Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    266/976 (page 246)
    The most valuable indication of the presence of the disease, even in this early period, is drawn from the respiratory sounds and move- ments. The voice may attract attention, the cough will soon give the trumpet-note of alarm, but without the impeded respiration and its physical signs, their indication is not conclusive, they may even be absent during some temporary lull in the symptoms, and then is the favourable moment for a careful auscultation. The inspiratory sound is prolonged, and, instead of the ordinary blowing murmur, there is a sibilant tubular sound, high in pitch and of a metallic quality, con- stituting a prolonged harsh stridor; the expiratory sound is also pro- longed, but is low in pitch and harsh, the respiratory murmur is weak, especially in the anterior and upper part of the chest, and is masked by the tracheal si file; this is very marked over the larger bronchi, but is not always enough to conceal the presence of a certain amount of mucous and sibilant rhonchus in some of the smaller bronchi posteriorly ; there is no dulness on percussion, not even over spots where the murmur is altogether absent. The respiratory movement may also be noticed to be deficient in this stage, and when exaggerated during dyspnoea, to be inefficient, the supra-clavicular spaces are depressed during inspiration, and though the diaphragm, may descend well, the intercostal spaces will not bulge, nor will the walls of the chest be fully expanded. The cough is sure not to be long quiet, and its short, dry, abrupt character attracts notice; it is not, strictly speaking, a hoarse cough, there is no deficiency in body of sound, and it is high in pitch; a shrill inspiration accompanies each effort; during the paroxysm the cough will be frequent, and it is then the sign most worthy of attention. Our further investigation of the state of the respiratory organs must at this time be limited to inspection of the front of the chest and percussion at the back; when the attack is over, during sleep, or after vomiting, auscultation can be satisfactorily accomplished. The condition of the whole extent of the body should now be examined, to remark the absence of spasmodic contraction of the thumbs or toes, the presence or absence of a rash on the skin, of oedema of the extremities or of the face and neck, and the degree of warmth and tone of colour of these parts as compared with the body generally; the last point is to be specially noted, so that any varia- tion in the depth or tone of colour in these parts and in the face and lips may be readily appreciated. The sides of the neck are to be examined for enlarged glands, there may be small lymphatic glands distinguishable in the posterior cervical triangle, or under the outer border of the sterno-mastoid, they are few and inconspicuous, and 1 is important to note that the glands at the angle of the jaw are no^ enlarged. An early opportunity must be taken for a full and clear inspection of the inside of the mouth and throat. There may be some redness of the soft palate, sometimes oedema of the uvula; the pharynx will be either of a pallid red or of a brighter pink hue, theie will be a remarkable absence of free secretion, and no speck o