Pleurisy: Including Empyema and Bronchiectatic Conditions |
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abdominal abscess acute adhesions admission admitted amount anteriorly apex aspiration associated auscultation bacillus breath sounds bronchi bronchial tube cause chest pain chest-wall collapse complaining condition copious costal pleura cough crepitations Diagram diaphragm diaphragmatic discharge distinctly drainage drainage-tube dulness dyspnoea empyema cavity evident expectoration exploring needle family history favourable fever foetid fœtid empyema fœtid pus gangrenous heart improvement incision inflammation interspace left base left side leptothrix leucocytosis liver loculi lower lobe lung gangrene lung tissue lymphatics malignant disease months normal noticed occur opening patient percussion percussion note phthisis physical signs pleural cavity pleuritic effusion pleuro-pneumonia pneumonia posterior posteriorly pulmonary and costal pulmonary pleura pulsating pulse puncture purulent re-expansion reabsorption recognised regards resection resonance respirations respiratory right side Royal Infirmary scapular line seen sero-fibrinous effusion sero-fibrinous pleurisy showed slight symptoms tapping thickened tion tubercle bacilli tumour tympanitic upper lobe vocal fremitus weeks whilst
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Page 4 - ... and with the next expiration a portion of pulmonary pleura further forward will be opposite to b. This in turn will be infected, and with the next inspiration the costal pleura opposite c will be involved. In time the pulmonary pleura at c will become affected, and so with the respiratory movements the inflammatory process will be transmitted forwards. Similarly, it will be transmitted backwards, B, Y being with the respiratory gliding of pulmonary and costal pleura: successively affected.
Page 10 - ... but what is of most importance to notice is, that the heart is displaced to the right side, as indicated by a tilting of the head of the needle to the left. Here nothing has pressed the heart over, it has simply been drawn over by the elastic retraction of the right lung. Under ordinary circumstances the heart and mediastinum are, as it were, held in position by the two lungs drawing them each to its own side : if this traction is abolished on one side by letting air in, as in Powell's experiment,...
Page 6 - Hence, as a lung collapses in thev. pleural cavity, the space formed by the separation of the pulmonary from the costal and diaphragmatic pleurae is peculiarly shaped. Looked at on section from in front (Diagram III.), its base is formed by the diaphragm, its outer border by the costal pleura, its apex by the junction of costal pleura and lung, and its inner least regularly shaped border by the lung and mediastinum. Looked at next from the lateral aspect (Diagram...
Page 5 - Farther, it is not unjustifiable to consider that the relative absence of symptoms and physical signs (pain and friction sounds) in such phthisical pleurisies may be similarly explained. Effusion of Fluid. — As the fluid begins to collect it first fills up the so-called complemental space of the thorax, ie, the space between the diaphragm and costal wall into which the lung passes at each inspiratory increase. As it accumulates, more and more space is allowed by the progressive collapse of the...
Page 205 - The contents consisted of tenacious yellow pus, which had a trabeculated appearance. " The right lateral sides of the dorsal vertebrae were covered over by the growth and superficially eroded. " Some of the ribs also between which the growth had passed to get to the outside of the chest were eroded. " Nothing worthy of note was found in any other of the organs.
Page 4 - ... that the correspondingly great stretching and relaxing of the pleural membrane which this implies will render it at this locality specially liable to be affected by morbific influences. What is probably, however, of more importance in connexion with our efforts to explain why pleurisy seems to be specially prevalent at this lower and lateral region of the chest is the fact that, as the result of the greatest movement being at this locality, a pleuritic process once originated will here have a...
Page 6 - IV.), the upper limit of this space, formed by the line of junction of pulmonary and costal pleurae, is arched, the arch being highest laterally and lowest posteriorly. Hence, then, as fluid collects in the pleural cavity, its surface is not a level one like that of fluid in a jar, but a curved one. This curved line...
Page 9 - V., which represents a section through the body about the level of the fifth rib. If next we make a free opening into the left pleural cavity, air enters and collapse of the lung occurs ; but what is of most importance to notice is, that the heart is displaced to the right side, as indicated by a tilting of the head of the needle to the left. Here nothing has pressed the heart over, it has simply been drawn over by the elastic retraction of the right lung. Under ordinary circumstances the heart and...
Page 191 - ... pericardial effusion, but cases have occurred without these. Walshe1 says of the pulsation that it "seems to be merely an excess of the slight fluctuation movement in the fluid which is not very uncommon in ordinary cases." Powell2 concludes that "probably nothing more is needed than an amount of fluid which shall exercise a certain degree of pressure, neither too much nor too little, upon the beating heart." Many other explanations have been proposed, for details of which I would refer you to...
Page 5 - ... greatest extent the pleuritic process must be most marked and severe. A small focus of pleural irritation, which at any part of the apex or posterior border of the lung would be able to induce but slight irritation and inflammation, has much greater potency for harm at any part of the lower and lateral regions. The great proneness, therefore, of pleurisy to affect the lower and lateral portions of the lung may be thus ascribed to the great amount of respiratory expansion and recoil rendering...