Clinical medicine : observations recorded at the bedside with commentaries / by W.T. Gairdner.

  • Gairdner, W. T. (William Tennant), Sir, 1824-1907.
Date:
1862
Catalogue details

Licence: Public Domain Mark

Credit: Clinical medicine : observations recorded at the bedside with commentaries / by W.T. Gairdner. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    740/772 (page 716)
    the pleurisy, or at least a nearly coincident fact. Like seve- ral others of the same kind which I have seen, this case is extremely interesting in its bearing on the theory of pneumo- thorax, as discussed at large in Art. XY., and in Appendix C.— Selkirk, 9th June 1862. “ I am afraid I did not give you a proper history of Wm. C.’s case when I was in Edinburgh ; indeed, I can scarcely recall what I did say ; but the facts are that C., when I first saw him, was suffering from a tubercular affection of the upper part of the left lung ; some months afterwards, he had a distinct attack of acute pleurisy, accompanied with effusion. Some time after this, 1 heard succussion-sound, not very distinct, but plainly enough ; there were, however, no metallic pheno- mena, and there was no great amount of preternatural clearness in any part of the left side. A few weeks after this, the succussion-sound dis- appeared, after which he was tapped. I had then the idea it would prove an empyema, but the fluid drawn off was thin and without pus. I stopped the withdrawal of fluid before the stream began to intermit, and was perfectly sure there was no air admitted through the canula. Then after this a little “succussion” again was audible, but not very plainly. It again disappeared on the collection of a greater amount of fluid, and there was nothing of it when I sent him to you. I am only sorry I did not keep a report of his case, but what I have stated above are the principal facts.” Since the preceding paragraph was written I have once more (June 27th) minutely examined the physical signs in this case with the following curious result:—The large amount of air which must have been present on May 26th, and which is indicated by the tympanitic percussion in Fig. 31 (it can hardly have been less than several pints), has been so far absorbed that when the patient is carefully examined in the recumbent posture, there is now only a very limited tympanitic space in the front 3 by 4 inches in diameter, which obviously is floated upwards according to the position of the patient, and is only sufficient to give rise to an almost doubt- ful succussion-sound heard under peculiarly favourable circumstances, and which might easily be simulated by the conveyed sounds of the stomach. Several good ears to-day were unable to detect succussion-sound at all.