Dissertations on the question How far are the external means of exploring the condition of the internal organs to be considered useful and important in medical practice? : for which premiums were adjudged by the Boylston Medical Committee of Harvard University, 1836 / by Oliver W. Holmes, Robert W. Haxall, and Luther V. Bell.

  • Holmes, Oliver Wendell, 1809-1894.
Date:
1836
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Licence: Public Domain Mark

Credit: Dissertations on the question How far are the external means of exploring the condition of the internal organs to be considered useful and important in medical practice? : for which premiums were adjudged by the Boylston Medical Committee of Harvard University, 1836 / by Oliver W. Holmes, Robert W. Haxall, and Luther V. Bell. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    had formed in consequence of some former attack. During the early part of the disease, aegophony is sometimes met with, before the effusion has made sufficient progress to impede its occurrence. Another sign, the consequence of effusion, is dilatation of the affected side, and this is frequently observable a few hours after the fluid is secreted ; because there are cases in which it at once becomes very considerable. The ribs appear to be elevated, the intercostal spaces are augmented in breadth, and in proportion to the excess of the fluid after it has reached a certain point, is the diaphragm depressed ; and hence it is that very often a deceptive appearance of enlargement of either the spleen or liver is observed, and more particularly the latter, on account of its superior volume. It is undoubtedly the chronic form of the disease, in which dilatation is more uniformly perceptible, and the phenomena to which we have alluded are more distinctly marked. Although always commencing early, it may not be clearly distinguishable for some little time, yet it ultimately increases to such a degree as no longer to be mistaken. All the physical signs hitherto mentioned, except aegophony, are eminently developed, and this for the reason already given. The lung, in consequence of protracted compression, appears to be nearly destroyed ; its tissue is pale and exsanguineous, and its vessels and bronchial tubes are flattened. The character of the effusion is also found to vary ; it is often purulent and is of a green or yellowish color. In this state the disease is denominated empyema. Should life continue sufficiently long, and the absorption of the fluid take place, the affected side becomes contracted in its dimensions. This is the result of the slow and gradual manner in which adhesions are developed ; and did it belong to us in this place to enter minutely into the mode of their formation, we might offer an interesting history of the process. It is sufficient^ for us to say here, that they ulti- mately assume a fibro-cartilaginous structure, and thus tend