On dilatation of the bronchi, or bronchiectasis / by T. Grainger Stewart.

  • Thomas Grainger Stewart
Date:
1867
Catalogue details

Licence: Public Domain Mark

Credit: On dilatation of the bronchi, or bronchiectasis / by T. Grainger Stewart. Source: Wellcome Collection.

    19/24 page 17
    Appendix of Illustrative Cases. Case I.—Bronchial Symptoms of some years’ standing—Consolidation of Lung— Death from Exhaustion—Autopsy—Bronchiectasis—Gangrenous Ulceration and Consolidation of Lung. Thomas Murray, set. 34, was under the care of Professor Maclagan. The patient had for some years suffered from short cough, especially in winter, but had not become emaciated or much enfeebled. His cough became gradually more severe, and he was admitted to the Infirmary, 1st June 1865. At that time there was complete dulness on the left side, posteriorly, with loud mucous rales, especially over certain parts, and harshness, with increased vocal reso¬ nance. Over the right side, also, there was dulness on percussion; and on auscultation, the breathing was harsh, and accompanied by mucous rales. His breath and sputum had a feculent odour. While under observation, gurgling sounds became more distinct throughout the chest. His pulse was of good strength. Suddenly, and without obvious cause, he became worse, and sank on 16th June. Autopsy.—The body was not emaciated. Both lungs were adherent; the left was dense and solid throughout the greater part of its extent; the right was consolidated in its upper half. Both contained numerous cavities through¬ out their substance, but there was no trace of tubercular deposit, and the cavities were evidently formed by dilated bronchi. A large proportion of the bronchi about the third and fourth division were dilated—some large enough to hold a minie rifle-ball. In some parts, the bronchial mucous membrane was thickened and ulcerated; and in the largest cavity, situated about the middle of the left lung, an ulcerative process had completely destroyed the walls of the dilated bronchi, and the cavity was bounded by consolidated lung tissue. The cavities contained purulent and slough-like masses, which had a peculiar feculent odour, and, on microscopic examination, were found to contain, besides numerous molecules and granules, a few vegetable structures and a large number of fine needle-shaped crystals of margarin. In some corners of the dilated parts, there were firm rounded masses of a dense consistence, but not calcareous. The other viscera were natural. Commentary.—Symptoms of chest affection, though not of an urgent character, had existed for some years ; and the lesions were doubtless well advanced when he was admitted on the 1st of June. The sudden increase of illness and the death were probably due to the gangrenous destruction of lung tissue, which had set in around one of the principal dilatations. Case II.—Deformity of Chest—Bronchitis, Haemoptysis—Fetor of Breath, Con¬ solidation of Lung, etc.—Death from Exhaustion—Autopsy—Bronchiectasis with Consolidation, etc. John Storrie, set. 32, a printer, was under the care of Professor Laycock. The patient had been deformed since he was nine months old; had marked lateral curvature; but was of steady habits, and had enjoyed tolerably good health until January 1865, when he had an attack of what he termed influenza. From this he entirely recovered, after five weeks’ illness. In July of that year he lay down in the Meadows, while heated, and at night had cough and sore throat. In August, he went to the country, and then spat a little blood. In the end of September he returned to Edinburgh, and again suffered from slight haemoptysis. His cough and weakness increasing, he was admitted to the Koyal Infirmary on 5th November 1865. At that time his pulse was rapid,— 120; his cardiac sounds were natural; his appetite was poor, his tongue foul, and he occasionally passed blood by stool. He had no haemorrhoids. His genito-urinary system was normal. There was dulness over the lower part of the right lung. The respiratory murmurs were harsh, and the vocal resonance increased. On the left side, there was dulness at the apex. The respiratory murmurs were the same as on the right side. The cough was short, frequent,
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