The Ætiology of Bronchiectasis (With special reference to Pulmonary Atelectasis)

Abstract

The clinical phenomena of bronchiectasis have been well known for over a century, and, since the earliest observations of Andral (1824) and of Laennec (1826), have provided a constant opportunity for speculation as to the mechanism of its production. Apart from certain cases in which a congenital origin has been postulated, the causes of bronchiectasis have been described as partly mechanical, partly inflammatory. For the most part the mechanical factors have been regarded as secondary, even in those cases in which the condition was admittedly a sequel of manifest obstruction of a main bronchus or its branches, theories as to the pathogenesis of the disease being based upon the primary factor of infection, with consequent weakening and destruction of the bronchial walls. The mechanical effects of contracting fibrous tissue have been described by most authors as an important contributory cause, although much dispute has existed as to whether the fibrosis of the lung, so often associated with bronchiectasis, is a cause or a result of the actual bronchial dilatation. The admirable clinical descriptions of many well-known observers of the last century leave little opportunity for criticism, but it is important to note that these have been based, for the most part, upon observations of patients in whom infection of the respiratory tract had been well established, and who therefore presented a clinical picture of sepsis as distressing as it was intractable.