The Lettsomian Lectures on the Combinations of Morbid Conditions of the Chest: Delivered before the Medical Society of London
Authors: F. T. Roberts
Journal: BMJ (1895)

LECTURE I. DR.ROBERTS, in his introductory remarks, observed that, though it was well known that the majority of chest cases did present combinations of morbid states and were not cut and dried examples of individual diseases, such as they were described in textbooks, yet his observation had forced him to the conclusion that the fact was by no means so generally recognised and appreciated as it ought to be, and, further, that certain conditions of real consequence were often entirely ignored.A not uncommon practice was to enter- tain an incomplete conception of the contents of the chest, and he enumerated the following structures as those which had to be borne in mind:1.The chest walls, including the superficial and muscular tissues, as well as the bony and cartilaginous framework.2. The diaphragm, a structure as a rule entirely forgotten and ignored.3. The lungs and pleurae, with the trachea and its primary bronchial divisions.4. The heart and pericardium, with the great vessels, both arteries and veins.5. The less prominent contents of the mediastinum, in- cluding the cesophagus, absorbent glands, thoracic duct, certain important nerves, not forgetting even the thymus gland, and the mediastinal cellular tissue.6.The abdominal viscera contiguous to the diaphragm, which, though not actually contained in the thoracic cavity, come normally more or less within the area covered by the ribs, especially the liver, stomach, and spleen.By morbid conditions he understood both functional disorders and organic changes.The organic changes might, he said, be grouped as follows:1.Those which are not injurious in themselves, but are important on account of the physical effects which they produce, and this class of lesions are often the remains of some previous acute or active disease.2. Permanent structural changes impairing the functions of organs.3.More or less acute diseases or morbid conditions, which are temporary, inasmuch as, if they do not prove fatal from their extent or severity within a limited period, they, as a rule, clear up in the ordinary course of events, or are re- stored to the normal state when their determining causes are removed.4. Changes which are grave in themselves, either from the immediate danger due to some serious lesion; from their essentially fatal tendency; from being of a destructive type, or of a septic and infectious nature; or because they become the occasion of, or predispose to, dangerous secondary lesions. 5. Morbid conditions, often obvious enough and persistent, but which in reality are of a curative or compensatory character.These may be quite harmless, or even in a way beneficial and helpful, but not uncommonly they become more or less injurious from a physical point of view, or they are accompanied with impairment of function, owing to the permanent damnage done to the affected organ, of which they are the evidence and outcome.GENERAL CLASsIFICATION.Entering, then, upon the proper subject of the course of lectures, Dr. Roberts presented the following table, being a general classification of the combinations of morbid condi- tions of the chest: TABLE I.-General Classification of Morbid Conditions of the Chest, and their Combinations.I. Conditions of chest walls and diaphragm.If. Slight, or indefinite intrathoracie changes.III.Combinations of changes belonging to Nos.I and Ir.IV. Secondary effects of certain intrathoracie physical conditions.V. Combinations of chronic chest diseases or their remains.VI.Combinations in acute cases.VII. Combinations due to accidental lesions or complications, usually sudden.VIII.Combinations associated with sudden or acute disorders of function, temporary or paroxysmal.IX.Combined conditions originating from the abdomen.I.