Chronic bronchitis : its forms and treatment / by J. Milner Fothergill.

  • Fothergill, J. Milner (John Milner), 1841-1888.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: Chronic bronchitis : its forms and treatment / by J. Milner Fothergill. Source: Wellcome Collection.

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    time. Then, when there is dilatation of the bronchi with lung-consoKdation the note is altered by the depth at which the disease is seated. When deep seated a cracked-pot sound can be elicited on deep percussion. When near the surface the note is resonant, or even tympanitic. When there is an emphysematous condition present then the sound is tympanitic and abnormally clear. It may be general, or it may be local. It is common to find emphysema of the anterior fringe, or borders of the lungs in many con- ditions, without there being anything like it elsewhere. Such a condition with ossified costal cartilages renders it often impossible to map out the heart, or even to make out any cardiac dulness ; and so may lead to error as to the state of the heart. There may be a large strong heart, evidenced by the sounds on auscultation and by the character of the radial pulse ; when percussion has nothing but a negative answer to give, it is dumb indeed. Another matter is the diminished area of liver-dulness in emphysema. The abolition more or less complete of the areas of cardiac and hepatic dulness is the essential characteristic of emphysema. At other times the local emphysema may be at the back only, and even on one side. Careful percussion, then, tells much about the compli- cations of chronic bronchitis ; even when it has nothing to say about the malady itself. Auscultation, however, is eloquent, even loquacious, about the disease. Rales are heard over the affected area, or areas, or over the whole chest. They may be so loud as to be audible at some distance, or only be heard on careful ausculta- tion, according to the nature of the case. Usually bronchial fremitus is well heard. The bubbling of the air through the bronchial fluid produces a well-known and characteristic sound. The accompanying wood-cut tells the how and why of these sounds. Harsh respiratory sounds may also be heard, obscured by the rales. When the large tubes are affected the sounds are loud ; when the smaller bronchia are