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BRONCHIECTASIS.
1033 the use of the endotherm knife in certain operations leads us to hope that further investigations will be carried out in this country. There is especial need for the correlation of the wave form of the highfrequency oscillations and the resulting changes produced in the various types of tissue cells. Apart from the destruction of neoplastic growth, the desirability is obvious of pursuing investigations into a technique by which no drop of blood is spilled. "Prepare thee to cut off the flesh," said Portia, "Shed thou no blood." It would seem that we are approaching an era of surgery when Portia’s dictum will not be accepted as a conclusive argument.
BRONCHIECTASIS. THE discussion
with pulmonary tuberculosis, but to watch carefully for the insidious onset of any signs of pulmonary sepsis which undoubtedly spell bronchiectasis. Children can be taught not to swallow their sputum, and the frequent bacteriological examination of their expectoration should never be neglected. In the late stages the onset of lardaceous disease seems to be a landmark in the slow progress of disease not infrequently overlooked ; frequent examinations of the urine would appear to be just as important as sputum On the morbid anatomy side of the picture tests. we are inclined to think that the frequency of cerebral abscess as a complication of bronchiectasis has Of much more importance been exaggerated. is the frequency with which a full bronchiectatic cavity is mistaken for an empyema, often with disastrous surgical results. The histological picture of bronchiectasis, too, is essentially disappointing. By the time these long-standing cases reach the postmortem room all hope of elucidating any satisfactory information as to causation has long since passed. In conclusion, therefore, we have frankly to acknowledge that although there are some recent signs of advance in knowledge, notably in the matter of lipiodol, the condition of bronchiectasis has not been. a conspicuous example of the advance of modern medicine, especially as regards the purely medical group of cases. That the purely surgical variety of the disease, associated with a traumatic factor or foreign. body, is a separate entity requiring separate consideration was well brought out in the Glasgow discussion.
bronchiectasis at the Royal Medico-Chirurgical Society of Glasgow reported in another column illuminates a number of issues upon which physicians and pathologists alike are still in doubt. Sometimes we may feel inclined to wonder if of this obstinate and unpleasant our knowledge disease is advancing at all. The treatment of the malady has certainly not made rapid strides, and the new major of surgery-thoracoplasty, and the like-have not been attended with that measure of success which has been noted in similar operations for pulmonary tuberculosis. Perhaps such success was hardly to be expected. The disease is usually far advanced when the patient readies the surgeon and the whole field of operation is saturated with the organisms of suppuration from which the numerous pleural adhesions are generally not exempt. It is JOHN LYDEKKER. clear, therefore, that if radical rneasures are to be A SMALL book written by Mr. W. R. Dawson and. adopted earlier diagnosis is essential, and along this published by the Seamen’s Hospital Society tells line, at any rate, some advance has been made with the story of a great hospital benefactor. John the introduction of lipiodol. The technique of this Lydekker, merchant of London and shipownerdiagnostic measure is safe and easy, and there is (1778-1831), had almost as great an influence on this reason to believe that the employment of the substance Society as would entitle him to the prayers usual on It behalf of a pious founder. His father left New York will go far to increase the value of diagnosis. presupposes, of course, the possession of an up-to-date when it ceased to be an English colony and brought X ray plant and a skilled technician to use it, and like his children to London. Here the eldest son was at one time an eminent physician, and the third son, John, so many of the modern diagnostic methods, it adds became a merchant in concerning himself yet another demand for increased facilities for the mainly with cane and Cheapside, then wanted for whalebone, institutional diagnosis and treatment of disease. But corsets and the ribs of umbrellas. he took Naturally even with this addition to our