Report on the progress of pathology, practical medicine, and therapeutics; for the years 1842-3-4 / By James Risdon Bennettt.

  • James Risdon Bennett
Date:
[1845]
Catalogue details

Licence: Public Domain Mark

Credit: Report on the progress of pathology, practical medicine, and therapeutics; for the years 1842-3-4 / By James Risdon Bennettt. Source: Wellcome Collection.

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    tion. The disease was singularly localized, occupying the glottis alone, the orifice of which was completely closed by warty excrescences growing from the edge. Two examples of polypoid growths in the trachea have been recorded. In one, detailed by Mr. Stallard,* death occurred after a severe paroxysm of coughing, lasting an hour. A loose polypus of the size of an almond was found in the trachea, and the root of the pedicle was attached to the mucous membrane, just below the cricoid cartilage. The woman had, for some time, been subject to cough and asthmatical symptoms. In the second case, M. Ehrmann,f having ascertained the existence of a fibro-cellular tumour engaged in the rima glottidis, had recourse to tracheotomy to save the woman from impending suffocation, and two days subsequently cleft the thyroid cartilage, when the polypous ex¬ crescence was exposed, and removed from the inferior ligaments of the larynx, to the whole length of which it was attached. Pneumonia. Dr. Addison t thinks that what is called simple pneumonia is not really so uncomplicated an affection as is supposed, but should rather be called a broncho-pneumonia. A truly simple pneumonia does, however, occur, and may be unattended by either cough, expectoration, or pain. He considers the air-cells to be the original seat of pneumonia, and not the interstitial tissue, of which he denies the existence. [In what way, then, does the author suppose the vessels which ramify on the exterior of the air-cells, are connected with the pa- rietes of opposite cells ; do they lie in naked apposition with the cells? There is surely, as all analogy would lead us to believe, some connecting tissue, and this, to other observers, at least, the microscope appears to reveal.] The first effects of inflammation are the arrest of the natural secretions of the cells, the effusion of serum into them, (not into the interstitial tissue,) subsequently the swelling of their walls, and thus encroachment on theircavities, and absorption of the serum previously effused. In this state the tissues are brittle and con¬ solidated ; in the state of red hepatization. As the inflammation proceeds, the parietes of the cells become more opaque and thickened, the minute blood¬ vessels are no longer visible, the tissues become soft, and with this loss of cohe¬ sion and diminished vascular turgescence, the cells admit of albuminous matter being poured into their cavities. This constitutes the gray hepatization. In cachectic subjects this change is commonly limited to separate lobules. What is called carnification of the lung, Dr. Addison considers to be merely the effect of pressure, sufficient to force out all the contained air. The above may be considered the immediate effects of inflammation. The permanent effects pre¬ sent three forms : 1. The uniform albuminous induration, which is the least fre¬ quent, but occasionally occurs as the result of acute pneumonia in healthy con¬ stitutions. The effect of this is to transform the parts implicated into a uni¬ form, homogeneous, opaque, or semitransparent mass, in which no trace of the ordinary structure of the lung can be detected. ‘2. The granular induration, which is caused by the effusion of a less organizable albumen. In this form the lobules, with their still distinct cells, filled with the effused matter, may be distinguished, and present something of the character of a raspberry. This is sometimes called inflammatory tubercle. 3. The gray induration, consisting of a mixture of yellowish, white, and black matter in varying proportions, the density increasing with the darkness of the colour. The albuminous effusion, in this condition of lung, has partially undergone organization and contraction and thus glued together, and hardened the aerial cellular tissue. In proof of these changes being the result of inflammation, and not of tubercular infiltration, Dr. Addison adduces various [and satisfactory] reasons. Gangrene of the lung. [This is by no means of so unfrequent occurrence as some have supposed, and the great interest and importance of the subject, as well as the complete obscurity in which the genesis of some forms of pulmonary * Londo i Medical Gazette, 19 May, 1843. t Guy’s Hospital Reports, 2d series. No. ii. f Comptes Rendus, April 1, 1844.
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