PHTHISIS PULMONALIS
\fθˈɪsiz pˌʌlmənˈɑːliz], \fθˈɪsiz pˌʌlmənˈɑːliz], \f_θ_ˈɪ_s_i_z p_ˌʌ_l_m_ə_n_ˈɑː_l_i_z]\
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Occasionally, this formidable disease occurs accidentally: but, usually, it is caused by a conformation obtained from progenitors. This, at least, predisposes to it; and but a slight exciting cause maybe required to rouse the predisposition into action. It is less a disease of the torrid zone; and in the temperate regions of the globe, its pathology is often intimately allied with that of scrofula. It consists in the formation of tubercles in the lungs, which sooner or later inflame and break down. In such a constitution, ulcerations of the lungs do not readily heal; and hectic fever- the universal attendant upon irritability and debility- is established. This persists, and gradually wears down the patient, till he ultimately expires, exhausted by the irritative fever. The chief symptoms are the following. The patient feels a sense of uneasiness in the chest, with severe fits of coughing, or a short and dry cough with dyspnoea. This may be considered the incipient stage. The cough then becomes extremely troublesome, especially in the morning; and dyspnoea is increased on the slightest exertion. The expectoration is evidently purulent, with fever in the evening, and circumscribed redness of the cheeks; wasting and colliquative sweats early in the morning. This must be considered the confirmed stage,-Phthisis consumma'ta, Pneumophthisis. In the third, or last stage, the hectic is constant, with small pulse, pungent heat, colliquative sweats, and diarrhoea. The weakness becomes extreme, and the patient exhausted. Physical Signs.-1. In the first stage, whilst there are yet scattered miliary tubercles,-the only appreciable change at the exterior of the chest, and this is not constant, is a want of freedom in the movements under one or both clavicles. Percussion will generally discover a slight diminution of sound corresponding to the summit of one lung. In the same situation, auscultation shows that the inspiratory murmur is either weaker, rougher, or confused. The sound of expiration is more distinct. The voice and cough are rather more resonant, and wheezing or mucous rales are occasionally heard in the same region. 2. When the tubercular deposition has become more abundant, the motion of the chest is more markedly diminished under one or both clavicles. The loss of sound on percussion is more distinct, the inspiration, on auscultation, is bronchia, the expiration louder and more superficial, and the resonance of the voice and cough is increased. The rest of the lung is perhaps healthy, or the respiration may be peurile. 3. When the tubercles are undergoing softening, -in addition to the preceding signs, auscultation exhibits a subcrepitant rale around the apex of the lung, decreasing from above downwards. It is most distinct during or after the cough, and at the close of a deep inspiration. As the disease proceeds, the bubbling becomes successively larger, and ultimately gargouillement is heard. The inspiration and expiration are cavernous or tracheal. The voice and cough indicate unusual resonance and pectoriloquy. The intercostal spaces are often depressed locally, and percussion may become gradually clearer and even tympanitic as the cavern increases. It is only in the incipient state of this formidable disease, that advantage can be expected from any plan of treatment; and of all means that can be devised, that of removing to a climate in which air and exercise can be daily enjoyed during the autumnal, winter, and spring months is the best. See Climate. If this be impracticable, the patient must be kept in a regulated temperature, taking care that the chamber is duly ventilated; and gestation in the open air be used, whenever the atmosphere, although cold, is dry. The other indications will be: 1. To moderate inflammatory action: 2. To support the strength; and, 3. To palliate urgent symptoms. The whole treatment indeed is palliative. Counter-irritants relieve pain: demulcents and mild opiates alleviate the cough: the mineral acids, united with opium, relieve the colliquative sweats: and chalk and opium the diarrhoea. Dr. Wilson Philip has pointed out a particular species of phthisis, which is characterized, in the early stage, by a deranged state of the digestive organs; flatulent, irregular bowels; furred tongue; impaired appetite; unnatural faeces; and the epigastric region more or less full and tender or pressure. The affection of the lungs is here secondary. He calls it Dyspeptic phthisis.
By Robley Dunglison
Word of the day
Dopamine Acetyltransferase
- An enzyme that catalyzes the of groups from acetyl-CoA to arylamines. They have wide specificity for aromatic amines, particularly serotonin, and can also catalyze acetyl transfer between arylamines without CoA. EC 2.3.1.5.