are some- | the paroxysms are most distressing and violent, the times requisite to dislodge the mucus, when very patient makes no complaint. In a very large proporviscid and tenacious. In an ordinary case of broncbialtion of cases, percussion and the stethoscope afford no inflammation, the following are the physical signs :- indications of disease, although in many cases there is
Percussion generally elicits a dull sound, which is more or less of the mucous rale audible, which of course regulated in extent by that of the portions of lung is indicative of increased secretion into the bronchial -affected; thus it may be confined to a single lobe of | tubes. This phenomenon deserves especial attention, one lung, or it may prevail over the whole of one or
| as it may appear to indicate the presence of sub-acute even both sides of the chest. When the stethoscope bronchitis; it may, however, be explained independent is applied in the early stage, we have the dry, sonorous, of such condition, and therefore shown not in reality and subcrepitating rales in the affected parts, whilst in to militate against the view of the pathology of the others, the respiratory sound will be so augmented as to disease which I am about to advocate. claim the term “puerile." As the disease makes pro. What has now been said of the symptoms suffigress, the sonorous dry rale is lost, and we have in its ciently indicates the difference between the syinptoms stead the moist or mucous rale, this last being mate- and pbysical signs of the two diseases; hence, it is rially influenced in its character by the tenacity and only necessary to take a brief glance at the pathological quantity of the mucus, and also by the size of the condition on which such difference depends, and whick tubes in which it is present.
will be found to be important, not only in fact, but still The foregoing very brief and superficial notice of more so as regards the successful treatment of either bronchitis has been given merely for the purpose of one or other. One prefatory remark may be made,
viz., that bronchitis very frequently supervenes on per- comparative health, except where the case presents tussis, or, in other words, becomes a complication of a complication with bronchial inflammation, I am led it, or, vice versa ; this being made evident by bronchitis to consider the actual seat and nature of pertussis as when the epidemic influence which generates pertussis essentially referrible to some morbid condition of the prevails, terminating in the latter.
pneumo-gastric nerve, the influence of which over the The pathology of bronchitis is now so universally organs of respiration and digestion is too well known understood, that it is superfluous to enter upon the to require comment. ratio symptomalum. Not so, however, that of pertussis ; The advocates of the inflammatory nature of hooping wherefore, some little space must be devoted to the cough have laid considerable stress on the presence of consideration of the phenomena met with in, and the mucous rale during the intervals. If, however, the characteristic of, this very peculiar disease. The fea- influence of the nerves generally, and of the eighth in tures which more especially call for notice are the particular, over secretion be considered, we shall in thisfollowing :-The character of the cough, its occur- sign even find corroboration of the nervous origin of rence in paroxysms, and termination in vomiting; the the disease. This is farther supported by the immense interval of health between the paroxysms of coughing; quantity of mucus so frequently discharged from the the general absence of the physical signs invariably stomach, to which fact is probably to be ascribed the present in bronchitis. On each of these heads a few notion of some of the older writers, that hooping remarks may now be made, in order to demonstrate, cough was “true catarrh of the stomach.” From our by subsequent comparison, the real difference between still very imperfect knowledge of the nervous system, bronchitis and pertussis.
it would be little short of presumptuous in me, and First, the cough is spasmodic in character, occurs most certainly idle, to enter into any speculations as to in paroxysms, and very generally terminates in the real condition of the nerves in this disease; romiting. It bas been well observed, that the rio- wherefore I will endeavour by a brief summary, to lence and convulsive nature of the cough resembles compare and point out the difference between this that which arises from the presence of foreign disease and inflammation of the air-tubes, premising bodies in the larynx; and that the larynx is very that, with laryngeal or tracheal inflammation, it is
mainly implicated in its production, may be easily impossible for any practical man for one woment to • perceived by any one who will carefully observe the confound it. • state of the child during the paroxysm, when, from Pertussis is essentially a disease peculiar to iofancy
the violent action of this organ and the contiguous and childhood. Bronchitis occurs indiscriminately muscles, it will be apparent that the chest itself is at every period of life. comparatively passive. The opposite is observable in The cough in pertussis is spasmodic or convulsive, cases of bronchitis, except where continued cougbing | always occurs in paroxysms, and very frequently is required to evacuate the viscid mucus, so commonly assumes a periodical type. In bronchitis it is casual present in the earlier stage of the disease. The violence in occurrence, however frequent and distressing, of the fits of coughing in pertussis forbids the idea of the and rarely attended with vomiting, which is the common existence of any continuous affection of the air-tubes termination of the paroxysm in hooping cough. as its cause; as, were such really the case, we should not! In pertussis, the patient is comparatively well during
only bave serious febrile action, but also during the the interrals; in bronchitis there is uo intermission, - prevalence of such agency no interval of repose could although there may be some remission of symptoms.
by possibility have place. That the larynx is mainly! Pertussis almost invariably occurs as an epidemic; concerned in pertussis, therefore, may be inferred; nor bronchitis is of sporadic occurrence, but from aby is this conjecture at all invalidated by the forcible and peculiarity in the atmosphere, or sudden vicissitudes loud inspirations to which the “hoop," or“ whoop," is in the weather, frequently prevails epidemically. properly attributed, such effort being physiologically Hooping cough is unattended by fever; bronchitisrequisite to compensate for the interruption which in its mildest form, presents us with febrile disturrespiration sustains during a paroxysn). The termi-bance. When fever is present in pertussis, it does Dation of the cough by vomiting deserves especial not bear any proportion to the frequency or violenceattention, not only because it is a pretty constant of the paroxysms; in bronchitis it corresponds with
occurrence in this disease, but also as tending to cor- the extent and degree of the local affection. * roborate the view now taken of its pathology. In all The cough in bronchitis is unattended by the
probability this symptom has its origin in the partici- “ whoop" to which pertussis owes its name, whilst pation of the stomach in the morbid condition already in the latter, this pathognomonic symptom is lost, alluded to as affecting the larynx. Nor does the quan, so soon as inflammation of the bronchial tubes actually tity of mucus discharged in this way in any degree sets in. . militate against such supposition.
Finally, the treatment which alope is to be relied From these symptoms, together with the interval ofl on in bronchitis, has little, if any, effect, either