A treatise on the diseases of the chest and on mediate auscultation / by R.T.H Laennec ... ; translated from the latest French edition, with notes and a sketch of the author's life, by John Forbes ... ; with plates ; from the third revised London edition, with additional notes.

  • Laennec, R. T. H. (René Théophile Hyacinthe), 1781-1826.
Date:
1830
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the chest and on mediate auscultation / by R.T.H Laennec ... ; translated from the latest French edition, with notes and a sketch of the author's life, by John Forbes ... ; with plates ; from the third revised London edition, with additional notes. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    can only be observed in cases where the fluids have penetrated the intercostal muscles and become extravasated beneath the skin, or in the still rarer instance where the intercostal spaces are ren- dered prominent by the pressure of the fluid within the chest. The simple application of the hand would seem to furnish some signs of greater utility ; for when a person in health speaks or sings, his voice excites in the whole walls of the thorax a sort of vibration, which is easily perceived on applying the hand to the chest. This phenomenon is no longer observable when, through disease, the lungs have ceased to be permeable to the air, or are removed from the walls of the chest by an effused fluid. This sign is, however, of inferior value, since a great many causes oc- casion varieties in the intensity of the vibration, or completely destroy it. For instance, it is little sensible in fat persons, in those whose integuments are considerable flaccid, and in those who have a sharp and weak voice. Anasarca of the chest completely destroys it, even when the lungs are quite sound. In any case, it is only very perceptible at the anterior and superior part of the chest, on the sides, and in the middle of the back. From these and other causes we can derive little practical benefit from at- tending to this particular circumstance. We can only presume that that portion of the lungs where it exists is permeable to the air ; but are not justified in drawing any conclusions from its absence. Notwithstanding the inefficacy of this method, I have frequent- ly employed it in practice, and the following are the results ob- tained :—1. In cases of abscess of the lung communicating with the cellular substance of the exterior of the chest, I have some- times perceived a sensation indicative of the passage of the air through the fluid. 2. In cases of extensive tuberculous excava- tions very near the surface of the lungs, and when these were also attached to the costal pleura, I have sometimes perceived a distinct guggling on the application of very gentle percussion or by merely pressing or touching the part* 3. In suffocative ca- tarrh, or the rattles of dying persons, when very stronc, a similar guggling is perceived. 4. I believe that a similar result is pro- * The same circumstance has heen observed by Andral, and is distinctly stated in the third volume of his Clinique Medicale, p. 66. It will be more particularly Hoticed when treating of the diagnosis of Phthisis.—Transl.