The Bradshaw lecture on the results of bronchial obstruction : delivered before the Royal College of Physicians of London on November 1st, 1910 / by G. Newton Pitt.

  • Pitt, G. Newton (George Newton), 1853-1929.
Date:
1910
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Credit: The Bradshaw lecture on the results of bronchial obstruction : delivered before the Royal College of Physicians of London on November 1st, 1910 / by G. Newton Pitt. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    ttVLXt \. + \ **•34& THE RE^^I^^g^BRONCHIAL ION. Delivered before the Royal College of Physicians of London on November 1st, 1910. By G. NEWTON PITT, M.D.Cantab., F.R.C.P.Lond , PHYSICIAN TO GUY’S HOSPITAL AND LECTURER ON MEDICINE. Mr. President and Gentlemen,—My first duty is to thank your predecessor in the chair for the honour he has done me in nominating me for this lectureship to-day, and to express the diffidence I feel in choosing a subject on which it may seem there is not much that is new to be said. We are met to-day to do honour to the memory of Dr. William Wood Bradshaw, who, it would appear, was a man of wide interests— he contributed papers on such subjects as the use of cod-liver oil in chronic rheumatism, on narcotics, on abdominal abscess, and other non- professional articles to the Miscellany and else- where. Born in 1801 at Bristol, according both to Foster’s Alumni Oxoniensis and to the inscription on his grave, he was educated at the Westminster and Mid- dlesex Hospitals, taking nis M.R.C.S. in 1833. In the early part of the same year he became M.D.Erlangen. He be- came an Extra Licen- tiate of this College in 1841, after examination by the President and the “ Elects,” which en- titled him to practise beyond seven miles from London. In 1854 he was elected a Fellow of the Royal College of Sur- geons of England. In 1859 Dr. Coplans Haw- kins and Dr. R. P. Smith nominated him as a Member of this College, which nomination was approved. At the mature age of 43 he matriculated at Newton Hall, Oxford, and was granted a degree in 1847 without any examination. He married the widow of a wealthy jeweller at Andover, and, according to Mr. Rickman Godlee, to whom I am indebted for his por- trait and for much of this information, her money was to be left away in case she remarried; but they bought the reversion, married, and settled down at Reading. He seems to have been a cultivated, refined, somewhat eccentric man with a rather theatrical manner, and never did much practice. He died in 1866; his widow founded a lectureship at each of the Colleges in order to perpetuate his memory. The Results of Compression of a Bronchus. The results of compression of a bronchus may be the following: Dr. William Wood Bradbhaw. 1. The lung may be slightly reduced in size. There may be definite diminution in the entry of air, but the resonance may be unaltered, and even post mortem beyond an in- crease in the amount of mucoid contents, and a diminution in the amount of air in the lung, this may be all that can be observed, even when there has been definite pressure on the tube. 2. The chest may be hyper-resonant, the lung over- distended, and the diaphragm displaced down abnormally. This occurs only with partial obstruction of the tube when respiration is vigorous, and will be discussed under the results produced by aneurysm. 3. The lung may be reduced in size, airless and solid from collapse. The chest will be dull on percussion. This results when the obstruction to the tube is complete, or when respiration is feeble. It may occur within a few hours, and was studied by Lichtheim by observing the effects of introducing foreign bodies into the bronchi so as to completely block them, but practi- cally complete obstruc- tion is generally due to other causes, and rarely to the presence of a foreign body. In the early stage the bronchi beyond the obstruction are empty. The lungs in the first and second conditions also tend gra- dually to become more or less airless. 4. The bronchi become filled with retained secre- tions, at first chiefly mucus, but catarrhal changes soon ensue and cells accumulate, with purulent and inflam- matory products a s well. 5. Secondary inflam- matory changes take place, due partly to the entry of secretions into the alveoli, so that what has been called a reten- tion pneumonia ensues; the alveoli fill with catarrhal cells and giant cells appear, although they are unconnected with tubercle, as has been shown by inoculat- ing animals with the products. When alveolar walls remain long in contact, organization with obliteration takes place and new connec- tive tissue is formed. The bronchi normally often contain a few staphylococci and streptococci, which when retained in suitable media begin to develop, with the result less acute pneumonic that pyrexia and a more or change develops. The changes that have taken place so far may all pass away and leave but little damage ; but two further changes soon take place—a general fibrosis of the lung beyond the obstruction and a bronchiectasis. These ultimately develop, whatever be the initial process, if the obstruction persist. 6. Dilatation of the tubes. This does not take place equally in all the tubes obstructed, and its distribution is largely determined by local causes. When only one branch of a bronchus has been pressed upon, the dilata- tion is limited to the tubes in its area. Generally the tubes at the posterior and lower part of the lung are the most affected, probably because the secretion tends to stagnate there, and set up local destruc- [641/10]