A treatise on the diseases of the chest, and on mediate auscultation / by R.T.H. Laennec ... ; translated from the third French edition, with copious notes, a sketch of the author's life, and an extensive bibliography of the different diseases, by John Forbes ... ; to which are added the notes of Professor Andral, contained in the fourth and latest French edition, translated and accompanied with observations on cerebral auscultation, by John D. Fisher ... ; with plates.

  • Laennec, R. T. H. (René Théophile Hyacinthe), 1781-1826. De l'auscultation médiate. English
Date:
1838
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 third French edition, with copious notes, a sketch of the author's life, and an extensive bibliography of the different diseases, by John Forbes ... ; to which are added the notes of Professor Andral, contained in the fourth and latest French edition, translated and accompanied with observations on cerebral auscultation, by John D. Fisher ... ; with plates. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

    90/842 (page 40)
    account of the great errors of diagnosis which must result from their being confounded, but because the former becomes a pathog- nomonic sign in several cases of importance. Jn peripneumony it is one of the first indications of hepatization, and commonly precedes the loss of the natural sound on percussion : it is like- wise one of the earliest signs of an accumulation of tubercles in the upper lobes of the lungs. :]. Cavernous respiration. T understand by this term, the sound produced by inspiration and expiration in an excavation formed in the substance of the lungs, whether arising from the softening of a tubercle, from gangrene, from abscess, [or from ex- tensive dilatation of the bronchi.] This variety has the same character as the preceding, only that it further conveys the idea of air entering into a larger cavity than a bronchial tube : and when there exists any doubt as to this being really the case, other circumstances connected with the sound of the voice and cough, remove all uncertainty. 4. Blowing or puffing respiration. In those cases wherein either the bronchial or cavernous respiration exists, it is some- times observed that when the patient is breathing quickly and by fits, during inspiration the air appears as if drawn from the aus- cultatory ear, while in expiration • it seems blown into §it. This species of respiration is one of those phenomena which serve to confirm the existence of an excavation near the surface of the lungs,—but there are others yet more precise which will be no- ticed hereafter. This sort of puffing or blowing is equally pro- duced during coughing and speaking. The illusion of blowing into the ear in these cases is so perfect, that it is only from the absence of the feeling of titillation, and of warmth or coldness, which a blast of air so impelled must necessarily occasion, that we are led to doubt its reality. This phenomenon is found to take place equally in the bronchi which adjoin the surface of the lungs, and particularly in the large branches at their roots, when the substance of the lung around is condensed, as in pneumonia, or by a pleuritic effusion. In the case of excavations, this variety of respiration always indicates that they are very close to the surface of the lungs. It sometimes also presents a further modi- fication which I call the veiled puff {souffle voile). In this case, it seems to us as if every vibration of the voice, cough, or respira- tion, agitates a sort of moveable veil interposed between the ex- cavation of the ear. This particular modification obtains under the following conditions :—1. in tuberculous excavations of which the walls are very thin, at least in some points, and which are unconnected by adhesions with the costal pleura ; 2. in perip- neumonic abscesses of which the walls are unequally indurated, and in some places only congested ; 3. in cases of peripneumony.