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

Date:
1867
Catalogue details

Licence: Public Domain Mark

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

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    and troublesome. Tlie sputum was copious, and smelt of moist mortar, while his breath liad a fiecal odour. Some amelioration of tlie chest symptoms followed the inhalation of iodine, but the weakness gradually increased and he died 18th November. Autopsy.—The body was defoi'med, in consequence of marked lateral curva- ture of the spine. The heart was natural. The rigiit lurig was densely adherent at the apex, and posteriorly. The left had only a few adhesions at its apex. Tlie lungs were in some parts emphysematous, in others consolidated. There was no recent tubercle, but some old deposits of limited extent. The trachea was natural. Throughout both lungs many of the bronchi were dilated. It was most marked in those about the fourth division, and existed among both consolidated and emphysematous tissue. In the middle lobe of the right lung there were several gangrenous cavities, the largest of the size of a small walnut, the walls of whicii were composed not of mucous membrane, but of consolidated lung tissue. In its neighbourhood there were numerous intercommunicating dilated bronchi, and many with bridges in their walls. Tlie bronchi contained much fetid and purulent mucus, among Avhich were many casts of natural and dilated tubes, exhibiting cells altered in various ways, granular and fatty transformation of the casts, and many which exhibited the purple reaction with iodine which was first pointed out by Dr Gamgee. Among the more opaque-looking contents of the tubes, there were many of the peculiar crystals of margarin, here and there a few vegetable structures (whose characters I did not determine) were seen, and in the gangrenous cavities and the bronchi connected with them there were distinct shreds of pulmonary fibrous tissue. The abdominal organs presented uo important lesion. Commentary.— It is to be noticed here that the patient was deformed, and that he had exhibited no distinct pulmonary symptom till four months before his death. That those symptoms came on after exposure to cold, and continued till his death. I cannot doubt that the process of dilatation had been going on for a longer period, and tliat the inflammatory process merely led to some of the secondary changes. It is to be noticed further, that the dilatation existed alike with emphysema and with consolidation of the neighbouring lung tissue, and was present on both sideSjalthough the adhesions were mostly confined to one. Case III.— Winter Cough for some years—Wealcness gradually increasiiuj for some months—Death from Empyema and Pneumo-ilwrax—Autopsy—Bronchi- ectasis, Empyema—Liviited gangrenous Perforation. John Storrie, a tailor, aged 59, admitted under my own care, 15th October 1866. He was a tall, sallow man, with a somewhat greasy skin, and with rounded shoulders. He stated that he had enjoyed good health, though subject to a cough, particularly in winter; tliat he had had little expectoration, and that his breath never had a disagreeable smell; but in the summer and autumn he had felt weak, and for five weeks before admission had been unable to work. He was uncle to the patient John Storrie, Case II. On admission, the bi'eath was offensive, the sputum copious, yellowish-green in colour, and with more solid grey streaks here and there. These streaks, on being washed out, were found to be casts of bronchial tubes, in the condition of degeneration, and they assumed a violet-blue colour with iodine. Tlie lungs were nowhere markedly resonant on percussion, but nowhere absolutely dull. Tubular breathing and coarse moist rales were heard over many points of both organs, and towards the base of the left lung there was distinct amphoric breathing. The voice was husky, and the digestion was feeble; there was no other morbid condition. There was no dilficulty in this case in establishing a diagnosis of dilatation of the bronchi. The patient was ordered good nutritious diet, and to inhale the vapour of creasote. He continued in much the same state until the 20tli, when a quantity of thin yellowish pus was expectorated, altering the general appear- ance, though not the smell of the sputum. After this he became rapidy weaker, and died 25th October. Autopsy.—The heart was natural, the aorta atheromatous, the two layers of