Chest disease

“ In this category are pulmonary emphysema and obstructive or regurgitant valvular lesions at the mitral orifice of the heart. The disease is rarely developed in chlorotic patients. Facts go to show that alcoholism opposes its development. In opposition to current belief, my clinical studies lead me to conclude that they who have had scrofulous disease of the cervical glands in early life are not likely to become phthisical in after years. Contraction of the chest from deformity diminishes the liability to the disease. ”

“ If the air enters the pleura and takes the place of the pus, the chest remains enlarged. Indeed, it sometimes increases in size to such an extent as to cause suffocation unless the pus and gas are withdrawn. The valve made by the false membrane allowing the air to enter the cavity, but not to escape from it, causes the fluid to accumulate rapidly, and we have pneumothorax to a very painful degree. The diaphragm is pushed down, and, if the disease is on the right side, the liver is forced down, and descends to a level with the umbilicus. ”

“ Such was the form which the plague assumed in the fourteenth century, for the accompanying chest affection which appeared in all the countries whereof we have received any account, cannot, on a comparison with similar and familiar symptoms, be considered as any other than the inflammation of the lungs of modern medicine, a disease which at present only appears sporadically, and, owing to a putrid decomposition of the fluids, is probably combined with hemorrhages from the vessels of the lungs. ”

“ In these cases the abdomen is protruded more or less with every inspiration. The difference between the two types of breathing is important, as in the latter class of cases there is more advanced and extensive disease than in the former, the symptoms being more urgent, and especially the dyspnoea greater. Inspection of the chest shows that the movement of inspiration is more quickly accomplished than that of expiration, which is prolonged, labored, and often wheezing in character. ”

“ Actual enlargement of the organ may, however, result from prolonged over-action, as in Basedow's disease, in the smoker's heart, and the irritable heart of neurasthenics, but it is usually slight. Increased dulness in the cardiac area may be due to a variety of causes, some of which may simulate hypertrophy, as pericardial effusion, aneurism, mediastinal growths, or displacement of the heart from pressure or the existence of malformation of the chest; but with the exercise of ordinary care the diagnosis can usually be made. There are two opposite conditions which not infrequently give trouble. ”

“ Sometimes, by the omission of bleeding in due quantity at the beginning, and sometimes in spite of all possible care, it terminates in an abscess, which, on bursting, may suffocate the patient; or, if the matter is coughed up, becomes an open ulcer, and produces the disease in question.
The third cause of the pulmonary consumption above mentioned, is, a spitting [227] of blood, from the bursting of vessels of the lungs, independent of external wound or bruise. People of a fair complexion, delicate skin, slender make, long neck, and narrow chest, are more subject to this than others. ”

“ Take, for example, the frame-work of the chest, in the cavity of which are situated those organs which seem especially to suffer whenever the recruit and the young soldier are subjected to over-exertion. Next to the inspiration of bad air, the imperfect, or continuously obstructed inspiration of the chest, tends more than any other cause known to bring about disease of the lungs and heart. ”

“ Of all things the most pernicious to people predisposed to a spitting of blood, is, playing upon wind-instruments. Previous to the spitting of blood, some perceive an uneasiness in the chest, an oppression on the breath, and a saltish taste in the spittle; but these symptoms are not constant.
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Nothing can be more insidious than the approaches of this disease sometimes are. The substance of the lungs, which is so full of blood-vessels, is not supplied so liberally with nerves; the lungs, therefore, may be materially affected, before danger is indicated by acute pain. ”

“ In severe forms of the disease the patient comes to acquire a peculiar puffy or bloated appearance, and the configuration of the chest is altered, assuming the character known as the barrel-shaped or emphysematous chest. ”

“ Owing to the greater liability of the light, or partly sanguine group, to active inflammations, a potent factor in causing this deficient size of the chest is inflammation, mainly pleurisy and pneumonia, and, as a not uncommon result, a collapse of one, or both, of the chest-walls. ”

“ Of course the only exact way of learning the nature of a chest trouble is thorough, careful examination by a physician, for cough, fever, rapid breathing and rapid pulse occur in many other diseases besides bronchitis, particularly pneumonia.
Pneumonia begins suddenly, often with a severe chill, headache, and general pains like grippe. In a few hours cough begins, short and dry, with violent, stabbing pain in one side of the chest, generally near the nipple. The breathing is rapid, with expanding nostrils, the face is anxious and often flushed. ”

“ Still, if an abnormal murmur, harsh or soft in character, become suddenly developed over the pulmonary or aortic orifice, where it was known not to have previously existed, it is a physical sign which points with much certainty to the presence of a heart-clot. Whenever the signs and symptoms given above which show disturbance in the heart's action occur in a similar sudden manner in the course of an inflammatory or cachectic disease, such as pneumonia, cancer, or phthisis, we should properly suspect the formation of an autochthonous or embolic clot in the heart. ”

“ It is perfectly idle to endeavor to avoid it by measures directed toward the protection of the lung or of the air-passages, and equally futile to attempt to arrest its course by treatment directed to the lung, or even the chest. The best place to wear a chest-protector is on the soles of the feet, and poulticing the chest for pneumonia is about as effective as shampooing the scalp for brain-fag. ”

“ Whoever has a defective chest capacity not only possesses a smaller allowance of organs fitted for respiration and circulation of the blood, but as a result of such anomaly of development he is also predisposed to attacks of special maladies, such for example as chronic catarrh of the bronchial tubes or pulmonary tuberculosis. Whoever, on the contrary, is overdeveloped in abdominal dimensions, will be subject to disturbances of the digestive system and of the liver. ”

