Copy 1, Volume 2

The study of medicine. Improved from the author's manuscripts, and by reference to the latest advances in physiology, pathology, and practice / [John Mason Good].

  • John Mason Good
Date:
1834
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Licence: Public Domain Mark

Credit: The study of medicine. Improved from the author's manuscripts, and by reference to the latest advances in physiology, pathology, and practice / [John Mason Good]. Source: Wellcome Collection.

    538/704 (page 530)
    Gew. IIT. Spec. V. Marasmus phthisis. Hence little trusted to by Rostan and others. CL. WI] HEMATICA. [orD. IV. a by M. Laennec himself, that some persons have an habitually re- laxed state of some of the bronchial vessels, from hooping-cough or chronic catarrh, or a few minute excavations in the organ of the lungs, without any serious deviation from a state of ordinary health ; as also that patients occasionally recover from the tuber- cular species of consumption, and have the interior of the hollows or fistulz hereby produced not filled up, but lined with a semi- cartilaginous membrane, thus effecting a natural cure, — the phe- nomenon of pectoriloquism will here be as distinct as in a morbid state of the pulmonary organ, and consequently may often lead the practitioner astray. And, lastly, as the stethoscope is limited, or nearly so, to the ulcerative forms of phthisis, the disease may exist in the catarrhal variety, and still elude its power. For these and other reasons, little dependence is placed on this instrument by M. Rostan, and still less by M. Foderé; nor is it likely to obtam a very extensive use in our own country.* It has also been em- sound on percussion ceases. The tubercular solid mass, which gave the dull sound, no longer exists; and the part being now excavated, yields the same hollow sound as in health. It is to be remembered, says Dr. Elliotson, that though you have pectoriloquy, and a large space which ought not to be there, yet the phenomenon does not show the nature of the cavity, and it is only from the general symptoms that you are satisfied it is the cavity of phthisis. A part of the lungs is sometimes separated by gangrene, and a cavity will remain ; so that you may here have pectoriloquy ; but the nature of the case is denoted by the foetor of expectoration, sudden extreme debility, &c. In chronic bronchitis the bron- chial tubes may be very much enlarged at one spot; and here, also, there may be pectoriloquy ; but the general symptoms of phthisis will be absent. No reliance is: to be placed on the ear alone; the symptoms, which are audible, are only to be taken in conjunction with those which are general. Certainly, a very wrong view is taken of auscultation, when it is regarded as superseding the necessity of attending to the whole of the symptoms. As Dr. Elliotson further explains, a person may be labouring under ulceration of the lungs, and yet he may not afford the sign of pectoriloquy. If the cavity be near the surface of the chest, and the walls of the cavity be very thin, and if the bronchial tubes that open into the cavity have mouths so small as to bear no proportion to the cavity itself, you may have a large cavity, and yet no pectoriloquy at all. Here is another instance of the fallacy of observations made by the ear alone, to the exclusion of the other symptoms. The-walls of the cavity must be of a certain thickness for pectori- loquy to be produced, and the bronchial tubes, opening into the cavity, must bear a certain proportion to it; but, when the cavity is near the surface of the lung, and only covered by pleura, there will be no pectoriloquy. If, however, you had seen the patient before the cavity became so large as to be out of proportion to the bronchial tubes opening into it, and before the sides of the cavity had become so thin, you would have had pectoriloquy. When the excavation is very large indeed, you will sometimes hear the metallic tinkling, a silvery-ringing sound, when the patient coughs, speaks, or breathes. The metallic tinkling, however, as Laennec observed, is heard also whenever a communication is formed between the air-cells and the cavity of the pleura. In the first stage of phthisis, nothing is to be learned from the ear; and as the case proceeds, the case is generally clear enough without the information to be derived from this source 3 but, when it is questionable, whether the disease be bronchitis or phthisis, the existence of pectoriloquy in the latter affection, previously to the excavation becoming too large, will prove the true character of the complaint, and serve for the discrimin- ation of one case from the other. See Professor Elliotson’s Lectures at the Lond. -Univ., as published in Med. Gaz. for 1833, p. 227.— Ep. a * The editor does not coincide in this remark ; but he believes, that, for the elucidation of many ambiguous cases in the practice both of physic and surgery, the stethoscope will always be a valuable instrument. Its use in the examination of tumours, suspected to be of the aneurismal kind, but attended with obscurity,