Contributions to the pathology and treatment of diseases of the chest / by Eben. Watson.

  • Watson, Ebenezer.
Date:
[between 1850 and 1869?]
Catalogue details

Licence: Public Domain Mark

Credit: Contributions to the pathology and treatment of diseases of the chest / by Eben. Watson. Source: Wellcome Collection.

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    with, suppuration of the affected lobules before the patient dies. But while I would, therefore, accord to the proposition that lobu¬ lar differs from lobar pneumonia in no essential, excepting the extent of the part affected by the disease, yet for reasons formerly given I cannot deny, nor is it necessary for consistency that I should deny, that the pneumonic affection is frequently secondary to bronchial inflammation, as Guersent originally stated. One has only to study the minute anatomy of the terminal bronchi, to be persuaded that inflammation may invade the air cells, by reason of their continuity with the bronchi, and yet the disease secondarily produced is something very different from bronchitis. For how materially is the structure of the tubes altered on their approach to the air cells; how few of the characters of a mucous membrane does their lining membrane retain. Why, about one- eighth of an inch from the last air cell to which it leads, according to Messrs. Todd and Bowman, the terminal bronchi lose their epithelium, as well as their muscular tunic, and are “ reduced to basement membrane, and yellow elastic fibres, which become blended into a single coat—the only membrane composing the tubes beyond, and the air cells.” * If, then, the structures of these two parts of the same tube are so widely different, it is but in accordance with the laws of the animal economy that disease should evoke from them different morbid products, and be accompanied with different pathological results. Thus it is, in short, to quote once more the words of Lebert, that—“ ces divers etats, tout differents les uns des autres qu’ ils paraissent au premier aspect, ont pourtant entre eux des lieus physiologiques bien reel et faciles a demontrer.”f Having thus, at some length, explained the nature of the lobular pneumonia of children, I must now discuss the subject of its treatment in a very few, and these very short paragraphs. The first therapeutic indication is to relieve the congested lobules and equalize the circulation through the pulmonary capil¬ laries. As an essential step to this end, the secondary excitement of the general circulation must be allayed ; the heart’s action must be diminished, in order that the over-loaded pulmonary capillaries may have time to disgorge their contents into the radicles of the pulmonary veins. And in pursuing this object, we must bear in mind the normal forces, the full operation of which we desire to recall. We must remember the power which a natural and full act of respiration exercises over the motion of the blood within the lungs, as well as the undoubted influence which the chemical changes there wrought in the blood exerts over its passage through the capillaries, where these changes are, or ought to be effected. It is not the quickness of the breathing, but the fulness of it which brings into most effective operation the forces just mentioned. The irritated or oppressed lung excites numberless * Physiological Anatomy, p. 390. t Phys. Path. tom. i. p. 129.