A treatise on the diseases of the chest and on mediate auscultation / by R.T.H. Laennec.

  • Laennec, R. T. H. (René Théophile Hyacinthe), 1781-1826.
Date:
1827
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the chest and on mediate auscultation / by R.T.H. Laennec. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    4. I believe that a similar result is produced by the effusion of the pus of an abscess of the lungs, or of the softened matter of a tubercle, into the pleura, in those cases where the pulmonary and costal pleura are intimately united by previous disease. 5. In certain subjects, the hand is sensible of a vibration, re- sembling that of a fiddle-string when touched, recurring after long intervals, and only momentarily. This phenomenon, which is of slight importance, and may have place even in a trifling catarrh, is occasioned by the contraction of some bron- chial ramification near the surface of the lungs, as is proved by the employment of the stethoscope. 6. Sometimes in cases of emphysema of the lungs, particularly the interlobular emphysema, a species of dry crepitation is felt by the hand. 7. Sometimes also we can perceive the fluctuation which takes place in a very large tuberculous excavation, or where there exists an effusion of air and fluid in the pleura at the same time, on the patient moving the chest quickly: in this case, however, we hear the fluctuation still more distinctly. From all this it may be concluded that the application of the hand to the thoracic parietes, is of very inferior value as a means of diagnosis in diseases of the lungs and pleura, and that even where its indications are of any value^ they are in some measure superfluous, inasmuch as the stethoscope fur- nishes us with others which are more constant and certain. The application of the hand to the region of the heart was, for a long time, the chief means employed by the ancient phy- sicians to judge of the strength, weakness or other characters of the pulse; but the indistinctness of the sensations commu- nicated generally, and the impossibility of perceiving at all the heart's action in many cases, have justly given the prefer- ence to the examination of the radial artery. Similar obsta- cles prevent us from deriving any benefit from this mode of exploration in most diseases of the heart, A very marked pulsation frequently indicates nothing more than thinness of the thoracic parietes, or a state of mere nervous agitation; while, on the contrary, there sometimes exists no perceptible pulsation even in cases of hypertrophy or great dilatation of the organ. There is only one sign of some value obtained by the application of the hand,—I mean the thrilling sensation analogous to the purring of a cat, wliich I shall have occasion to notice hereafter.