A manual of medicine.

  • Allchin, William Henry, 1846-1912.
Date:
1901
Catalogue details

Licence: In copyright

Credit: A manual of medicine. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    actual recession. The movements of the upper part of the thorax are excessive, to compensate for inaction of the diaphragm, but dyspnoea is not necessarily present when the patient is at rest, although it supervenes on the slightest exertion. Moreover, any lung disease, such as bronchitis or pneumonia, is rendered much more serious by the respiratory inefficiency. The prognosis is good in rheumatic and in post-diphtheritic cases, less so in alcoholism, and worst in central disease of any kind. Treatment.—Electrical stimulation of the paralysed nerve is advisable only in cases of peripheral origin. In cases of diaphrag- matic palsy due to lesions in the cord, treatment by electricity is not indicated; attention should then be devoted to the central lesion. The nerve can be stimulated by placing one pole of the battery deeply to the outer side of the clavicular head of the sterno-mastoid, the other pole being placed over the epigastrium. Hypodermic injections of strychnia are of benefit in alcoholic and pcst-diphtheritic cases. THE BRACHIAL PLEXUS Origin and distribution.—The brachial plexus is derived from the anterior primary divisions of the four lowest cervical nerves and of the first dorsal nerve. Of these, the anterior primary divisions of the fifth and sixth cervical nerves unite to form the upper trunk of the plexus. The seventh cervical runs on as the middle trunk, whilst the eighth cervical and first dorsal unite to form the lower trunk. Each of these trunks divide into an anterior and a posterior branch, of which all three posterior branches unite to form the posterior cord of the plexus, the anterior branches of the upper and middle trunks combining to form the outer cord; whilst the inner cord is formed by the anterior branch of the lower trunk. The cords of the plexus closely embrace the axillary artery. For a further description of the origin and distribu- tion of the various supra- and infra-clavicular branches of the jdIcxus, the reader is referred to anatomical text-books. Paralysis of the brachial plexus.—The plexus may be paralysed in whole or in part. It is not always possible to tell whether the site of the lesion is in the plexus itself or in the nerve roots before they form the plexus. Moreover, a lesion often extends from the roots into the plexus. Paralysis of the whole brachial plexus is rare. It is almost always traumatic, resulting from injuries in the region of the