PATHOLOGY AND PRACTICE OF MEDICINE.
Of the peculiarities of Structure in Individual Parts and Organs
and particular regions of the Bodpin the Taberculous Predisposition. By
Henry Ancell, Esq.,—The morbid state of the blood and blastema, and
the malnutrition of cells and fibres are not only exhibited in the various
tissues, but some remarkable peculiarities are observed in the form and
development and the general characteristics of individual parts made up
of different tissues. Generally there is a defect of symmetry, with a ten-
dency, according to Hufeland and others, to the disunion of various parts
of the body at the median line. The median line is also frequently re-
moved from the centre, the lateral halves of the body being unequal; a con-
firmation, it is remarked by Lugol, of the worst augury, as respects future
disease. Many of the features of the face present highly character-
istic appearances. In some of the most unequivocal cases the structure
of the eyes exhibit several peculiarities. A bluish tint of the sclerotic
coat, even in adult age, resembling that presented in the earliest infancy,
is very common ; countenancing the idea, already several times adverted
to, of an arrest of development. This coat is sometimes pearl-white,
which, according to Hufeland, betrays a tendency to the mesenteric
variety of the disease ; it is also frequently traversed by streaks of en-
larged and injected blood-vessels. The eyes, at other limes, particularly
in young children, are haggard and inexpressive, and the Meibomian
glands are liable to be spuriously hypertrophied. The eyelids are
sometimes thick or (edematous. The mouth is unsymmetrical—
small or large, or too much arched ; the upper or lower lip, or both
lips, are liable to become tumid from a spurious hypertrophy, consist-
ing of an infiltration of the mucous, cutaneous, and cellular tissues of
which they are composed; and as stated of the cellular tissue itself,
and from a similar cause, this tumidity is subject to a rapid increase or
decrease from slight variations of the general health, and is frequently
more perceptible in the morning than during the remainder of the day.
Tn the upper lip, the swelling frequently extends to the column® nasi
and lower part of the nostrils, and there is occasionally a chap in the
middle of the lip. The nose is sometimes swollen, red, and shining,
and the a’.ie nasi spread in a remarkable manner. The lobes of the
ears are also sometimes affected with a tumidity similar in its nature to
that of the lips. These peculiarities, with the modified conditions of
the dermoid, cellular, and muscular structures incidental to the tubercu-
lous predisposition, according to their degree and varieties, and the
mode in which they are combined, give the countenance several well-
marked aspects. There is the pale, pasty,full cheek, with large upper
lip and wide spread alae nasi of early childhood; the unnaturally fair
or white complexion, resembling blanched wax,, with large and con-
spicuous veins, combined with the roseate hue already described; the
full dark eye, with dilated pupil, long eyelashes, regular features,
placid expression, but extremely delicate skin ; or similar features,
with equally fine skin, and a fair florid complexion. There are com-
binations, sometimes of great beauty, sometimes the contrary, among
the associations, which, with other peculiarities belonging to the tuber-
culous habit, strike the experienced medical observer, and frequently
lead him at once to the inference, that the structures have been devel-
oped from a defective blastema, and that probably they continue to be
nourished from vitiated blood endowed with a low degree of vitality.
The peculiarities of tint in different parts of the body, as in the skin,
hair, and capillaries, depend in part upon the tenuity and transparency
of the tubes and vessels themselves, which traverse their structures,
allowing the fluids, whether circulating or stagnant, to reflect the rays
of light through them, and in part upon a change of tint of the paren-
chyma, the whole of the phenomena being ultimately referrible to the
blood; which is not only, as we have seen, deficient in red corpuscles,
but in which the yellow and blue coloring principles of the liquor san-
guinis have probably undergone some unknown changes, either in quan-
tity or quality, involving modifications of tint in the blastema of the
different organic tissues.
In the tuberculous predisposition the lymphatic glands over the whole
body, but most especially in the neck, are believed to be larger than
usual, although no accurate observations have been made on this point.
