106 



PRODUCTS, ADVENTITIOUS. 



tubercular matter, in other situations as an 

 admixture of the same matter and coagulable 

 lymph ; the majority of observers hold them 

 to be actual tubercle in an early stage of 

 development. The latter opinion under cer- 

 tain modifications, we believe, for reasons 

 which will presently appear, to be the true one. 



These bodies occur in different organs and 

 textures in association with yellow tubercle ; 

 they are more or less transparent, and, though 

 in their own substance of light greyish colour, 

 their translucency sometimes gives them in ap- 

 pearance the tint of the circumjacent structure; 

 their section exhibits a smooth and close sur- 

 face ; hard as cartilage almost in some instances, 

 and invariably remarkable for firmness ; in gene- 

 ral outline seeming roundish, yet in reality of 

 somewhat angular form ; and adhering so closely 

 to the adjoining tissues that they cannot be 

 removed without particles of these, they have 

 a striking tendency to accumulate in groups. 



Now the motives for connecting this pro- 

 duction pathologically with yellow tubercle, and 

 regarding the one as a phasis of the other, are 

 derived as well from (a) naked-eye observa- 

 tion and considerations of general pathology, 

 as from () microscopical examination, (a) 

 Common yellow tubercle appears in the sub- 

 stance of the grey granulation at a certain stage 

 of its existence, and gradually (in the lungs and 

 in bone for example) fills the entire space it had 

 occupied. In the lungs the grey granulation 

 follows the same topographical course as yellow 

 tubercle ; originating in the upper regions, it 

 migrates downwards ; and the quantity of the 

 one, as of the other, is greatest at the apex.* 

 Grey granulations are found mixed with yellow 

 tubercle in various organs, and so rare is the 

 development of the one without the other, that 

 M. Louis f only encountered grey granulations 

 without yellow tubercle five times, and the lat- 

 ter without the former once. The material 

 composing the grey granulation also occurs in 

 the form of shapeless masses, and when so de- 

 posited (as in the lungs and lymphatic glands) 

 also becomes the seat of yellow tubercle. (6) 

 Microscopically considered, the elements of the 

 granulation prove the relationship of the two 

 products. A hyaline substance, non-stromal, 

 holds together cells, identical with those already 

 described, mixed (sometimes) with melanic 

 matter in small quantity, and the elementary 

 fibres of the implicated tissue (doubtless the 

 objects mistaken in the lung by Kuhn for vege- 

 table filaments). The proper granular matter 

 of tubercle alone is absent, or present in very 

 minute proportion only. The disintegration 

 and breaking up of the cell-structure, and the 

 exudation, further, of blastema, which, incapa- 

 ble of furnishing cells, generates granules, cause 

 the appearance of yellow opaque amid grey 

 semi-transparent tubercle. 



It appears, then, that the two conditions, 

 grey and yellow, are stages of each other. But 



* In acute miliary tuberculization, however, the 

 grey granulation, scattered equably through the 

 various parts of the lung, is deposited in an isolated 

 manner. 



f On Phthisis, Transl. p. 2. 



is this sequence necessary ; must grey matter 

 precede the yellow in the order of evolution? 

 No : for in some textures, as the lymphatic 

 glands, grey matter is very rare ; in others, as 

 the brain, it is not, as far as we know, ever 

 seen, though yellow tubercle is not of very 

 uncommon occurrence there in infancy ; and, 

 lastly, in the lungs, tubercles are sometimes 

 found of the minutest conceivable size, yet yel- 

 low throughout their entire substance without 

 the least grey appearance. It follows, then, 

 that the ordinary first or grey stage may be to 

 all seeming passed over, an idea by no means 

 repugnant to reason, inasmuch as such a state 

 of things would naturally occur wherever a 

 peculiarly low crasis of the system leads to 

 primary production of granular matter in ex- 

 cess and unusually rapid disintegration of cells. 

 Another kind of granulation occurring in the 

 lungs, first described by Bayle, and by him 

 supposed to be composed of adventitious carti- 

 lage, has been by almost all writers confounded 

 with the common grey production. This va- 

 riety is, we believe ourselves justified in affirm- 

 ing, of great rarity; at least we have met with 

 but one example of it some years since at the 

 Hospital for Consumption. In this instance 

 the granulation was of round or oval form, as 

 large as a good-sized pea (all present very 

 uniformly so), of dull white colour, opaline 

 without yellow points, present in moderate 

 numbers, disseminated equably through all 

 parts of both lungs, not grouped, but deposited 

 solitarily, producing no visible change in the 

 circumjacent texture, and unassociated with 

 yellow or grey tubercles. Bayle, maintaining 

 the obviously erroneous opinion, just stated, 

 of their anatomical nature, connected these 

 bodies pathologically with phthisis; Laennec 

 regards them as a modification of the common 

 grey granulation; our own opinion on the 

 point is unformed. 



Among the numerous published analyses of 

 tubercle, we have for some years been in the 

 habit of referring to that of Preuss* as at least 

 the most elaborate in existence. According to 

 the results of this analyst, one hundred parts of 

 tuberculized pulmonary substance consisted of 



Water 79.95 



Tuberculous matter . . . 13.52 

 Fibrous residue, vessels, bronchi, &c. 6.53 



One hundred parts of the fibrous residue 

 consisted of 



Fat 4.13 



Substances yielding gelatin by boil- 

 ing 20.67 



Substances yielding no gelatin by 

 boiling 75.20 



The tuberculous substance itself, without 

 water, contained : 



Substances soluble in hot alcohol only. 



Cholesterin 4.94? 



In cold alcohol and not in water. 

 Oleateofsoda .... 13.50 



* Preuss, Dis. Inaug. Tuberc. Pulmon. Crudorum 

 Analysis Chemica. Berol. 1835. 



