Notice of cases of pleurisy and pneumonia in the clinical wards of the Royal Infirmary, in summer 1850 : being the substance of two clinical lectures, delivered on 7th May and 18th June / by W.P. Alison, M.D.

Alison, William Pulteney, 1790-1859.

Date:: 1850

Credit: Notice of cases of pleurisy and pneumonia in the clinical wards of the Royal Infirmary, in summer 1850 : being the substance of two clinical lectures, delivered on 7th May and 18th June / by W.P. Alison, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

18/22 (page 14)

$u {IS described by Louis. Tlie sound on percussion, almost natural at first, be- came quite distinctly dull in the upper jiart of tlie left side, both anteriorly and posteriorly, and this was attended with absence of the vocal tlirill; and the sound of respiration became faint, and mixed with somewhat of tlie crepitous rule gradually changing to snbcrepitous, almost to tlie base of the lung, while the sputa remained distinctly pneumonic, even after the last leeching and blister- ing. By these marks we were well assured of the extension of inflammatory exudation both in the lungs' and on the pleura; and, by the way, I may re- mark that these unequivocal marks of pleuritic effusion are nearly enough of themselves to set aside the idea of typhus or epidemic fever, during the con- tinuance of which 1 am sure you will find that true pleurisy hardly ever exists, although j)articular forms of peripncumony and bronchitis are common. 3. You might observe here, that, co-existent with this extension of the inflam- matory exudation, there was abatement of the general symptoms, particularly as to the essential points, the state of the pulse and breathing, the pulse coming down below 80, and the breathing, never in this case marked as above 30 in the minute, becoming less frequent and easier, while yet extension of the ef- fusions was going on. I think this implies that the inflammation, although extending, was of slight intensity, and this is confirmed by the improvement which has since taken place, and I hope will be by that which, unless I am much mistaken, you will find is to follow. This we cannot ascribe to the use of the antimony, for it was discontinued after two small doses. Neither do I think we can ascribe it to the use of calomel and opium, for, although he took this in small doses (12 gr. of calomel in all) on the 11th and 12th, this was discontinued on account of diarrhoea, with ver}' slight soreness of mouth ; and besides, the improvement as to the pulse and breathing had begun be- fore the mercury was used. The abatement of the symptoms may have been referable only to mildness of the inflammatory attack; but judging by the local symptoms, I can certainly say this, that many cases are fatal in which the portion of lung obviously disqualified for its functions is less than that which appeared here to be involved. I think it, therefore, reasonable to sup- pose, that as it certainly was the object, so it was the effect, of the evacuations practised in the first three days that he was in the house (although much smaller than in many cases, where the febrile reaction is stronger, is necessary for this purpose), so to modify the inflammation, that the eff^usions consequent on it, although extending considerably thereafter, did not produce such condensation of the lung as they otherwise would ; and were liable, subsequently, to the rapid absorption which I think is already in progress, and of which, unless I am much mistaken, you will see further evidence by watching this case. If this case had occurred to me twenty-five years ago, 1 should have prac- tised the same evacuations on his admission, and after that, being warned b}' the typhoid nature of the symptoms, and further by the diminished frequencj' of his pulse and improved breathing, to suspend such treatment, I should, without putting my ear to his chest, merely have watched and prescribed for the state of his general symptoms; and finding them gradually to improve under the cautious use of wine and ammonia, should have regarded the case as an illustration of one of the best established and most easily understood principles in medicine—the pow^er of blood-letting—suited in its extent to the state of the general symptoms,—to check inflammatory effusion and its efl'ects on the lungs, even as late as the fifth day from the attack ; although aff^ording less striking evidence than we should have had from using the same means on the second or third day,—and although used in a case where the general symptoms were such as to demand the use of stimuli almost immediately after. The information which we now have enables us to speak more precisely as to the changes going on in the lungs; and requires us to alter our language so far, as to use the term modify or moderate, instead of check or subdue, the inflammation, as api)licable to the power of blood-letting on the fifth day of the disease ; but this is a change of language which a little reflection would$