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
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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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    secondary affections of the right pleura and lung in abscess of the liver, inflammatory affections of the gall bladder and bile ducts, and other morbid conditions of these viscera. Tropical abscess is by no means a common disease in this country, yet there can be but few of us here this evening who have not met with it in practice, and many of us must have seen at least one instance of hepatic abscess bursting through the lung. It is the right chest that is invaded as a rule; and the physical signs, not only at the base but occasionally at least well upwards into the pulmonary region, can be easily traced. Only a few days ago I met with an instance of invasion of the left pleura in this connection. A young man who had suffered from dysentery and hepatitis in Burmah was found to have a large swelling in the epigastrium, and the lower sternal region pitted on pressure. The most urgent condition, however, of quite recent development, was dry pleurisy of the left side, characterised by pain and loud friction sound all over the anterior and lateral base. Two days later a large hepatic abscess was safely evacuated. I will not dwell longer on this class of cases, which, as I have said, are comparatively common, very obvious and readily recognised. Nor will I do more than make a passing reference to the occasional occurrence of right pleurisy in gall stones and their local effects on the neigh¬ bouring parts. This association is met with not only as an acute complication of the presence and passage of gall stones, that is, as acute right pleurisy following on hepatic colic, but also as a chronic process involving the base of the right chest and the right hypochondrium, where the signs may be extremely complex and difficult to interpret. We have now reviewed a sufficient number of cases belonging to the first of the two classes which I proposed to examine, to justify us in formulating a practical conclu¬ sion. I would do so in these terms: In all obscure diseases within the abdomen, particularly diseases of an inflamma¬ tory kind, let it be a clinical rule to examine the chest with special care. I fancy I hear some of you saying to yourselves, “ Of course this is a clinical rule, recognised, taught, and followed.” With all respect I would ask, Do we follow this rule on all occasions, or even as a matter of ordinary clinical routine ? I confess I am somewhat doubtful. And now I would go further and give you as a corollary the further counsel; Let such physical examina-