On diseases of the lungs and air-passages : their pathology, physical diagnosis, symptoms and treatment / by Henry William Fuller.

  • Fuller, Henry William, 1820-1873.
Date:
1867
Catalogue details

Licence: Public Domain Mark

Credit: On diseases of the lungs and air-passages : their pathology, physical diagnosis, symptoms and treatment / by Henry William Fuller. Source: Wellcome Collection.

    162/596 (page 144)
    eating with the cavity j or to obstruction of the air-passages which lead to the cavity. When its cessation is dependent on the complete evacuation of the fluid, the gurgling is usually replaced by hollow, breathing sound; when it is referable to the second-mentioned cause, the gurgling may be often reproduced by change of posture and the consequent bringing of one of the openings below the level of the fluid in the cavity j and when it depends upon the third- named cause, coughing will often lead to its rc-cstablishment by dislodging a plug of mucus or muco-purulent matter. When the obstruction is due to external pressure, cough has not much influence in restoring it, and its cessation is more permanent; and again when the space or cavity is completely full of fluid and does not admit the presence of air, gurgling cannot be produced. Sometimes, when a cavity is unusually large, and not only has very elastic walls, but contains a large quantity both of air and fluid, suc- cussion of the patient, or the impulse against the cavity produced by the action of the heart, will give rise to an admixture of the air and fluid, and occasion a gurgling or splashing sound. I have had the opportunity of noting this fact on three occasions; and it is quite possible to conceive that if the communicating bronchi were ob- structed, a gurgling or splashing sound might be thus produced, when no such sound was attendant upon respiration. Another modification of bubbling is clicking. Authors are not agreed as to the mode of origin of this sound, nor, indeed, have I ever met with a reasonable interpretation of it. Dr. Walshe says of dry clicking,* the ronchus, though its mechanism is unexplained, is of considerable diagnostic importanceand again, in reference to moist clicking* Its mechanism is almost as obscure as that of the dry crackling. But careful consideration of the conditions essential to its existence, and repeated experiments as to its mode of production, bave convinced me tbat when it is met with in the lungs it is due to the sudden and forcible passage of air through a small bronchus, the sides of which, at one or more points, have been brought close together by external pressure, or have been aggluti- nated, as it were, by tenacious mucous secretion. Thus its common cause is the presence of tubercle pressing here and there upon the