armamentarium we an interest in whaling ships in the South Seas, and he are still faced with many problems in the causation In 1830 he made a handsome owned four in 1829. of bronchiectasis. At the discussion in Glasgow donation to the Seamen’s Hospital in recognition Dr. JAMES ADAM mentioned the cases traceable to of their kindness to some Polynesian seamen from nasal sinusitis, a group not generally recognised in this i his ships. In those days, less than a hundred years life in London was much less secure than now ; country though described in American literature, I ago, water was often drawn from shallow, contaminated: whilst Prof. LEONARD FINDLAY, quoting Prof. Thames,. ARMAND DELILLE in support, emphasised the wells, drainage was by open sewers to the churches burials were apt to be made in the crypts of difficulties of those cases in childhood which had to avoid the resurrectionists. In July, 1832, Lydekkersymptoms but no signs, or even a complete absence went from his house in the Strand to stay with a friend of either. There is abundant evidence, indeed, for in Fenchurch-street, fell sick of cholera which was recognising non-tuberculous fibrosis of lung in then prevalent, and feeling himself near his end, childhood as the starting-point for many of these wrote out a short will which he signed, leaving the cases, and physicians who work in chest hospitals residue of his property to the Seamen’s Hospital This will, although unwitnessed, was not not infrequently have the mortification of watching Society. contested by his family, and brought the Society cases pf fibrosis of lung in children slowly going a sum of £58,729. At that time the Seamen’s Hospital downhill from fibrosis to bronchiectasis without was situated in the 104-gun ship Dreadiioi4rlht lying in any clear line of demarcation and without being the Thames off Greenwich, but in 1870 a 99-year lease able to call a halt in the disease. It seems unjustifiable of the old infirmary of Greenwich Hospital was to resort to drastic surgical measures as long as the acquired, and in 1926, with the help of the Lydekker condition is merely one of fibrosis and once sepsis- bequest, 1!23,00O left by B. T. Crichton, and other in other words bronchiectasis—has become established benefactions, patients to the number of 28.264 werein one or other of its eight establishments. surgical aid may well be too late. Probably, however, treated The Seamen’s Society owes many of its opportunities of these cases of fibrosis a certain go of usefulness to the munificence of only proportion shipowners. of on to bronchiectasis, and it would be a great boon if whom Lydekker was the most bountiful. There is We knew definitely what was the deciding factor. a marble monument to his memory at Lloyds and Meanwhile it is essential not to confuse the cases a stained glass window in the chapel at Greenwich. on
operations
BRONCHIECTASIS. THE discussion
with pulmonary tuberculosis, but to watch carefully for the insidious onset of any signs of pulmonary sepsis which undoubtedly spell bronchiectasis. Children can be taught not to swallow their sputum, and the frequent bacteriological examination of their expectoration should never be neglected. In the late stages the onset of lardaceous disease seems to be a landmark in the slow progress of disease not infrequently overlooked ; frequent examinations of the urine would appear to be just as important as sputum On the morbid anatomy side of the picture tests. we are inclined to think that the frequency of cerebral abscess as a complication of bronchiectasis has Of much more importance been exaggerated. is the frequency with which a full bronchiectatic cavity is mistaken for an empyema, often with disastrous surgical results. The histological picture of bronchiectasis, too, is essentially disappointing. By the time these long-standing cases reach the postmortem room all hope of elucidating any satisfactory information as to causation has long since passed. In conclusion, therefore, we have frankly to acknowledge that although there are some recent signs of advance in knowledge, notably in the matter of lipiodol, the condition of bronchiectasis has not been. a conspicuous example of the advance of modern medicine, especially as regards the purely medical group of cases. That the purely surgical variety of the disease, associated with a traumatic factor or foreign. body, is a separate entity requiring separate consideration was well brought out in the Glasgow discussion.
