Lectures on the specific fevers and diseases of the chest / by Samuel Wilks.

  • Wilks, Samuel, Sir, 1824-1911.
Date:
[1875?]
Catalogue details

Licence: Public Domain Mark

Credit: Lectures on the specific fevers and diseases of the chest / by Samuel Wilks. Source: Wellcome Collection.

    80/160 (page 72)
    but being localised we give to it the name of gurgling. When we use tbis term we imply tbe existence of a cavity, but in many cases the sound not being distinguishable from a mucous rale a bronchitis may really be present. Sometimes the cavity in the lung is of great size, occupying half the organ, and the walls at the same time may be very thin and large tubes may be entering into it. Under these circumstances the ear at once appreciates, from the resounding of the voice and cough, and from the excessive hoUowness of the sound as the air enters, that the cavity is very large ; indeed, the breath sound is like that produced by blowing into a pitcher; it is therefore called amphoric breathing. The sound is more commonly heard and to greater perfection when the space full of air is altogether outside the lung, and in the cavity of the pleura. Then it is that these amphoric sounds are best heard. Having now told you of the morbid sounds which you hear in the tubes and lung substance whilst the patient breathes, there is only one other structure to remember, and that is the pleura. If lymph be on the surface of the lung, and the patient breathes, you may hear a, pleuritic rub. This is generally double, but it may be heard with inspiration only. It is heard always best at the lower part of the chest where the lungs are most movable. Voice.—Having endeavoured to discover the various morbid sounds during inspiration, we now make the patient speak. We ask him questions or tell him to count. In health, when a patient speaks, the voice vibrates through the chest. The words do not remain distinct, but are confused and lost. In disease, however, the articula- tion maybe precise and defined, the words passing directly into the ear; in fact, more clearly than the words spoken by the mouth pass to the other ear through the air. Now, in the case of a cavity, as I mentioned before in speaking of Laennec's discovery of the stetho- scope, the voice becomes painfully distinct to the ear. This is called pectoriloquy. The intensity often varies with the tone or timbre of the voice, so that sometimes a whisper is carried more directly through the chest to the ear than would a full-toned note. It has been said that if a patient blows the scale through pitch-pipes some notes are more easily transmitted than others. Now, there are other circumstances under which the voice comes direct to the ear in the same manner, and that is when the lung is consolidated, as in pneu- monia. The voice is transmitted down the bronchial tube, and car- ried through the good-conducting Imig direct to the ear, as before