Practical remarks on some points in the physical diagnosis of phthisis pulmonalis / by John Hughes Bennett, M.D.

  • John Hughes Bennett
Date:
1856
Catalogue details

Licence: Public Domain Mark

Credit: Practical remarks on some points in the physical diagnosis of phthisis pulmonalis / by John Hughes Bennett, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    13/42 (page 11)
    Professor Van der Kolk of Utrecht1 was the first who directed attention to the fragments of the elastic fibres of the lung in sputum, as occasionally being of diagnostic importance. That such fibres were common in the sputum of consumptives, after ulceration of the lung has commenced, is easily proved, and has been familiar to myself for the last fifteen years. The important part of Van der Kolk's Memoir, however, is contained in the following passage :— But we ought to determine if these fibres are only observed when phthisis is already well advanced, and produced great ravages, or if they exist in expectorated matter at the first formation of vomicas, so that they enable us to determine their existence when com- mencing. My conviction, with regard to this important problem, is, that it is exactly at the commencement of phthisis, and at the first formation of a vomica, that the elastic fibres were present in the greatest abundance, and that they may then be considered as among the most positive signs we possess of the presence of a cavern. Later, when the cavity has acquired a certain extent, these fibres become more rare in the expectoration, and are with diffi- culty distinguished. This statement is supported by a case, in which very insignificant signs could be determined by ausculta- tion, although the general symptoms indicated phthisis—yet, where the fibres existed in considerable numbers in the sputum, and led to a diagnosis, which was confirmed by the subsequent progress of the disease. Such an instance as that described by Van der Kolk I believe to be very rare, and the question always arises whether the lungs were examined with sufficient care, so as to render it certain that, whilst fibres of elastic tissue, derived from those organs, existed in the sputum, no auscultatory sign could be detected. But that this does occasionally occur, I have now no doubt—1st, from the facts previously given, which show that advanced phthisis may exist without any positive signs; and, 2d, from the following case, which fully confirms the statement made by the distinguished Pro- fessor of Utrecht. Case IV. In August 1854, I was consulted when in London by a lady, Mrs B., at. 23, who had for some time suffered from cowffh, 1 Nederlandsch Lancet, 2 Serie. D. 1.