Part 2 — CHAPTER II. PATHOLOGICAL CONDITIONS. (continued 2)

In other cases, cavities lined with a smooth, semi-cartilaginous false membrane are found, containing air only, and with dilated bronchial tubes opening into the same, no appearance of ulceration being visible, everything indicating that a tubercular mass had once occupied the cavity, its softening and expectoration having been followed by a healing of the inner surface.

Morbid Growths.

Cancer. Malignant disease of the lungs is by no means frequent, yet we have abundant evidence that cancer in its 121several forms may be developed in these organs. Colloid cancer, has been usually found more or less infiltrated through the substance of the lungs, while other forms appear in nodules or isolated tumors.

It is seldom, perhaps, that cancer exhibits itself as a primary affection of the lungs, the disease first appearing in some other part, and more frequently, it is said, in the bones or testicles; operation for the removal of cancer in these parts being very liable to be followed by an early development of the disease in the lungs or other internal organs. On the other hand, where the cancer is connected with any organ whose veins form a part of the portal system, as the stomach, spleen, pancreas, intestines, etc., the disease does not so frequently extend to the lungs, while in those cases the liver is more liable to become affected.

The encephaloid form of cancer, is that more frequently met. It may be connected either with the bronchial glands, when the diseased mass will be mainly confined to the mediastinum, and may consist of bodies varying in size from that of a cherry to that of a large apple, or, the disease may commence directly in the substance of the lungs, the tumor rapidly increasing in size, and crowding the lungs from their normal position. After death, the encephaloid mass may be found compressing the lungs into a very small space. The tumor presents the usual character of this disease, some of the lobules being soft and pulpy, or brain-like, others of a more firm, cheese-like consistence.

Melanosis. Two forms of melanotic deposits are observed in the lungs: one, true melanosis, and frequently associated with encephaloid disease; the other a deposit of carbonaceous matter from coal dust, smoke, etc., which has been inhaled during life, and distinguished as spurious melanosis.

True melanosis consists in a deposit of a dark pigmentary 122matter in the substance of the bronchial glands, found at the bifurcation of the trachea, and along the main bronchi. The glands are at the same time enlarged. The coloring matter may be solid, or slightly fluid, or pasty. At the same time the melanotic matter may be infiltrated to some extent into the substance of the lungs, or deposited in cysts within the same.

In spurious melanosis, the dark carbonaceous matter is diffused more or less through the whole lung, and may be seen distinctly through the pleura. The bronchial mucous membrane is more or less tinged with the same substance, and generally a quantity of black-colored fluid may be expressed from the cut surfaces.

Hydatids. Acephalocysts or animal hydatids, have not unfrequently been found in the lungs, and in several instances they have been discharged by expectoration.

These cysts vary in size from a cherry to an egg, and consist of a double membrane containing a limpid fluid within which other hydatids may be found, of the same character as the parent cyst. They may excite inflammation and suppuration in the tissues around, and thus become discharged into the bronchial tubes, the pleural cavity, or through the diaphragm into the abdominal cavity.

Cystic, Fibrous, Cartilaginous, and other forms of tumors, are occasionally found in the lungs, and, while they are generally small, they may acquire such size as to become a source of trouble during life.

The Bronchial Tubes.

The examination of the trachea and bronchial tubes in post-mortem examinations, is too frequently omitted. The lungs having been removed from the chest, they may be readily opened along their posterior aspect, and the bronchial tubes traced into the substance of the lungs. The 123pathological conditions of the bronchial tubes which may claim our attention, are inflammation in its various forms, obliteration, and dilatation.

Bronchitis. Bronchial inflammation has been divided into two varieties, according to the portion of the tubes affected. In one case the disease may be confined to the large and medium sized tubes; it is then known as tubular bronchitis. In the other, it is seated principally in the terminal ends, where the lining membrane is more delicate, and the tubes much smaller, and from this, extending to the air cells, forms what has been called vesicular bronchitis. The latter form is closely allied to pneumonia; in fact the two diseases pass into each other, and in most cases probably coexist.

Ordinary, or tubular bronchitis, is not often a fatal disease, hence we cannot speak accurately of its anatomical characters; yet, being frequently associated with other forms of fatal disease, we have opportunities of examining it under those circumstances. The lining membrane is then found thickened, rough, of a dark red or brown color, with more or less contraction of the calibre of the tube, and covered with a viscid, jelly-like mucus, often streaked with blood, and in some cases of a puriform character. This form of bronchitis may occur as a primary disease, or it may accompany tubercular consumption; is frequent in cases of heart disease, and may arise in the course of typhoid fever, measles, scarlet fever, and small-pox.

