A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint.

Austin Flint I

Date:: 1884

Credit: A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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$have been supposed to have either dyspepsia, irregular mah^rial fever, hepatic trouble, or some ailment not connected with the chest. If the symptoms point to the existence of intra-thoracic disease, patients are often supposed to be phthisical, and the cough, deticiency of breath, night perspirations, etc., rationally favor such a conclusion. A positive diagnosis can hardly be made without the aid of physical signs. The signs on which, taken in connection with the history and symptoms, the diagnosis may be based, are those denoting pleuritic effusion. The signs of effusion are the same in chronic, as in acute, pleuritis, and need not be again stated; but in chronic, more frequently than in acute, pleuritis, the accumulation of liquid is so large as to occasion more or less dilatation of the affected side, and then are superadded signs obtained by inspection and pal- pation, notice of which was deferred in treating of the acute disease. Dilatation of tlie affected side hj liquid is apjmrent to the eye, and may be ascertained by mensuration, either with graduated tape or callipers. The intercostal spaces are pushed out to a level with the ribs, and may be bulging. The side is motionless, or nearly so, in the acts of respiration, the movements oFtlie opposite side being exaggerated. By applying the fingers within the intercostal spaces and applying peripheral and diametrical percussion, a sense of jluctuati^n is sometimes obtained. Tlig heart is moved from Us iiprmal situation, as ascertained either by palpation or auscultation. If the effusion be in the left side, the apex-beat and the maximum intensity of the heart- sounds is on the right side of the sternum ; and they are carried toward the left lateral portion of the chest if the effusion be in the right side. The_dia- p_hragm is d(2.pressed, pushing downward the abdominal organs in contact with it. The addition of these signs renders the diagnosis of pleuritic effu- sion still more complete and positive than the signs wliich denote the presence of liquid without dilatation. The presence of liquid is demonstrated by the introduction of a small ex- ploring trocar. A hypodermic syringe, the needle being sufficiently strong to obviate danger of its being broken off and remaining in the chest, answers for the exploratory puncture; or a small aspirating needle may be used. This should be resorte 1 to in all cases, both of acute and of the different varieties of chronic pleuritis, in order to ascertain the character, as well as the presence, of liquid. With, as well as without, this exploration, there is one liability to error in diagnosis, namely, carcinomatous or sarcomatous infil- tration of an entire lung may cause an enlargement of its volume, and, a cer- tain amount of pleuritic effusion coexisting, the signs may seem to denote simply chronic pleuritis. An exploratory puncture demonstrates the presence of liquid. Thg. dia^nflsis can onjy bi^ settled b^^ asj^iration Removing the liquid, the affected side remains enlarged ; the needle or trocar even passes into a solid mass, as shown by its remaining fixed ; that is, the point not movable while in the chest. \ A sanguinolent effusion, if scorbutus be excluded, renders the coexistence Qof phthisis probable. During the stage of absorption, the signs show the progressive diminution of liquid until the quantity is no longer sufficient to occasion dilatation, and, from this point, the continued decrease in quantity is ascertained as in acute pleuritis. The contraction of the affected side which follows chronic pleuritis is more marked than that succeeding the acute affection. Treatment—The main objects of treatment in simple chronic pleuritis are twofold, namely. First, to effect the removal of the effused liquid ; and, second, to develop and sustain the powers of the system. For the tirst object, the measures which may be employed are the same as in the second and the 10$