Volume 2

The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan.

  • Gabriel Andral
Date:
1836
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Licence: Public Domain Mark

Credit: The Clinique médicale, or, Reports of medical cases / by G. Andral ... Condensed and tr., with observations extracted from the writings of the most distinguished medical authors: by D. Spillan. Source: Wellcome Collection.

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

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    pulmonary inflammation may still be very well resolved, though a great portion of the lung be in a state of red hepatisation. We do not know an instance which proves the possibility of a cure in the third stage. A pneumonia in the first stage, but very extensive, is generally as dangerous as a pneumonia in the second stage, but much more circumscribed. By reason of unaccountable idiosyncracy, simple engorgement of the lung, occupying but a small portion of this viscus, is sometimes fatal, whilst in another individual, placed in the same circumstances, a red hepatisation, occupying more space, terminates in resolution. Such cases arc luckily very rare, and do not destroy the general rules laid down. Inflammation of the upper lobes is generally more dangerous than that of the lower lobes. The state of the res])iration modifies the prognosis more than any other symp- tom. A considerable dyspnoea, whatever be the state of the lung, is always an alarming sign. The state of the pulse, on the contrary, can hardly furnish any certain datum regarding the issue of the disease ; its weakness, particularly, is often but apparent. If, however, a weak pulse coincides with considerable difficulty of breathing, and if it does not become more full after the first bleeding, we should infer from this, that the inflammation is very intense, and consequently affords a very alarming prognosis. Great viscidity of the sputa, their deeply reddened tint announces intensity of the inflammation ; their return to the catarrhal state indicates that resolution is going on ; watery and brownish sputa, more or less resembling prune-juice, should incline us to suspect suppuration of the lung, and are in general a bad sign. The same may be said of greyish and purulent sputa ; their difficult excretion, their retention in the trachea and bronchi, announce a fatal termination ; their suppres- sion, owing to the cessation of their secretion, is less unfavourable ; it indicates, however, in general, an exasperation of the inflammation ; it does not always prove that a recovery will not take place. Those pneumonias which are not accom- panied with any expectoration during their entire course, do not seem to be more dangerous than the others. Only, as their diagnosis is more difficult, they are often overlooked, and terminate fatally, because they are not properly treated. Thence the greater danger of latent pneumonias. Constant dryness of the skin is much less favourable than its habitual moisture. The resolution of pneumonia often coincides with the appearance of profuse sweats. We shall not insist on the greater danger of pneumonia, when it is complicated with other diseases, whether it precedes them, or declares itself during the course of the latter. The pneumonia which attacks phthisical patients seems less injurious by its own immediate danger, than by the baneful influence it exercises over the tubercles, whose increase and softening it favours. 92. Pneumonia is one of those diseases whose treatment is at once most simple and most efficacious. For many ages back, observation led phj'^sicians to employ copious blood-letting in this affection more than in any other. It is easily con- ceived, in fact, how useful copious bleedings may be in this case ; they not only act as in all other inflammations, they have the additional advantage of directly dimi- nishing the quantity of blood, which, in a given time, must traverse the lung in order to be subjected to the action of the air; they diminish then the activity of its functions, and thus concur in curing the pneumonia, in the same manner as an ophthalmia is cured by preventing the exercise of vision, and rheumatism by prescribing rest. The application of leeches cannot here be substituted for opening a vein ; but we may employ both kinds of bleeding simultaneously with great advantage. In former times there was great disputing as to which was the most suitable part to bleed from. The jdace of election is of little importance ; but what is essential is, that the blood should flow in great quantity at once by a large orifice.