Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner.
- Date:
- MDCCCXLIX [1849]
Licence: Public Domain Mark
Credit: Monthly retrospect of the medical sciences : January to December 1849 / edited by George E. Day, Alexander Fleming, W.T. Gairdner. Source: Wellcome Collection.
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![gurgling. There the lung was in the stage of suppuration, and hence the purulent expectoration. The patient was bled. The blood had a huffy coat, and this contained numerous opaque yellow granulations, of the size of a hempseed, which are believed by M. Piorry, in this and similar cases, to re¬ sult from the reabsorption of pus. In this state of the system, M. Piorry de¬ precates further bleeding. He gives good diet, and places his trust in the administration of tartar-emetic. The prognosis, however, is grave. [In this case the diagnosis of suppu¬ ration of the lung, as opposed to soften¬ ing tubercle, appears to depend, not on percussion, but on the recent origin of the symptoms and rapid course of the disease. The following observations are more illustrative of the results of M. Piorry’s practice.] 2. A man, aged forty, was attacked eight days before admission with stitch in the left side and dyspnoea. Dulness on percussion was present at the lower part of the left side, w'ith absence of respira¬ tory murmur, and oegophony at the upper limit of the dulness ; these signs indicated a pleuritic effusion. As the dulness, how¬ ever, occupied the situation which w'ould have been assumed by an enlarged spleen, M. Piorry applied the following test, founded on the power which he ascribes to quinine of diminishing the volume of the spleen. He gave the patient a dose of quinine, haHng previously marked out the limits of the dulness, and on percuss¬ ing again some minutes afterwards, found it unchanged, from which he concluded that the spleen was not at all involved in the disease. 3. A vigorous high-complexioned man complained of extremely laborious re¬ spiration and pain in the region of the liver. The veins were full of blood; and percussion showed the heart to be large, and the liver enormous. There was slight fevernishness, but no other sign of disease. The man had been in the habit of being bled annually. It was evident that the circulation was overloaded, and the heart and liver in particular gorged with blood. Venesec¬ tion was performed for the relief of the plethora. After twelve ounces of blood had been removed, decided relief was experienced. Immediately after the bleeding, a decided diminution of size was observed on per¬ cussion of the heart and liver. The lat¬ ter organ had retired from its upper limit by four-fifths of an inch, and by somewhat more than this from its lower limit. Had this reduction of size been insufficient, M. Piorry would not have hesitated to push the bleeding further. [The above use of percussion is worthy of more attention than it has generally received in this country.] 4. On the eighth day after delivery, a woman began to complain of abdominal pain; in the evening she had shivering, followed by an accession of fever. There was a suspicion of puerperal fever. It was found, however, by percussion, that the colon was loaded with fsecal matters, and with gas; and that the spleen was enlarged so as to measure four inches from above downwards. It appeared also that she had received, some days before her confinement, a blow on the left hypo¬ chondriac region. M. Piorry, judging according to his well-known principle of the constant enlargement of the spleen in intermittent fever, at once referred the woman’s symptoms to an attack of this kind. The indications of treatment were to unload the bowels, and to reduce the size of the spleen by quinine.—Gazette des Hopitaux, Dec. 24, ) 848. 46.—On the Configuration of the Chest in Emphysema, as compared with that in Health and in other Chest Diseases. By Fkancis Sibson, M.D.—The form of this chest in health is distinguished from that in emphysema by this—that its symmetry is not altered by any excessive or partial development. The upper part of the chest, in form, is neither raised nor brought prominently forward. The neck is long, not short; the shoul¬ ders are sloping, not elevated ; the cla¬ vicles are oblique, not square and for¬ ward, and elevated at their sternal end; the curve of the dorsal and cervical vertebrae is normal, not excessive; the dorsum is gently convex, not rounded and prominent, especially over its lower portion; the intercostal spaces are wide above and narrow below, not narrow above and wide below ; the angle formed between the seventh costal car¬ tilages below the sternum, is a right, and not (as in emphysema) an acute angle. The form of the chest, in considerable narrowing of the larynx or trachea, with consequent obstruction to respiration, is distinguished from that in emphysema by its being narrow, flattened, and elongated, instead of being rounded, prominent, and deepened. The form in phthisis is distinguished by the walls of the chest being flattened, in-](https://iiif.wellcomecollection.org/image/b29348390_0034.jp2/full/800%2C/0/default.jpg)
