Phthisis; its morbid anatomy, etiology, symptomatic events and complications, fatality and prognosis, treatment and physical diagnosis : in a series of clinical studies.

  • Flint, Austin, 1812-1886.
Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: Phthisis; its morbid anatomy, etiology, symptomatic events and complications, fatality and prognosis, treatment and physical diagnosis : in a series of clinical studies. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    25/492 (page 21)
    equally. To this rule there are very few exceptions. The dis- parity is evidently owing to the affection being of older date in one lung than in the other. These statements apply to chronic phthisis, but not to the affection known as acute miliary tuber- culosis. In a case of the latter affection both lungs were alike crammed with miliary tubercles which were also found in other organs. In a few other cases of the same affection, it is simply noted that both lungs were crammed with granulations or miliary tubercles. Is the greater amount of disease, in the majority of cases, seated in the right or in the left lung; or, what is an equivalent question, which of the two lungs is oftenest affected primarily? Of 55 cases, in 28 the greater amount of disease was in the right lung, and in 27 cases the left lung was most diseased. Hence, there is no uniform law as regards a greater tendency in either lung to phthisis. The practical bearing of such a law would relate chiefly to diagnosis ; and it is evident that physical signs, when they are of a doubtful character, derive no diagnostic force from their situation on either side of the chest.1 It is a well-known fact that, as a rule, phthisis is either limited to the upper lobes, or, if it affect the lower lobes, it is greater in extent and more advanced in the former. The primary seat is at or near the apex, and the disease advances from above downward. Three cases only furnished exceptions to the rule. In one of these cases the lungs were adherent on both sides to the walls of the chest, excepting that, on each side, at the base there was a collection of puruloid liquid within the pleural cavity. At the base of the right lung there was a cavity of the size of an English walnut, anfractuous and evidently tuber- culous. At the lower part of the left lung were several nodules. There was no affection at the upper part of either lung. In an- other of these cases the lower lobe of the left lung contained two cavities of the size of a large American walnut. Both lungs, in this case, were crammed with miliary tubercles, which were sufficiently numerous to produce solidification of the upper lobe of the left lung. Of the third case it is simply stated that 1 Of 38 cases analyzed with reference to this point by Louis, the left lung was most affected in 28 and the right lung in 10 ; hence, he concluded that the left more than the right lung is liable to become affected.