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BOVINE TUBERCULOSIS

IN MAN

BY THE SAME AUTHOR

CONTRIBUTIONS TO THE

PHYSIOLOGY AND PATHOLOGY OF THE BREAST

AND OF ITS LYMPHATIC GLANDS 8vo, pp. 300, with Thirty-Jive Woodcuts and a Plate. 1S7S. 9s.

MACMILLAN AND CO.

BOVINE TUBERCULOSIS

MAN

AN ACCOUNT OF THE PATHOLOGY OF SUSPECTED CASES

BY

M.A. CANTAB., DEMONSTRATOR OF ANATOMY IN THE UNIVERSITY OF CAMBRIDGE.

WITH ILLUSTRATIONS

Hontron:

MACMILLAN AND CO.

SKILL AND COMPANY, EDINBURGH, GOVERNMENT BuOK AND LAW PRINTERS FOIC SCOTLAND

Preface

The title of this book has been chosen for its brevity, and with no intention of being dogmatic. If the designation had not been too cumbrous for a modern titlepage, I should have preferred to describe the work as relating to a form of tuberculosis in man, which had the characters of an infection, and at the same time a suggestive likeness, in the morbid products, to the bovine form of tuberculosis (Perlsucht). I preserved the affected parts from the earlier cases without any anticipation of the views that I now express, and merely because they seemed likely to repay study. The examination of them pointed to the pearl-disease of the bovine species as the source of the infection, and each succeeding case confirmed me in that opinion. It was from the tenth case, in order of time, that I took the distinctive appearances shown in the first plate ; and it was from a case that occurred after the work had all been sent to the press, that I obtained the specimens of pearl-nodules which are represented in the woodcut in Appendix B. I am thus encouraged to believe that the attention of the profession requires only to be directed

VI PREFACE.

to certain points of morphological resemblance, in order to elicit evidence that will be sufficient to settle this question of a conveyance of tuberculous disease from the bovine species — if, indeed, the evidence of likeness in form and structure can settle it.

My opportunities for pathological study, in the intervals of teaching another subject, are owing to the good-will and liberality of the Physicians and the Surgeons of Addenbrooke's Hospital, and I owe my especial thanks to Dr Latham and to Dr Bradbury for the privilege of using the cases upon which the present work is based.

Cambridge,

Uth December 18 SO.

Chapter I. Definition Of The Subject

PAfiR

Anomalous cases of general tuberculosis — Bovine tuberculosis suggested by the form and structure of the morbid products — Structural mimicry of infection — The bovine disease colloquially named from the serous-membrane affection — Not identical with human tuberculosis in general — The latter an unassorted group of morbid conditions — Morphological evidence of identitj' not without value : criticism of the statements of Cohnheim — Opinion of Virchow that pearl-nodules have never been acquired by man . 110

Chapter II

SUMMARY OF THE PATHOLOGICAL ANATOMY' OF TUBER- CULOSIS IN THE BO VINE SPECIES.

Frequency of tuberculosis or peail-disease in the bovine species — Con dition of the serous membranes — Condition of the lungs : observations of Trasbol. — Smooth-walled vomicre in the lungs not always dilatations of bronchi — Criticism of Virchow's statements on bronchiectasis in the bovine disease — Condition of the lymphatic glands — The disease in other organs .... 11-20

Chapter III. Com Mu Nic Ability Of Bovine Tuberculosis To Animals By Experiment

Experiments of Gerlach — Morbid anatomy of a cow from which experiment-material was taken — Details of Gerlach's feeding

CONTENTS.

experiments with milk and with the pearl-nodules— Conclusion of Gerlach : how far the induced disease identical— Case of bovine tuberculosis communicated to pigs by accident through the milk (Walley) . ... 21-2C

Chapter IV. Cases In Ma N

Cases 1-12, from the medical practice of Addenbrooke'fl Hospital, Cambridge : under each case a brief commentary, with references to the plates . . • 27-46

