Tubal and Parietal Fœtation

1850 Boston Medical and Surgical Journal  
violent cold which settled on bis lungs," " the pressure and weight felt in the chest," with the increase of these during the progress of the disease, the " stiff jet of matter, which followed the blade," after the puncture had been made at the " point where was felt the greatest pressure and tenderness," " the large quantity of matter discharged at the time, and also afterwards, but which continued to lessen in amount until recovery," can there ho any doubt that this was a case of empyema, and
more » ... not" pulmonary consumption." And had this been the diagnosis of Dr. Prior, he would not have asked the question, when requested to perform the operation of empyema, " who ever heard of such an operation ? " for it is as old as the time of Hippocrates, and one with which he must have been acquainted, unless the confidence of his patient in him was very much misplaced. " Accuracy of diagnosis is the foundation of good practice in all diseases." " The pronouncing a disease to be incurable, which in reality may not be so, is a most grievous error ; for it cuts off from the patient resources which had been available, were they not interdicted by ignorance of the nature of the disease." In the case related in my former communication, the first physician who saw the patient pronounced the disease consumption, because, on applying the ear to the chest, he heard " mucous rattle," and therefore gave him over. The second one found, on applying his ear, there was absence of the respiratory murmur in the left lung, and his diagnosis was consumption, " the lung destroyed by ulcération." The first examined the chest before the accumulation of the fluid was so great as to compress the lung completely, and consequently heard bronchial respiration. The other made his examination after the accumulation had become so great as to compress the lung entirely. Now at the time either of these physicians was called in, if he had had clearly in his mind the pathognomonic symptoms of tubercular phthisis and empyema, and also the physical signs, the diagnosis would most probably have been correct; and then a puncture made in the proper place might have resulted as favorably as did the one made in the patient, as detailed in the second case of this communication, or as the jack knife puncture did, in the case related by your Boston correspondent. Why any one should mistake the case for cancer of the stomach and apoplexy of the lung, I am at a loss to determine, there being very little likelihood of the two last named diseases ever occurring in the same individual, or either of them being confounded with empyema. In the case where empyema was mistaken for aneurism, it was done because the pulsations of the heart were communicated to the tumor. But taking into consideration the history of the case, and the svmntoms and physical signs, there could be no difficulty in makin¡r out the diagnosis.
doi:10.1056/nejm185002200420304 fatcat:woivm55uwnf5xjqqskab77hcom