Pneumothorax : a historical, clinical and experimental study.

  • Emerson, Charles Phillips, 1872-1938.
Date:
1903
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Licence: Public Domain Mark

Credit: Pneumothorax : a historical, clinical and experimental study. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    P. 309. If the eruption of pus has not yet occurred, succussion pro- duces a noise in the side as in a leathern bottle.'1 (But it is uncertain whether Hippocrates wrote this book or not.) Vol. V, p. 681. Coacse praenotiones. Those empyema cases who when shaken by the shoulders produce much sound have less pus in them than those who produce little sound. The latter also have more dyspnoea and their face is more discolored. Finally, those who produce absolutely no sound; they have great dyspnoea, and livid finger nails; they are full of pus, and their case is desperate. (Laennec remarks that the writer of this sentence almost discovered pneumothorax and would have, had he had enough cases, and noticed why those with least pus made the most noise on succussion. Yet this book also is denied Hippocrates. Adams says, The Coac« praenotiones have very little ancient authority in their favor. Of late years the opinion has gained pretty general assent that these two treatises are more ancient than the days of Hippocrates, that in fact they constitute the materials out of which he composed the ' Prognostics ' and are the results of the older observations made by the priest-physicians in the Asclepion, or Temple of Health at Cos. We claim no right to discuss this question of age but nevertheless would ask these critics if these similar descriptions of suc- cussion would not be evidence that the books in which they are found were either all before or all later than Hippocrates, granting that he made no mention of it.) In conclusion, the writers of the above mentioned books formerly ascribed to Hippocrates, certainly describe cases of pneumothorax under the name empyema, for the splash on succussion occurs in no other disease. They did not consider it an infallible sign, for when it fails they advise to incise the distended, or the painful side. They were correct in considering it a sure indicator of the affected side. Another point of importance is that they Avere dealing chiefly with cases of pneumothorax following disease of the lungs, for until the beginning of the last century such cases Avere for the most part over- looked, and traumatic cases alone were described and misinterpreted. There has been considerable discussion as to what disease it was that caused a pleural effusion which on succussion would splash. If, as the descriptions would indicate abscess of the lung is meant, then Littre may be right in saying it Avas perhaps more common in that age and climate than now. Adams, however, thinks that under the term abscess were included the tuberculous areas, especially of acute phthisis, which in the age and climate of more recent writers is cer- tainly common enough. But pneumothorax is a rare condition when compared with empy-