Pleural effusion

“ They are more serious than ordinary pleurisies. We meet with them in aspirating, when, after draining off the fluid from the base of the pleural cavity, we find the lung expanding, but above that point there is absence of respiratory murmur and of other physical signs indicating the presence of fluid. Reybard189 divides multilocular pleurisy into three varieties, with varying symptoms and physical signs, according to whether it exists at the upper, middle, or lower portion, right or left side. ”

“ With the aid of fresh air and abstinence the remedies of the movement-cure might be entirely dispensed with, if the accumulation of purulent matter were the only risk, but in acute pleurisy there is a greater danger from another cause, namely, that the inflamed surface of the visceral pleura has a tendency to adhere to the lining of the thorax and thus obliterate the pleural cavity. ”

“ Non-inflammatory collections of fluid also occur in general œdema. In these conditions the pleuræ are not cloudy or dull, while in the case of inflammation the pleural surfaces are dry, cloudy, dull-shining, injected, rough or covered with fibrinous or purulent exudate. ”

“ Progressive asthenia in which the muscles are exhausted; injury of spinal cord or pneumogastrics; paralysis of muscles of respiration from the use of curare; the spasms of tetanus and strychnia poisoning; the entrance of air into the pleural cavities with collapse of the lungs—all tend to cause mechanical suffocation either by pressure or by paralysis (for deaths in epileptics, see Cases 1, 10, 11, 33, and 40) . ”

“ The sobbing and sighing attendant upon grief are not convulsive movements, they are occasioned by the sensorial power being so expended on the painful ideas, and their connections, that the person neglects to breathe for a time, and then a violent sigh or sob is necessary to carry on the blood, which oppresses the pulmonary vessels, which is then performed by deep or quick inspirations, and laborious expirations. Sometimes nevertheless the breath is probably for a while voluntarily held, as an effort to relieve pain. ”

“ Pleurisy with effusion may be a complication which the physician is called upon to treat. A lung compressed by liquid which fills the affected side of the chest cannot be interrogated by means of physical signs. Under these circumstances subcrepitant râles may denote a phthisical affection on the summit of the chest on the opposite side. The existence of cough and expectoration prior to the pleurisy is strong evidence of an antecedent phthisical affection. ”

“ The loss of a sufficient quantity of blood is often prevented by patients being apparently worse, after the first or second bleeding. This change for the worse, shows itself in some one or more of the following symptoms, viz. increase of heat, chills, delirium, hæmorrhages, convulsions, nausea, vomiting, faintness, coma, great weakness, pain, a tense, after a soft pulse, and a reduction of it in force and frequency. ”

“ Powell26 compares the peculiar flat percussion sound of pleuritic effusion to that elicited on striking against a brick wall. The flatness is characteristic and more marked than the dulness of lung-consolidation. If we are not careful to make the distinction between impaired resonance and non-resonance, we may easily draw erroneous conclusions as to the rise and extent of the fluid in the chest. We have shown elsewhere (Pathological Anatomy of Pleurisy—Distribution of Fluid) that, as the fluid collects in the cavity, the lung contracts before it. ”

“ In subacute or in chronic cases the effusion may slowly become augmented until the pressure upon the lungs and interference with the circulation become so great that death will result. Whether the attack is acute, subacute, or chronic, the characteristic symptoms which will guide us to a correct diagnosis are the friction sound, which is always synchronous with the heart's action, the high temperature with hard, irritable pulse, and, in cases of pericardial effusion, the increased area of dullness over the cardiac region. ”

“ From these and other recorded cases, the symptoms seem generally to be a quick pulse, fainting or collapse, nausea, vomiting, convulsions, slow respiration, and death, as a rule sudden and unexpected. We may suppose that the sudden death is really due to a rapid paralysis of the respiration, and suffocation. ”

