On pneumo-thorax : an essay, read in part at the Physical Society of Guy's Hospital / by H.M. Hughes.
- Henry Marshall Hughes
- Date:
- 1844
Licence: Public Domain Mark
Credit: On pneumo-thorax : an essay, read in part at the Physical Society of Guy's Hospital / by H.M. Hughes. 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.
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![former part of this paper in reference to the preservative influence of adhesions in cases of pneumo-thorax, and resembles a case related by Laennec, in which the chest was similarly punctured, but no fluid evacuated, in conse- quence of similar adhesions of the lung to the costal pleura. At what time air escaped into the pleura could not be correctly deter- mined, as no decided symptoms characterized the occurrence. But as the expectoration is said to have increased on January 31st, and Hippocratic succussion was first noticed on February 3d, it is probable that it took place a few days only before the patient's death. As no aperture was found in the pleura, this case may be supposed to favour the notion of the formation of gas by the de- composition of the effused fluids : but to this opinion are opposed the facts of the fluid withdrawn by the trochar being destitute of disagreeable odour, and the oc- currence of amphoric breathing after the operation. I have not myself the slightest doubt that with the expenditure of a necessary amount of care and trouble in the investiga- tion of this case, the examination of which, as it was actually conducted, occupied a very long time, the opening would have been discovered. Case XII.—Phthisis—Pneumo-thorax— Empyema—Death after nine weeks. (Very beautifully drawn up by my young friend Mr. Weston, now in India, and reported almost entirely in his own words.) J. S., aged 32, a rather emaciated man, of sallow complexion, with dark hair and eyes, by occupation a labourer, was admitted into the hospital, April 3d, 1839. He liad been accustomed to work hard and drink freely, sometimes as much as two gallons of beer a day. His mother had died of phthisis, but the rest of his family had enjoyed good health. Sixteen years ago he suffered from ague, and he had since had three attacks of rheumatism. For the last nine or ten years (the first two-thirds of which period he spent near Chichester, and during the last third had been working in the Dock- yard at Woolwich) he had been subject to cough, which for the last twelve months had been much more frequent, and accompanied with increased expectoration, dyspnoea, gradually progressive emaciation, and per- spiration upon waking in the morning. While in nearly the same condition as in months passed, he was, during a violent fit of coughing three weeks ago, suddenly seized with severe pain in the lower part of the right side of the chest, accompanied with great dyspnoea, which lasted for three or four hours. At the expiration of this period he felt a little easier, though not free from pain and shortness of breath. Thus he continued till-the next morning, when he awoke with pain as severe as before. Some internal medicines were administered, and a blister applied, which produced a mitigation, but not a cessation, of his suffering, which had continued more or less ever since. The expectoration, which before was copious and muco-puriform, had since been trifling, but it had been, once or twice, streaked with blood. On these occasions only had he ever noticed any blood in the sputa. Before his present attack he never tried to lie upon the right side, as he was accustomed always to lie upon the left; but during the whole of his present illness he has found it impossible so to lie. For the last five weeks he had been unable to lie even upon the left side, and had consequently kept upon his back. The breathing, except at the onset of the malady, had not been shorter than it was before. During the last week or ten days he had perspired at night more profusely than usual, but it did not appear that he had had any distinct hectic paroxysms. Upon admission, he complained chiefly of pain in the lower part of the right side of the chest, increased upon pressure. His cough was only occasional, and his expecto- ration rare and scanty. The breathing did not a])pear much oppressed—respirations twenty-six in the minute; the pulse was regular, small, easily compressed, 120 in the minute; the skin was cool and rather harsh ; the tongue moist, but slightly furred; the bowels open. Physical signs.—In the recumbent posi- tion, the lower two-thirds of the right side of the chest were much too resonant on percussion. The upper third of the right](https://iiif.wellcomecollection.org/image/b22274522_0036.jp2/full/800%2C/0/default.jpg)
