Medical clinic : diseases of the chest / by G. Andral ; condensed and translated, with observations, by D. Spillan.

  • Andral, G. (Gabriel), 1797-1876.
Date:
1843
Catalogue details

Licence: Public Domain Mark

Credit: Medical clinic : diseases of the chest / by G. Andral ; condensed and translated, with observations, by D. Spillan. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

    397/410 (page 399)
    fication connected with some varieties of pleurisy. Thus in costo-pulinomry pleurisy the breathing is principally diaphragmatic ; on the contrary, in inflam- mation of the pleura lining the diaphragm, this muscle becomes immoveable, and the dilatation of the thorax is principally the result of the elevation of the ribs. 150. The cough never occurs in kinks ; it is small, as if cut short, and more or less frequent. It may even be entirely wanting, though the inflammation is intense and a considerable efi'usion exists in the pleura. This total absence of cough has been well ascertained by us in more than one case; it is easy to see that the cough may very naturally not show itself in persons not very irritable, whose bronchial mucous membrane is not symptomalically irritated by inflam- mation of the pleura. We should not forget, then, that a very .severe pleurisy may exist, though the patient may have no cough. 151. When the cough exists, it is dry, or accompanied by an expectoration purely catarrhal. Areteeus clearly laid down the difference between pleuritis and pneumonia, with respect to the expectoration. There are scarcely any sputa, he says, in pleuritis, sputa vix exsecreta, wlnht they are more profuse and bloody in the case of pneumonia. We do not find ideas so clear either in the writings of Hippocrates and Galen, or in the works of several physicians of the two last centuries, who seem to have often confounded the symptoms of these two inflammations. When pleuritis has terminated in efTusion, the expectoration always remains catarrhal. Sometimes, however, v.'lien a communication is set up between the cavity of the pleura and of the bronchi, the eff'used liquid is discharged through the trachea, and is found in the expectoration. The particular nature of the sputa, and the manner in which they are thrown up, are generally considered as un- equivocal signs, by help of which we may readily recognise the existence of a pleuritic effusion opening into the bronchi. Thus the extreme foelor of the sputa, their alliaceous odour, or an odour similar to that of phosphuretted hydrogen, has been considered one of the surest marks that the sputa which present this odour arise from a pleuritic effusion. But we have observed a similar fetor in persons affected with simple chronic bronchitis (see ante) ; these latter cases are how- ever very rare. On the other hand, we have seen patients whose sputa were inodorous, or but very slightly fetid, though there was found in them a commu- nication between the cavity of the pleura and the air-passages. It is said that in cases of this kind a liquid has been easily made to pass from the cavity of the pleurae as far as the large bronchi, but that it has been impossible to force the air from the bronchi into the pleurae, by reason of a peculiar disposition of the air-tubes. It has been then thought that the same was tlie case during life, and that the sputa remained inodorous, because the air, not being able to penetrate into the cavity of the pleurae, had not been in contact with the purulent collection. The other qualities of the sputa, such as their colour, consistence, and form, may also be found in chronic bronchitis. It is also an opinion generally laid down, that in the case where the matter of the effusion has been discharged through the lung, this evacuation takes place suddenly, and in great quantities at the time ; the patient seems really to vomit pus: but this can only occur where a large opening is suddenly made. If, on the contrary, the opening is at first small, and enlarges only by degrees, it is clear that the evacuation of the pus should take place but slowly, and in small quantity at the time. Now, in this latter case, it is very difficult to ascertain the real origin of the matter expectorated ; at the very most it can only be j)re- sumed, from the aggregate of the symptoms which indicate the existence of a pleuritic effusion ; the diagnosis would acquire additional certainty, if these symptoms were observed to disappear according as the expectoration is esta- blished. In the case of a sudden discharge of a great quantity of pus, it cannot be affirmed that the liquid discharged has come from the cavity of the pleurae ;