Vesicular bronchitis, from its involving the smaller tubes and air cells, is much more frequently fatal than the tubular form of the disease, although in fatal cases the two forms will usually coexist. In a post-mortem examination of these cases, we find the bronchial membrane red and injected, pulpy and thickened. In a more advanced stage, the air cells and smaller tubes are filled with a viscid, puriform mucus, which prevents the air from reaching the vesicles during life, and the 124lungs from collapsing upon opening the chest after death. Minute ulcers are not uncommon upon the mucous membrane, the effect of these, being that of changing the character of the secretion from a transparent mucoid, to an opaque purulent form.

Bronchial inflammation, as has been stated in another place, may result in emphysema of the lungs. In these cases, a valvular-like obstruction is produced in some of the bronchial tubes, which, offering little impediment to the entrance of the air, interferes with its escape, and thus by producing increased pressure upon the air cells supplied by the obstructed tube, a gradual dilatation or rupture ensues, resulting in the former case in vesicular, and in the latter, in interlobular emphysema.

Disease of the heart may also result from chronic bronchial inflammation. Not only respiration, but the circulation may be so impeded as to exert a direct influence upon the heart. From the difficulty which the blood encounters in flowing through the branches of the pulmonary artery, the main trunk of that vessel becomes permanently dilated, while the right ventricle, from the increased force required to overcome the obstruction in the lungs, becomes gradually dilated, and at the same time, perhaps, hypertrophied. From the union of the two ventricles, the excessive action of the right may induce a similar action in the left, and thus in time result in that hypertrophy of both ventricles, which is sometimes found in persons who have suffered from chronic bronchitis.

Narrowing or Obliteration of Bronchial Tubes. In some cases, in carefully tracing the bronchial tubes, we may find either a remarkable narrowness of the vessel, or a complete closure of the same. In the former cases, there is a distinct thickening of the walls of the tube, by an effusion of lymph, or blood and lymph, into the submucous tissues; 125or, from induration of the lung tissue around the smaller bronchial tubes, from tubercular or other deposits, a similar narrowing may result from external pressure.

Complete closure may be found in any portion of the tubes, in the large trunks, arising from the main branches, as well as in the smaller branches. They may be detected by passing a blunt probe into the tubes. The branches will frequently be found continuing from the points of closure, as a fibrous cord. The most common seat of these closures is in the upper lobe of the lung, yet they have been found in the lower lobes.

The causes of obliteration of the bronchial tubes is not well understood, yet, they are more frequently observed in persons who have suffered repeated attacks of bronchitis, or of chronic pneumonia.

Dilatation of the Bronchial Tubes. This condition of the bronchial tubes is more frequent in its occurrence than obliteration. It takes place in two forms, either several tubes are uniformly dilated, like the fingers of a glove, or a single tube may form a cavity, by undergoing a sacular enlargement. Some mechanical obstruction, by interfering with the free passage of air through the tubes, will usually have caused the difficulty, as an enlarged bronchial gland, pressing one of the bronchi. Here the free exit of the respired atmosphere being prevented, an accumulation of air takes place behind the narrowed point. Any impediment to the entrance or exit of the air into the lungs will produce irregular and forcible breathing, and throw a greater strain upon those parts especially which are in the vicinity of the obstacle. If, at the same time, the patient suffers an attack of asthma, bronchial catarrh, or whooping-cough, the violence of the cough materially aids in developing the dilatation.

The degree of dilatation is greatly variable. Tubes which, in their natural state, are not larger than a crow-quill, may, 126especially in the lower and middle lobes, reach the size of the finger, while at various points, sacular dilatations may occur, which at first sight may appear as vomicæ, but which upon more careful inspection, prove to be dilated portions of the bronchial tubes. The tubes in this state are usually filled with a puriform fluid, upon the removal of which the lining membrane is seen to be reddened and softened, or perhaps ulcerated.

This condition of the bronchial tubes may frequently be detected during life. The voice is hoarse, like a person in croup. The cough is also hoarse and brazen, while the breathing is difficult, and mucus rattling is heard in the middle or lower portion of the lung.

The post-mortem appearances in cases of foreign bodies in the bronchial tubes, may be readily anticipated and easily recognized.

The Mediastinum.

Inflammation may arise in the anterior mediastinum, from fracture or caries of the sternum; and in the posterior, from injury, inflammation, caries, or necrosis of the vertebræ. This inflammation may also result in the formation of an

Abscess; or, ulceration and perforation of the œsophagus, or inflammation of the lymphatic glands may lead to the same results. These abscesses may reach large size, resulting in displacement of the heart, and may rupture into the pleural cavity, the trachea or œsophagus.

Tumors of various kinds, may also develop within this space, including the several forms of cancerous growths. The latter will frequently have their origin in the bronchial or lymphatic glands, or, perhaps, in the remnant of the thymus gland.

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