A case of tuberculous excavation of the left lung, treated by perforation of the cavity through the walls of the chest / by John Hastings, M.D. and Robert Storks, Esq.

  • Hastings, John, M.D.
Date:
1844
Catalogue details

Licence: Public Domain Mark

Credit: A case of tuberculous excavation of the left lung, treated by perforation of the cavity through the walls of the chest / by John Hastings, M.D. and Robert Storks, Esq. Source: Wellcome Collection.

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

    9/16 page 7
    ling noise from coughing. His appetite for food hns returned. 2 P.M.—Has felt comfortable since morning, and completely lost headache; pulse 80. Wound healing rapidly ; tube adherent, bringing away a portion of granulations (evidently from the ca- vity) between the openings of the tube. Air freely escapes through the wound and tube on the slightest cough or effort. There has been little or no cough, difficulty of breathing, nor ex- pectoration, since the morning. Two or three mucous sputa, transparent, and mixed with air-bubbles, being all that was coughed up. Evening.—Very com- fortable ; good appetite; pulse 82; has had no expectoration, and little cough, 2d, half-past 8 a m.—Has passed an exceedingly comfortable and tranquil night (the best night he has passed for some time), and has been perfectly free from headache, or pain in any part. Had no expectoration till about two o'clock A.M., since which he has spit up about half an ounce of a tenacious mucus, without much cough or effort. The sputa are nearly free from air- bubbles, rusty-coloured, some almost of a fleshy aspect, and one with a streak of florid blood. His countenance is ex- pressive of strength, and is quite free from anxiety ; lips moist. Air freely escapes through the tube on coughing, or even on retaining the breath, with a hissing noise. He was at breakfast, and eating with appetite, sitting up with apparent ease in the chair. He states that his pulse were about 70 till he commenced his meal; they are now 90; respirations 28. 9 P.M.—The expression of the pa- tient's countenance is highly favoura- ble; and he states that he is conscious of an acquisition of health andstrength. During the day he has been perfectly free from headache and uneasiness, and has partaken of food with a good appe- tite. There has been but little cough, and no difficulty of breathing, except when the sputa were about to be ex- pectorated. The expectorated matters amount to about half an ounce, and consist chiefly of transparent frothy mucus, mixed with some more tena- cious sputa, of a brownish colour. Air continues to escape freely through the tube on every eflbrt. The skin is soft, moist, and of a comfortable tempera- ture; lips moist; no thirst. Pulse 80; respirations 24. 3d, 8 A.M.—The pulse were 88 ; the respirations 20. Air had passed freely out at the orifice of the wound at every inspiration ; he was very comfortable ; had slept eight hours without cough, and had very little expectoration ; the appetite was much improved; the bowels confined. He felt satisfied he was gaining both flesh and strength. An enema was ordered, 8 P.M.—Has passed a very comforta- ble day, and is conscious of an increase of strength. Thinks that instead of any increase of emaciation (which was the case for the first fortnight after the operation,) he has visibly gained flesh during the last few days. His appetite and digestion are now excellent, and he has been free from any pain or un- easiness. During the day there has been but little cough, and no difficulty of breathing, except when mucus was about to be expectorated. Sputa amount to about half an ounce, chiefly of clear, transparent, mucu, mixed with a few of greater consist- ence, of a salmon tint. Pulse rather small, moderately strong, and 88 ; re- spirations 20. Wound healing most favourably; air passes very freely through the tube. Tube adherent; when withdrawn, removed a long-por- tion of granulations from the cavity. Bowels have not been moved; tongue clean and moist. To use an enema of water gruel, with chloride of sodium. 4th, 8 A.M.—Has passed a very good night, having had about seven hours of refreshing nearly undisturbed sleep. Bowels moved spontaneously, without the use of the injection ; stool healthy. Has had but very trifling cough during the night, and has expectorated rather more than half an ounce of a tenacious mucus (the chief part having a fleshy aspect), without difficulty. Air freely escapes from the wound. Pulse 92; respirations 20. 5th, 8 A.M.—He has had an excel- lent night, without cough or expecto- ration. On waking had a little uneasi- ness about the wound, which apparently arose from the tube becoming blocked up with secretion, thereby preventing the free passage of air through the ori- fice. He had on waking expectorated two or three pieces of tenacious flesh- coloured mucus, similar to that which had been brought up during the last eight days. He complained of nausea after taking his medicine, in conse-
    digitised image 1
    digitised image 2
    digitised image 3