A treatise on the diagnosis and treatment of diseases of the chest. Part I, Diseases of the lung and windpipe / by William Stokes ; with memoir by Dr. Acland ; edited for the New Sydenham Society by Alfred Hudson.

  • Stokes, William, 1804-1878.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diagnosis and treatment of diseases of the chest. Part I, Diseases of the lung and windpipe / by William Stokes ; with memoir by Dr. Acland ; edited for the New Sydenham Society by Alfred Hudson. Source: Wellcome Collection.

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    either to the right or left side, as the case may he. Now all these displacements of the lung, mediastinum, and heart, are easily appreciable by physical signs. But we observe displacements of the abdominal viscera conse- quent on thoracic disease, a circumstance explicable by consider- ing the nature of the floor of the thorax; that it is not, as the rest of its parietes, bony or cartilaginous, but formed principally by muscle and some tendinous expansion. Under circumstances of great accumulation of fluid, or of hypertrophy of the lung, this muscular wall yields to pressure, its convex surface becomes flattened or even concave, the viscera of the abdomen, on the side corresponding to the affected lung, are pushed down before it, and from their displacement a new and most important source of diagnosis is obtained. It is true that the reverse may happen, and the thoracic viscera shall be displaced by abdominal disease; thus, an enlarged liver or spleen, an abdo- minal aneurism, or an accumulation of air or fluid in the belly, by pressing on the concave side of the diaphragm, may displace the lung or heart, but it is obvious, that when we consider the difference between the abdominal and thoracic walls, and the yielding nature of the latter, such can only occur in very exten- sive disease. It is plain, too, that the natural action of the diaphragm will tend to diminish these effects, while in the former case it could have no such influence; and it will be proved in the following pages, that an amount of pressure on the concave side of the diaphragm, carried even so far as to displace the superjacent viscera, does not deprive it of its contractile power. If we take a general view of the cranial, thoracic, and abdo- minal cavities, it would appear that in none of them is the diagnosis of disease, from symptoms alone, so difficult as in the chest. ^ But further investigation will prove to us, that there is no cavity in the diseases of which, when we combine the study of symptoms, properly so called, with that of physical signs, the determination of the nature, extent, and modifications of disease is so easy and certain. In fact, the diagnosis of thoracic diseases is founded on the combination of signs and symptoms, and we shall find, that of all the cavities the chest is that in which the physical signs are most numerous and of most exten- sive application. The nature of thoracic disease may be occasionally determined