Albuminous Tubercle. Acute Tuberculosis

Under this denomination is understood a disease presenting many points, both of resemblance and of dissimilitude with the tuberculoses already discussed. It devolves upon us to investigate these analogies and differences; the former appearing to us to preponderate so far as to preclude our separating the disease from tuberculoses generally.

There is a disease which, under an acute course, and under typhoid symptoms, determines a tubercle differing in many respects from the fibrinous. It always represents solid, mostly poppy-seed-, rarely, if ever, millet-seed-sized, sometimes limpid, softish, glutinous, gray granulations, either of vesicle-like or of a dull transparency, often only cognizable under a favorable incidence of light; at other times, although far less frequently, opaque, whitish, or whitish-yellow.On a closer inspection, this tubercle appears marked by cell-formation. It is found to contain -

(a.) The ordinary nucleated, exudate cell, in considerable numbers.

(b.) Cells with two or three nuclei.

(c.) Cells with filial cell-formation.

(d.) A structureless soft basement connecting these elements.

It exudes always in great abundance under the symptoms of hypersemia, in scattered granulations, uniformly distributed through the parenchyma of the affected organ, and either all at once, or at intervals rapidly succeeding each other. A manifest equality of size and character is observable in all those deposited simultaneously, or during the same attack. With it there is always effused a grayish, sero-albuminous semi-gelatinous humor, with which the diseased textures become infiltrated.

This tuberculous deposition affects not only entire organs or large sections of organs and of textures, but commonly several organs and textures simultaneously or in rapid succession; a single one, however, generally operating as the main point of concentration. Its seat is in the lungs, the pia mater, especially at the base of the brain, the spleen, the serous membranes, especially the peritoneum.

This tuberculosis is only in rare instances the primitive one. For the most part, it is based, so to speak, upon a precursory fibrin tuberculosis of the lungs or lymphatic glands. In these cases its point of concentration is generally either the organ previously affected, or some structure standing in immediate relation with it.

The disease proves fatal through palsy of affected organs essential to life, or else through dyscrasial influence.

This tubercle is subject to no metamorphosis.

The dyscrasial character of the blood is manifest, and closely assimilates to the exanthematous crasis. (See "Crases.") In accordance with it are the livid coloration of the common integument in the dead subject, the dark coloration of the muscles, the general appearance of flabbiness, the serous infiltration of the parenchymata.

In this description of the disease we recognize the albuminous crasis, and a product which, in its subordinate coagulability, its soft, gluey character, its cell-development, gives evidence of its albuminous nature.

This tubercle renders it probable that albumen, without previous conversion to fibrin, may acquire a considerable amount of coagulability, and become tuberculous; nay, that where the opaque yellowish or whitish-yellow acute tubercle does not form upon a basis of croupous fibrin, even albumen may, without conversion into fibrin, acquire the croupous character.

In this description we recognize not only the distinctions, but also the analogies between the fibrinous and the albuminous tubercle. These analogies stand forward the more prominently if we recall to mind the fibrin tubercle of acute production.

Such analogies, apart from the resemblance in outward form of the two heterologous deposits, that is, the tubercle form; apart from the uniform size of the granulations thrown out at the same period of exudation; and apart from their equable dissemination through the parenchymata; are as follows:

(a.) Both are rarely the primitive tuberculoses in an organism.

(b.) Both are thrown out under manifestations of hyperaemia.

(c.) With both there is effused, as a sort of vehicle for the coagulable portion of the entire exudation, a serous, sero-albuminous fluid.

(d.) Both affect the same organs and sections of organs.

(e.) The albuminous tubercle bears the same relation towards other diseases as the fibrinous.

(f.) In by no means rare instances, a step-like transition from the fibrinous to the albuminous tubercle is incontestable. Upon the groundwork of a fibrin-tuberculosis, which has undergone frequent phases of phthisis, there exudes, with augmented dyscrasis, in the lungs more particularly, a tubercle which, with every fresh act of exudation occurring in rapid succession, becomes softer and poorer in fibrin, until ultimately reduced to a soft, semi-fluid, albuminous tubercle, - a consummated acute tuberculosis.

(g.) Occasionally we discover, especially in the texture of the pia mater at the base of the brain, an exudate consisting of albuminous tubercle and tuberculizing croupous fibrin, a primitive combination of the two products.

(h.) Not only does albumen enter into the composition of fibrin tubercle, but a certain amount of fibrin modifies that of the albuminous tubercle. A complete exclusion of the one or the other is hardly conceivable, and it is only the predominance of the one or of the other that characterizes the product. Between the extremes of fibrinous and of albuminous tubercle there exist numerous middle and transition forms.