PURULENT PHTHISIS-BRONCHITIS. 203 repeated. When examined in intervals most free from cough and oppression, there were much less dulness, crepitus, and obstruction in the middle parts of the right lung, but always croaky or cavernous sounds at the base. The patient was not seen by Dr. Williams after the last date; but it was reported that he continued to use the same remedies, and lived in a tolerable state till the autumn of 1868, when he was carried off by an attack when Dr. W. was out of town. The case probably originated in abscess at the base of the right lung, the deep position of which prevented its being emptied and healed, and favored the continual accumulation of offensive decomposing matter. In such cases the fingers become clubbed more than in ordinary phthisis. CASE 49.-Purulent Phthisis after Inflammation.-Recovery. - , aged 30, florid.-September 4, 1841. Mr. Was sent to Dr. W. for an opinion as to prognosis. Three years ago had inflammation of the chest, and last spring two years was sent by Sir J. Clark to Ventnor, where he was very ill, expectorating large quantities of matter and blood. He was leeched and kept very low, and was said to have much disease of the lungs. Returned to London in a very weak state, and was sent for the next winter to Madeira. Not improving there, in June he went on to Brazil, where he improved rapidly, and returned in May apparently well, and has continued so ever since. Breath and strength good. Deficient breath in upper right front, and tubular sounds. Slight dulness at and below left clavicle. February 22, 1845.-Continues well. Signs the same. October 20, 1845.-Been generally quite well, except occasional headache and indigestion. Physical signs the same, but slighter; prognosis favourable. CASE 50.-Bronchitis and Induration of Lung.-Recovery. Mr. B., aged 50-December 10, 1862. Brother and sister died of phthisis. Twelve months ago had cold and cough, which has continued more or less ever since, with loss of taste and smell, much snuffling, coryza, and transparent expectoration. Urine often thick. Much given to field sports cautioned thereon. Only bronchial rhonchi in various parts. Iodide and carbonate potass. squill, hemlock, and liquorice mixture. May 28, 1863.-Living in Yorkshire, he has not abstained from his usual amusements. Therefore he has had cough all the winter, and two months ago had inflammation of the lung, with pain in right chest, low fever, and some gout after. Had profuse sweats, and was much reduced in flesh and strength; but has since taken oil and improved. Still cough and yellow expectoration. Dulness and deficient breath in upper half of right lung. Tubular sounds above scapula.-To continue oil, with nitric acid mixture. October 10.-Much improved in flesh and strength, but still has cough, with opaque muco-purulent expectoration. Now a fresh cold, with coryza and deafness. Still dulness, obstruction and tubular sounds at and above right scapula. Tubular also within left scapula.-Continue oil and tonic, and winter at Hyères. July 14, 1864.—Except an increase of cough in December from a fresh cold, has done well at Hyères; having been much in the open air, gained much flesh and strength, and has hardly any cough or expectoration. Taken oil regularly. Still dulness and tubular sounds as before, but with more vesicular breath. March 24, 1865.-Passed the winter in Yorkshire, and has occasionally hunted. Breath much better; strength good; but he is not free from cough and expectoration. Dulness and tubular sounds diminished. stone. July 2, 1868. Has remained at home since, moderately joining in field sports, and is much improved in general health, and now weighs thirteen But he is rarely free from cough; has a fresh cold during the last two months. Often retches in the morning. Urine thick, and other symptoms of gout. Some tubular sound remains in upper right, but no dulness or obstruction.-To take a course of effervescent salines, and afterwards tonic and oil. June 7, 1871.-Has continued well in general health, and active as usual; but suffers from cold, and has generally coryza and bronchial cough. Urine often thick and red. Breath short on exertion. Sibilant rhonchi in parts. Little tubular sound. To go to Ems. The chronicity and degenerating tendency of the lung consolidations during twelve years threatened to end in phthisis, but appear to have been arrested by treatment and change of climate. CASE 51.-Phthisis after Inflammation.-Recovery. A young lady, aged 13; first seen May 9, 1848. Two maternal aunts had died of phthisis. Was well till three months ago, when she had inflammation of the right lung, with severe pain in back, cough, and expectoration, and was reduced to a state of great weakness and emaciation. Had since been taking iron and much animal food, and improved in strength, but not in flesh, and the cough and short breath are very distressing, with high fever at night. Dulness in right chest, especially in lower half posteriorly. Loud tubular sounds with peculiar piping sibilus in lower part ; tubular without sibilus above. Dulness and tubular respiration in left scapula. Was ordered cod-liver oil in acid tonic twice daily; an effervescent opiate at night; and iodine liniment. INDURATION AND CAVITY. 205 The state of this patient had been pronounced hopeless by an eminent London physician; yet in a fortnight she was free from cough and fever, and so rapidly regained flesh and strength that she was considered well, and was not seen by Dr. W. till September 15, 1849, when she had become very anæmic in the previous six weeks, having only once menstruated. The right lung had recovered its permeability in the lower parts, but there were still dulness and tubular sounds in the scapular region. January 7, 1852.-Under long-continued use of iodide of iron regained colour and strength, and catamenia returned, but tardily, and had to continue iron, sometimes with oil, several years. Had no return of cough, became quite well, and has been married several years; 1870. CASE 52.