“ Among warm-blooded animals, on the contrary, convulsions are constant, and the sequence of the symptoms appears to be—dyspnœa, slowing of the pulse, giddiness, falling down, then convulsions with expulsion of the urine and fæces; dilatation of the pupils, exophthalmus, and finally cessation of the pulse and breathing. The convulsions also frequently pass into general paralysis, with loss of reflex movements, weak, infrequent breathing, irregular, quick, and very frequent pulse, and considerable diminution of temperature. ”

“ Some of the principal symptoms are delirium and drowsiness, fullness of the blood vessels of the head, beating of the temporal arteries, redness and fullness of the face, the pupils dilated, (though in the very early stage they may be contracted.) If the membranes of the brain be the seat of the disease, the pain is more intense, and frequently the limbs are in a palsied state. The patient sometimes vomits immoderately, and the pulse is slow and irregular, but full. The breathing becomes stertorous. The fever is very considerable, and the head hot. ”

“ Oppression about the heart, as if it had stopped beating, as going into convulsions. Feels as if a spasm of the heart, tetanic. As if the blood too thick to circulate. Thinks she would have died but for the Camphor I gave her. Felt as she did when near dying of hemorrhage. Brain is active, intellect clear, thoughts vivid, the whole being intensified. Next morning, sense of constriction at base of lungs. Some cough. Clammy feeling of skin. Very sensitive to air.
No. 2. Causes a glow all over, hands sweat. Some pain in finger joints. Throat feels obstructed. ”

“ Shock is evidenced by general depression, with weakness, apathy, cold feet and hands, and failure of the pulse. If the patient rallies from this condition, then fever and pain become prominent. If steam has been inhaled, there may be sudden death from swelling of the interior of the throat, or inflammation of the lungs may follow inhalation of smoke and hot air. ”

“ Crying consists of short deep inspirations and prolonged expiration's with the glottis partially closed. Long-continued crying leads to sobbing, in which sudden spasmodic contractions of the diaphragm cause sudden inspirations and inspiratory sounds generated in larynx and pharynx.
Sighing is a sudden and prolonged inspiration following an unusually long pause after the last expiration. ”

“ If the convulsions have continued until the pulse is weak, the face very pale, the nails and lips blue, and the feet and hands cold, the hot bath will be useful by bringing blood to the surface and relieving the heart, lungs, and brain. ”

“ In others, the ball, without ascending, rolls tumultuously and convulsively round the abdomen. The paroxisms are preceded and accompanied with palpitation of the heart: the patient often falls down in a fainting fit, turns cold and pale, and the breath and pulse are scarce perceptible. Sometimes the paroxism deviates into immoderate laughter or tears; sometimes into muscular convulsions and distortions, resembling epilepsy; or into stupor and insensibility; and there is usually a profuse secretion of limpid urine; sometimes there is vomiting. ”

“ Symptoms.—Pallor of the face and mucous membranes, dimness of vision, cold perspirations, sense of impending death, restlessness, air hunger and gasping for breath, nausea, and, maybe, vomiting, noises in the ears, passing delirium, quick, feeble, and fluttering pulse, or the latter may be imperceptible at the wrist, insensibility, convulsions.
In ordinary fainting attacks many of the above symptoms are absent; such as are present are temporary. In collapse, consciousness is retained. ”

“ Convulsions arise from almost any cause—from worms in children, affections of the brain in adults, hysteria, and in some persons the taking of chloroform. Adults are sometimes attacked by such convulsions. Affections of the spinal cord or eating indigestible food will produce them. I know no instance in which convulsions have arisen from retching and vomiting. I agree with Dr. Copland that these convulsions sometimes end immediately in death. The immediate proximate cause of death is frequently asphyxia.
By Lord Campbell: Death from a spasm of the heart is often described as death by asphyxia. ”

