Medicine chest

“ 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. ”

“ In inspecting the organs in the chest, a cursory examination should be first made by turning them over, ascertaining the nature and measuring the quantity of effused fluids, feeling for fractures of the ribs, tumours, or other diseases, and opening the pericardium to obtain a view of the heart. The most convenient course to pursue next is, without moving the heart from its place, to lay open its several cavities, in order to judge of the quantity and state of the blood in both sides of that organ. ”

“ PHYSICAL SIGNS.—The chief of these are determined by inspection of the chest, by palpation, by auscultation, and by percussion.
Inspection.—In inspection of the chest the age of the patient is to be regarded in the interpretation of the appearances. In pericarditis with effusion we are apt to find a change in the shape of the chest—a bulging in the region of the heart, even though the effusion be somewhat small in quantity. This change is more apparent when it occurs in young persons, where the chest-walls are very elastic. ”

“ It is quite improbable, I think, that we should be here to-day, or, indeed, have an existence as a society largely devoted to the consideration of diseases of the chest, were it not for the methods of thoracic examination which Auenbrugger and Laennec have given us in their discoveries of percussion and auscultation. ”

“ The whole parietes of the chest on the diseased side have nothing to antagonize their elasticity, so it is kept enlarged. In addition, at this stage the fluid of itself presses against the walls of the chest in all directions.
The elastic pulmonary tissue is always, to a certain extent, on the stretch. It is striving to pull asunder the pulmonary from the parietal pleura; but this it cannot do, because the air can have no access to the pleural cavity. The five mm. of mercury elasticity of the lungs can be increased by a distension of the chest from a forcible inspiration to thirty mm. ”

“ If fluid should compress the chest, some of it must be removed by aspiration, but care must be exercised, for the presence of fluid is conservative in its effects. Its pressure stops up the orifice and promotes its healing. If it becomes fetid, pleurotomy, with detersive washes, ought to be resorted to. Food should be frequently administered, with quinine and cod-liver oil, and good hygienic surroundings prescribed. ”

“ 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. ”

“ On applying the stethoscope over the upper part of the right side of the chest, at every point, and also over the whole of the right shoulder blade, I heard acute sounds similar to those produced by air strongly passing through a key-hole. I considered that these sounds indicated active inflammation in the whole ramifications of the bronchiæ of the right lung. A large quantity of blood was drawn from the right arm; and cupping was also freely employed, both on the chest and shoulder blade. A saline draught with tartar emetic and nitre was administered every two hours. ”

“ Treatment, diuretic, tonic, derivative, thoracentesis, trochar and cannula or aspiration, point of election for puncture, method, asepsis, drainage by aspirator, or into an antiseptic solution, eligible cases, dangers attending thoracentesis, shock, rupture of false membranes and lung, infection of pleura, injection of antiseptics.
Hydrothorax or water in the chest is common to all domestic animals. It is as we have seen one of the most ordinary results of pleurisy, and may persist long after that disease has disappeared. ”

“ In examining the chest of a person whose respiration is calm, we should desire that it be made purposely quicker, and stronger; but not so audibly as to cause [Pg 17] confusion by that external sound. The perception afforded to the auscultator by healthy lungs, is that of air entering a cavity, as it were with a gentle stream of sound. If the pupil first apply his naked ear to the chest, he will have a clear idea of what he has to expect. As a general rule, in making our investigation of the state of the lungs, the stethoscope should be applied immediately under the clavicle, near the axilla ”

“ These are, of course, most concentrated and effective in the seat of their production, yet when drawn suddenly in large amount, into the general circulation, by the vigorous aspiratory action of the chest, they may prove seriously detrimental to the blood at large. ”

“ Care must be taken not to depress the powers of reaction by too much morphia. Hot water in india-rubber bags applied to the chest gives great relief. Alcoholic stimulants must be given to prevent sinking from exhaustion. When the distension from air is excessive, paracentesis gives marked relief, the lives of patients having been prolonged for days by it. If the opening is valvular, to prevent the air from accumulating in excessive quantity Reybard's protected gold-beater's skin trocar may be used and kept in the chest. ”

“ In general, there is disengaged much more aeriform fluid from the organs of the fœtus, than from those of the adult, in the experiments of maceration.
II. State of the Serous System in the after Ages.
In the adult, the serous system remains a long time without undergoing any very sensible change; its mem163branes follow only the laws of the organs they surround. Thus in the age nearest youth, the serous surfaces of the chest are the most frequent seat of inflammations, dropsies, &c.; whilst in that bordering on old age the inferior surfaces like the peritoneum, are the more often affected. ”

“ 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. ”

“ Inflammation of the Chest, Pneumonia or Pleurisy Inflammation of the chest usually involves both the pleura or lining membrane of the chest, and the substance of the lungs, so that they may be advantageously treated. ”