-Induration and Cavity after Inflammation.-Recovery. A young gentleman, aged 14, first seen by Dr. W. on August 3, 1843. Three years had inflammation of the chest, for which the patient was bled five times and otherwise severely treated, and suffered much from faintness and palpitation for several months afterwards. A similar attack occurred half a year later; and since then he has had occasional cough, which during the last six months has become constant, and is accompanied by abundant green expectoration, sometimes fœtid. Did lose much flesh and strength; but he has lately regained them, and his colour is good. Dulness and deficient motion in upper right front. Tubular sounds and loud mucous or sonorous rhonchus in the mammary region on deep breath. Some dulness and obscurity of breath in upper left. Right side three-quarters of an inch larger in circumference than left.-Ordered iodide of potassium and sarsaparilla, with an iodine liniment, also a linctus containing stramonium. September 15.-Expectoration diminished, and now opaque white, not fœtid. Flesh and strength good, and face blooming. Less rhonchus, but pectoriloquy below right clavicle. Tubular breath below left clavicle. Ordered a tonic of nitro-hydrochloric acid and sarsaparilla. To winter in Madeira. July 1, 1845.-Lost cough and expectoration soon after his arrival in Madeira, and has remained well since, except short breath and occasional epistaxis. Collapse and dulness in right upper chest; loud tubular sounds below the clavicle; breath free on left side. Ordered a liniment of camphor and cantharides. October 13, 1846.-Wintered again in Madeira without cough, except for about a month. Well grown and active, but thinner. Still collapse of upper right chest, with tubular sounds, but more vesicular breath. Left side moves more slowly and fully than the right. April 21, 1849.-Has wintered successively in Ventnor, Devonshire, and Oxford well. Walks several miles, and breath improved. Has only occa Some dulness within right sional cough, with copious expectoration. scapula, and marked tubular sounds below right clavicle; but vesicular sounds audible everywhere, with fair motion of the chest. Upper intercostal spaces protrude on cough (partial emphysema). Took oil afterwards, got quite well, and has required no advice since. Was heard of as quite well in 1864-twenty-one years after the first visit, and twenty-three after the first attack of inflammation of the chest. CASE 53.-Induration of Lung after Empyema.-Recovery. Mr. K., æt. 37, April 11, 1864. Had a slight cough since croup in childhood, but was in good health till 14 years ago, when he had right pleurisy, followed by empyema and very offensive expectoration. A deep incision was made in right dorsal region of chest, and half a pint of very fætid pus was discharged, after which the cough and expectoration ceased. The wound discharged for several months. The side contracted considerably, the ribs being drawn together, and he was restored to fair health. He married (has now eight children) and lived an easy country life, but was never quite free from cough. Four years ago he took the command of a Volunteer Corps, after which had more cough, and breath was shorter. He paid no attention to these symptoms till they increased, with some pain and expectoration and considerable loss of flesh, then he took oil and iron, and used counter-irritation. Defective motion of right chest, most lower half, dulness only on deep percussion. Breath-sound weak, especially below: above right scapula, stroke clearer than on left (emphysema) —To take oil in nitric acid mixture, and use croton oil liniment on the side. October 11th.-Much improved in flesh, breath, and strength. Still cough and morning expectoration, chiefly mucus, with opaque streaks. Still defective and irregular breath in right lung, chiefly below. Tubular sounds at and within left scapula. December 2nd.-Continued better till last week, more cough and expectoration. More obstruction in right lower lobe. To go to Pau. May 29, 1865.-Not much out at Pau on account of weather. Has still cough and expectoration, and short breath. Took Cauteret's waters three weeks. Has lost 14 lb. in weight. Signs not altered.-To resume oil and tonic. Saline at night. October 5.-Much improved, and has gained 14 lb. Cough and expectoration much diminished, he thinks by the application of turpentine to his moustaches. Sounds of right lung clearer. 1871.-Favourable reports. No examination. CASE 54.-Gangrenous Abscess of Lung.-Recovery. Mr. H., æt. 56, consulted Dr. Williams, January 21, 1844.-He had been well, except being subject to winter cough, and five months ago had broken GANGRENOUS ABSCESS. 207 his leg and clavicle. Was chilled at the end of November, and attacked with cough, rusty sputa, and feverish symptoms, for which he was largely bled, with considerable relief, but is now extremely weak, and oppressed. The expectoration became opaque and offensive, and is now abundant, amounting to from six to eight ounces a day. Cough violent, especially so when the expectoration is most fœtid. Pulse 70. Dulness throughout right lung, most marked in the lower portions, where coarse crepitation and friction sounds are heard. Tubular sounds in upper portion.- Was ordered quinine in dilute nitro-hydrochloric acid, good living and wine. April 16, 1845.-Cough and expectoration gradually diminished in three weeks, and the patient improved in flesh and strength. Only occasional stitches of pain in right side. Dulness, obscure breathing, and slight subcrepitus through right chest, dulness being most marked at apex. Was ordered a mixture of nitric acid, iodide of potassium and sarsaparilla, twice a day, and a blister to right side. May 1st.-Quite well. Sounds in right lung almost natural. 1871.-Has enjoyed good health ever since, and is now a hale old man of $3. |