bronchiectasis at the Royal Medico-Chirurgical Society of Glasgow reported in another column illuminates a number of issues upon which physicians and pathologists alike are still in doubt. Sometimes we may feel inclined to wonder if of this obstinate and unpleasant our knowledge disease is advancing at all. The treatment of the malady has certainly not made rapid strides, and the new major of surgery-thoracoplasty, and the like-have not been attended with that measure of success which has been noted in similar operations for pulmonary tuberculosis. Perhaps such success was hardly to be expected. The disease is usually far advanced when the patient readies the surgeon and the whole field of operation is saturated with the organisms of suppuration from which the numerous pleural adhesions are generally not exempt. It is JOHN LYDEKKER. clear, therefore, that if radical rneasures are to be A SMALL book written by Mr. W. R. Dawson and. adopted earlier diagnosis is essential, and along this published by the Seamen’s Hospital Society tells line, at any rate, some advance has been made with the story of a great hospital benefactor. John the introduction of lipiodol. The technique of this Lydekker, merchant of London and shipownerdiagnostic measure is safe and easy, and there is (1778-1831), had almost as great an influence on this reason to believe that the employment of the substance Society as would entitle him to the prayers usual on It behalf of a pious founder. His father left New York will go far to increase the value of diagnosis. presupposes, of course, the possession of an up-to-date when it ceased to be an English colony and brought X ray plant and a skilled technician to use it, and like his children to London. Here the eldest son was at one time an eminent physician, and the third son, John, so many of the modern diagnostic methods, it adds became a merchant in concerning himself yet another demand for increased facilities for the mainly with cane and Cheapside, then wanted for whalebone, institutional diagnosis and treatment of disease. But corsets and the ribs of umbrellas. he took Naturally even with this addition to our armamentarium we an interest in whaling ships in the South Seas, and he are still faced with many problems in the causation In 1830 he made a handsome owned four in 1829. of bronchiectasis. At the discussion in Glasgow donation to the Seamen’s Hospital in recognition Dr. JAMES ADAM mentioned the cases traceable to of their kindness to some Polynesian seamen from nasal sinusitis, a group not generally recognised in this i his ships. In those days, less than a hundred years life in London was much less secure than now ; country though described in American literature, I ago, water was often drawn from shallow, contaminated: whilst Prof. LEONARD FINDLAY, quoting Prof. Thames,. ARMAND DELILLE in support, emphasised the wells, drainage was by open sewers to the churches burials were apt to be made in the crypts of difficulties of those cases in childhood which had to avoid the resurrectionists. In July, 1832, Lydekkersymptoms but no signs, or even a complete absence went from his house in the Strand to stay with a friend of either. There is abundant evidence, indeed, for in Fenchurch-street, fell sick of cholera which was recognising non-tuberculous fibrosis of lung in then prevalent, and feeling himself near his end, childhood as the starting-point for many of these wrote out a short will which he signed, leaving the cases, and physicians who work in chest hospitals residue of his property to the Seamen’s Hospital This will, although unwitnessed, was not not infrequently have the mortification of watching Society. contested by his family, and brought the Society cases pf fibrosis of lung in children slowly going a sum of £58,729. At that time the Seamen’s Hospital downhill from fibrosis to bronchiectasis without was situated in the 104-gun ship Dreadiioi4rlht lying in any clear line of demarcation and without being the Thames off Greenwich, but in 1870 a 99-year lease able to call a halt in the disease. It seems unjustifiable of the old infirmary of Greenwich Hospital was to resort to drastic surgical measures as long as the acquired, and in 1926, with the help of the Lydekker condition is merely one of fibrosis and once sepsis- bequest, 1!23,00O left by B. T. Crichton, and other in other words bronchiectasis—has become established benefactions, patients to the number of 28.264 werein one or other of its eight establishments. surgical aid may well be too late. Probably, however, treated The Seamen’s Society owes many of its opportunities of these cases of fibrosis a certain go of usefulness to the munificence of only proportion shipowners. of on to bronchiectasis, and it would be a great boon if whom Lydekker was the most bountiful. There is We knew definitely what was the deciding factor. a marble monument to his memory at Lloyds and Meanwhile it is essential not to confuse the cases a stained glass window in the chapel at Greenwich. on
operations