The pathology and diagnosis of diseases of the chest; illustrated especially by a rational exposition of their physical signs. With new researches on the sounds of the heart / [Charles J.B. Williams].

  • Williams, Charles J. B. (Charles James Blasius), 1805-1889
Date:
1835
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Licence: Public Domain Mark

Credit: The pathology and diagnosis of diseases of the chest; illustrated especially by a rational exposition of their physical signs. With new researches on the sounds of the heart / [Charles J.B. Williams]. Source: Wellcome Collection.

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    hepatized state, which passed superiorly into simple inflam- 'matory engorgement; and still higher up the tissue was healthy. There were no tubercles in either lung. The history of the case, and the rationale of the symptoms, is obvious. ‘The effusion of a former pleurisy had been ab- sorbed, but the lung being bound down by a tense false mem- brane, could not expand to refill the cavity ; hence it became filled with air exhaled into it, constituting a variety of passive pneumothorax. The tinkling echo was produced in this cavity by the voice and cough, transmitted through the pul- monary tissue condensed by the former effusion and by the hydatids. I have since met with a case of pneumothorax produced in this way, and Dr. Stack notices a similar sequel of pleuritic effusion.* Dr. Forbes, in his valuable notes to Laennec’s work, also adverts to a case of distinct metallic tinkling, in which, on dissection, no communication between the bronchi and the cavity could be discovered.} But in com- parison with the other form of pneumothorax, these cases are rare. Active pneumothorax, or that which results from a genera- tion of air within the pleura which presses the lung, may become a fit subject for the operation of paracentesis, and there are instances on record of its having been performed with the effect of averting impending suffocation.{ Where there is fistulous communication with the bronchi, the relief can be but temporary; and the coexistence of tubercular dis- ease must give to the case a hopeless character. The form of passive pneumothorax which supervenes to fill a void left by a partial pleurisy, has no other bad effect than that of perma- nently contracting the sphere of the pulmonary function. * Dublin Hosp. Rep, vol. iv. p. 90. ft 4th edit. 1834, p. 56. } Dr. Johnson, Med. Chir. Rev. No. 20, and Dr. John Davy, Phil. Trans. 1823.