A treatise on pulmonary consumption : comprehending an inquiry into the causes, nature, prevention, and treatment of tuberculosis and scrofulous diseases in general / by James Clark.

  • Clark, James, Sir, 1788-1870.
Date:
1835
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on pulmonary consumption : comprehending an inquiry into the causes, nature, prevention, and treatment of tuberculosis and scrofulous diseases in general / by James Clark. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    on the opposite sides, the signs afforded hy auscultation are not much to he depended on at this early state ; and in many cases we have to form our opinion of the patient's condition from the local and constitutional symptoms only. In other instances, however, with the same symptoms, the physical signs afford the most unequivocal indications of the existence of pulmonary disease. The sound elicited by percussion is evidently less clear under one clavicle ;* the respiration less soft and easy, and the voice decidedly more resonant than under the opposite clavicle ; and, even at this early period, the motions of the upper parts of the chest, carefully ob- served during inspiration, may often be remarked to be une- qual ; one side of the chest being more fully expanded during inspiration than the other. When this is the case, it will generally be found that the side least elevated is that which gives the most evident signs of the existence of tubercles. When the tuberculous matter is diffused over a large portion of the lungs, a degree of puerile respiration occasionally indi- cates its presence. A marked inequality in the sound of the respiration in different parts of the chest also affords strong suspicion of tuberculous disease, when such inequality cannot be otherwise accounted for. By a careful inquiry into the state of the patient's health previously to the period now under consideration, and by attention to the various symptoms which have been enume- rated, the physician who has been accustomed to trace the relation of symptoms to the morbid changes of the organ, will rarely fail to arrive at a correct opinion ; and if he can avail himself of the evidence derived from the physical signs, he * In no case, says Dr. Forbes, is the importance of percussion so fre- quently and strikingly evinced as in the earlier stages of phthisis. A single tap on the clavicle will often afford the means of a more certain diagnosis than weeks or even months of observation of the general symptoms.—See Translation of Laennec, last edit., p. 308.