DOI: 10.7925/drs1.ucdlib_280456
title: Typhoid pleuro-pneumonia

description: Watercolour medical illustration depicting typhoid pleuro-pneumonia. It has the alternative reference number 1976 and P2C on the front. The Richmond Hospital Museum reference is B.e.36. The entry for this in P263/1 pg. 17 reads 'Typhoid pleuropneumonia. Bernard Duke aet 40. Dr Gordon'. Below the illustration is written 'Typhoid pleuropneumonia'. The artist's name is in the bottom right corner 'J. Connolly fect' and in the left corner 'Case of Bernard Duke Aet 40'. The handwritten note on the back reads 'See Dublin Hospital Gazette N.S Vol.5. page 71, March 1st 1858. Dr Gordon's Case. Jan.y 18th 1858' and the typescript note begins 'Chronic Diabetes – Typhoid Pleuro-pneumonia. Acute Pneumothorax'.
description: Scope and content: The handwritten note on the back reads 'See Dublin Hospital Gazette N.S Vol.5. page 71, March 1st 1858. Dr Gordon's Case. Jan.y 18th 1858' and the full typescript note reads 'Chronic Diabetes – Typhoid Pleuro-pneumonia. Acute Pneumothorax. (Case noted by Mr Scott) Bernard Jukes, aet 40, was admitted into the Hardwicke Hospital early in January, 1858, labouring under an attack of simple fever, from which he recovered in a few days. It was then discovered that he had for some time been labouring under well-marked symptoms of diabetes, and he was treated for this disease. He had no cough, nor any symptom of thoracic disease, and a stethoscopic examination failed to detect any sign of it. On the 21st he complained of having caught cold; said he was much weaker than usual and asked to be allowed remain in bed. On the 22nd he was very much prostrated; complained of some pain in the right side; his respiration was short and rapid, although he did not complain of cough or dyspnoea. There was some dulness [sic] over the right side of the chest posteriorly, with slight bronchial breathing. On the 23rd he complained of sudden violent stitch in the right side, and had intense dyspnoea, with extreme collapse. He partially recovered out of this state, and it was then found that the right side was tympanitic, and that there was no respiration audible, except near the spine. With such history of the case, and such physical signs, it was scarcely possible to doubt the existence of a pneumothorax, particularly when the side was dilated and the diaphragm depressed; but there were present none of the auscultatory signs usually considered characteristic of this disease – amphoric breathing, or the metallic phenomena; and a loud pleuritic frottement was audible over the cartilages of the ribs on the left side. Notwithstanding the administration of very large does of opium, the patient continued to suffer great pain, and survived for twenty-four hours, the physical phenomena remaining unaltered. Post-mortem examination – The right pleura contained a great quantity of air; the right lunch was reduced to about one-fourth of its proper size, and was compressed towards the spine. There was no fluid in the pleura, but its entire surface, both costal and pulmonary, was covered with large patches of soft yellow lymph; the upper and posterior portion of the lung was the seat of a very large rent about three inches long, and about the same width at its lowest part; very narrow above. The pleura around this rent was of an ashy grey colour, and through it protruded the pulmonary structure in loose shreds; the lung in its immediate vicinity was in a state of gangrenous suppuration. The upper portion of the left lung was emphysematous; the lower portion in a state of cadaveric congestion. (Richmond Hospital Museum) The debilitated condition of this patient, which was induced by the long-continued, most depressing illness to which he was subject, was doubtless the cause of the pulmonary attack assuming the typhoid disposition which characterised it. These characters were sufficiently well marked in the sudden depression of the already reduced vital powers; the absence of cough or expectoration (which signify that the vital depression is so low, that the pulmonary irritation, although considerable, is not able to produce any reflex action), combined with dyspnoea, and the abnormal collection of physical signs. This typhoid inflammation appears to have engaged the pleura also, and on this membrane giving way, a free communication was established between the interior of the lung and the cavity of the pleura. Repeated examinations were made in this case for the auscultatory phenomena indicative of pneumothorax, but they did not exist. We must presume, therefore, that for the existence of amphoric breathing, it is necessary that the air should pass from the lung through a small aperture into the cavity of the pleura. It remains only to account for the pleuritic frottement which existed on the left side. Post-mortem examination showed the surface of the left pleura to be perfectly smooth and glistening, therefore it was not caused by a pleuritic of the left side. The right lung was compressed and not acting, therefore it was not caused by friction between the costal and pulmonary pleura of that side. It therefore only remains that it must have been caused by friction between two folds of the thoracic pleura of the right side. This fact is almost conclusive as to the enlargement of the side, at least in pneumothorax, arising from a paralysed condition of the side rather than from mechanical distension. If the latter had been the cause in the present instance, the air would have most fully distended the pleura, and not allowed of any such laxity of the mediastinum as would permit its being rubbed against the posterior part of the sternum and the costal cartilages, by the motion of the left lung. The frottement was synchronous with the respiration, rather than with the action of the heart'.
description: Numbering/sequence: Original reference number: 1976.