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.

    42/704 (page 34)
    34: Gen.. I, ~ Spec. IV. Apostema em- pyema. Other changes. Pus not always to be referred to any particular organ. Instances of metastasis. Matter some- times makes its way outward between the ribs. CL. 111. | _ -HAEMATICA. ‘Lorp. I. manifestly larger; the intercostal spaces grow broader, and rise to a level with the ribs, and sometimes even higher. The lung, com- pressed towards the mediastinum and spine, and retained in this position by pseudo-membraneous exudation,is sometimes so reduced in size as not to be more than four or six lines thick, even in its middle. In this state, the pulmonary tissue is soft, pliant, and dense, without any crepitation, more pale than natural, and almost without blood ; yet the alveolar texture very distinct.* ] Modern researches prove, that collections of pus in the chest frequently occur without any appearance of ulceration. To such cases Mr. Hewson has several references. ‘“ The cavities of the pleura, pericardium, &c.” says he, “ are sometimes observed to contain considerable quantities of pus without the least marks of ulceration. In one patient I found three pints of pure pus in the pericardium, without any ulcer either on that membrane or on the heart. In another, the cavity of the pleura of the right side was distended with a pus that smelt more like whey than a putrid fluid, and the lungs were compressed into a very small compass : but there was no appearance of ulcer or erosion, either on these organs or on the pleura; but only under the pus was a thin crust of coagulable lymph.” We have already made some observations upon this secretion of imperfect pus, and it is not necessary here to dwell upon it. | Numerous cases are recorded, in which the contained fluid has disappeared. It has passed off by the intestinal canal+, by the bladder, and by the vagina§, in the form of pus. It has also been frequently carried off by an opening formed by nature, and the patient has recovered his usual health. This opening has com- monly been between the ribs; most usually between the third and fourth, but in one instance we find the abscess pointing and burst- ing under the scapula. || [The escape of effused fluid through generally a little turbid, from an admixture of coagulable lymph. In chronic pleurisy, the fluid is not only in larger quantity, but of a consistence approaching to that of common pus, and generally mixed with flakes of coagulable lymph. However, as Dr. Townsend has observed, it is not always easy in practice to determine a priori the precise nature of the fluid collected within the chest, as its physical characters are found to vary considerably, even. in those cases that most closely resemble each other in their origin, progress and symptoms. Cyclop. of Pract. Med., art. Empyema. — Ep. hee * As in empyema the matter is usually contained in only one side of the chest, its pressure sometimes displaces the heart. The editor has seen several has caused such a change in the position of the heart, that its pulsation could only be felt on the right side of the sternum. The pus, however, may be circum- scribed by the adhesive inflammation, and then this effect will not be produced. In the case lately published by Mr. Woolley, the heart pulsated on the right side, in a situation precisely corresponding to what it ought to have occupied on the left. This was in a child between five and six years of age, that was cured by paracentesis alone. (Med. Gaz. for Nov. 1833, p. 318.) Such displacement is one of the least fallible symptoms of a collection of fluid in the chest, — Ep. t Kelner, Diss. de Empyemate, Helm. 1670. Marchetti, Obs. 82. 89. ¢ Buchner, Diss. sistens solutionem Empyematis per mictionem purulentam. Hal. 1762. N. Act. Nat. Cur., vol. i. obs. 5. § Schlichting, Phil. Trans., vol. xlii. p. 70. || Hurten, Diss. de Empyemate. Argent. 1679.