“ 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. ”

“ Diseases of the chest are generally confined to heart, lungs, pleura, the pericardium, mediastium, blood vessels, with nerves and lymphatics. As we open the breast we behold the heart, a very large machine or engine, situated conveniently to throw blood to all parts of the body. To it we see hose or pipes that go to each organ, all muscles, the stomach, bowels, liver, spleen, kidneys, bladder and womb, all bones, fibers, ligaments, membranes, and its body, lungs and brain. ”

“ He at that time laboured under an inflammatory affection of the chest, and it was feared that when this abated, an effusion of fluid into some part of the cavity of the chest might take place; but it was believed that, though his recovery might be slow, and not complete, he would ultimately recover, and enjoy life on terms on which it would have been a blessing. ”

“ In wounds of the heart, all extraneous matters should be removed, if possible, and all inflammatory symptoms should be subdued by general bleeding, by leeches, by calomel, antimony, opium, etc. The chest should be examined daily by auscultation. If the cavity of the pleura should fill with blood, it ought to be evacuated to give a chance for life, and if the pericardium should become permanently distended by fluid, it should be evacuated. ”

“ All wounds of the chest, though not involving bloodvessels of a large size, are productive of severe consequences—effusion of blood or bloody fluids into the cavities, escape of air into the external cellular tissue, collapse of the lung, and inflammation and its results, are always to be dreaded. The danger is not uniformly tantamount to the extent of injury inflicted. ”

“ The ancient physicians appear to have practised a kind of auscultation, by which they were able to detect the presence of air or fluids in the cavities of the chest and abdomen. Still no general application of this method of investigation was resorted to, or was indeed possible, till the advance of the study of anatomy led to correct ideas regarding the locality, structure, and uses of the various organs of the body, and to the alterations produced in them by disease. In 1761 Auenbrugger of Vienna introduced the art of percussion in reference more especially to diseases of the chest. ”

“ 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. ”

“ Interference with the blood return to the heart may be due to causes within the chest, such as chronic bronchitis or heart obstruction, to swellings in the glands of the neck pressing on veins which convey the blood back to the heart, and improper dress, such as tight stays, or tight collars and cravats. ”

“ Some of the most striking indications of existing disease are demonstrated by the neck. By feeling the neck and carefully watching its external appearance, the experienced scientist will obtain much valuable information that will aid in his diagnosis, and give him additional knowledge as to the processes going on within the body of the patient.
The significance of the formation of the thorax (chest) is well known, even to many laymen. Flat chest, so-called chicken chest, indicates imperfect development of the lungs, and when extreme, even tuberculosis. ”

“ If a boy have delicate lungs, do you approve of his wearing a prepared hare-skin over the chest?
I do not. The chest may be kept too warm as well as too cold. The hare-skin heats the chest too much, and thereby promotes a violent perspiration; which, by his going into the cold air, may become suddenly checked, and may thus produce mischief. If the chest be delicate, there is nothing like flannel to ward off colds. ”

“ 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. ”

“ The chest wall is driven out by the systole only where the heart muscle touches it; at other places it is slightly drawn in. This in drawing is attributed to the expulsion of the blood out of the thorax by the left ventricle. The thorax is a closed cavity and the vacuum therein produced by systolic output into the arteries of the head, limbs and abdomen is filled by (1) the drawing of air into the lungs, (2) the drawing of venous blood into the great veins and right auricle, (3) the slight in drawing of the chest wall. ”

“ If the abstraction of blood from the system generally is useful, no less so is it when drawn from the part itself, by the application of cupping-glasses, and the scarificator to the chest. This mode of obtaining blood is peculiarly useful in those frequent cases, where the patient is too much debilitated to bear the loss of much blood, but the existence of inflammatory action makes its abstraction necessary.
Emetics are a powerful remedy in the treatment of Phthisis. ”

“ Modern writers on pathological anatomy have prosecuted with considerable zeal and ability, their researches into the nature of the diseases of the organs within the chest, but they have done but little towards elucidating the true relation, which subsists between the diseases of the several viscera, and the serous effusions which take place into their cavities; for, by limiting their views to the disease which the post mortem examination exhibited, they have overlooked those intermediate actions or states of excitement which connect the organic disease with such effusions. ”

“ Apply strong counterirritant to chest and put seton in dewlap. (See "Setoning," p. 293.) If collapse of the lung is threatened, a surgical operation, termed paracentesis thoracis, is sometimes performed; this consists in puncturing the chest cavity and drawing off a part of the fluid. The instruments used are a small trocar and cannula, which are introduced between the eighth and ninth ribs. The skin should be drawn forward so that the external wound may not correspond to the puncture of the chest, to prevent the entrance of air. Only a portion of the fluid should be removed. ”