Observations on the mechanism and diagnostic value of the fiction vibrations perceived by the ear, and by the touch in peritonitis / [Robert Spittal].

  • Spittal, Robert, 1804-1852.
Date:
1845
Catalogue details

Licence: Public Domain Mark

Credit: Observations on the mechanism and diagnostic value of the fiction vibrations perceived by the ear, and by the touch in peritonitis / [Robert Spittal]. Source: Wellcome Collection.

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    of tlie serous surfaces after inflammation. It is not always that we find these surfaces so universally and intimately united as to impede all motion reciprocally of the one upon the other, though it may be very much limited. But this we know does occur, as well in the case of the pericardium and pleura, as in the peritoneum ; and in such instances, we should not expect the development of any fric¬ tion vibration. On the other hand, when the adhesions are much interrupted by spaces without any union, although coated with lymph, it is evident that friction motion may occur by one or other of the mechanical causes to be afterwards noticed. And even, although the adhesions be general, and the adherent spaces few and small, still the yielding nature of the soft, recent lymph, it ap¬ pears to me, might be sufficient to allow of the physical conditions proper for the production of the friction vibration,—for a time, at least, before it had intimately united the surfaces together,—it may be however of diminished intensity. The amount of motion neces¬ sary for the production of the friction sound, seems to be very limited, if we may judge from the simple experiment of bending two portions of dry and somewhat stiff leather—not necessarily new —closely applied to one another ; or, by very gently rubbing the glazed surfaces of thinner leather together. In both instances, the degree of motion of the one upon the other is very trifling, and, in the first case, hardly perceptible, and yet the creaking vi¬ brations are distinctly enough perceived. This seems also apparent from Dr Corrigan's experiment, in which he found that by “ squeez¬ ing two peritoneal surfaces covered with a layer of tolerably dense and spongy lymph, a creaking could be produced.1 Different de¬ grees of motion, however, may be necessary in the different modifi¬ cations of the friction vibrations ; and the less dense, and thick the layer of lymph, and the more elastic the subjacent organs, probably the greater will be the amount of motion required for their pro¬ duction. From the sixth column in the table, it appears that almost every author who has made original observations on this subject, has re¬ corded the peculiar vibratory indications perceived by the sense of touch over the part affected; and this, no doubt, has arisen from the necessity of manual examination of the abdomen leading so directly to their detection. The character of the sensations has been very differently described, even in the same case, at different periods of the inflammation ; so much so, indeed, as to render it more than probable that the various physical conditions of the serous surfaces had given rise to corresponding modifications of this peculiar sen- 1 Op. cit. p. 397. As has been remarked, there is little doubt that the honey¬ combed appearance of the recent lymph, so often seen in pericarditis, and which has also been observed on other serous surfaces, as the pleura, and peritoneum covering the liver, (Bright, Op. cit. p. 202), is the result of motion between these surfaces while the adhesions are soft and extensible. And so long as there is motion between the sur¬ faces, there may be sound.
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