Notice of cases of pleurisy and pneumonia in the clinical wards of the Royal Infirmary, in summer 1850 : being the substance of two clinical lectures, delivered on 7th May and 18th June / by W.P. Alison, M.D.

  • Alison, William Pulteney, 1790-1859.
Date:
1850
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Licence: Public Domain Mark

Credit: Notice of cases of pleurisy and pneumonia in the clinical wards of the Royal Infirmary, in summer 1850 : being the substance of two clinical lectures, delivered on 7th May and 18th June / by W.P. Alison, M.D. 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.

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    comparative observations on the other ; hut even among them we can point out some as hy much the most uniform and distinct, and, therefore, the most practically important. A young man is apt to fancy that he has acfiuired the most important information of this kind, when he has heard and learnt to distinguisli the greatest variety of morbid sounds; but when he goes into prac- tice he may be disappointed on finding, that some of those on which lie has bestowed the most pains, seldom present themselves to his observation, and that, when he can hear them, he can draw no practical inference from them. What is most desirable is, that young men during their studies should fami- liarise themselves with the sjanptoms of this class, whicli are of most uni- form occurrence, and form a judgment of their true import and comparative value. In the case of pleurisy, there are three symptoms of this kind, easily ob- served in almost all those patients, and worth all others put together, as indicat- ing that effusion or exudation exists in the cavity of the chest, and, if preceded or attended by febrile and inflammatory symptoms, that inflammatory exuda- tion exists there. These are the dulness on percussion (greater when resulting from pleurisy than is ever observed from condensation of the lung without effu- sion into the sac of the pleura); imperfect expansion of that side of the chest on inspii'ation ; and suppression of the respiratory murnmr, excepting in the neighbourhood of the spine, where it is to be expected to be tubular or bron- chial. There are three others, very distinct and satisfactory in some cases, and noted in several of those in the wards, but much less uniformly observed, requiring more peculiar conditions for their manifestation, and therefore less generally useful—viz., the modification of resonance of voice, termed cego- phony, depending on the presence of a thin film of semi-fluid effusion between the layers of the pleura; the friction sound attending the acts of inspiration, and depending on the pleura pulmonalis and costalis, roughened by partial solid effusion, rubbing on one another; and the absence of the vocal thrill, felt by the hand applied to the chest when the patient speaks or coughs. Of these three, the last appears to me the most constant, and therefore the most valu- able, particularly when going along with the dulness on percussion; as charac- terising the case of fluid eff^usion, separating the pleura pulmonalis and cos- talis at the part, and distinguishing it from the case of adhesion-of these two membranes by solid lymph, over a condensed portion of lung;—in which case the dulness on percussion is attended with an increase of the vocal thrill, often very obvious in the upper part of the chest in advanced phthisis, as in several phthisical cases now in the wards. The enlargement of the side of the chest, or bulging of the intercostal spaces,—more or less general, according to the extent of the eff^usion,—is often very obvious and satisfactory in the advanced stage of the disease—at least of one of its forms ; but is not to be looked for in the early stage, which, in all inflammatory diseases, is practically the im- portant stage. As to the special indications of peripneumony, whether with or without attending plfeurisy, 1 think you will find the most important and practically useful to be that given by the sputa—i. e., the appearance of tenacious and at first translucent sputa, thoroughly stained with blood, and thereby acquiring a considerable variety of colours in different cases, the reasons of which variet}^ I do not pretend to know,—rusty, pink, purple, dark yellow or greenish,—all to be regarded as inflammatory ; but the darker coloured, or more opaque, being generally the indication of the more advanced stage of inflammation. The crepitotis rdle is in some cases very distinct and satisfactory, but in many it is unperceived, or if perceived is faint and of short duration in the early stage of the disease, while it may be of long standing in the advanced stage, and during the convalescence ; and in some it is not easily distinguished from the somewhat coarser soimd of the subcrepitous rale, winch may depend on conditions in the lungs, or minute branches of the bronchial, very different from inflammation. On these accounts this syniptoni has never seemed to me I