The principles of treatment of chronic phthisis pulmonalis / by Edward Smith.

  • Edward Smith
Date:
1857
Catalogue details

Licence: Public Domain Mark

Credit: The principles of treatment of chronic phthisis pulmonalis / by Edward Smith. 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.

    18/74 page 10
    evidences are shorter breathing, less breath motion, feeble and shorter inspiratory sounds and particularly the vesicular sounds, and this may be more or less general over the whole of botli lungs. Ex- piration quick, forcible, and perfect. Deep inspiration may be effected, but it is not effected by the patient unless at least his attention be directed to the defect, and more commonly not until he has given attention by repeated efforts. This may be readily proved by the In- spiration. The quantity of tidal air is often diminished in ordinary breathing. The general indications of body will be those of atonicity, and possibly the rate of pulsation and respiration will be increased, and the complexion and condition of system evince a state of mal-nutrition. There will probably be flattening of the chest, depending upon original conformation or upon the progress of the disease. The same remark will also apply to dulness on percussion. Cough may or may not exist, as also some haemoptysis. The essence of the whole is less respiratory action ; and as this varies in degree, extent, and duration, so will the other signs vary. The evidences of the disease when tubercle is deposited in its very early period, are the same, but with the addition of those of the existence of obstruction at certain defined places. Hitherto there was lessened action but no localised obstruction, but the deposit of a matter more or less solid offers obstruction to the entrance and exit of the air in the precise spot in which it is placed, and then by extension as the quantity increases. This is evinced by wavy or jerking respiration and prolonged expiration. In addition, the new substance will displace a quantity of air, and then, by its own heavier specific gravity, cause the resonance on percussion to be less clear. Thus the essential difference in the two stages is, that in the first we meet with simply lessened action and its consequences, whUst in the second there is added obstruction and solidification; and these signs are sufficiently diagnostic, except perhaps at that short period when the two meet, or the first passes into the second stage. The connexion between the two is proved both by the evidences of the first and tlie continuance of them into the second. We are accustomed to attribute the signs existing with tubercle to the tubercle alone; but this is an error as has been already proved, and also by the further fact that the amount of lessened vital capacity (say 100 cubic inches in the very earliest moments of recognised tubercle) is infinitely too great to be accounted for by the displacement of it l)y the tubercle, but is readily understood wlien the conditions attending the earlier stage are admitted. With regard to the dm-ation of the first stage, we admit universally, under the name of a predisposition, that it is commonly long, and as we cannot deny the influence of defective organisation over its pro- duction in many instances, we must admit that in these cases the
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