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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    the Obliteration of Bronchi/ It takes place on one or both sides ot the stricture, and is manifestly connected with that condition. It probably owes its origin to the increased pressure of tlie air in inspiration, or in forcible expiration, which naturally tends to expand the walls on either side of the constricted part. 3c?, Dilatations from long-standing indurations of lung substance^ tubercular or inflammatory.—These are always slight, local, and unimportant. They appear to result from retraction of the altered pulmonary tissue around them. 4^7t, Spurious Bronchiectases, which are in truth not bronchial at all, but the remains of chronic tubercular cavities, or abscesses in the lung tissue, which communicate with bronchial tubes. Such are the minor varieties which we must bear in mind. It remains for us now to consider the most important form, the eluci- dation of which is tlie object of the present paper. There are two forms of bronchiectasis, viz., the general, or uniform; and the sacular, or ampullary. 1st, The general, or uniform, is a cylindrical or fusiform dilatation of a tube, or of several tubes, throughout considerable stretches of their extent. 2d, The sacular, or ampullary is, as the name implies, an abrupt dilatation of a tube at a particular point, or at several points. Many writers distinguish two forms—the solitary, when but one sacular dilatation exists in a tube; and the moniliform, or bead-like, when a succession of them is met with. This distinction is, however, unnecessary, as solitary saculated dilatations are exceedingly rare, if ever they are met with. Indeed, it is almost doubtful wliether it is necessary to distinguish between the cylindrical and the sacular, they so constantly co-exist in the same lung, and even in the same tube—the whole course being dilated, but special sacules projecting from the side here and there. When dilatations exist in neighbouring bronchi, it not unfre- quently happens that communications become established between them, and this may go on to such an extent that several bronchial tubes open into one common cavity. This fact was observed by Cruveilhier, but has hitherto attracted less attention than it deserves. In considering dilatations more minutely, we shall first describe— The Condition of the Bronchial Walls. {^•) ,Qf the Mucous Membrane.—In some dilatations this mem- brane is natural. Its surface may be coated with mucus, but the epithelium presents its ordinary cliaractcrs, the cilia are distinct, the nuclei not enlarged, and tlie subjacent vascular layer is neither congested nor thickened. In others the membrane is thickened and opaque, the epithelial elements, though still distinct and 1 Op. cit., p. 876.