W.H. Walshe
1844 The Lancet  
564 The consequences of this trial would seriously affect the prisoner's interests through life ; and looking to that circumstance, the absence of everything like ill-will towards his patient, and his advanced age, when a long imprisonment must be attended by the most prejudicial effects, the Court was induced to pass on him the mitigated sentence, that he be imprisoned for one calendar month. Anatomy in University College, &c. PHTHISIS ; EMPHYSEMA; HYDRO-PERICARDIUM. W. S., setat. 33,
more » ... , admitted under Dr. Walshe, March 25, 1843. Hair very dark brown, irides greyish-blue, pilous system ill-developed. Father killed by an accident; mother died suddenly ; brothers and sisters enjoying excellent health. Has been eight months ill (from close of last July) ; had a severe wetting then, and felt uncomfortable generally, without having any particular symptom to complain of. Remained for about six or eight weeks without medical aid, when he applied to a dispensary. Is certain that he did not cough till the beginning of the winter; spat from the first in small quantities; occasional pain from the outset in the right infra-clavicular and inter-scapular regions. Affirms that he has never suffered from shortness of breath ; but he considers his respiration at this moment (26 in the minute) natural. Night-perspirations set in four months ago; began then to lose flesh, especially in the arms; fancies his legs are less emaciated now than a short while since (probably from the cedema present). Has ceased to work within the last two months only. Present State.-March 26. Tongue very much pointed, clean, slightly flabby, but not pitted at the edges ; appetite good; deglutition easy; no thirst. Abdomen rather full (which he notices himself), not painful or tender in any part. One or two motions daily, not remarkable in any way. Liver extends some two or three inches below the ribs; pulse 126 (patient lying down), easily compressible, tolerably full, regular in force and rhythm; says he has no palpitation or pain at praecordia ; respiration 26, very slightly gasping; cough frequent, short, commonly dry; sputa very small in quantity, separate, light-coloured, not striated, nor ragged at edges ; some gravitate, others float in water; voice slightly rough ; no pain in region of larynx; no headach ; intellect slow, but in a natural state ; organs of sense unaffected. Skin generally pallid; sweats at night; no rigors ; tissues flabby; ankles have swelled during exercise for the last few days, both now pit slightly on pressure in front of the tendo-Achillis ; no cedema of chest or arms. Is often called up twice in the night to make water (usually has a basin of milk before going to bed) ; urine, sp. gr. 1029.3. deep gold colour, slightly turbid, very slightly acid, rendered transparent and reddish by nitric acid; no obvious effect by heat; finely flocculent turbidity by ammonia. Decumbency on the right side ; he cannot lie on the left; face pale, expressive of distress, inclined to puffiness; sleeps badly, and has bad dreams; is extremely weak. Physical Examination. Anteriorly : intercostal spaces not obvious inferiorly on the right side during inspiration ; distinctly so on left; costal movements visible on right side, but dragging and limited; obvious bulging in right lateroinferior region. Posteriorly : manifest bulging, on right side inferiorly. lUensllration.-Circumference on level of ensiform cartilage thirty-two inches and three quarters; right side, sixteen inches and seven-eighths ; left side, fifteen inches and five-eigliths. From nipple to middle line on right side, four inches and a quarter; on left, four inches. From sterno-clavicular joint to nipple on right side, six inches and a quarter; on left, barely six inches. Applicatiun of llund.-Vocal fremitus stronger under left than right clavicle ; totally absent in right lateral regions inferiorly, but becomes distinct near the nipple. No simple fluctuation on right side, but here peripheric fluctuation distinct infero-laterally. Percussion.-Sound less clear on left clavicle internally than on the right; the contrary is the case with the external two-thirds of the bone. Right side, dulness bounded anteriorly by a vertical line passing over the nipple, and extending from apex to base; three inches behind this line the dulness is perfect, and the resistance to the finger extreme ; the limits of this dulness alter about a finger's breadth by change of posture. Left side: sound clear, except in region of heart. Posteriorly: sound perfectly dull from base to summit; resistance extreme in the former situation. -MMMKattoM.—Right side : immediately under clavicle respiration towards sternum obscure, but slightly hollow and blowing, almost suppressed towards the acromion; two inches below the nipple short, quick, blowing, and divided; three inches behind the nipple (where the dulness reaches its maximum) diffused blowing respiration still audible ; no rhonchus; obscure vocal resonance under clavicle, altogether lost about the nipple. Posteriorly, respiration weak, distant, and slightly blowing, except close to spine, where strong; superiorly, harsh, blowing with hollow character well marked, where, too, occasionally a few clicks of large-sized, thin metallic rhonchus, and pectoriloquous resonance corresponding to right bronchus; cegophony about inferior angle of the scapula. Left side : respiration under clavicle and inner axilla strongly exaggerated with blowing character, especially in inspiration excessive vocal resonance, not at all circumscribed. Heart.-Undulating motion visible between fourth and fifth ribs, directly beneath nipple, where the sounds of the heart are both obscure and distant; similar undulation two intercostal spaces higher up ; no pulsation between fifth and sixth ribs; impulse, as felt with the hand, inconsiderable ; dulness on percussion begins at the cartilage of the third rib, and continues downwards to free margins of ribs ; extends laterally from left border of sternum to a little outside the nipple. First sound more audible between fifth and sixth ribs than where pulsation is visible; both sounds more audible under left clavicle than at cardiac region ; no murmur with either sound ; respiratory murmur audible over entire cardiac region. 28. Pulse 126-132 (lying) ; skin rather dry ; bowels open; right side, posteriorly, half an inch below angle of scapula, respiration caverno-amphoric, especially marked after he has spoken ; occasional distant gurgling with metallic character; here, too, pectoriloquy with slight cegophonic character. Slight pulsation is visible to-day between the fifth and sixth ribs; none to be felt, however, though distinct, between fourth and fifth; undulating motion higher up diminished ; ankles not swelled since last report; can lie on either side now. April 1. Slight hoarseness ; night perspirations as before; slight oedema and glossiness of surface on right side of chest; quantity of urine has been increased for some days, is straw-coloured, of low specific gravity, alkaline, rendered slightly turbid by heat, and transparent (with much frothing) by nitric acid; heart's sounds obscurely audible in most prominent part of the latero-infe1'ior region of right side; pulse 120 (lying). 4. Pulse 120; respiration 28; thirst ; abdomen free from pain, its muscles contract strongly when percussed ; one stool daily ; tongue furred at edges ; heart's sounds mure audible at cardiac region than under the left clavicle ; pulsation visible between fifth and sixth, more marked between sixth and seventh ribs, less so than formerly between third and fourth; dulness of sound does not begin now till directly above the cartilage of fifth rib ; respiration still exaggerated under left clavicle, but of softer special character ; thin gurgling rhonchus in larynx on both sides ; can still lie on both sides comfortably. 6. Abdomen painful; six motions yesterday.
doi:10.1016/s0140-6736(02)73335-7 fatcat:6lazohomyjcyrbq7fyacalz6oy