Pulmonary consumption, pneumonia, and allied diseases of the lungs : their etiology, pathology and treatment, with a chapter on physical diagnosis / by Thomas J. Mays.

  • Thomas Jefferson Mays
Date:
1901
Catalogue details

Licence: Public Domain Mark

Credit: Pulmonary consumption, pneumonia, and allied diseases of the lungs : their etiology, pathology and treatment, with a chapter on physical diagnosis / by Thomas J. Mays. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    affected side and diminution or absence of the vocal fremitus below the level of the liijuid; and an increase of the same above, as well as on the normal side. In some cases the apex beat of the heart may be felt on the right of the sternum, or beyond the left of the niiiplc line. During the stage of res- olution the ai^ex beat of tliL' heart returns to its natural place or, indeed, may be drawn too far in the other direction by the suction. In chronic empyema of the side of the chest the impulse of the heart is transmitted through the effusion to the thoracic wall and gives rise to what is known as pul- sating empyema. Percussion shows very little if any change in the first .=tage of pleurisy. In the second stage, or in that of effusion there are dulncss or flatness and an increased sense of resistance in the lower part of the chest, which terminate abruptly at the level of the fluid (unless the side is entirely filled) and exaggerated percussion resonance ])revails above the fluid. If no adhesions confine the fluid, the line of the level of dul- ness changes by altering the position of the patient. For example, the level of the fluid is marked with ink or chalk, while the patient is sitting or standing, and on assuming the lying position it will be seen that the line of dulness sinks to a lower level in front and rises again to the fonner level when he returns to the first position. Sometimes a cracked- pot sound is jxTceivcd in the summit of the lung, which is brouglit about by the vibration of air in the trachea and large bronchi. This may ndslead one to believe in the existence of a cavity in this area. During absorption of the liquid the level of dulness gradually recedes towards the base of the chest, but impaired percussion resonance may remain almost indefinitelv on account of a thickened condition of the costal pleura. In chronic pleurisy, or in empyema, the flatness is marked generally throughout the affected side. In hydro- thorax, dei>endent on circulatory obstruction, there is dul- ness or flatness over both bases, the level of which also varies