A plea for early operation in cases of undoubted tubercle of the lung : part of the inaugural address to the Chelsea Clinical Society for the session 1899-1900 / by J. Foster Palmer.

  • Palmer, J. Foster (James Foster)
Date:
[1900]
Catalogue details

Licence: In copyright

Credit: A plea for early operation in cases of undoubted tubercle of the lung : part of the inaugural address to the Chelsea Clinical Society for the session 1899-1900 / by J. Foster Palmer. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    well known and has been recognised from the earliest times. irdyt] 5’ iv irved/xovi xaX/c6s.9 In this case death does not seem to have taken place until the abdomen was also ripped open with a sword. 3000 years ago it was understood that wounds of the lung were not immediately fatal.10 The experiments of Professor A. Richet of Paris 11 on the living dog showed that the total collapse of one lung from opening the pleura caused a considerable degree of dyspnoea (suffocation he called it), but very rarely an immediate fatal result. In man, he says, the case is different: the sudden loss of so large a proportion of the breathing apparatus causes fatal suffocation.12 He gives one case (from the “Bulletin de Therapeutique,” 1842, tome xxii., p. 358) in which death occurred several hours afterwards from an accident in which the pulmonary pleura was torn open and the lung collapsed ; and another (from the “Archives de Medecine,” 1840, tome ix., p. 489) in which death took place in three hours, when the right lung was found torn in three places and so collapsed as to be hardly visible. In this case the injured lung was normally the larger of the two.13 On the other hand, Professor Longmore, in Holmes’s “System of Surgery,” in his article on Gunshot Wounds, states that “ when the compression is limited to one lung, though it may be com- pletely collapsed in consequence, especially if the opening in the chest wail be a large one, the symptom of dyspnoea may be wholly absent.”14 This, however, must be unusual. Indeed, all observers, both ancient and modern, are agreed 9 Iliad, A 528. 10 This fact has been emphasised more than it has ever been before by the large proportion of recoveries from wound of the lung among the troops now fighting in South Africa. The antiseptic treatment has given such wounds fair play and the opportunity of running their normal course, which in former wars they did not have. In them the deaths were evidently due, not to pneumothorax or emphysema or haemorrhage, but to septic poisoning. 11 Surgeon, when I attended hib course in 1869-70, to the Hopital des Cliniques, the special hospital in connexion with the Ecole de Medecine. 12 A. Richet: “ Traite Pratique d’Anatomie Medico-Chirurgicale,” 1866, p. 581: “Dans les experiences sur les animaux, sur les chiens, par exemple, la privation subite d’une moitie de l’appareil respiratoire determine des suffocations qui n’entrainent que rarement une morte immediate ; mais il n’en est pas de m§me chez l’homme ; cette brusque suppression d’une aussi notable partie d’une fonction si prochainement liee it la vie, entraine des suffocations mortelles.” 13 Ibid., pp. 588 and 589. 14 Holmes’s “System of Surgery,” second edition, vol. ii., p. 191.