On chronic bronchitis : especially as connected with gout, emphysema, and diseases of the heart, being clinical lectures delivered at the Middlesex Hospital / by E. Headlam Greenhow.

  • Greenhow, Edward Headlam.
Date:
1869
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Licence: Public Domain Mark

Credit: On chronic bronchitis : especially as connected with gout, emphysema, and diseases of the heart, being clinical lectures delivered at the Middlesex Hospital / by E. Headlam Greenhow. Source: Wellcome Collection.

Provider: This material has been provided by University of Bristol Library. The original may be consulted at University of Bristol Library.

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    or mainly to mere mechanical causes, is founded upon too narrow a view of the subject. This brings me to the second, and fi-om my point of view the more important, question ; namely, whether mechanical causes of distension usually produce emphysema in pulmonary tissue which was previously healthy, or whether its development be not usually preceded by some abnormal condition of the walls of the air-cells which become emphysematous. This question applies chiefly to those cases in which the lungs become gradually and extensively emphysematous ; for, as I stated in referring to Dr. Gairdner's theory, partial emphysema does occasion- ally take place in the healthy portions of otherwise diseased lungs. Laennec, as we have seen, appears to have regarded emphysema as the result of a mechanical process, taking place in those parts of lungs which had previously been the seats of extensive dry catarrh; but nevertheless, his accurate clinical observation compelled him to recognise that, in certain cases, the dilatation of the cells appeared to be the primary affection, and the catarrh consecutive. Dr. Gairdner emphatically states, as his opinion, that the source of emphysema is to be sought exclusively in a derangement of the mechanism of respiration, and not in any previously morbid condition of the affected part. On the other hand. Dr. Waters, the author of a recent and valuable monograph on Em- physema of the Lungs, entertains no doubt that the disease, in its severer forms, is of a constitutional