Cancerous and Other Intra-Thoracic Growths Their Natural History and Diagnosis, the Substance of the Lumleian Lectures

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1872. Excerpt: ... the lung does not appear to have been seriously interfered with,and therefore we may conclude that its nervous supply was not seriously interrupted. Great engorgement was probably early induced before much effusion into the pleura took place, so that pressure from the pleuritic effusion which subsequently took place did not exert its usual effect in reducing the size of the lung, it being previously rendered to a great extent solid. A greater degree of general and haemoptoic engorgement I have rarely seen, unattended by the least evidence of inflammatory action. That the pleuritic effusion was of comparatively recent occurrence seems also to be shown by the considerable collapse and falling in of the whole of the left side which existed. During life there was no distinct obliteration of the intercostal spaces, and though vocal fremitus was diminished or lost there was more bronchial breathing about the angle of the scapula than was consistent with the supposition that much fluid existed in the chest. Neither was there any evidence of displacement of the heart. The precordial pain of which the sufferer chiefly complained must have been due to nervous communication, and symptomatic only of the disease in the upper mediastinum. Various opinions had been given of the nature of the case, and it had been considered at different periods as aortic disease, emphysema, chronic pneumonic consolidation, and phthisis. By the patient himself it was considered that the heart was the principal seat of disease. The differential diagnosis between aneurism and malignant tumours is sometimes beset with difficulties. Dr. Sibson, in his ' Croonian Lectures, ' has ably illustrated the principles of diagnosis in the several varieties of intrathoracic aneurism, especially pointin...