“ The simplest of the more serious results from injuries not penetrating the chest is the occurrence of inflammation, either of its lining membrane, giving rise to what is called pleuritis, or of the substance of the lung, termed pneumonia, or of both, constituting what has been named pleuro-pneumonia; but many severe blows on the chest are not followed by such serious consequences. ”

“ It is a very serious matter when we have superadded to a deficient chest development a deficient chest expansion. For these are the very women in whom because of their general run-down condition and undeveloped muscles the breathing is very superficial; the apices of the lungs, the favorite site of tuberculosis, and the deeper portions are seldom expanded; and not only does the body suffer from a deficient oxygen supply, but there is an equally defective suction power on the part of the heart, which means a poor circulation and a lowered general nutrition of the whole body. ”

“ Blood-letting in large quantities, and repeated in proportion to the strength and habit of the patient and violence of the symptoms, is then absolutely necessary. Unless the plethora, which is oppressing the system, and exciting the hæmorrhage from the lungs, be relieved by general blood-letting, blood will not cease to pour out from that viscus. At the same time the free exhibition of saline cathartics, a blister to the chest, a rigidly abstemious diet and a strict adherence to the antiphlogistic regimen must accompany this treatment. ”

“ Other post-mortem appearances which are met with less frequently than those above detailed are inflammation, and even ulceration, of the mucous membrane, of the bladder, inflammation of the salivary gland, peritonitis, and congestion of the pancreas and of the stomach.
The muscular tissue of the heart is generally softened and easily torn. It is not, however, as stated by some authors, invariably so, for in several cases in which it was examined by Da Costa it had undergone this change in one case only, in which there was no reason to suspect previous disease of the heart. ”

“ Very profuse white discharge, leaving white and gray spots on the linen, with itching in the abdomen.
The white discharge has a sweetish odor.
A chronic rattling in the throat causes a dry cough.
The whole chest pains as if compressed, and when breathing, sharp stabbing pains traverse the chest, worse on the left side.
Stinging in the chest which prevents him from taking a long breath.
Pain in the region of the diaphragm as if it was inflamed; when gaping, drawing pains under the right ribs, extending as far as the spine; they come and go frequently and are aggravated by respiration. ”

“ Inflammation of the muscular structure of the heart occurs in limited, circumscribed areas, as evidenced by post-mortem examination, and it is probably always somewhat involved in connection with pericarditis and endocarditis. It may readily be inferred that if the whole organ were inflamed death would ensue immediately. Usually myocarditis results from the preexistence of blood poisoning or of some infectious febrile disease.
Symptoms.—The chief symptoms are those of heart weakness. The heart beat is fast, weak, and often irregular. Respiration is difficult and rapid. ”

“ ETIOLOGY Rheumatism is the cause of most instances of cardiac disease which date back to childhood or youth, while arteriosclerosis and chronic infection cause most cardiac diseases in the adult. In the former case it is the mitral valve which is the most frequently affected, while in the latter it is the aortic valve. Any cause which tends to induce arteriosclerosis may be a cause of chronic endocarditis, such as gout, syphilis, chronic nephritis, alcoholism, excessive use of tobacco, excessive muscular labor and hard athletic work. Lead is also another, now rather infrequent, cause. ”

“ It occurs commonly in nearly all acute diseases of the lungs, especially in bronchitis and inflammation of the voice-box. These are the common causes. In all the amount of blood spat up is very small—usually merely streaks. In consumption and some forms of heart disease blood-spitting is common and is often very profuse. Other causes of profuse bleeding are the rupture of an aneurism and some diseases of the vessels of the lungs. Or the blood may come from the stomach. This is a formidable list, but we have no doubt whatever which of these caused your blood-spitting. ”

“ The diseases affecting the pericardium by continuity or contiguity of texture are chiefly myocarditis, tubercle of the lung and mediastinal glands, cancer of the same structures, pleurisy, pneumonia, and cancer of the oesophagus. On fibroid disease of the heart pericarditis is a frequent attendant.3 The diseases affecting the pericardium by a special election, and which are remote from the membrane, are, principally, acute articular rheumatism, Bright's disease, inflammation and other diseases of the liver, phlebitis, typhus, typhoid and eruptive fevers, scurvy, and acute alcoholism. ”

“ In the advanced or dangerous stage of the disease, the pulse is weak, soft, and irregular. Sometimes there is nausea of the stomach; and sometimes delirium.
The termination of pulmonick inflammation is by resolution, by suppuration, by gangrene, by fatal effusion of blood, or exudation of coagulable lymph into the cellular texture. Favourable symptoms are, as in anginous excreation, facility in expectoration, without much exertion or coughing, copious, of due consistence, a little yellow, white, thick, slightly streaked with blood ”

“ A normally-sized heart with irregularity, increased frequency, and a variable systolic murmur in the mitral area, is characteristic of tobacco poisoning. A heart enlarged on both sides, and acting irregularly without murmur, is (apart from cardiac failure) suggestive of strain in early life.
Cardiac symptoms taken individually are of less diagnostic value than signs. No symptom is pathognomonic. Palpitation is a nearly universal phenomenon of cardiac disease and disorder. Faintness and actual faints are not uncommon in cases of early cardiac strain, gouty heart, and nervous disturbances. ”

“ I found the following symptoms: the pulse frequent, hard, and rather full; the skin hot; cheeks flushed; the tongue much furred; the urine high-coloured, not depositing sediment; the bowels torpid; cough rather occasional than constant, but for the most part violent; the expectoration copious and muco-puriform. In the upper parts of the right and left sides of the chest, the indications afforded by the stethoscope were, very sharp and strong sounds, both in inspiration and expiration, conjoined with the mucous rattle. ”