SEAT OF GREY TUBERCLE IN LYMPHATIC TISSUE. 23 the independent observations of Dr. Wilson Fox, whose experiments led to the same results, and will be further noticed hereafter. The conclusions of Drs. Sanderson and Fox appear to me much more correct than the notion of Virchow, that tubercle, as well as pus and all other new formations, has its origin in the cells of connective tissue only: a notion incompatible with the production of tubercle and pus on serous membranes and within blood-vessels and lymphatics. But although I think that Dr. Sanderson has proved that miliary tubercles are modifications of the adenoid tissue, I do not admit that any and every inflammation or overgrowth of the adenoid tissue will produce miliary tubercle; nor do I admit that adenoid tissue is essential to the production of other phthisical consolidations, especially of what has been called yellow tubercle, either in its crude or in its caseous stage. But this subject and the general relations of inflammation to consumption demand consideration in another chapter. Pour revenir maintenant aux tubercules qui constituent la phthisie originaire, je pense, d'après l'examen le plus attentif, qu'ils sont formés et par des engorgemens des glandes lymphatiques, répandues dans presque toutes les parties du poumon, ou loin des bronches, ainsi que par des engorgemens lymphatiques du tissu cellulaire des poumons, lesquelles, après avoir pris une consistance plus ou moins grande, terminent fréquemment par tourner en une mauvaise suppuration.'-Obs. sur la Nature et le Traitement de la Phthisie pulmonaire. Par Antoine Portal, Prof. de Méd. au Coll. de France, &c., 1809, tome ii. p. 307. CHAPTER IV. RELATIONS OF INFLAMMATION TO TUBERCLE AND OTHER PHTHINOPLASMS. When and how does inflammation produce Tubercle?—The plastic process of Inflammation-Sarcophytes, or Bioplasts: their formation, migration, and changes-Nature of Bioplasm; Cells not essential-Observations of W. Addison, Max Schultze, Stricker, Lionel Beale, &c.— Explanation of production of membrane, pus, tubercle, &c. by changes in Sarcophytes-Examination of other phthinoplasms in the Lung-Chronic Induration-Fibroid-Pathological and Clinical results—Contraction— Dilated Bronchi-Emphysema-Asthma--Bronchial exudations, fibrinous and albuminous. THE adenoid tissue of the lymphatic glands may inflame, swell, and the inflammation either subside by resolution, or go on to complete suppuration in healthy abscess; and in neither case does tubercle or any other morbid change remain behind. In acute pneumonia also it can hardly be supposed that the adenoid tissue does not partake of the general inflammation; and yet the inflammation may end in resolution and absorption of its products, and leave not a trace behind. It is the scrofulous inflammation of lymphatic glands that makes them enlarge first, and then harden, and at length degenerate into caseous masses, which soften eventually, and discharge from scrofulous sores. It is a similar type of inflammation which may develope miliary indurations in the adenoid tissue of the lungs, tending in like manner to caseation, softening, and spreading, and to the formation of vomicæ. In both cases the death and destruction of the tissue is preceded by induration, and the microscope reveals the nature of this induration in the abundant production of cells, PHTHINOPLASMS PRODUCED BY INFLAMMATION. 25 which change their colour from red to grey, and eventually so press on each other and on their containing fibrous stroma, as to choke their nutrition, and they then become cheesy, that is, undergo fatty degeneration and disintegration. It is therefore not the mere inflammation or simple growth of the adenoid tissue that constitutes the destructive changes of scrofula and tubercle, but the excessive multiplication of perishable cells doomed to speedy decay. These cells have the closest resemblance to leucocytes, the ordinary corpuscles found in lymph, and circulating also in considerable numbers in the blood; and there are good grounds for concluding that these all are identical in nature. The strong probability is, therefore, still in favour of the opinion which I have entertained, and in general terms expressed during the last forty years, that variations in the plasma, as represented by these bodies, constitute the essential element in the production of lymph, pus, and tubercle. The coagulable lymph, composing the plastic exudations from inflamed serous membranes, contains more or less of these corpuscles or leucocytes; their greater abundance causing a more opaque appearance, and a lower capacity for organisation in the inflammatory product, and constituting the kind of lymph termed corpuscular by