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.

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    CHANGES IN THE FOKM OF THE CHEST. creased resistance. Under such circumstances, it is not very un- usual to find the movements of the lateral regions of the chest actually reversed, the parietes being, as it were, sucked inwards at each descent of the diaphragm, owing to the external atmospheiic pressure overcoming their power of expansion. This yielding of the ribs I have indicated as probably one of the causes of the extremely frequent occurrence and great extension of bronchitic collapse m very young subjects. In rickety individuals it is not only more marked, but apt to become permanent, especially when such subjects are affected with any considerable or persistent bronchitic affection. In such cases, the reversed movement of the ribs is stereotyped, as it were, in the form of chest called pigeon-breast, m which the sternum is protruded, particularly below, and the whole lateral region, including also the lower costal cartilages m front, flattened, or even at some points rendered irregularly concave. Many slighter and more partial permanent irregularities m the form of the chest are no doubt owing to infantile bronchitic attacks, either modifying the original expansion of the lung, or producing subsequent partial coUapse of its tissue. The immense frequency ot such diseases in childhood, and the unquestionable tendency which they are now shown to have towards structural changes, will prob- ably go far to account for many of those disorganizations in the lung, revealed by morbid anatomy in a large proportion of cases, and which often seem to have no connection with any thing in the history of the individual. To a similar source may, in all probability, be justly traced most of the so-called physiological heteromorphisms of the chest, described and investigated with such elaborate minuteness by M. Woillez.1 According to this writer, these slight and trivial devia- tions of the apparently healthy chest, occupy, for the most part, the same situations as those which are known as the results of disease; and, indeed, it would appear that the physiological and patho- logical irregularities are by no means separated by a very distinct line of demarcation. It is quite true that, in many of the individuals presenting these changes, no history of chest-disease can be procured; but every one accustomed to the task knows that the elimination of information in regard to diseases of early life, is, in the cases of most hospital patients, nearly impossible, even where the disease has been of considerable importance. In so far, therefore, as these physiolo- gical irregularities are worthy of consideration at all,21 cannot but 1 Recherches Pratiques sur l'lnspection et la Mensuration de la Poitrine. Paris, 1838. 2 This qualification is not unimportant, seeing that M. Woillez, hy means of rather ponderous statistical machinery, has arrived at the singular conclusion, that only 1 in 3 of the healthy chests, and about 1 in 5 of allthe chests examined by him, present a strictly regular conformation. It is obvious that, with a few more refinements such as those to which this observer has devoted so much labour, the ideal of regularity would require to be sought altogether beyond the K