On the pathological anatomy of bronchitis, and the diseases of the lung connected with bronchial obstruction / by W.T. Gairdner, M.D.

  • Gairdner, W. T. (William Tennant), Sir, 1824-1907.
Date:
1850
Catalogue details

Licence: Public Domain Mark

Credit: On the pathological anatomy of bronchitis, and the diseases of the lung connected with bronchial obstruction / by W.T. Gairdner, M.D. Source: Wellcome Collection.

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

    13/86 (page 11)
    CONNECTION WITH BRONCHIAL OBSTRUCTION. H mostly natural; but in its lower portions it approached more in colour tc.the middle lobe This was perfectly non-crepitant, of a grey co our, having a Smooth S like section, and infiltrated with a thin serosity, having a feint red- dSli t nge nearly transparent, and presenting under the microscope only epithe- lium, pigment cells, and a very small amount of pus cells, and g^nular mat ei The ower lobe was not quite so much compressed, and contained a good deal of blood. The bronchial glands were slightly enlarged, and the whole pulmonary mucous membrane highly vascular. In this case, as in the former, there were no pneumonic appear- ances ; for the small amount of pus cells which existed m the serosity scraped from the lung, were probably derived from the small bronchi, and were, at any rate, quite inadequate to account for so remarkable a consolidation. Neither can it be supposed that there was any older structural lesion of the pulmonary substance, as the girl was undoubtedly in good general health at the period of her admission into the hospital, and the whole stages of the fatal disease were too rapid to admit of any complicated structural change. The collapsed lung presented exactly the appearances so commonly seen in organs compressed by pleuritic effusion, except that the middle lobe had rather more of an oedematous appearance than is common under such circumstances. Here, then, is an instance of collapse of the entire lower lobes, and part of the upper in the right lung, as com- plete as it could have been from external pressure, and coinciding with a manifest cause of obstruction in the whole of the bronchi of that lung; whereas on the opposite side, where the obstruction had been much less considerable, the lung was comparatively expanded and normal. It is impossible not to see here a relation of cause and effect; and as it will not be maintained that the deposit of false membrane was the result of the collapse, the converse proposition is, I think, scarcely to be avoided. The form of bronchial obstruction in this case is a sufficiently rare one in the adult, but by no means unexampled. It is not at all clear whether the membrane had never extended to the bronchi of the oppo- site lung, or had been dislodged by expectoration. In the former case it is not easy to understand the non-symmetrical character of the fibrinous exudation, while the mucous membrane appeared equally inflamed on both sides of the chest; in the latter it is still more incomprehensible, how the complete expectoration of an exten- sively ramified membrane could take place, without being observed during life. But of the fact of its presence on the right, and its en- tire absence on the left side, there is no doubt. The observation of these two cases, and the conclusions which appeared naturally to follow from them, as to the connection between collapse of the air cells and bronchial obstruction, tended to throw light on many of the obscurities of the preceding observations. More particularly, it seemed to me that they furnished the connectiim- link necessary for the explanation of the peculiar forms of lobular pneumonia (as they were generally considered), which had fre- quently occurred both in the lungs of children and adults. The