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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    2d, The theories of the origin and pathological nature of the disease; and 3d, The therapeutic indications presented by it, and the most suitable means for their fulfilment. Looking to the disclosures of the scalpel in subjects dead of this disease, there are evidently two kinds or degrees of it; one in which the affected lobules are isolated, with healthy pulmonary tissue inter¬ vening ; and another in which the superficial lobules of greater part of a lobe, or of all the lobes of a lung, are implicated. In all my cases of lobular pneumonia, the disease has invariably affected only one lung, and more frequently the anterior than the posterior lobules of its lower lobe. In the inspections which I have had the opportunity of making, but which, it must be confessed, do not number very many, I have generally found the superficial lobules specially affected by the pneumonic condensation; and I am inclined to consider this the general rule in children; for in adults, when lobular pneumonia results from phlebitis, some of the cen¬ tral lobules are more usually attacked, and in the latter cases also, more frequently than in the former, does suppuration, or the third stage of the pneumonic process, ensue before the death of the patient. But wherever it is situated, whether on the surface or in the substance of the lobe, in the cases with which I have at present specially to do, the affected lobule is usually found of a deep red or violet colour; it does not crepitate when pressed be¬ tween the fingers, but a little bloody fluid is generally squeezed out of its air tubes; it sinks in water, and its cells can only some¬ times be inflated. Its cut surface is smooth and like that of he- patized lung. The capillaries in the walls of the air cells are gorged with dark blood, and they seem thickened with exudation matter. The lining of the bronchial tubes, especially of the smaller ones near to the diseased lobule, are generally deeply con¬ gested, and contain frothy mucus, which is occasionally tinged with blood. Morbid anatomy, therefore, establishes two lesions in most of these cases, viz. bronchitis and condensation of the vesicular tissue of the lobules. It cannot, however, prove to us the priority of either of them. For evidence on this point we must look to clinical data, but even these do not afford a very satisfactory solution of the difficulty. I am well aware of the common opinion that lobular pneumonia is always secondary, but I am by no means persuaded that this opinion rests on a logical foundation. True it is, that in many cases bronchitis seems to precede, for a longer or shorter period, the pneumonic condensation of the lobules ; but this is neither a universal nor a necessary course of things. Case I.—I have notes of one case, of a child six years old, that died suddenly in a fit. He had been in good health up to the very day of his death, when certain obscure head symptoms pre-
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