TON MEDIC Clinical Lecture! I much stress, since it is a physical sign which CASES ILLUSTRATING COMMON orarily is of little value in women. FORMS OF LUNG-DISEASES. A Clinical Lecture delivered at the Medico-Chirurgical BY FRANK WOODBURY, A.M., M.D., Professor of Materia Medica and Therapeutics and of Clinical Reported by WILLIAM H. MORRISON, M. D. GENTLEMEN-I shall to-day show you several lung-cases, giving you their histories, examining them in your presence, and then make a few remarks in regard to the diseases from which they are suffering. The first case is that of a young woman, aged 16 years, an American by birth. She works in a printing house. She informs us that she was perfectly well until three weeks ago when, as the result of exposure, she caught cold. Since then she has had cough and expectoration with progressive loss of strength, night sweats and poor appetite. She has not spat any blood. The expectoration is mucous in character, and, while perhaps more profuse in the morning, occurs at all times. Turning now to the examination of the patient, we find no appearance of anæmia. The lips are of good color and the nails show a pink hue. Her blood is deficient neither in oxygen nor in hæmoglobin. I ask her to take a full breath. This gives us information on several points. In the first place it shows us that she can take a full inspiration, and as the ribs are felt to move under my hands, it shows that the lungs do expand, and to an equal extent on both sides. It also shows that there is not much irritability of the bronchial mucous membrane, for if there were, a full inspiration would cause pain and excite cough. Both the apices and the bases of the lungs are observed to expand when she takes a deep inspiration. Directing her to speak with her voice at a low pitch I find that the vocal fremitus is a little more distinct over the upper part of the right lung than at any other portion of the chest, although upon this I do not lay On percussion there is easily detected a relative dullness over the right apex, both anteriorly and posteriorly. On respiratory percussion, the same condition is manifested. Sometimes this procedure intensifies the difference in pitch and makes it more easy of recognition. Auscultation reveals some moist mucous râles at the right apex. These râles are also audible, here and there, over other parts of the lungs. The rhythm of the respiratory sound is not changed. There is no evidence of fever at present. We have then, in this case, evidences of increase of bronchial secretion throughout both lungs, accompanied by a certain amount of dullness at the upper portion of the right lung. The points in this case are the acute beginning, the absence of antecedent history of pulmonary disease, the absence of any family tendency to phthisis, and the fairly well preserved nutrition of the patient, in spite of the loss of appetite and loss of strength. The second patient is G. W., æt. seventy years, whose occupation is that of sexton of a church. The present illness began fifteen months ago, with what he states to have been pneumonia. He was confined to bed for some time and remained in the house for six months. During this sickness he lost twentyfive pounds in weight, but during the past year he thinks, that his weight has remained stationary. There is no history of any previous illness and the family history is good, with the exception that his mother is said to have had asthma, but she did not die with any pulmonary disease. Inspection shows à certain amount of deformity of the chest. There is some sinking in of the right side, seen more markedly at the back than at the front. When he takes a full breath, the difference is more evident because the motion is confined almost entirely to the left side. You observe here an evidence of dyspnoea in the very decided depression of the supra-clavicular spaces and of the suprasternal notch. This has been caused by atmospheric pressure. In asthma, as you |