Report on the Pathological Anatomy of Pleuro-pneumonia. 189 
Broncho-vascular Lesion. — The part taken by the bronchial 
tubes in the chain of pathological processes seems to me so 
important, that I think it well to describe the changes found in 
them quite independently of those occurring in the lung tissue. 
I find it convenient to associate the description of the vascular 
lesions with those of the air-passages, because, anatomically, they 
are very intimately connected, and because the morbid processes 
in the one help to explain the changes that take place in the 
other. 
The bronchial tubes and blood-vessels have not, as far as I 
can ascertain, received very much attention. Those authors who 
describe the change commonly found in them, consider it to be 
secondary to, or sympathetic of, the affections of the lung and 
pleura. Every examination I have made of diseased lungs 
appears to me to contradict this view, and, in spite of a prejudice 
in favour of the accepted views, the opinion has been gradually 
forced upon me that the pathological processes in the bronchi 
are of the greatest importance, and throw considerable light on 
the initial stages of the disease. 
I have never examined a lung affected with pleuro-pneumonia 
in which there was not a well-marked and characteristic lesion 
of the bronchial tubes of the part most severely affected. No 
matter how small the focus of disease in the lung may be, or how 
little advanced a stage these morbid changes may have reached, 
there is always definite disease in the corresponding bronchus, 
extending some distance along the tube, but more or less localised 
to the diseased neighbourhood. In the small foci of consolida- 
tion, where the disease may be regarded as just beginning, the 
morbid process in the bronchus is generally more extended, and 
shows evidence of longer duration than the change in the lung 
parenchyma. This applies only to the part of the lung in a 
state of real consolidation, and not to that part which is trans- 
lucent and extended over a large sub-pleural area. In the latter 
part the bronchial lesion is often wanting. 
The cavity of the air-tubes of the opaque solid part is always 
plugged with a dense adherent mass of tough granular material. 
This completely occludes all the small bronchi, and extends into 
the neighbouring larger ones, tapering to a fine point towards the 
less diseased tubes, Avhere it is commonly surrounded with a 
quantity of tenacious frothy mucus, which occupies the bronchi 
for some distance towards the root of the lung. In passing from 
the larger healthy bronchi to those in the diseased focus, one 
meets with every stage of transition, from the ordinary frothy 
sputum of acute bronchitis to tenacious mucous or fibrinous 
masses which stick to the wall of the bronchus. Often a long 
branching cast of the air-tubes may be drawn out from them, 
