Volume 1

Diseases of the organs of respiration : a treatise on the etiology, pathology, symptoms, diagnosis, prognosis, and treatment of diseases of the lungs and air-passages / by Samuel West.

  • West, Samuel.
Date:
1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Diseases of the organs of respiration : a treatise on the etiology, pathology, symptoms, diagnosis, prognosis, and treatment of diseases of the lungs and air-passages / by Samuel West. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    38/450 (page 16)
    Thus, Rdles is a general term, with several varieties. Laennec described five different kinds of rales, namely : 1, crepitant; 2, mucous; .3, sonorous ; 4, sibilant; 5, dry crackling. This is really a good classification, and if it had been adopted in its entirety, as Laennec intended, there would be little confusion. Unfortunately, this is not done. 1. The Crepitant Rdle.—This is tine crackling sound, such as is heard when the hair is rubbed between the fingers over the ear, and is now more commonly known by the name of fine hair crepitation. It is heard most frequently in the early stages of pneiimonia, but it is also met with in some other conditions of lung disease. It is usually explained as being due to the opening out, by the entrance of air, of collapsed air vesicles which have stuck together, the crackling sound being produced on the separation of the two surfaces. It would be well to place the fifth variety of rdle, viz., dry craiMing, also under this heading—a noise which Laennec compared to the crackling of a di-y bladder, and described as met with occasionally in emphysema. It is not a fine, but a large, coarse crackling [rdle crepitant sec a grosses hulles ou craquement). Between these two forms of crepitation Laennec placed another variety which he called subcrepitant, not quite so fine as the fine-hair crepitation, nor yet so coarse as the other form. This was observed frequently in cases of early phthisis. Laennec, however, did not say, as subsequent writers have done, that this subcrepitant rdle was pathognomonic of phthisis. Nor is the statement true, for this rdle may be heard in many conditions of the lung which are not of tuber- culous nature, and notably in bronchopneumonia. This term subcrepitant rdle is one which is not required; it is very indefinite, difficult to comprehend and to explain, and therefore would be best formally lianished from our nomenclature, as indeed it now almost is in practice. All these forms of rdle Laennec thought not to be due to fluid, and he there- fore called them dry rdles. 2. The Mucous Rdle.—Mucous rdles are crepitant, crackling sounds also, but regarded as due to the bursting of air bubbles in fluid. They have therefore been called moist rdles. These rdles vary in character according as they make more or less noise, or are produced in larger or smaller tubes, and so they give the impression of being caused by large, medium-sized, or small bubbles bursting. They are therefore described as small, medium, and large-sized crepitation. The largest of all is often called bubbling, and in its coarsest form is known as the death rattle, from which the name rdle was originally taken. All these mucous rdles alike are now termed crepitation. The larger forms of crepitation are easy to recognise by the ear, and are obviously due to the bursting of bubbles in fluid. The small crepitation has been likened to the crackling of salt when thrown on the fire, or the bursting of very fine soap bubbles in lather. This small-sized crepitation is by no means easy to distinguish from the crepitant rdles just described, and which are now called fine-hair crepitation. Nor is it easy sometimes to distinguish it from a form of friction in which the sound, instead of being one of rubbing, has tliis crackling character. All the sounds alike may be modified by the condition of the Imig which surrounds their place of production. Thus, if the lung be solid, they may acquire a sharp, clear character, and appear as if produced immediately beneath the ear. In this respect they may be compared with the clear transmission of the voice sounds which is called pectoriloquy. Again, if the crepitations are produced in a cavity, they may not only be large and bubbling, but, in addition, have a