Peter Kerley

Congenital Diseases of the Lungs

Since radiography was first applied to diseases of the lungs, radiologists have proceeded along certain well-defined lines, evolved partly from clinical and partly from pathological foundations. Clinicians based their ideas of living pathology exclusively on inspection, percussion, auscultation, and symptomatology. The accuracy of conclusions founded on a basis of pure clinical examination was always problematical, nor could such conclusions be verified at autopsy because the gross changes which always take place a few weeks before death were an insuperable obstacle to the correlation of clinical findings and living pathology. A great gap existed, and this has been bridged by radiology. Radiology is the study of living pathology. Applied to diseases of the lungs it has yielded information of the utmost importance. Quite apart from its value in early diagnosis, it has altered considerably our ideas on the mode of dissemination of the common pulmonary infections. We are still only on the fringe of chest rad...

The Etiology of Erythema Nodosum

The large number of recent publications on erythema nodosum is a reflection of dissatisfaction with the existing theories of its etiology. The disease occurs chiefly in young children and young adults. The majority of investigations have been carried out on children, but the following observations are based on a study of the disease in thirtyseven adults with an average age of 21 years. The youngest was 18 and the oldest 33. Nineteen of the patients were male and eighteen female, but this equal sex incidence is only apparent, as most of the cases were drawn from the Services. There is no reason to doubt that the disease is commoner in females in the proportion of three to one. In the majority of the cases there was a prodromal stage varying from 3 to 10 days, with malaise and anorexia. The acute stage then began with fever between 99° and 101°F., and a nodose rash appeared on the shins or forearms, or both, 24 to 48 hours later. More than half the patients had coryza or pharyngitis with dry cough. More th...

Congenital Diseases of the Heart

Congenital diseases of the heart have always excited the interest of clinicians because the mechanical defects produced by them throw light on many of the problems of acquired heart disease. In the nineteenth century acquired heart disease was extraordinarily prevalent and was responsible for a much higher mortality than any other disease; as a result, congenital anomalies were only studied in so far as they were helpful in solving the mechanical problems of acquired lesions. Until the beginning of the present century congenital heart lesions were always regarded gloomily, but then it was recognised that many of them were by no means inconsistent with normal life and that in many of them life could be prolonged by suitable therapy and careful supervision. Recognition of these facts led to an intensive study of congenital diseases for their own sake, and in this study radiology is slowly but surely playing a part. Unlike the study of diseases of the lungs and gastro-intestinal tract, where an X-ray examina...

The Pathology of Early Pulmonary Tuberculosis as Revealed by X Rays

Pulmonary tuberculosis is the commonest disease of mankind and has been the subject of scientific investigation since time immemorial. Many of the symptoms of consumption were known and described even before the Christian era, and the literature of the Middle Ages contains numerous astute observations on the mode of onset and mode of death in this disease. It was not until 1882 that the bacillus was discovered, and this date marks the beginning of scientific knowledge of pulmonary tuberculosis. A host of papers, many of them clinical and pathological classics, have appeared since that date, but despite all the intellect and energy devoted to the problems involved, most of them are still unsolved. The mode of entry of the bacillus, the anatomical nature of the primary lesion and its site are still subjects of contention. The spread of the disease through the lungs and the stages and types of the tubercle formations, are intimately associated with the problem of immunity; but to-night I intend to discuss on...

Neoplasms of the lungs and bronchi

Malignant disease of the lungs is considered to be such a rarity, that it is usually given no more than a paragraph in our text books and is consequently seldom brought up in discussion of differential diagnosis. As long ago as 1889, Hare estimated that of all the deaths from pulmonary disease in London, 2·3 per cent, were due to primary neoplasms. If this be true, and if malignant disease of the lungs has increased since then in the same proportion as it appears to have increased in other organs, this figure should now be much larger. Unfortunately, as the diagnosis is so difficult, and our tacilities for postmortem examinations are so unsatisfactory, it has not yet been possible to verify this.

Editorial—Pulmonary Sarcoidosis

Sarcoidosis is a chronic indolent disease of unknown etiology. It may affect every tissue or organ of the body, or it may be limited to certain groups, such as the parotids and eyes, or the lungs and lymph glands, or the skin and bones. It was originally described as a skin lesion (lupus pernio), by Jonathan Hutchinson who called it Mortimers malady, Mortimer being the name of the original patient. Another manifestation in the eyes and parotids was described as uveoparotitis or Heerfordts syndrome, while the bone changes go under the name of Junglings disease or osteitis tuberculosa multiplex cystica. Identification of a similar underlying pathology for these varied syndromes was made by Boeck, Besnier, Tenneson, and Schaumann, all of whose names have been attached to the disease. Fortunately sarcoidosis is now accepted as a universal name.

Two Unusual Cases of Cyanosis in Infants

The common causes of severe cyanosis in young infants are congenital heart disease and atelectasis. The clinical differentiation between the two conditions is not always easy, and the following cases are good illustrations of the value of radiography in arriving at an exact diagnosis. A female child admitted to hospital at the age of four months for “blueness” and a discharge from the ear. The child had been delivered normally at full term. It was not cyanosed at birth, but after 14 days became blue and remained so. It was breast-fed for a month and appeared to be thriving until the fifth or sixth week. On examination, the child was much under normal weight for its age and moderately cyanosed. There was no clubbing of the fingers and no deformities of the skull, mouth, spine or limbs. Respiration was rather rapid, but it cried well and fed well. The cyanosis increased at times, but especially during feeding or crying. A loud systolic murmur could be heard all over the heart. The breath sounds were normal....

Two Unusual Aneurysms

Aneurysm of the aorta is still comparatively frequent, although there is a popular impression that the condition is rare as a result of the introduction of arsenical and bismuth treatment of syphilis. The following two cases show several unusual and instructive features. An unmarried female, aged 70, attended the out-patient department of Westminster Hospital complaining of severe abdominal pain and vomiting She was obviously anaemic and had lost weight, hence she was referred for barium meal examination as a suspected case of carcinoma of the stomach. Routine screen examination of the chest showed gross aneurysmal dilatation of the thoracic aorta with extensive atheromatous plaques. The left ventricle was enlarged. The œsophagus and trachea were not displaced. Oblique and lateral views of the chest showed that the aorta was not only dilated but was also considerably elongated and kinked. A complete gastro-intestinal examination showed no abnormality, but on one of the films a small aneurysm of the abdomin...

Blind Ductus Arteriosus

In congenital pulmonary stenosis, either valvular or infundibular, but especially in the former, the jet of blood passing through the narrowed orifice under pressure usually strikes the anterior wall of the main pulmonary artery well above the valves and in so doing raises a shallow bulge at the point of impact. This bulge can be clearly seen on angiocardiography. Again in pulmonary stenosis but more often in the Tetralogy of Fallot a second projection may some-times be seen a little higher up the artery just beyond the “bulge of the jet” and usually at the point of bifurcation. It is shorter based, deeper and more angular in appearance and looks like a diverticulum of the pulmonary artery. A similar appearance is described by Rudhe, Kjellberg, Mannheimer and Jonsson (1959) in the chapters dealing with pulmonary stenosis and Tetralogy of Fallot. It is attributed by them to the reflection of the pericardium from the dilated pulmonary artery, although it is difficult to see anatomically how such a bulge is ...