« PreviousContinue »
of the descending cornua of the thyroid cartilage on the right side.
The left lung was in a state of congestion like the right, but otherwise healthy. The heart was small but normal.
The liver was large and gorged with dark blood, but no traces of inflammation in it were discoverable.
The other portions of the abdominal viscera were not examined.
A portion of the calcareous mass taken out of the right bronchus was analysed by Dr. Burton, and found to consist of phosphate of lime.*
The foregoing case offers much matter for reflection. The real seat of disease was certainly not known, nor even suspected, during life, but, nevertheless, some points had been diagnosticated, which dissection fully verified. Auscultation had pointed out the healthy condition of the heart and of the lungs.
Percussion of the chest had dispelled the apprehension, at one period entertained, of effusion into the cavity of the pleura.
Laryngitis had been very clearly distinguished, as soon as the stridulous breathing and the hoarseness were added to the spasmodic cough.
Deep-seated dysphagia certainly did exist, and ought perhaps to have attracted more attention, but the peculiar nature and extreme rarity of this case, may well plead in extenuation of the diagnostic error committed.
* A preparation of the diseased mass was made, which is deposited in the Museum of the Medical Department of the Army at Chatham.
It is scarcely possible to conceive a case wherein the appearances on dissection more satisfactorily explain the whole course of the phenomena during life. It is evident that the moment the fcetor was noticed by the patient the abscess had opened into one, or probably into both, bronchial tubes. The sense of suffocation attending the recumbent position no doubt arose from the pressure of the large tumour upon the trachea, and probably by a portion of the calcareous mass slipping occasionally into the right bronchus, the aperture of which was so much larger than that of the left bronchial tube.
The sudden extinction of life may be accounted for by the calculus found wedged in the right bronchus, added to the partial obliteration of the left.
Spasmodic closure of the glottis was probably the last in the series of phenomena.
The observations of authors on the diseases of the bronchial glands, and of the cellular tissue in which they are imbedded, are few, and not characterized by great accuracy. Dr. Baillie's " Morbid Anatomy" is silent on this portion of pathology.
Laennec (chap. 9) remarks, that "inflammation of the bronchial glands is very little known, and appears very rare." He adds, that "Cretaceous matter and tubercle are the two kinds of accidental productions observed in these glands. The former is sometimes found quite dry and hard, but more commonly so soft that it may be forced out by pressure." "When cretaceous matter is formed, it is rare," he says, " to find the whole structure of the gland involved. It occupies the centre of the gland." He has seldom met with abscess in the bronchial glands, nor has he ever seen the disease in them assume the character of bone. He further remarks, that " tuberculous disease of this structure is frequently found without accompanying tubercles of the lungs, or marks of any severe affection of that organ."
Dr. Stokes remarks, (page 303,) that "disease of the bronchial glandular structure has not obtained separate investigation. Yet from recorded cases, we may conclude that these glands, when hypertrophied or otherwise diseased, seldom produce any striking symptoms."
Dr. Stokes proceeds to observe, that " according to Andral, tumours of the bronchial glands frequently cause tracheal and bronchial compression. I have never myself," he adds, "met with any instance of stridulous breathing, or even bronchial compression, produced by this disease."
Berton, who, according to Dr. Stokes, is the latest writer on the subject, dwells strongly on the fact that the bronchial glands may be greatly hypertrophied, without causing compression of the blood-vessels and air-tubes.
A case is recorded by Andral, where an enormous 28 Dr. Tice's Case Of Bronchial Calculus.
mass of melanosis compressed the right bronchus so as to diminish its diameter by one half. There was here no stridulous breathing, the signs being a feeble respiration in one lung, with intense puerility in the other.
My own reading has not furnished me with any case resembling the present.
At all events, there can be no question, that such an occurrence as calculus of the bronchial glands finding its way into the bronchus by ulceration, and suddenly destroying life, is extremely rare.
The case is interesting, too, on another account.
Disease of the bronchial glands, was in this instance, uncomplicated with disease either of the lungs, or of any other important viscus. The character of the symptoms, therefore, attending this singular variety of thoracic disease is here very unequivocally manifested.
The diagnosis of bronchial disease will probably be always attended with difficulties. Stethoscopic investigations may, as in the case now recorded, afford indirectly much assistance, but our surest and most efficient guide will be found in careful reflection on the nature and succession of the symptoms.
CONSEQUENT UPON SURGICAL OPERATIONS,
By JOHN E. ERICHSEN, Esq.
READ JANUARY 24th, 1843.
Notwithstanding the care with which the diseases of the lungs have, of late years, been studied, there is one form of inflammation of these organs that has escaped, with but few exceptions,* the notice of writers on this subject; but which, from the frequency of its occurrence, and the latent and insidious character of its symptoms, peculiarly de
* The only writer, with whose works I am acquainted, that enters to any length upon this subject is Sir C. Bell; who in his " Surgical Observations," devotes a "Report" to its consideration. Guthrie, in his Treatise on Gunshot Wounds, speaks of Pneumonia as a cause of death after operations, more particularly secondary amputations. Dr. Forbes, in his translation of Laennec's work on the Diseases of the Chest, mentions the subject in a note, and Dr. C. J. B. Williams, in the article "Pneumonia," Library of Practical Medicine, alludes to it as a variety of that disease.