On some points in the pathology, diagnosis, prognosis and treatment of pneumonia / by C.H.F. Routh.

  • Routh, C. H. F. (Charles Henry Felix), 1822-1909
Date:
1855
Catalogue details

Licence: Public Domain Mark

Credit: On some points in the pathology, diagnosis, prognosis and treatment of pneumonia / by C.H.F. Routh. Source: Wellcome Collection.

    16/46 page 14
    absorbed, he has also observed it in the neighbourhood of a friction sound. This interpretation was subsequently given to Fife’s case. Dr. Walshe mentions a case of phthisis in his Manual in which there was slight serous effusion in the meshes of adventitious cellular tissue produced on the pleura, as proved by a post mortem examination ; and in which, during life, he had heard fine crepitation. The case mentioned of Jane Fife was admitted Nov. 30th; and yet as late as Jan. 13th, fine crepitation was heard. It is highly probable, therefore, that some of these cases of pleuritis with so little effusion are sometimes mistaken for pneumonia; and how frequent partial pleurisy is, in which little or no notice of the disease has been taken by the patient during life, is evidenced by the adhesions of the pleura found so com¬ monly after death. In former times, these cases would have been treated as pleurodynia ; and in these stetho- scopic times, perhaps, more heroically as pneumonia. The means of diagnosis here would be in the history of the case chiefly, and in the character of the dyspnoea, absence of lividity of the face, and the nature and extent of the crepitation. The French author above alluded to, states, the crepitations in these varieties of pleur¬ itis are less numerous, less frequent or instantaneous, than those of pneumonia ; they also occur less in puffs, and are not quite so fine. They either resemble the dry crepi¬ tation observed by Laennec in emphysema, or returning crepitation after consolidation in pneumonia; although he acknowledges that the diagnosis is very difficult. He sup¬ poses that, when the pleura is moist, no sound is produced by the rubbing of one upon the other; but when inflamma¬ tion occurs, then certain isolated points are formed on the pleura, which become rough, and then, by rubbing one against another, produce this fine crepitation. When these points are more numerous, then the ordinary friction sound only is heard. There are two other diseases, both of which give rise to fine crepitation. But I need not dwell much upon either of these. In the first, oedema of the lungs, the disease is usually accompanied with general anasarca, and the crepi¬ tation scarcely so fine as that of pneumonia. In the second, haemorrhage from the lungs, in which the uncoagulated blood may have penetrated to some of the finer bronchi, fine crepitation may be induced. Dr. Hughes, of Guy’s Hospital, distinguishes this kind
    digitised image 1
    digitised image 2
    digitised image 3