Researches on phthisis: anatomical, pathological and therapeutical / by P. C. A. Louis.

  • Pierre Charles Alexandre Louis
Date:
1844
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Licence: Public Domain Mark

Credit: Researches on phthisis: anatomical, pathological and therapeutical / by P. C. A. Louis. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    Compression of the bronchi by tubercles developed at the root of the lungs is a phenomenon of which I have myself witnessed no example; nor have contemporary observers been more fortunate. Still the occurrence can be easily conceived ; the more so as M. Reynaud, in his ' Essay on Phthisis in the Quadrumaua/ actually narrates a remarkable example (Case viii) of the kind^ observed in one of those animals. In this case a globular mass of bronchial glands, completely con- verted into tuberculous matter, surrounded the left bronchus, and flattened the tube to such an amount as to obliterate its cavity altogether, and render it difficult to force the blade of a small scalpel through the contracted part;—^this part measured about half an inch [12 millimeters] in length.: further on, the caliber of the tube became natural. The corresponding side of the chest was remarkably contracted, and the left lung com- pletely collapsed and free from air,—in the precise state, in short, in which it is found in cases of compression of the organ by chronic pleuritic effusion. But there was no liquid present; the pleura was perfectly healthy and free from adhesions. Were a case of this kind to present itself in the human sub- ject, its nature would almost inevitably be mistaken, unless the patient were observed while the compression of the bronchus was still recent, and unless the observer could follow the pro- gressive diminution in the force of respiration and the equally gradual decrease in the bulk of the thorax. These conditions would, however, point to the real nature of the case; for where diminution in the size of the chest coadvances with^diminution in intensity of the respiratory murmur, the idea of pleurisy could not be entertained, inasmuch as this would be accom- panied by symptoms following an opposite course. It would then be scarcely possible to do otherwise than suspect the existence of a tumour of some kind or other pressing upon the bronchi. Since the publication of the first edition of this work, the morbid anatomy of the tuberculized lung has made unquestion- able progress, more particularly in respect of its vascular system. It was, no doubt, well known fifteen years past, that the rami- fications of the pulmonary artery penetrate neither into tubercles properly so called, nor into gray semi-transparent gi'anulations ; but our knowledge on this subject has since then advanced.