The bacillus tuberculosis and the etiology of tuberculosis : is consumption contagious? : second communication, read, by invitation, before the Philadelphia County Medical Society, November 14, 1883 / by H.F. Formad.

  • Formad, H. F. (Henry F.), 1847-1892.
Date:
1884
Catalogue details

Licence: Public Domain Mark

Credit: The bacillus tuberculosis and the etiology of tuberculosis : is consumption contagious? : second communication, read, by invitation, before the Philadelphia County Medical Society, November 14, 1883 / by H.F. Formad. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tissue was formed, made up of epithelioid and giant cells, and cheesy changes had oc- curred. Ziegler very properly declared the latter product to be tubercle-tissue. I have had, and have at present, ample opportu- nity to corroborate the accuracy of these observations. Ziegler’s experiments were repeated in the pathological laboratory of the University of Pennsylvania, by Ham- mer, and at present are being carried on by Woodnut. By these experiments, made, with slight modification, after the method of Ziegler, under varying conditions and upon various animals, it was shown that the granulation tissue gradually gave origin to tubercle-nodules. Furthermore, these experiments showed that the tubercle- nodes and cheesy changes ensue without the action of bacilli, as the latter were found not to be present when proper care was taken, during the execution of the ex- periment, to exclude them. From the examination of tubercular tis- sue from various sources, I may say that I have seldom succeeded in finding tubercle- bacilli in newly-formed tubercular tissue made up of small lymphoid cells. In older tubercular tissue, made up of opaque epithe- lioid cells and giant cells with a nodular arrangement, particularly when this tissue is undergoing necrotic change, bacilli are quite common, except in some forms of tubercles of serous membranes, to be re- ferred to later. Tubercle-tissue that has undergone a complete cheesy change contains the greatest number of bacilli. Cheesy matter of any source is a dead substance, and it is usually inhabited by bacilli, if these get access to it; while other bacteria are scarce in this nidus. Examination of materials from the au- topsy-table shows that tubercle expresses itself in various manners. Primarily tu- bercle occurs as a mere infiltration of lym- phoid cells in the adventitia of blood-ves- sels, or as small nodular masses of lym- phoid infiltration around blood-vessels or ducts of any kind ; or tubercle-tissue may organize within blood-vessels and various ducts. Sometimes tubercle appears as a diffuse lymphoid infiltration, extending over a larger area, showing a greater or less tendency towards the formation of nodes and cheesy or fibroid change, as in the lungs. Tubercle-tissue may form masses of the size of a hen’s egg, particu- larly in the brain and serous membranes. In the lungs, in racemose glands, and in mucous membranes, catarrhal changes always follow the tubercle-infiltration. On serous surfaces primary tubercles ap- pear often as flat or nodulated patches of various sizes (in peritoneum), or as fun- goid vegetations (in synovial cavities), or even as large plastic masses (in omentum). In the skin and mucous membranes, tuber- cles produce eruptions, ulcers, or nodular indurations; in bones—caries, with ab- scess formation in surrounding parts (cold abscesses). Fibroid capsules, made up of connective tissue, due to reactive inflam- mation, enclose often smaller or larger tu- bercular masses, especially if these have undergone cheesy change. Primary tubercle manifests itself quite variously in different animals* In guinea- pigs and rabbits, it appears mainly as small cellular infiltrates; in dogs, it often undergoes a fibroid change; in goats, and especially in cattle, tubercle often forms large nodular, sometimes pedunculated masses which often calcify;* in birds it forms, preferably in the liver, large round mulberry masses, which, on section, ap- pear sometimes as horny radiating struc- tures. Secondary tubercle presents an aspect entirely different from primary tubercle, and it manifests itself in nearly all in- stances in but one form, namely, as a fine miliary eruption representing those well- known gray, semi-transparent nodules, of the size of a millet-seed, called miliary tubercles. These seem to lie in the .peri- vascular lymph-spaces, and are probably distributed throughout the body mainly by means of these lymph-channels of the blood-vessel walls. Tubercles do not oc- cur in avascular tissues. There is, how- ever, a second form of embolic or meta- static tuberculosis which evidently distrib- utes itself by the blood-current proper, and it appears in the form of conical masses or round nodes which may reach the size of a walnut and are located usu- ally at the bifurcation of arteries. No mention of this form of tubercle is made in text-books, although upon the post- mortem table this variety of tubercle is a very common occurrence. Especially is * I have met with, on the autopsy-table of the Philadel- phia Hospital, two cases of tuberculosis in man that were identical in every respect to bovine tuberculosis. Dr. Creigh- ton, of Cambridge, England, describes a number of cases from his own observation, and collected from literature. Bo- vine Tuberculosis, London, 1881.