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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    bilical level, as if matter were pointing* immediately under¬ neath ; but it passed off again, leaving us once more in doubt with respect both to the pathological condition and the proper treatment to pursue. Almost immediately however, a simple patch of dulness appeared at the posterior base of the left chest. It increased daily in size, and presently it yielded the ordinary signs of pleurisy with effusion. From that moment the diagnosis was easy. There was suppuration, or at any rate active inflammation, under the left wing of the diaphragm; and I may add that pus was found in this situation at the operation which followed. I can understand how the history of this case as I have recounted it may sound very commonplace to you to-night, one, indeed, hardly worthy of record or even reference. We see almost daily in hospitals, and by no means rarely in general practice, cases of a similar kind, or closely related, which are readily diagnosed and unhesitat¬ ingly and successfully treated by the surgeon. This, however, is beside the point, which is that at a time when perforation of the stomach was quite unfamiliar to us as a condition amenable to operation, and very imperfectly understood clinically, the phenomena at the base of the chest revealed its existence, progress, and local develop¬ ment after the abdominal phenomena had failed us. So even now, with all our improved knowledge of perigastric abscess, careful observation of a similar kind will surely be of service. Tuberculous Peritonitis Now take another illustrative case. A medical student, aged 24, consulted me for distension and tenderness of the abdomen, accompanied by fever. He had lived in India as a child, and from the age of 6 had suffered from occa¬ sional attacks of malarial fever and dysentery. I found considerable abdominal enlargement and the signs of free fluid in the peritoneal cavity; the temperature was 103 degrees. I confess I could not reach a definite diagnosis but I suspected that along with malarial fever there was chronic hepatitis, the liver not being palpable in conse¬ quence of the ascites. For a short time I remained m doubt. Then an event occurred which gave an entirely different complexion to the whole case. It was a simple enough event in itself: the appearance of friction over the base of the left lung, which was quickly followed by the development of crepitations upwards. This was enough.