Paget, croupous by Rokitansky, and by myself cacoplastic and aplastic, having the further varieties purulent and tubercular. Now it is in the subjects in which inflammation of serous membranes produces this kind of lymph, that inflammation of lymphatic glands causes induration followed by caseation, and inflammation of the minute patches of adenoid tissues in the lung, produces miliary tubercle. There is even a preference in the lymphatic system for the manifestation of this tendency; and, therefore, lymphatic swellings often precede its development in other tissues, and occur in slight degrees in consequence of wounds or cutaneous eruptions, without necessarily infecting the system. The artificial production of miliary tubercles in so large a proportion of animals, by inoculation or mechanical injury, is another proof of the peculiar susceptibility of this system, to which we shall have occasion to advert hereafter. But although showing this preference, this degenerating cell proliferation is surely not confined to the adenoid, to the connective, or to any other tissue. In some form or other it may occur in other textures of the body; and in none more surely, perhaps in none sooner, than in the blood itself. I allude not only to the case of leukæmia—the distinctive feature of which is an excess of the pale corpuscles at the expense of the other animal constituents of the blood-but also to all cases of extensive inflammatory disease, especially those of a chronic character. It was an observation long ago made by Mr. Gulliver,' that blood taken from an inflamed part contained an unusual quantity of pale corpuscles. Mr. W. Addison2 first noticed an increased appearance of these in the inflamed vessels of the frog's web; and soon after I observed, not only their increased production within the blood-vessels, but that they manifested a remarkable adhesive quality, making them stick to the coats of the vessels and in some cases, together with the entangled blood-discs, to cause their complete obstruction.3 It was the sudden appearance of these adhesive corpuscles in the blood-vessels of the frog's web irritated with capsicum, that riveted my attention; and after repeated observations I was led to conclude that herein lay the chief cause of that obstruction of the vessels, 1 Willis's Translation of Wagner's Physiology, 1844. Ibid. July 23, 1841. PLASTIC PROCESS OF INFLAMMATION. 27 which, combined with determination of blood through the enlarged arteries, constitutes the distinctive part of the process of inflammation. In this increased production of adhesive lymph-globules (termed by Mr. Gulliver embryo flesh and blood), I thought I saw the commencement of that overflow of the plasma or material of nutrition, which in 1828 I pronounced to be a characteristic result of inflammation. The completion of the process is seen in the increasing distension of the vessels thus partially obstructed, yet open to the increased vis a tergo from the heart and arteries, and in the abundant exudations into the adjoining tissues, in which the same pale corpuscles appear outside the vessels in increasing numbers (subsequently named exudation corpuscles). The prominent share which I was led to assign to these leucocytes (which, for reasons given below,' I will call sarcophytes), in both the processes and the products of inflammation, was called in question by some subsequent writers; but it has been fully accredited by numerous recent observers, and has been amplified in a remarkable manner by the discoveries of Waller, Cohnheim, Von Recklinghausen, Stricker, and Bastian, on the emigration and amoeboid properties of these sarcophytes. Although assured of the reality of the appearance of 1 The word leucocyte (λeúKOV KÚTOs), meaning white cell, was applied to this body under the supposition that it is a nucleated cell, as at one time almost every histological element was supposed to be; but we now know that, although later it does assume a cellular character, in its early and most active condition it is not a cell, but a mere morsel of colloid or jelly, yet endowed with wonderful vital properties of motion, migration, absorption, digestion, and multiplication, and being, in fact, a living rudiment of flesh and blood. I have therefore proposed the term sarcophyte (σapós QUτóv), flesh-germ, to express its condition and destination. (Med. Times and Gaz., Jan. 21, 1871). Dr. Lionel Beale uses the word bioplast, which also indicates its vital and formative properties; and I am quite willing to use the terms, bioplasts and sarcophytes, as synonymes, in preference to the inaccurate designation leucocyte, and the older and cumbersome names, pale blood corpuscle, and lymph-globule. |