Page:A Handbook of the Theory and Practice of Medicine - Volume I - Frederick T. Roberts.djvu/495

DIAGNOSIS OF PULMONARY AFFECTIONS.

479 5. Sometimes there is a difficulty in distinguishing between chrofitc hronchilts and phthisis, when the former is attended with profuse purulent expectoration, and with g-eneral wasting. The slow pro- gress and comparatively slight degree of emaciation ; absence of fever; non-occurrence of ha3moptysis ; and absence of physical signs of consolidation followed by cavities, will serve to charac- terize mere bronchitis in the majority of cases, but it must be borne in mind that this complaint frequently terminates in phthisis. For the diagnosis of the different forms of phthisis from each other, which is often difficult, reference must be made to what has been stated when discussing its varieties.

6. It may be necessary to determine the nature of any Jlriid in the pleura, and the cause of its presence ; and here it may be mentioned that fluid in rare instances finds its way from the abdomen, as from the bursting of an abscess of the liver or kidney through the dia- phragm. There will then have been previous symptoms indicative of either of these conditions. With regard to the determination of the nature of the fluid in cases pleuritic effusion after inflaiinnation, it is impossible to come to any positive conclusion without making use either of the hypodermic syringe, aspirateur, or exploratory tro- char, and obtaining some of it for examination. Barlow and Parker found that in children the signs usually regarded as being distinc- tive between serous and purulent effusion were quite unreliable ; but they regard a peculiar anaemia, with an earthy complexion, and especially clubbing of the finger-ends, as suggestive of empyaema. In children, however, if the fluid has remained in the pleura for some weeks, it will probably be of a purulent character. Mere hydrothorax is distinguished from inff.ammatory effusio?i by the follow- ing characters : — a. It is usually a part of general dropsy, b. Fluid is found on both sides, but not in excessive quantity; it accumulates in the lower part of the pleurse, pushing down the diaphragm, but not displacing the mediastinum and heart as a rule; and it is freely movable, c. There are no friction-phenomena, d. Pain and tenderness are absent; but dyspnoea is generally very severe, e. There is no pyrexia. Hcemothorax is characterized by the circumstances under which it occurs; and the signs of loss of blood. If there is any uncertainty in the diagnosis, the aspirateur should be employed.

7. It must be mentioned that symptoms and physical signs may be observed in connection with the lungs, which are due to certain morbid conditions not originally associated with these organs, such as rupture of a hydatid tumour of the liver or of an hepatic abscess into the pleura or lung; a hernia of the stomach through the dia- phragm; and other exceptional lesions.