Copy 1, Volume 2

The study of medicine. Improved from the author's manuscripts, and by reference to the latest advances in physiology, pathology, and practice / [John Mason Good].

  • John Mason Good
Date:
1834
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Licence: Public Domain Mark

Credit: The study of medicine. Improved from the author's manuscripts, and by reference to the latest advances in physiology, pathology, and practice / [John Mason Good]. Source: Wellcome Collection.

    40/704 (page 32)
    Gen. I. Srec. IV. Symptoms no- ticed by Hip- pocrates. Not always a sequel of pneu- monia,.as pre= sumed by Cul- len. Sometimes pro- duced by the bursting of a vomica. Diagnostics of percussion and the stethoscope. Vomicex burst into thé chest. ' 6 pa CL. III. ] HEMATICA. [ ORD. II. SPECIES IV. APOSTEMA EMPYEMA. LODGMENT OF MATTER IN THE CHEST. FIXED PAIN IN THE CHEST: BREATHING LABORIOUS, BUT EASIEST IN AN ERECT POSITION; DIFFICULT DECUMBITURE ON THE SOUND SIDE; FLUCTUATING ENLARGEMENT ON THE SIDE AFFECTED; DRY, TICKLING COUGH. To the symptoms, enumerated in the above definition, Hippocrates adds*, cedema of the feet, hollowness of the eyes, and a gurgling sound on shaking the shoulder. Of these additional signs, the first two belong rather to the hectic fever that generally accompanies met with in modern times.+ Dr. Cullen regards empyema as a mere sequel of pneumonia, which, with him, includes inflammation of the pleura, as well as of the Jungs; but as it may take place from in- flammation of the mediastinum, pericardium, or diaphragm, to say nothing of that from external injuries, and as it is often doubtful what particular organ is directly injured, a separate species seems decidedly called for. An empyema is sometimes produced by the bursting of a large vomica of one of the lungs into the cavity of the pleura: in which case, the cough becomes more frequent than before this result, and is either dry, or accompanied with a scanty, frothy, and noisy ex- pectoration. The breathing becomes extremely difficult, with repeated fainting fits, and the dew of a cold sweat hanging over the throat and forehead; the cheeks and lips are of an omimous red, while the nails are livid, the pupils dilated, and the sight dim. If percussion or the stethoscope be employed, before the vomica has broken, to the part in which the matter is seated, little or no sound will be returned, in consequence of the pressing fulness wards, it will be found restored, in a considerable degree, to the part affected, from the hollowness which now exists there, while it will be comparatively found diminished in the posterior and inferior parts of the chest to which the discharged load is transferred. For the history and relative value of these diagnostics, the reader must turn to the treatment of PHTHISIS.§ [Laennec does not seem to approve of the application of the term empyema to the bursting of a large vomica into the chest. “I * Tlepl Tlaapy, pp. 476. 496. + Trécourt, Mémoires de Chirurgie, &c. ¢ Dulness of sound on percussion, and absence of the respiratory murmur on the diseased side, which remains perfectly motionless. Puerile respiration in the opposite lung, accompanied with increased action of the respiratory muscles, and of the abdomen. — Ep. § Cl. n1, Ord, rv. Gen. m1. Spec. v. a I