Volume 2

On pneumo-thorax: an essay, read in part at the Physical Society of Guy's Hospital / [Henry Marshall Hughes].

  • Hughes, Henry Marshall, 1805-1858
Date:
[1844]
Catalogue details

Licence: Public Domain Mark

Credit: On pneumo-thorax: an essay, read in part at the Physical Society of Guy's Hospital / [Henry Marshall Hughes]. Source: Wellcome Collection.

    6/38 (page 6)
    she had a “ bad breast,” which was poul¬ ticed, suppurated, and burst spontaneously ; and that very soon after this event she observed air proceed from the opening of the abscess ; that she began to cough and expectorate, and had continued to do so, with gradually increasing debility, up to the time I saw her. She was ordered tonics and sedatives, and to continue the poultices to the sinuses. After several weeks, the discharge diminished, and the cough de¬ creased, though her general health improved very slowly, and her debility remained nearly as great as upon my first visit. For the purpose of improving her general health, and that she might not be exposed to the harsh usage of a drunken and dissolute hus¬ band, she was now advised to go into the country, and was not seen by me for more than two years. After the lapse of about six and twenty months, a person applied to me at the Dispensary for some trifling stomach complaint. She was stout, sleek, and ruddy, and looked in such really rude health, that I was surprised she required the aid of the doctor. After I had made some inquiry, she said, “ You do not recollect me, sir; I am the person you attended in Crosby Row. My husband died, and I have got another, sir, and have had a child, sir, since you saw me.” Even after this statement, I could scarcely recognise in her the pallid, emaciated, sickly thing, I had formerly attended. She, however, told me that the discharge, cough, and expectoration, had ceased, and that the wounds had healed, but that she was occa¬ sionally troubled with flying pains in the side, and shortness of breath. I much regret that my engagements at the time prevented me instituting an examination of her chest, and that, being unacquainted with her ad¬ dress, I have since had no opportunity of doing so. C as e 11.—Anne J ohnson, aged 3 6, was ad¬ mitted into Guy’s Hospital, Sept. 21, 1841, with cough, expectoration, and discharge from the right side, immediately below the mamma, with all of which she had been troubled for ten months. The history of her complaint, and the symptoms and local signs of her disease, were so similar to those related of the last person, that I consider it quite unnecessary to detail them. She was occasionally at¬ tended by Dr. Barlow and Mr. Cock con¬ jointly with myself. Mr. Cock, while adopt¬ ing means to ensure a free opening for the discharge of matter, and thereby to favour the collapse and contraction of the side, was able to pass an elastic catheter four or five inches into the chest, and he was inclined to the belief that the cavity from which the discharge proceeded was situated, principally at least, in the lung itself. She continued in the hospital till March 10,1842, and though little or no progress was made in the cure of her complaint, she left with her general health in no degree diminished by the long- continued drain to which she had been sub¬ jected. Doubts may, I am aware, exist, as to the origin of the disease in these two cases, and a difficulty may be felt in deciding whether the empyema or the mammary abscess was the pri¬ mary affection ; as the information necessary for a correct determination of the question was, in both cases, derived from the patients themselves. After repeated examination in each case, I was myself led to believe that the mammary abscess certainly preceded the affection of the pleura. The late Dr. Andrew Duncan* mentions a case in which abscesses of the parietes of the chest became em¬ physematous in consequence of communi¬ cation with the bronchial tubes, and in which the fluid contents of the abscesses were expectorated through those channels. Thus it appears that though matter may always have a tendency to make its way to the sur¬ face, it does not necessarily take the most direct course; and it is clear that even in mammary abscess, as to the desirableness of opening which great diversity of opinion exists, “ the line of road may sometimes be marked out” by the surgeon with great advantage to the patient. Causes of pneumo-thorax. Pneumo-thorax may arise from causes ex¬ terior to the lung, or from disease or lesion of the organ itself. Among the former set of causes may be mentioned,— 1. The fluid of an empyema bursting * Edin. Med.-Chir. Trans. Vol. i. p. 458.