Volume 1

The practice of medicine / by Thomas Hawkes Tanner.

  • Tanner, Thomas Hawkes, 1824-1871.
Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: The practice of medicine / by Thomas Hawkes Tanner. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    608/672 (page 584)
    bronchitis. [pabtiv. tubes, will be found ehoked with mueus or muco-pus, and the lungs will be hyperjEinie and often oedematous, while they will also be large and not collapsing. Spnj)tom.s.—i:\\e chief symptoms consist of fever, which, how- ^r^^i MV and is characterized by recurring sensations ot chilliness with a sense of tightness or constriction about the chest, sternal pain or tenderness, impeded respiration with wheez- ing, severe cough, and expectoration—at first of a scanty viscid glairy mucus which subsequently becomes more copious and puru- ent. The pulse is frequent and often weak; the temjierature in the axilla varies from 99-5 to 102°; the tongue is furred and foul; and there is headache, together with lassitude, sickness, and often much mental uneasiness or even great anxiety. Inflammation of the larger and medium-sized tubes is attended bv less severe symptoms, and is much less destructive to life than general and capillary bronchitis, in which all the ramifications of the bronchi are affected. This latter form of the disease is chiefly seen in the very young and old, being rare in adults : while it is readily recognised by its tendency to produce asphyxia; by the paroxysmal attacks of dyspnoea [Auc =• difficulty + irvio) = to breathe], as well as by the congestion of the surface of the body, the perpetual cough, and the extreme general restlessness. The patient is obliged to sit up in bed ; orthopnoea [’OpObg = erect + TTVEtt)] ; the urine is scanty, deep-coloured, of high specific gravity, and sometimes slightly albuminous ; the skin is clammy ; the pulse is regular but feeble, and from 120 to 150 ; fhe prostration rapidly increases, and we may have anasarca of the feet and legs ; while in fatal cases there will soon be somnolence, muttering delirium, coma, and death. That severe suffering, not uncommonly ending in the destruction of life, should thus result, is only what we might expect; for to congest and thicken the lining mucous membrane of the capillary bronchia, and then to coat it with viscid mucus, is virtually to completely occlude these air passages. From time to time it happens during the progress of a case of bronchitis, that one or more of the tubes become choked uj) with the viscid phlegm ; and we have, as the result, ptdmonary collaj^se, a portion of the lung being emptied of air. Thus, supposing a plug to form in one of the bronchi, the lung beyond it in expira- tion soon forces out the air by the side of the foreign body ; but each inspiration draws the obnoxious substance towards a narrower part of the tube, which it seems effectually to cork up. The con- sequence is, that as each succeeding expiration expels the air re- tained behind the obstacle, while none is inspired to take its place, the sacs or vesicles must collapse. Then the collapsed portion of the pulmonary tissue becomes condensed; this condensation having been formerly considered as due to inflammation, whence it was termed lobular pneumonia. One frequent result of the collapse is the production of vesicular emphysema ; so that the loss of volume