Volume 2

The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan.

  • Andral, G. (Gabriel), 1797-1876.
Date:
1836
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Licence: Public Domain Mark

Credit: The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan. Source: Wellcome Collection.

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

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    usually diffused over the entire face. This appearance of the face is often so well marked, that it has served us, in some cases, more than any other sign, to diagnose the third stage of pneumonia. 80. Delirium manifests itself rather frequently during the course of pneumonia. Sometimes appearing only at intervals, and particularly during the night, it is a symptom not at all important. Sometimes, on the contrary, it is continued, and is accompanied by other nervous phenomena. In this case it may be produced by a real meningitis ; but most frequently no other lesion is found than a certain quantity of limpid serum effused into the ventricles, and particularly at the base of the cranium. The delirium, owing to this cause, manifests itself principally when the respiration is ver}' much embarrassed ; it seems that here, as in aneiirismatic patients, as in all cases where there is a commencement of asphyxia, the serous cere- bral effusion arises from the purely mechanical difficulty experienced by the venous blood in its return from the encephalon to the lungs through the right side of the heart, which is gorged, and as it were obstructed with blood. At other times again, we find no appreciable lesion either in the encephalon or its appendages to account for the delirium of pneumonias. 81. The mode of lying down in pneumonia has this long time engaged the attention of practitioners ; constant decubitus on the affected side has been given as one of the characteristic signs of inflammation of the lung. Now nothing is less true. At the onset of pneumonia, as in its course, there is scarcely one patient in fifteen who lies in this way ; all the rest constantly lie on the back. It is not in pneumonia, but in certain pleuritic effusions, that this decubitus on the affected side is observed, as we shall prove another time. 82. The state of the pulse is very variable ; its most usual character is that of being frequent and large. When the inflammation is very intense, it is some- times remarkably small ; this smallness disappears after copious blood-letting. In other patients there exists a real weakness of the pulse, which is increased by bleeding. As much as numerous bleedings are useful in the first stage, in the same way would they be injurious in the second. The sudden suppression of the sputa, the increase of the dyspnoea, a prostration rapidlj^ fatal, have been more than once the result of these unreasonable bleedings. It is then that active revulsives should be employed. It is often very difficult to establish, a priori, and from the mere consideration of the symptoms, the distinction between the pulse which is really weak, and that which is only apparently so. The effects of bleeding may assist considerably in establishing this distinction. Sometimes, on the contrary, after copious bleedings, and when every thing announces that the inflammation is lessening, the pulse loses nothing of its strength and hardness ; but in that case very often, and this is observable in old people particularly, the hardness of the pulse does not indicate the severity of the inflammation or the strength of general reaction ; it is connected with hypertrophy of the heart, confined to the left ventricle, the parietes of which are thickened at the expense of the cavity. It is easily seen how important the knowledge of such a circumstance is with respect to treatment. It rarely happens that the pulse presents an intermission or well-marked irregularity, even in the most alarming cases, unless there be a complication of organic lesion of the heart. Great frequency of the pulse announces danger in this disease. It seldom happens that recovery takes place when the pulse exceeds one hundred and thirty. The irequency of the arterial pulsations is always in a direct ratio with the frequency of the inspiratory movements ; however, in the last periods of life it is often observed that the pulse loses its frequency and seems to have returned to its natural state, though the respiration becomes more and more accelerated. This is invariably a fatal sign. When the different rational symptoms of pneumonia have disappeared, when