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
Catalogue details

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.

    52/215 (page 258)
    In other patients, the stomach is but little altered; but there comes on a diarrhoea, sometimes serous, and free from pain, sometimes attended with abdominal pains; tenesmus and bloody stools also may be observed. In these different cases, the tongue is very far from being always a faithful index, of the state of the primae viae. Thus, on more than one occasion where there was obstinate vomiting with pain in the epigastrium, we have seen the tongue preserve its natural moisture and colour. On the other hand, we already remarked, that the black incrustation of the tongue was not necessarily connected with the degree of intensity of the gastro-intestinal inflammation. 21. The mucous membrane of the air passages, as well as that of the digestive passages, frequently becomes, in aneurismatic patients, the seat of sanguineous congestions. They are observed also whether there be dilatation, or narrowing of the cavities of the heart, whether its parietes be hypertrophied or thinned, whether, in a word, the seat of the disease resides in the right or in the left cavities. In all these cases, in fact, the circulation of the blood in the interior of the heart no longer going on as in the normal state, this fluid must have a tendency to flow back, and stagnate in the pulmonary vessels. It is easy to conceive then that in proportion to the variable intensity of this cause of stagnation, or, of the accumu- lation of blood in the lung, the congestion produced in this organ must also present a great number of degrees. The different degrees of pulmonary sanguineous congestion, from w’hence there are produced, in the bronchial mucous membrane, a great many shades of redness, are indicated during life by different degrees in the difficulty of the respiration. In fact, if more blood than is natural be accumulated in the pulmonary vessels, it is evident that the quantity of air ordinarily introduced into the lungs, will no longer be sufficient to arterialise the entire mass of blood, which is diffused in superabundance over the parietes of the pulmonary vesicles ; thence the necessity of the introduction of a greater quantity of air in a given time, and consequently a greater frequency in the inspiratory movements, and a feeling of oppression. So long as the sanguineous congestion is not very considerable, this introduction of an e.xcess of air into the lungs is performed instinctively ; the patients do not yet habitually feel any oppre.ssion ; but it is easily perceived that their speech is already short, and their breathing hurried; if we apply the ear to the thoracic parietes, the respiratory murmur is heard to be performed with rmusual strength, an evident proof that the air passages receive a greater quantity of respirable fluid. This anormal intensity of the respiratory murmur, its distinctness being still preserved, is often observed before any other sign has demonstrated the existence of an organic affection of the heart: it does not prove that the latter exists, but it affords a certainty that some cause or other impedes the free passage of the blood through the pulmonary vessels. But if the sanguineous congestion becomes more . and more considerable, a period arrives when, notwithstanding the efforts made by the patient to introduce the greatest possible quantity of air into his lungs, the quantity of atmospheric gas which enters as far as the ultimate bronchial ramifica- tions becomes insufficient to duly modify all the blood accumulated in the lungs ; on the other hand, the portion of this blood, already arterialised, oftentimes can no ; longer flow freely into the left cavities of the heart: thence, an additional obstacle to the entrance of the venous blood into the lung, and consequently a reflux and stagnation of this latter : 1st, in the right cavities of the heart; 2nd, in the large | venous trunks which enter into it; 3rd, in all the parenchymatous tissues, whence these venous trunks bring the blood towards the heart more or less directly. Then the difficulty of breathing is carried to the highest degree of intensity, the asphyxia is imminent; the patient feels that an unsurmountable obstacle is opposed to the j| entrance of the air into his lungs ; however, this air still enters freely into the || vesicles, and the feeling of suffocation arises solely from the quantity of air || introduced being no longer proportioned to the mass of blood to be arterialised. |i