Clinical researches on auscultation of the respiratory organs, and on the first stage of phthisis pulmonalis. Part 1 / by Jules Fournet ; translated from the French by Thomas Brady.

  • Fournet Jules.
Date:
1841
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Licence: Public Domain Mark

Credit: Clinical researches on auscultation of the respiratory organs, and on the first stage of phthisis pulmonalis. Part 1 / by Jules Fournet ; translated from the French by Thomas Brady. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    on plithisis, in the Library of Medicine now publialiiug, we find the following: Peclo- riloquij is another very striking sii/n of a cavity in the lungs. Its value was, perhaps, overrated by Laonncc ; but we think it has been neither appreciated nor understood by subsequent writers. After describing the mode in which it is produced, he proceeds: the sound is not a mere vocal resonance, like the bronchopliony from consolidation, which is often as loud or louder, and may seem to pa.ss up the tube quite as much ; but it is an articulate though indistinct speaking The circumscription of pectoriloquy is another of its peculiar characters, and by this it may generally be distinguished from the loud bronchophony of condensed lungs, which is diffused over some extent of surface. (27.) I have already, in note 14, alluded to a case iu which a different physical con- dition from any of those stated here, namely, remarkable density of its parietes appeared to be chiefly instrumental in producing metallic sounds in a tubercular cavity. (28.) It is not my intention to prolong, by any remarks here, a chapter wliich most persons will doubtless deem unnecessarily prolix; I am only anxious to direct the pai*- ticular attention of the student to the new and valuable source of diagnosis it reveals. He will scarcely find a trace of it in any English writer ; indeed it could only originate in the separate study of the two periods of respiration. (29.) The following signs of a very advanced state of emphysema of the lungs should be added: displacement of the heart; descent of the diaphragm and the liver, and consequently clearness of sound in tlie postero-inferior portions of tlie chest, and in the region of the liver anteriorly—(see Stokes on emphysema of the lungs). Dr. Stokes differs from M. Fournet, and indeed from most writers, in his account of the state of the intercostal spaces in this disease. Wlien'we examine, saj's he, the intercostal spaces in tliis affection, even after great dilatation of the chest has occurred, we see them, so far from being obliterated, deeply marked, and the muscular fibres acting powerfully, so as to elevate the ribs, and assist in the imperfect inspiration. (30.) Dr. Stokes had been long since led, as well from observation as fi-om analogy, to believe in the existence of a stage of pneumonia, antecedent to that indicated by the crepitant ronchus (the 1st stage of Laennec) ; but the anatomical characters, as well as the stethoscopic signs of this stage, as described by him, ai-e very different from those of M. Fournet's stage of congestion. The pulmonary tissue, according to Dr. Stokes, is at this period drier than natural, not at all engorged, and of a bright vermillion colour, from intense arterial injection. He found this condition in the upper portions of lungs, in the middle and lower portions of which Laennec's first and second stages existed—in cases of pneumonia, where death occurred from other causes—and in sub- jects who died of acute phthisis, with severe inflammatory symptoms. It vrill be re- marked, that the anatomical characters assigned by M. Fournet to this stage of the disease—the moist, congested condition of the pulmonary tissue, are derived from the examination of a single case. Though Dr. Stokes hesitates to pronounce positively on the subject, his observations lead him to think, that an intense puerility of respiration in the affected part will be found to be the cMef physical phenomenon at this stage of the affection. After referring to some of the facts on wMch tliis opinion was founded, he adds : ft'om these and many other observations I would conclude, that we may diag- nosticate the first stage of pneumonia, by the sudden occurrence of a local puerility of respiration, combined with fever and excitement of the respiratory system. (31.) The opinion of Dr. Williams, that the supervention of the 3rd, or suppurative stage of pneumonia, is to be inferred from the duration of the disease and the general symptoms, rather than from the physical sig7is*, seems to be that of the majority of the profession. Dr. Stokes and M. Foui-net however agree in thinking that this diagnosis is sometimes possible, and that the occurrence of interstitial suppuration is characterized by a peculiar form of mucous ronchus. M. Fournet makes its coexistence with inspi- * Library of Medicine, vol. 3, p, 142.