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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    ration onli/ the chief dififercntial character of this ronchus. Dr. Stokes describes it as a sharp and peculiar muco-crepitating rale, combined with bronchial respiration. Dr. Stokes appears to have first recognized the occurrence of contraction of the chest as a consequence of pneumonia. Though it usually corresponds to an indurated and impervious state of the pulmonary tissue, it may coexist, he remarks, with a gra- dual and ultimately perfect resolution of the disease. (32.) M. Fournet has scarcely noticed what Dr. Stokes considers the most valuable of the physical indications—the signs o'f eccentric displacement: of those the most important is the displacement of the heart. (33.) Dr. Williams seems to think with M. Fournet that auscultation is of little value in the diseases of the larynx or trachea. The only useful application of it to which he alludes is in incipient croup:—The sonorous inspiration of croup is audi- ble, he says, through the stethoscope applied to the throat or upper part of the chest, before it can be heard by the unapplied ear. Dr. Stokes on the other hand states that he has seen, in cases of lai-yngeal disease, enough of variation, both in the passive and active signs, to persuade him of the importance of the subject. With respect to per- cussion in laryngeal affections, he says he has not made sufficient observations to announce the alterations in the sound produced by disease; but he has seen enough to conclude that disease modifies the sound. The stethoscopic signs are the altered cha- racter of the laryngeal sounds of inspiration and expiration, and the existence of a rale in the larynx. This rale is said not to exist in all instances, but to be, when present, extremely characteristic. It may exist on one side of the larynx without being perceptible on the other, as if it there corresponded to a circumscribed ulceration; (see Stokes on diseases of the lungs, page 248, &c.) One of the most interesting applications of the study of laryngeal auscultation, made by Dr. Stokes, is to the diag- nosis of intro-thoracic tumours; (see Dublin Med. and Chem. Journal, 1834). (34.) The theory of M. Beau appears to have met even a less favourable reception here than in France. This was to be expected. So paradoxical a view, however ingeniously brought forward, was not likely to find at first supporters in this country, more especially when contrasted with the simple, obvious, and seemingly satisfactory explanation adopted by Laennec; and perhaps it has been rejected by most persons almost without an exammation. One ingenious inquirer, indeed. Dr. Spittal, has investigated the subject, and, with a slight modification of M. Beau's opinion as to the seat of the guttural sound, has been led by new and well contrived experunents to nearly the same conclusions ; (see a paper read at the meeting of the British Associ- ation in 1838, and published in the Edinburgh Med. and Sur. Journal for Jan. 1839). M. Beau, adopting the view of Dr. Spittal, that the guttural sound is produced not by the impulse of the air against the soft palate but by its passage across the glottis, has recently renewed his inquiries on this subject, and in a series of elaborate papers, pub- lished in the Archives Generales for 1840, has endeavoured to show the applicability of his theory to explain the various physiological and morbid sounds produced in the respiratory apparatus. The reader will see a good analysis of two of those papers in the Medico-Chirurgical Review, Nos. 67 and 68 for January and April, 1841. END OF FART I.