On Certain Points in the Pathology and Treatment of Indigestion
Authors: T. L. Brunton
Journal: BMJ (1881)

THE BRITISH MEDICAL JOURVAL.41 6.In so-called catarrhal pneumonia, the phenomena ultimately in- volve a new growth in the alveolar walls and interlobular spaces, affecting the vascular supply of those tissues.7. A further necrosis of the alveolar walls, and of the new growth surrounding the vessels and involving the neighbouring parts, may lead to cavity in the lung.8. A cretifaction may occur, the products being imbedded in the lung.9. Or a new development of fibrous tissue may take place, deficient in vascularity, and of low vitality, but contractile and capable of exten- sion, involving all tissues of the lung and also the pleura.o1.A resulting contraction of the lung and of the whole side may take place, followed by displacement of viscera.II.These fibrous alterations in the lung-tissue are an inevitable feature of all chronic lung-affections, and influence their progress and termination more than any other factors in such diseases.As a leading feature in any case, their influence is conservative, and tends to chro- nicity and prolongation, retarding and counteracting the more serious events of hemorrhage and secondary septic infections.There are one or two points which suggest themselves from the con- siderations I have brought before you.If chronic phthisis arise out of inflammatory products in the lung, and not from a special and peculiar deposit-the result of a diseased constitution, or a previously existing condition, antecedent in point of time, to all local disorder-is it to be considered a local or a constitu- tional affection ?If local, it belongs to the class of inflammations; or, at least, it is a specific inflammation.Another and most practical question is, whether catarrh in its ordinary form leads to phthisis ?As it has been ascertained that catarrhal pneu- monia, which seems, indeed, undistinguishable from phthisis, originates in a catarrh of the minutest bronchi, which has become localised.If this question be answered in the affirmative, we should find innumer- able cases of ulcerative disease of the lung arising out of that capillary bronchitis which affects the minutest bronchioles.But I believe it may be clinically asserted that such sequence is a very rare event-so rare, indeed, as to be exceptional.While most cases of phthisis arise out of a gradual, almost unperceived, disorder of health, in which the patient can scarcely say whether the weakness or the cough was the earlier symptom.It is quite certain, as Louis has observed, and every other authority has confirmed, that it is most rare that any patient can refer the first beginnings of his cough to a cold-catching or exposure well within his notice.Again, such catarrhal colds affect large tracts of both lungs when they become bronchitis; and the essential character of phthisis is local- isation-one apex-one limited tract of lung.This opens the way to much deeper considerations, which I shall take leave to bring before you at my next lecture.WOLVERHAMPTON.-The report for this borough is for the twelve months, ended September last.This is to be regretted, as the statis- tics of Wolverhampton cannot be properly compared with those of other large towns.The death-rate during the period reported on, was 21 per I,o0o, or, deducting deaths not belonging to the borough, 20 per I,OOO.Of the I,640 deaths, no less than 726 were of children under five years of age, and 491 of infants under one year.Mr. Love seems to think that the sanitary authority can do nothing to reduce this terrible pro- portion, though the uninhabitable nature of the dwellings in some parts of the borough, would seem to point to the adoption of the Artizan's Dwellings Act, as a partial remedy for the evil.He, Mr. Love, whilst admitting that errors of diet and delicacy of infants, have their place in causing infantile mortality, feels "constrained to add, that it may in the main be traced to the scourge of this country, drunkenness; for where do we find premature birth, marasmus, inanition, atrophy, diarrhoea, and convulsions most prevalent, but in the wretched squalid hovels of the drunkard, the dissipated, and the indolent ?"The num- ber of deaths from "preventable " disease is given as 46, though we find I96 deaths referred to the zymotic class, including IOI from diar- rhcea.Scarlatina was fatal in 31 cases; the agency of schools in the propagation of the disease having been especially noticed.The mor- tality from measles has largely diminished, and typhoid fever was fatal in only two cases.Phthisis and chest affections again contributed the largest quota of deaths, 491, and were especially fatal to young chil- dren and old persons.The sanitary work of the borough seems to be pushed rapidly forward, and if we may judge from this prefatory report, there is an unusually enlightened sanitary committee in the town.