Some considerations in regard to acute obstructive diseases of the lungs / by Andrew H. Smith.

  • Smith, Andrew H. (Andrew Heermance), 1837-1910.
Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Some considerations in regard to acute obstructive diseases of the lungs / by Andrew H. Smith. 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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    obstruction, and this in turn adds to the burden of the right ventricle, thus completing the vicious circle. The struggles of the ventricle become feebler and feebler, while the tension within its cavity constantly increases, as the blood presses into it from behind. At last there comes a moment when the over- taxed muscle cannot summon the energy for another contrac- tion, and its action ceases in diastole. The steps which lead up to this result are in a great degree traceable by symptoms and physical signs. First of all, there are auscultatory and other signs of pulmonary obstruction ; then come signs of general venous congestion. The distended right auricle may be traceable by percussion, or even may be seen pulsating at the right of the sternum. An increased area of cardiac dulness extending toward the xiphoid cartilage in- dicates the repletion of the right ventricle, and in spare sub- jects the labored beating of this may be felt by pressing the fingers under the costal cartilages. The tense, hard pulse of inflammation is replaced by the small creeping pulse of arterial, depletion. The superficial veins are seen to be unusually pro- minent, and the liver is enlarged. The spleen also is increased in size, an.d evidence of intestinal congestion may be afforded by copious diarrhoea. Proof of passive hyperaemia of the kidneys is found in lessen- ed excretion and in albuminuria. Thus all things combine tc indicate a general preponderance of blood in the venous ■ side of the circulation, the result which we should naturally expect from a retardation of the blood in the pulmonary ves- sels. Now, what is the indication for treatment to be derived from this accumulation of blood in the venous system ? Manifestly it is to diminish in every safe and proper way the disparity be-, tween the venous and the arterial supply. Formerly this wa< attempted by copious bleedings, which, however, were prac-j tised rather as a general antiphlogistic measure than with any j exact notion of the mechanical conditions present. Certain il | is, that the practice often resulted in at least temporary relief ■ which was ascribed to subduing the inflammation. Withdraw | ing a large amount of blood from the venous systenr j