DISEASES OF THE CHEST.
(Also see Anatomy of the Lungs and Respiratory Organs.)
As it was asserted a short time ago that the incurability of consumption was an acknowledged fact, it is encouraging to know that in many instances now we may effect a cure even under relatively poor conditions, also that many persons have the disease and get well of it without their knowledge. This is proved by the large number of cases that have come to autopsy for death from some other cause and the diseases of the lung which has healed are discovered. If the disease can be taken in hand early enough and the constitution of the person's body protected from these ravages by appropriate climatic conditions, good food, and possibly a little medicine, we are justified in thinking that a favorable outcome will occur. It is necessary to keep the weight of the person maintained and especially the digestion more than good.
Marriage should be avoided by anyone afflicted with the disease, as the bearing of children on the part of the woman will of ten cause the disease to take a fresh start and the extra effort required by the husband to maintain his family will do the same for him. It is only fair to the friends surrounding the patient that precautions should be taken to prevent the contraction of this disease from one whom they are trying to help, as the disease is propagated by the increase of the germ known as the bacillus of tuberculosis; we must destroy this organism as soon as it is expelled from the person.
In the expectoration these germs are present in very large numbers and in singing and coughing they are sent into the air to possibly be inhaled and land on new soil for future trouble. The kiss of a consumptive is very dangerous and even the use of toilet articles which have been used to wipe the nose or mouth is dangerous until they have been boiled. All expectoration should be received in articles which can be burned before they become dried, and if the person is confined to the house they may be received in an earthen vessel which holds a solution of disinfectant such as carbolic acid, 1 part of the pure acid to 20 of water, or corrosive sublimate, 1 part to a 1000.
It is for this reason that the boards of health of all the large cities of the United States and Europe within the past few years have passed ordinances prohibiting expectoration of sputum on the sidewalks, floors of cars, at stations or public places, and the disease is now reported to them by physicians under penalty of fine in the same manner as smallpox and diphtheria. Sunlight is another prevention, for this germ cannot live in the rays of the sun and this is taken into account in our treatment of the patient, as good air and sunlight are perhaps the most important aids in helping us to get the better of the disease.
Methods of Examining the Chest. Before speaking further of consumption, I propose to do what has never been done, namely, to instruct the general reader very briefly in the method of examining the chest to learn the existence of disease. Perhaps this will be considered a departure, in some slight degree, from my purpose to make this entire book intelligible to the general reader. If so, my reply is, that there are many school teachers, mechanics, masters of vessels, and farmers, who have inquiring minds, and sagacity enough to learn the physical signs of chest disease, and to make them, in many cases, practically useful; and that even readers of little reflection cannot fail to comprehend a portion of my explanations.
Position of the Patient. In performing percussion upon the front of the chest, the patient should be required to sit in a square position, with the arms booked over the comers of the back of the chair, and the head thrown a little back.
Instrument with which to Thump. The index and middle fingers of the right hand are to be brought together, into a line, and used as the percussion instrument. The blow given with these is to be smart and quic7c, rather than heavy.
Medium to Thump Upon. Either the index or middle finger of the left hand is to be pressed firmly upon the surface of the chest to be percussed or struck, and thus used as a pleximeter.
Auscultation. Listening for the purpose of hearing within the chest the sounds produced by breathing, talking, coughing, etc., is called auscultation.
Instruments with which to Listen. The naked ear is generally considered best for hearing low and delicate sound&; but for hearing loud and rough ones, it is not so good as the stethoscope, represented by Fig. 90. A still better instrument is the double eared stethoscope, Fig. 91. It magnifies the sounds very much, and is apt to confuse an examiner not accustomed to it; but when the ear is once familiar with it, the aid it affords is very valuable.
The examiner should pass from side to side, continually comparing the sounds upon one side, with those upon the other.
The patient must be calm, and the examiner in no hurry.
Healthy Sounds. To become skilful either in percussion or auscultation, the examiner's ear must first be trained to healthy sounds.
These are best heard in the child, in whom they are louder than in the adult.
In describing the healthy sounds in the different regions of the chest, I shall refer the reader constantly to Figs. 92 and 93.
Clavicular Region. This, in Fig. 92, is represented by 1, 1. Upon thumping upon the collar bones, the sound given out at the breast bone end should be very dear; less clear in the middle; and dull at the shoulder end.
Subclavian Region. This is represented by 2, 2, and lies between the collar bone and the fourth rib, on both sides. It covers a considerable portion of the upper lobe of the lungs. The sound upon striking this place should be very clear.
The Mammary Region, represented by 3, 8, extends from the fourth to the seventh rib, on each side. In the upper part of this region, the healthy sound is clear; but at the bottom of it, on the right, the sound is deadened by the liver; on the left, by the heal
The Infra Mammary Region, 4, 4, lies between the seventh rib and the edge of the cartilages of the false ribs. On the right side, the liver makes the sound dull; but under the left side lies the stomach, which is hollow, and the sound is generally quite loud
In the Sternal Region, 5,, 6, 7, which covers the breast bone, the sound is generally clear.
The Auxiliary Region, 8, 8, is in the arm pits. In this the sound should be clear.
The Lateral Region, 9, 9, is immediately below the above, and yields, likewise, a clear sound.
The Lower Lateral Region, gives a dull sound on the right side, and on the left a very hollow one.
Fig. 93 represents the bac7c part of the chest. In looking at this, we see the
Acromial Region, represented by 11, 11. In this space the sound is dull, but it has not much meaning.
The Scapular Region, 12, 12, covers the part occupied by the shoulder blades. It gives rather a dead sound.
The Intra Scapular Region, 13, 13, lies between the shoulder. blades, on each side of the back bone. If the patient's arms are crossed, and the head bent forward, a clear sound will be obtained.
The Dorsal Region, 14, 14, covers the base of the lungs, and, in health gives, a clear sound.
Observation. If, now, on thumping upon the chest, we find a dull, dead sound in any spot where a clear one ought to be yielded, we are to conclude that underneath there is not the usual quantity of air; but we cannot tell merely by percussing, whether tubercles are deposited there, or the lung has become solid by inflammation, or water has been poured out into the cavity of the pleura. This point must be determined by auscultation, etc., to be explained gradually as we go along.
Auscultation of Breathing. On applying the ear or the stethoscope to the chest, two sounds are heard which immediately succeed each other, the louder is produced by the ingoing breath, or inspiration; the weaker by the outgoing breath, or expiration. These sounds will be further explained as we go along.
Auscultation of the Voice and Cough. The chest of a healthy person speaking communicates to the ear no distinct sound, but only a vibratory sensation, called, in technical language, the pectoral fremitus.
Over the larynx and windpipe, the examiner may hear natural pectoriloquy; between the shoulder blades, in the space corresponding to the roots of the lungs, natural bronchophony.
Philosophy of Chest Sounds. The fullness and clearness of sound upon percussion, depends upon the amount of air in the chest.
The sounds called breathing murmur, are caused by the expansion and contraction of the air cells or vesicles, as the air passes in and out; hence they are called ve8icular murmurs.
The friction of the air against the sides of the windpipe and large bronchial tubes causes the blowing sound heard in those parts.
In children a larger amount of air enters the lungs, and the air vesicles are expanded with more force; hence their breathing has a louder sound, which is called puerile respiration. This kind of breathing, heard in the grown person, is a sign of disease.
The lung tissue is a bad conductor of sound; and the voice is accordingly heard only over those parts where large bronchial tubes are near the surface; heard elsewhere, it indicates disease.
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