The Science of Therapeutics - Classical Homeopathy Online

Full text of "The Science of Therapeutics: According to the Principles of Homeopath...Page 558 of 653Except perhaps in very acute cases, the form of the thorax isplainly and characteristically altered. The thorax is flattened,pressed in and descends lower down, so that the shoulders form avery obtuse angle with the longitudinal axis of the thorax, and tneck appears to be elongated. The intercostal spaces are sunken,more particularly the jugular fossa, the clavicles are very prominent ; the sternum is much depressed, its upper portion often stout, so as to form an angle with the rest; the shoulderoutvery prominently. These changes are most striking, if theyonly exist in one side of the thorax ; it is true that in such aTuberculos's. 665not all these changes are so decidedly marked, but they are morestriking to the eye. The movements of the thorax are very muchchanged ; respiration is carried on with the lower portion of thethorax, and still more with the diaphragm and the abdomen,whereas the upper ribs are scarcely moved. On palpation, increased vibrations are often perceived from the voice in the uppeportion of the lungs.In the beginning of chronic miliary tuberculosis, percussion sometimes does not reveal the least change ; as the depositions increthe sound becomes less full, tympanitic, and finally completelyempty. Percussion only yields truly valuable results at the apiceof the lungs and in the infraclavicular region; if dulness is plareturned in these parts, an empty sound in other portions of thelungs authorizes the conclusion that tubercles are deposited. Kcaverns have formed close to the thoracic wall, percussion sometimes returns a metallic ring or the sound of a cracked pot.Auscultation returns the most reliable results, because they aremost commonly present. In a previous paragraph we have shownthe value of the prolonged expiratory murmur and of the ^^respiration saccadee" in the apices of the lungs. If these symptoms becoassociated with sub-crepitant rales, the diagnosis becomes so mucmore certain. In proportion as the infiltration increases, the reatory murmur becomes more and more bronchial, and remains so,even if caverns form, or else amphoric sounds and the metallic risupervene during the rale. It is often of importance to auscultatduring a paroxysm of cough, because at such a time certain soundsespecially the rale, are heard more distinctly. If the tuberculardeposits are very extensive, pectoriloquy has often a very high pThe cough of tuberculous persons varies exceedingl3\ At thebeginning a constant short and hacking cough is very usually present, sometimes interrupted by severe paroxysms, resulting in theexpectoration of a light-colored, scanty mucus ; or else, the cousets in in irregular paroxysms which are generally excited bymarked changes in the temperature and by pulmonary eftbrts;these paroxysms often last for several hours, and end with retching ; the sago-like expectoration follows in a few hours. A coughthat at once sets in, with a copious expectoration, is a rare occrence. After suppuration has taken place, the cough becomes nmchless wearing and spasmodic; the coughing fit readily results incopious expectoration. Between the more violent paroxysms, a constant hacking takes place, during which the mucous rdle is dishttp://www.archive.org/stream/sciencetherapeu00kafkgoog/sciencetherapeu00kafkgoog_djvu.txt