Chapter V. The Formations On The Serous Membranes

Difficulty of separating distinctive bovine tubercle in man from human tubercle in general : microscopic definition of tubercle by Schiippel and by Rindfleisch probably includes bovine tubercle — Distinctive characters of latter best seen in serous-membrane outgrowths — " Duckweed " on the serous membranes — Under surface of diaphragm a favourite situation — The formations may be soft and membranous, or hard and solid — May grow into adhesions: the latter not of inflammatory origin — Cord-like outgrowths — Especially round sharp margins of lung — Same as Gerlach found in experiment-animals — These marks of identity often slight, but not the less reliable . . . . 47-0.3

Chapter VI. The Disease In The Lungs

Process in the lungs mostly acute — Whitish medullary character of nodules in acute lung infection — Encapsuled, firm, round yellowish nodules in chronic cases — Large size of nodules : conglomerates of small tubercles — Sometimes wedge-shaped masses of new growth in periphery of lung, both in chronic and acute cases — Vascularity of outer zone of nodules — Clean separation of necrosed centre from vascular periphery — Closed vomica; with smooth walls — Other kinds of central softening — Smooth-walled

CONTENTS. IX

PAOIi

vomica; not due to bronchiectasis — Vascularity of periphery leads to appearance of encapsulation of nodules — Vascularity of new growth approximates it to sarcoma — Giant-cells in the new formation — They mark the limited degree of vascularization — Their vaso-formative significance — Physiological type in placental giant-cells — Abundance of giant-cells and epithelial-like cells in bovine pearl-nodules — And in suspected cases in man — And in pearl-disease communicated to rabbits by experiment — Experiments of Orth on rabbits — " Scrofulous tubercle " of Rindfleisch — Giant-cells in many other conditions both of health and disease — Vascularity of pearl-nodules greater than that of human tubercle in general — Affinities to sarcoma illustrated by an additional case (710(e) — Pneumonia, both croupous and catarrhal, may coexist with tubercles — Observations of Orth on coexistence of pneumonia with tubercles in rabbits infected with pearl-disease — Histogenesis of lung-nodules not discussed . . 54-72

Chapter VII. The Condition Of The Lymphatic Glands

Conventional opinion that caseous lymphatic glands are a primary source of general tuberculosis — Caseous lymphatic glands may themselves contain tubercles, which are co-ordinate with the tubercles in other parts — Details of lymphatic-gland tuberculosis in the series of cases — Tubercle-conglomerates visible to the naked eye — When caseation advanced, tubercles found only in periphery of gland — They begin in follicular tissue — Hyperemia of follicular tissue around tubercle-centres — Large size of tuberculous glands — Calcareous degeneration — Orth's observations on lympathic glands in rabbits infected with bovine disease — Schiippel's Untersuchungen iiber Lymphdriisen-Tuberculose — Schiippel's argument for identity of tuberculosis with Perlsucht — His disregard of distinctive naked-eye features of the latter — Carswell's plate of the lung of a tuberculous cow — Value of the microscopic evidence — Theory of Schiippel and of Rindfleisch as to the place of lymphatic-gland tuberculosis in general tubercular infection — Its place is not causally intermediate, but co-ordinate — Analogy between infection of tuberculosis and that of syphilis — Summary . . 73-85

X CONTENTS.

Chapter VIII. The Intestinal Lesion

PAGB

Account of case 10 : tubercular infection issuing from thickened floor of healed intestinal ulcer— Analogy with syphilitic sore— Case 1< » originally a case of typhoid fever : the infection due to introduction of the bovine virus — Similiar cases from Hoffmann's work on morbid anatomy of typhoid— J. Harley's coses of "tubercular fever"— Remarkable outbreak of typhoid-like tuberculosis at Bristol : observations of W. H. Spencer— Epidemics of typhoid due to poisoned milk — Is there ever anything in morbid anatomy of such cases to suggest pearl-disease of the cow? — Intestinal lesion in cases 11 and 12 — And in a case of scrofulous disease of hip-joint : the misroscopic test of bovine tubercle — Intestinal lesion in the rabbits in Orth's experiments . . . 8G-97