Report on Thoracic Diseases

1902 Boston Medical and Surgical Journal  
ascertain if all pupils have been successfully vaccinated. (3) The examination several times a year of the eyes and ears of each pupil, that errors in refraction of vision may be corrected and defects in hearing may be treated. Many a child, naturally bright, has been considered hopelessly dull, simply because no one had discovered that there was a defect in his sight or hearing. (4) What may be called outside inspection ; that is, investigating into causes of absence of children from school,
more » ... d if they are found to be sick, the nature of their illness. The custom of sending children from the schools for this purpose is very wrong and should not be allowed. I have several times been present in houses in which there were contagious diseases, when children have come from the schools and were intending to return immediately, and have known them to be invited in to wait, which they would have done except that I prevented it. I am convinced that in this manner contagion is sometimes conveyed to the schoolroom. It is plainly the object of medical inspection of schools, not only to exclude those actually sick, but to use all means to preserve the health and happiness of the pupils and their relations and friends at home. Tlie increased agitation by sanitarians, within the past few years, of this important subject, school hygiene, has awakened an interest among tlie parents of children that attend the public schools, and they are now expecting precautions against diseases by health and school authorities, that ten years ago had not even been considered possible. I know of no more tangible results than can be obtained from the labors of local health authorities than by attention to school hygiene. IN PERICARDITIS. ZezscSWITZ l reports the case of a patient suffering from pericarditis complicated by a leftsided pleural effusion. A striking feature of the physical examination was the presence of numerous dilated veins appearing on the surface in the upper chest, and supplying neck, head and left arm. The obstruction to the internal veins of ' Muon. Med. Woch., No. 84. which this collateral circulation seemed a proof was taken to be an inflammatory affection in the mediastinum (no ground for assuming new growth). In the left supraclavicular depression was to be felt a cord-like thickening which corresponded in situation and direction to the external jugular, and another corresponding to the course of the thyroid vein. At autopsy (six weeks after first observation and several months after beginning of the ill-defined sickness) was found chronic and acute pericarditis ; thrombosis, from compression, of the left innominate, the internal jugular and the inferior thyroid on the left; and a leftsided hydrothorax ; the left pleural cavity containing five litres fluid (in spite of several aspirations during life) while the right contained only one-half litre. A discussion follows as to the mechanical factors in the case, and the difficulty of satisfactorily explaining the existence of unilateral hydrothorax. EIGHT-SIDED CARDIAC HYDROTHORAX. Stengel • having had his attention originally attracted to a frequency of this condition much greater than is granted in the majority of writers, by a double scries of cases observed by him from 1893 to 1S97 and reported by Steele, analyzed a further series of 100 consecutive cases of cardiac disease ( chronic mvocardialor valvular 1. Of these. seventeen showed the existence of hydrothorax, and out of the seventeen the effusion was at some, time confined to the right side in seven, was bilateral with greater involvement of the right side in seven, and was left-sided in three. Tlie inadequacy of other explanations that have been offered led him to seek for one in the anatomical relations of the greater azygos vein to the right auricle. He shows that even a moderate dilatation of the right auricle will press upon the vein and produce a congestion felt throughout tlie supply of the right intercostals and often resulting in a right-sided hydrothorax. A secondary and less extensive leftsided effusion (shown in seven of his cases) may be explained by the fact that the upper and lower azygos veins on the left empty into the greater azygos, and consequently feel the effects of stasis to a greater or less degree. TRANSPOSITIONS OF THE IIEA11T ; ACQUIRED AND CONGENITAL. Under the heading of Acquired Dextrocardia Lohsse8 describes a case of extreme displacement in which the heart's dulness apparently extended from anterior axillary line on right along tho lower border of fourth rib to about 4 cm. from right sternal border, then obliquely downwards to the sixth rib at about 2 cm. from right sternal border where tlie apex was located; the evident cause was the pull from contraction of right lung as a result of tubercular disease and the push of the emphysematous left lung. He satisfied himself by experiments that such displacement is the result of two motions: (1) The rotation of the
doi:10.1056/nejm190203271461306 fatcat:lxxihfvgyfbgpp7ozw5xmu6d3m