On dilatation of the bronchi, or bronchiectasis / by T. Grainger Stewart.

  • Stewart, Thomas Grainger, 1837-1900.
Date:
1867
Catalogue details

Licence: Public Domain Mark

Credit: On dilatation of the bronchi, or bronchiectasis / by T. Grainger Stewart. Source: Wellcome Collection.

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    of bronchial tubes, and the bronchi may not only be traced into them at one extremity, but out of them at the other. 3. That the mucous lining of many of them presents the ordinary character of bronchial mucous membrane. 4. That they are not common towards the apices, where tubercular excavations are most frequent. III. The Theory of Stokes.l 2—Dr Stokes conceived that most im¬ portance must be attached to loss of elasticity, contractility, and ciliary movement, and that the starting-point is in all cases bron¬ chitis. From inflammation, he said, ls£, The non-muscular longitu¬ dinal fibres lose their elasticity, and so cough and forced inspirations may dilate the tubes. 2dy Paralysis of the circular muscular fibres, whereby the tubes dilate on the same principle as the intestines do in cases of enteritis or ileus. 3d) The cilia of the epithelium lose their mobility. This view appears to be correct, in so far as it assumes certain changes in the bronchial walls, but in the explanation of the origin of these changes, it appears that there are certain difficulties,—1 st, That if bronchiectasis depended simply on bronchitis, it would necessarily be much more frequent than it is. 2d, That this theory affords no satisfactory explanation of the formation of the bridges and communications which have been described. IV. The Theory of Lebert.2—This author concurs generally in the opinion of Stokes, but thinks the loss of power dependent upon nervous causes rather than upon inflammation of the bronchi. He thus obviates one of the difficulties which beset the view of Stokes; but it must be borne in mind that the supposed influence of the nervous system is purely hypothetical. Still his view is the only one which is not opposed to known facts. The conclusions which appear legitimately deducible from my own observations are,— 1. That the essential element of bronchiectasis is atrophy of the bronchial wall; that the cause of such atrophy is not yet ascertained, but may perhaps be connected with constitutional peculiarities. 2. That the walls, being so thinned and weakened, readily yield to the pressure of air; it may be in deep and sudden inspirations or during violent muscular exertions, certainly in the sudden expi¬ ratory effort made while the glottis is closed in the act of coughing. 3. The enfeebled and dilated condition of the bronchi favour the accumulation of the mucus secreted by the bronchial membrane. 4. That the mucus, accumulating and undergoing decomposition in the dilatations, irritates the mucous membrane, leads to inflam¬ mation, and the formation of villous processes from it, to the forma¬ tion of increased connective tissue in the walls, to irritation of the cartilages, and frequently to consolidation of the surrounding lung 1 Stokes on the Diagnosis and Treatment of Diseases of the Chest. Dublin, 1837. 2 Lebert’s Anatomie pathologique, tome i. p. 620.