Volume 1

On pneumo-thorax: an essay, read in part at the Physical Society of Guy's Hospital / [Henry Marshall Hughes].

  • Henry Marshall Hughes
Date:
[1844]
Catalogue details

Licence: Public Domain Mark

Credit: On pneumo-thorax: an essay, read in part at the Physical Society of Guy's Hospital / [Henry Marshall Hughes]. Source: Wellcome Collection.

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    much moderated ; but on the following day she was still lower than before. Her ex¬ haustion w'as now extreme; her respirations 60, and her pulse as nearly as it could be counted 160. She appeared, indeed, almost beyond a justifiable hope of recovery, but was ordered large doses of ammonia and opium, with mucilage, and infusion of ser¬ pentary or cusparia, every three hours; to have the enemata administered if required, and to take brandy and water and nourish¬ ment frequently. By these means, together with perfect quiet and excellent nursing, to the great surprise of her friends, and the still greater surprise of her medical atten¬ dants, she began slowly to recover. The affection of the bowels was no longer trou¬ blesome ; but as there could be no doubt whatever of the existence of serious and extensive mischief in her chest, her ultimate recovery was considered and stated to be exceedingly problematieal. As to tue exaet nature of that disease, the eonsiderations of her belonging to a phthisical family ; of her having been previously examined, and stated to be free from thoracie aflfeetion ; of her never having suffered from cough, or, to her recollection, from pain of the affected side; together with the exceedingly rapid breath¬ ing and extreme collapse, perhaps eaused by the serious drain on her system taking place by the bowels, led me to suppose that the complaint in the chest was pneumo-thorax. I did not visit her again for about two weeks, when she had much improved, and the dysenteric affection had long ceased. The pulse was still 140, very small and feeble, and the respirations 40 in the mi¬ nute ; the skin soft and clammy, and the features pinched, though the expression of countenance had much altered for the bet¬ ter. On exploring the ehest I still found the left side free from the evidenees of dis¬ ease. The right was almost motionless upon inspiration ; it was generally not dull upon percussion, and anteriorly was rather more resonant than natural, except below the clavicle. It was destitute of pure re¬ spiratory murmur in every part. Tubular breathing existed anteriorly, even below the clavicle, and over the scapula posteriorly; while below that bone the breathing was de¬ cidedly fistulous, and the voice shrill and| metallic. Hippocratic succussion was not? present. She has for the last three months jf been very slowly, but, with one brief excep- t tion, gradually improving in health and 4- strength, and she is now able to walk out, I , to join her family circle, and to engage in ^ . the lighter domestie duties of her establish- 4 ment without inconvenienee. I have not ► examined her chest, nor seen her in a medi- : cal capacity, since the oecasion last referred to ; I am therefore unable to make any re- f port upon the present state of the lungs and I circulation, though I was informed by her 4 medical attendant that for some weeks, or even months, the pulse had continued ex- ® ceedingly feeble, small, and rapid. The , facts of her case, so far as they are here re- v | lated, are those that I myself observed. I am | unable to account for them, excepting upon ; the supposition of the thoracic affection hav- x j ing been pneumo-thorax, and of its being '1 i either cured, or so much reduced in amount | j as to be comparatively harmless. ^ Conclusions. — From what has been ^ stated in the preceding pages, and for the I most part illustrated by the cases therein 4 related, the following conclusions may, li S think, be fairly derived :— S ]. That pneumo-thorax is often not so # speedily fatal as has been represented, espe-J ■ daily by the French pathologists. ^ i 2. That the decomposition during life of ^ | effused fluids, and gaseous exhalations from| [ the pleura, are, to say the least, doubtfull' , causes of pneumo-thorax. J | 3. That pneumo-thorax has not been! i proved to arise from other causes than aj j communication of the pleura with the ex-r' < ternal air. f 4. That the most frequent causes of/ pneumo-thorax are phthisis, empyema, andj , gangrene of the lung, in the order in which! li they are mentioned ; and that, independently/ of external violence, pneumo-thorax from other causes is extremely rare. 5. That pneumo-thorax occurs as a con-a sequence of phthisis, with a very small ca-,B vity, or without any cavity, existing in the lung- !