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.

    17/24 (page 15)
    Symptoms.—The symptoms of bronchiectasis which most attract attention are, the odour of the breath, the characters of the sputum, and the cough. The breath is often peculiarly fetid, the fetor somewhat different from that of the sputum, and often intensely disagreeable to the patient himself. It is difficult to find a smell closely corresponding to it, but it is certainly quite distinct from that of gangrene. This symptom is not present in all cases (see Cases V., VI., and VII.), nor is it present in the earlier stages of any case. It is only as the disease advances, and when decomposition of the bronchial secretion has taken place, that it occurs. The sputum is usually copious—15 to 30 oz. daily—of a greenish- yellow colour and nummular, rarely frothy on the surface; some¬ times gelatinous, and with a tendency to adhere to the walls of the vessel. Sometimes it sinks, sometimes floats in water; and when a quantity of it is allowed to stand in a glass jar, it separates into layers or strata ; a more mucous and fatty layer, which floats on the surface; a more purulent and granular, which sinks to the bottom ; and a greenish watery fluid, in which the other two are embedded, but which forms an intermediate layer. In a majority of cases—at least of cases in which this disease is recognised—it is very fetid. The fetor resembling that of the breath, but in a more concentrated form. It is quite distinct from that of gangrene. On agitating the recent sputum with water, more opaque filaments, of varying thickness, separate themselves, and sink to the bottom. These are casts of bronchial tubes. Their character has been sufficiently described in a previous part of the paper. On micro¬ scopic examination, one may find the different elements previously described; but I have not seen, as yet, the needles of Margarin, which are found so abundantly postmortem in the recesses of the bronchi. Hcemoptysis.—Blood is expectorated along with the sputum, some¬ times in small quantities, merely streaking the expectoration, which otherwise presents the characters above described; but sometimes it is brought up in large quantities, much as in phthisis. In such cases (see Case V.), the sputum may be not at all abundant; it is only when the hsemorrhage occurs that almost any discharge takes place. Barth met with two cases in which the haemoptysis proved fatal. Cough is frequent, and occurs in paroxysms; but moist, and usually quite painless. After a fit of coughing, large quantities of the sputum are brought up without difficulty. Respiration is generally easy and quiet while the patient is at rest, but exertion speedily induces dyspnoea. Physical Signs.—There is, in the advanced stages, dulness on percussion over the parts of the lung which have become consolidated, sometimes relieved by an unusually clear note, if a dilatation be situated near the surface, and empty. In the earlier stages the