On diseases of the heart and great vessels .. / by Henry William Fuller.

  • Fuller, Henry William, -1873.
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: On diseases of the heart and great vessels .. / by Henry William Fuller. 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.

    197/762 (page 177)
    ^^ from the extension of a tuberculous excavation, arc the most freorontj^f^ those which not only excite pleurisy, but lead to the admisM^ i^air ^ into the pleural cavity, and give rise to pneumothorax.* Of fhe*a^eno^ '■ of the first-named cause, viz. exposure to cold, which is genei^lljj^^ be the most common source of pleurisy, I feel bound to e^resjSi^iny entire disbelief. Nothing, I think, admits of clearer proof, than. th9.t cold, however intense, and however applied, will not produce pleurisy in a healthy person; and that when exposure to cold is followed by inflam- mation of the pleura, the disease is due to some morbid condition of the blood, and not merely to cold. Possibly the patient might have escaped an attack if the exposure had not taken place, for his general health might have improved, and the blood might have regained its natural condition, without the supervention of pleuritic inflammation. But strictly speaking, cold is a mere accessory cause of the disease—a predisposing or exciting cause, but not the proximate or essential cause. Over-fatigue, anxiety of mind, undue excitement, or any of the thousand causes which tend to lower the vital energy and disturb the various functions of the body, might, equally with cold, have served to overcome the patient's power of resistance, and thus to excite an immediate attack. But popular feel- ing and casual observation combine to assign to cold the discredit of the seizure. Eigors precede or accompany the disease, and it is not sur- prising, that the Public should mistake them for shivering, the result of exposure to cold. But the physician should be aware that something more is needed than mere exposure to cold, or to atmospheric vicissi- tudes, in order to induce inflammation of a membrane which is protected on all sides from the influence of cold.f The blood must be out of order, and probably contains some noxious, irritating matter, which acts directly on the pleural membrane, and excites inflammation. Experience has long since proved that a tuberculous, scrofulous, or cancerous diathesis, and the cachectic condition of the blood, which results from Bright's disease of the kidneys, intemperate habits, syphilis, pyemia, gout, and rheuma- tism, are amongst the more active provocatives of pleurisy, and equally * Suppurative disease in the abdominal viscera has been known to produce perfora tion of the diaphragm, and to excite pleurisy, and hydatids have given rise to the same result; but such cases are extremely rare, and only deserve notice as medical curiosities. t J-'or a detailed examination of the popular f-Ulacy respecting cold, see the Intro duction to the third edition of my work on Rheumatism, Rheumatic Gout and Sciatica, where the subject is fully discussed. 12