The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2).
- Date:
- 1849-59
Licence: Public Domain Mark
Credit: The cyclopaedia of practical medicine: comprising treatises on the nature and treatment of diseases, materia medica and therapeutics, medical jurisprudence, etc., etc (Volume 2). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
41/812
![the ascent of the diaphragm, and the protrusion of the mediastinum from the increased dilatation of the op[)osite lung, reduced the cavity of the dis- eased side to so small a compass, especially in young subjects, whose ribs are susceptible of a much greater degree of motion than those whose cartilages are ossified, as to leave very little space unoccupied for the reception of air. This space is subsequently filled up as the lung gradually ex- pands and rises into contact with its parietes : this, however, is always a very slow process, as several weeks in general elapse before the slight- est trace of respiration can be perceived in the dis- eased side; as the lung continues to expand, the contraction of the side gradually diminishes, until at length the lung resumes its original dimensions and the contraction of the side disappears altoge- ther. In some cases, however, the dilatation of the lung is never complete, and the side remains permanently contracted in consequence. Lastly, there are some cases in which recovery takes place, although the lung never expands so as to fill the space left by the evacuation of the empye- ma. In these cases the wound made by the operation is converted into a permanent fistula, through which the atmospheric air is allowed to enter, and the matter secreted by the walls of the cavity to escape, without producing any very con- siderable inconvenience to the patient's health. Several cases of this termination of the operation are recorded by Plater and Schenkius, and by MM. Lefacheux and Audouard. (See Empyetne, in the Dictionnaire des Sciences Medicales.) But perhaps tlie most remarkable case of this kind on record is that recently published by Dr. Wendel- stadt of Hersfield, who underwent the operation of paracentesis for empyema in his own person, thirteen years ago, since which time the wound has remained open, and the fluid has been drawn off twice every day, sometimes so much as three or four ounces daily. Three years ago, be- ing anxious to ascertain the dimensions of the cavity which existed in the thorax, he found that it was capable of containing a quart of warm water. The diseased side is much contracted, and does not move at all in respiration, yet he can blow the flute, and walk faster than many persons who are in perfect health, and for several years he has resumed the active discharge of his professional duties. (Journal der Praktischen Heilkunde, Januar. 1831.) Various expedients have at different times been contrived for extracting the air out of the pleura, with the view of removing the pressure from the lungs' surface, and thereby facilitating their ex- pansion. A variety of syringes have been con- trived for this purpose, and recently M. Laennec lias proposed to apply a piston-cupping-glass over the wound immediately after the discharge of the liquid, and to produce a vacuum in the chest more or less quickly, continuously and completely, ac- cording to the effects. If this suggestion were to be put in practice, care should be taken to avoid exhausting the air so far as to suck out a portion of the lung through the wound, as happened to the writer of this article, when trying the efficacy of the proposed plan on a dog. Another objec- tion to the success of this contrivance is the diffi- culty of preventing the air from again rushing in through the wound the moment that the exhaust- ing glass is removed. After all, it appears very doubtful whether the admission of air into the pleura is really as dan- gerous as IS generally supposed, or whether the quantity of air which is contained within the chest affords any sucli serious obstacle to the ex- pansion of the lung, that its removal may not be safely entrusted to the power of the absorbents ; as the experiments of Nysten, and more recently those of Speiss, (De vulneribus pectoris penetran- tibus,) have fully proved that air introduced into the pleura is invariably removed by absorption in the course of a few days. In those cases where the introduction of air produces an unhealthy discharge from the wound, the practice of using injections may be had re- course to with advantage for the purpose of cor reeling the morbid action of the suppurating sur face, and removing the putrescent qualities of the discharge. Willis relates a remarkable in- stance of the efficacy of injections in such cases The fluid drawn off at the time of the operatior was perfectly inodorous, and continued free from smell for the first three days; after which, when- ever the wound was opened, a smell, which he describes as odor teterrimus, cloaca cujusvis maxime putentis ftetorem superans,' infected the whole chamber; but by the repeated use of injec- tions, the horrible fetor of the discharge was en- tirely corrected, and the patient ultimately reco- vered. (De Empyeinate, p. 98.) M. Freteau records another case in which, shortly after the operation, the discharge assumed a dark ichorous appearance, and exhaled a gangrenous smell; but by persisting in the use of injections for twenty days, the matter discharged from the wound as- sumed a healthy appearance, and lost its disagree- ble odour. Willis was in the habit of using a decoction of various aromatics and stimulating herbs for this purpose. MM. Freteau, Billery, and Audouard recommend the decoction of cin- chona as less irritating than that used by Willis, and equally efficacious. (Diet, des Sciences Med. art. Einpycme.^ A weak solution of the chlo- rate [chloride] of lime will probably be found to act still more efficaciously as an antiseptic. [But it need scarcely be said, that all such applications must be used with the greatest caution, for fear that inflammatory action may be set up, which may not be easily subdued.] R. TOWNSEND. ENDEMIC DISEASES.—E^^emt'c is a word applied to those diseases which occur among the inhabitants of a particular place or country, in consequence of something local or peculiar in the air, or water, or soil, or in the food and habits of the people. Hippocrates has left a treatise, which, though containing some crude observations, is a model that has been too much neglected by me- dical writers. His book De Aeribus, aquis, locis, according to Haller, is composed in a style, and contains reasoning, worthy of its great author. If we except the Dissertation on Endemic Diseases, by Hoffmann, we have few works written expres.s- ly on the subject. Yet it is one which we might suppose would have engaged the serious attention of physicians in all ages.](https://iiif.wellcomecollection.org/image/b21116817_0041.jp2/full/800%2C/0/default.jpg)