“ In the vast majority of cases, however, this lull in the symptoms is deceitful, and lasts only from a few hours to a day, when the gravest stage of the disease sets in. The pulse soon becomes small and thready, beating only thirty or forty to the minute, and the heart often works vigorously after the pulse can no longer be felt at the wrist. The nausea and vomiting return and become constant, the respiration is often embarrassed, the tongue becomes dry and brown, the skin is cool and dry, there is often a distressing hiccough, and the thirst is insatiable. ”

“ The pulse and temperature rose, and to general symptoms of loss of blood were added: occasional lividity of countenance; severe dyspnœa, accompanied by inability to lie on the sound side or to assume the supine position; absence of respiratory movement on the injured side; pain, restlessness, cough, and sometimes continuance of hæmoptysis, small clots usually being expectorated.
Accompanying these symptoms were the usual physical signs of fluid in the pleura in differing degrees and combination. ”

“ The symptoms in one of the cases which have been recorded were those of delirium tremens; in another, which terminated fatally, vomiting of blood was followed by convulsions. First contraction and then dilatation of the pupil, spasmodic respiration, and an almost imperceptible pulse were the effects noticed. Death may take place in a few hours.
Post-mortem Appearances.—Congestion of the vessels of the brain, and gastric irritation. The face has sometimes a bloated expression, and blood may escape from the ears and mouth. ”

“ MEDICINE.——Almost every person knows, when a fever is attended with a violent pain of the side, and a quick hard pulse, that bleeding is necessary. When these symptoms come on, the sooner this operation is performed the better; and the quantity at first must be pretty large, provided the patient is able to bear it. A large quantity of 166blood let at once, in the beginning of a pleurisy, has a much better effect than repeated small bleedings. A man may lose twelve or fourteen ounces of blood as soon as it is certainly known that he is seized with a pleurisy. ”

“ The two layers in health touch each other, but are separated when there is fluid in the cavity. The inner layer covers the lungs and drops into the grooves of the lungs. You can thus readily understand how easy it is for the pleura to be attacked. Also when the lung is inflamed we have what we call pleura-pneumonia. Pleurisy is a very painful disease. It hurts to move, breathe, or cough. The patient holds his chest when he coughs. The fluid that forms is poured out from the inflamed membrane, sometimes it is so great in quantity it must be drawn off,—tapped ”

“ The patient lies on the affected side, and cannot rest on the sound side. The pulse is full, hard and frequent, the fever high, pain in the head, and sometimes delirium. If the disease is not arrested, the patient generally dies from suffocation, by the lungs filling up, hepatized, or abscess and ulceration come on, and then what is called "quick Consumption" carries him off. ”

“ Bleeding in inflammation of the pleura, in young and healthy persons, should therefore be effected with an unsparing hand, until an impression has been made on the system—until the pain and the difficulty of breathing have been removed—until the patient can draw a full breath, or faints; and the operation should be repeated, from time to time, every three or four hours, according to the intensity of the recurrence, or the persistence of the essential symptoms. ”

“ Most frequently the child is awakened in the night by a sense of suffocation. He may cry out that he is choking. The countenance is livid, the breathing is hurried [pg 880] and each respiration is attended by a crowing sound. The child has fits of coughing or crying, and makes vehement struggles to recover his breath. This complaint, unlike croup, is unattended by fever, it being of a purely spasmodic character with no inflammation. ”

“ Beside a most rigorous abstinence from animal food, heating liquors, and every kind of irritation, either by the indulgence in passions, or exercise of body or mind, the first remedy to be employed in a pleurisy, is copious bleeding, either with the lancet, or by means of leeches. ”

“ Sometimes it produces unconsciousness without being fatal. In attempting resuscitation employ artificial respiration, and if there are any signs of life treat as directed for shock. If there are burns complicating the case, of course the burns must be treated. When there is SHOCK the patient lies in an apoplectic state, the surface pale; there is faintness, trembling, cold perspiration, low temperature, feeble pulse, and probably nausea and vomiting. Keep the patient’s head low, give aromatic ammonia, and apply heat to the extremities and to the stomach. ”