Tubercular meningitis as it occurs in children : with an appendix of illustrative cases and two chromo-lithographs / by Martin Oxley.

  • Oxley, Martin.
Date:
[1885]
Catalogue details

Licence: Public Domain Mark

Credit: Tubercular meningitis as it occurs in children : with an appendix of illustrative cases and two chromo-lithographs / by Martin Oxley. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    5/36 (page 261)
    found, at others the pia mater will be crowded with them. The Sylvian and longitudinal fissures are often so firmly glued to- gether that the brain on either side cannot be separated without tearing its tissue. The base may be covered with purulent lymph, obscuring the cranial nerves and sulci, or we may have only a slight milkiness of the membranes. Masses of tubercle in various stages of the tubercular condition are frequently found in the substance and on the surface of the brain. In 41 cases which I have examined after death 19 had only a slight opacity of the membranes, while in 22 there was a well-marked deposit of yellow lymph; in 9 instances caseating masses were found, forming in 4 cases single, and in 5 two or more, tumours. In every instance there was a great excess of fluid in the ven- tricles, the effusion being serous in character with one exception, where it was mucilaginous. Causation.—In considering the cause of tubercular meningitis, I will refer briefly to the most recent views on the subject of tuberculosis, the complaint under consideration being one of its manifestations. Macalister, in his General Pathological Anatomy, says:— The term tubercle was formerly applied to all varieties of nodular growth. Baillie (1794) and Bayle (1810) were the first to direct attention to the grey miliary nodules which we now call tubercles. Laennec applied it mainly to the cheesy masses found in phthisical lungs. Larger caseous foci and caseous lobular infiltrations were also described as tuberculosis. The caseous nodes and masses were simply ' tubercles'; the diffused infiltration was * tuberculous infiltration'; the grey nodules (or true granulative ' tubercles') were ' miliary tubercles.' Cheesy change was thus made the main characteristic of tuberculosis. In opposition to this view, Yirchow maintained that caseous masses might arise in many different ways, and hence had very various significance in different cases. In consequence of the recent investigations of Koch, the definition of tubercle will probably have to be amended. He announced in 1882 that the tuberculous virus is a special bacillus, and that he had found it in general miliary tuberculosis, in caseous pneumonia, caseous