Chest complications in abdominal disease : a study in diagnosis : the first Hunterian lecture of the Hunterian Society session 1901-2 / by J. Mitchell Bruce, M.A., L.L.D., M.D., F.R.C.P.

  • Bruce, J. Mitchell (John Mitchell), 1846-1929
Date:
1902
Catalogue details

Licence: In copyright

Credit: Chest complications in abdominal disease : a study in diagnosis : the first Hunterian lecture of the Hunterian Society session 1901-2 / by J. Mitchell Bruce, M.A., L.L.D., M.D., F.R.C.P. Source: Wellcome Collection.

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    hypochondrium, which presently shifted to the right sub¬ axilla. There the pain persisted, quite slight in degree, but aggravated by deep inspiration. With these symp¬ toms the temperature, which was being carefully observed and recorded by the nurse, rose to a moderate height, and the ordinary constitutional phenomena of fever developed. Having confirmed the physical signs of invasion of the right pleural cavity, I searched the abdomen for evidences that might exist of continuity of the processes in the abdomen and chest, but there were none to be found. The whole abdomen was perfectly soft and free from ten¬ derness, nor could any abnormal sign be elicited in the loin. It was resolved to give nothing more than a dose of calomel, followed by a saline. The result was entirely satisfactory. Next day the temperature had returned to normal, and the patient was much better in every respect, although naturally the physical signs in the chest re¬ mained. When I saw the patient for the third and last time, six days later, only a small patch of impaired resonance over the lower ribs could be found, and he was practically well. Unfortunately the secondary affection within the chest in appendicitis is not always of that moderate degree and favourable course which these two cases illustrate. In some instances severe inflammation occurs, characterised by a large serous effusion in the right pleural cavity. I found this association, for instance, in a middle-aged man, the subject of purulent perityphlitis, which required im¬ mediate operation, the primary disease having commenced fifteen days before, and the pleurisy seven days. Evacua¬ tion of the intraperitoneal abscess was sufficient to relieve both conditions. But you all know that the termination of cases of this class is not favourable in every instance, or, if favourable, by no means so easy or uneventful. I have met with a series of instances of purulent inva¬ sion of the right chest associated with appendicitis. In some of the cases operation had been neglected, in other cases it had been successfully completed. Such an em¬ pyema may extend over months, and gravely compromise the prospects of recovery. Or right pleuro-pneumonia may be found lying over a sub-diaphragmatic abscess which connects it with the diseased area around the appendix. I have known both pleural cavities invaded under similar circumstances—a hopeless complication, Another form is equally alarming, although fortunately.