Page images
PDF
EPUB

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.

ON

CONGESTIVE PNEUMONIA,

CONSEQUENT UPON SURGICAL OPERATIONS,

DISEASES AND INJURIES.

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.

serves the attention of the surgeon. I mean that variety of Pneumonia, which occurs in connection with, or as a consequence of, surgical operations and injuries, and which is not dependent upon the absorption of pus.

In a Table* appended to this paper, will be found an account of the condition of the lungs in sixtytwo cases of death after surgical operations and injuries. Before proceeding to the analysis of this, it may be necessary, in order to avoid all misconception, to point out those circumstances that have been considered to serve as distinctive signs between Pneumonia, properly so called, and mere passive congestion of the lungs.

The anatomical characters of the first stage of inflammation of the lungs, more especially when that disease assumes an asthenic type, are in all respects similar to those of mere passive congestion of those organs. The lungs, in both cases, being heavy from sanguineous engorgement, presenting externally a livid violet hue, mottled with spots of a dark red, or purple colour, and preserving the impression of the finger, as if oedematous. When pressed upon, they will be found to be more compact and solid than natural, scarcely crepitating. When cut into, a frothy, spumous, reddish fluid

* I may mention that the cases contained in this Table have been calculated indiscriminately, and not selected, from the records of University College Hospital, that very many of them fell under my own observation, and that all deaths occasioned by burns, which are attended by peculiar lesions, have been omitted.

exudes in considerable quantity, and the pulmonary tissue will, at the same time, be found to be altered in its consistence, breaking down readily under even moderate pressure of the finger into a grumous pulpy mass. This friability of the tissue of the lung has been, by many, supposed only to occur in those congestions of that organ which were of an inflammatory nature, but it has been proved by the observations of Andral, and others, to be of no value as a diagnostic mark in distinguishing these from the mechanical engorgement that frequently supervenes but a few hours before death, and which, when it occurs, is probably the immediate cause of that fatal event. In order, therefore, to avoid all source of fallacy by confounding together these two conditions, that so closely resemble one another in their anatomical character, though differing so materially in their essential nature, I have comprised under the term Pneumonia, only those cases in which either one lung alone was affected, or else, in which some other possible sign of inflammatory action was manifested in the cavity of the thorax beyond a merely congested or softened condition of these organs, such as solidification of their tissue, whether hepatization or splenization of it, the effusion of recent lymph or serum into the pleural sacs, or marked evidences of inflammation of the bronchial mucous membrane.

In accordance, then, with this distinction, between an inflammatory and merely congested condition of the lungs, between an active and passive hyperemy

« PreviousContinue »