They are unquestionably, very prone to become enlarged, and in that
state are regarded as one of the most certain diagnostic signs of that
important variety of tuberculosis which comes under the designation of
scrofula. The same remark applies to the tonsils, which, without any
apparent deviation from the usual state of health, are liable to become
spuriously hypertrophied, sometimes to the extent of affecting the voice
and respiration. Baumes refers the habitual enlargement of the glands
to an increased quantity of the blastema or nutritive fluid of the cellular
tissue of these organs, which fluid he believes to be of an acescent
quality. We have given the grounds upon which the acid theory, of
tuberculous affections generally, rested, and there are no direct experi-
nients to prove this acidity in the glands. The abdomen, parlicularly
in tuberculous infants and children, is frequently very much enlarged ;
a circumstance readily explained by the weak organization of the in-
testinal tunics and of the abdominal parietes, giving rise to habitual
over-distension from flatulence and other dyspeptic effects produced
by slight causes, and in some cases this distension is increased by en-
largement of the mesenteric glands, which are liable to changes analo-
gous to those of the external glands.
As respects the viscera, great doubt hangs over the real condition of
their organization in the tub' rculous predisposition. Pathologists have
made numerous observations of the morbid appearances exhibited after
death from the different varieties of tuberculosis ; but in almost all these
cases some local disease has for a long time existed, and contributes to
destroy the patient. These pathological appearances will have to be
considered under the head of tuberculosis in a state of actual disease ;
but it is difficult, if not impossible, to draw any inference from them as
to the state of the same organs, where only the predisposition to disease
exists. No doubt they participate in the general malnutrition of the
elementary tissues of which they are composed, and the defective
cell-growth constituting the malnutrition, with the deteriorated qualities
of the blood which pervades the organs, occasion the functional de-
rangement about to be described. Most likely this constitutes the whole
of their pathology in the tuberculous predisposition ;—an inference sup-
ported by the fact, that where tuberculous subjects have died of diseases
other than tubercular disease, no constant pathological appearances are
recorded.
Before terminating this account of the structural peculiarities of the
tuberculous predisposition, the condition of the heart demands special
consideration. It is very generally admitted that, in some tuberculous
diseases at least, the heart is within its usual dimensions, and this would
be consistent with the malnutrition of its cellular and fibrous structures
and corresponding with malnutrition of these tissues generally. Ac-
cording to Bigot, of Geneva, the linear dimensions of the heart, are
cwt er is paribus, in every way less in phthisis than under ordinary cir-
cumstances. Louis observed in 112 cases, in which death was caused
by phthisis, that the heart, in the majority, was small, and very fre-
quently not more than one-half or two-thirds its ordinary size. Dr.
Clark states that he regards a small heart as a strong “predisposing
cause” of consumption, and Mr. F. A. Bulley, and I believe other
writers in our own country, have insisted upon this point. This, it is
necessary, however, to state, has been disputed by others. Andral ap-
pears to have found the heart larger than nature in a majority of phthis-
ical subjects, and the late Dr. Clendenning arrived at a somewhat simi-
lar conclusion ; he found that the heart weighed considerably more
in phthisical subjects than in health, but in chronic diseases generally
there was an increase of weight in the viscera ; and the increase or
weight in the heart in phthisis, relative to the increase in weight of
the other viscera, was very small indeed. New observations are re-
quired as to the size, density, and general nutritive condition of the
heart in tuberculosis, distinguishing as accurately as possible its state
of nutrition in the earlier and later stages of the affection, in the general
disease, and after local affections of the viscera, particularly of the
lungs, have for a long time existed, and previous and subsequent to
the supervention of the hectic fever. I have been in the habit, for
many years past, of examining the heart in fatal cases of phthisis,
and to the sight and touch it has almost invariably appeared to me
to be of small dimensions or defective substance. The physical
signs derived from percussion of the chest have also, in the main, fa-
vored this view. In the minor degrees of the tuberculous predis-
position, in which the cellular structures alone appear to have been
imperfectly developed, leaving the fibrous structures comparatively
intact the heart may not only be as large as natural, in relation to the
organization of the individual, but even larger ; still I consider that in
the more decided cases the heart is small and its nutrition imperfect,
and that this condition of the organ is in relation to the low vitality of
cells, cytoblastema, and blood ; and from the large amount of fibrous,
as compared with cellular structure, the malnutrition of this organ may
be very unequal in different cases.— London Med. Times.