PHYSICAL SIGNS OF PHTHISIS. 79 



The voice will be conveyed with unusual loudness through the 

 solidified lung, so as to give the sensation called bronchophony. 



But yet auscultation is far from an infallible means of judging of 

 the existence of tubercles in their earliest stage, and moreover, 

 numerous tubercles, either still in a state of crudity, or already 

 softened, may exist in the lungs ; these tubercles may give rise to 

 all the symptoms of phthisis in the second and even in the third 

 stage, and yet the sound yielded on percussing the parietes of the 

 thorax may not have undergone any alteration. This perfect sono- 

 rousness of the chest in phthisical patients is always observed, when 

 the pulmonary parenchyma has retained its healthy state around the 

 tubercles. Increased sonorousness may exist under three circum- 

 stances — 1st. When there exists a large tuberculous cavity, into 

 which the air enters by one or two bronchi which open into it, and 

 the parietes of which secrete but a little liquid, so that the cavity 

 contains more air than pus. 2dly. Where a partial emphysema has 

 been produced. 3dly. When a pneumo-thorax occurs as the result 

 of the opening of a tubercular cavity into the pleura ; this occur- 

 rence is generally manifested by the sudden accession of an acute 

 pleurisy. 



When tubercular induration in the upper parts of the lung is con- 

 siderable, it has the effect of conducting the sounds of the heart 

 with great distinctness to the upper regions of the chest. This fact 

 was first noticed by Dr. Townsend. 



Indications of vomicce. — First, supposing the vomica to be half 

 filled with liquid, and to communicate freely with the air-tubes, there 

 ^will naturally be heard on every entrance and exit of air, a gurgling 

 sound like the bursting of very large bubbles. The same may also 

 arise from dilatation of the bronchi, or from abscess of the lung ; 

 but these conditions, and especially the last, are rare. 



If the vomica is empty of liquid, there will be heard a class of 

 sounds called cavernous respirations ; consisting of certain variable 

 sounds indicating the passing of air into and out of a cavity. 



If the vomica be partially full of liquid, the latter may perhaps 

 be heard to splash, when the patient coughs. 



The particular resona?ice of the voice which constitutes pecto- 

 riloquy, is another sign of a vomica. When a cavity of moderate 

 size and regular form, empty, or nearly so, is in free communication 

 with a large bronchial tube, and is very near the surface of the lung 

 in contact with the thoracic parietes, or when the intervening struc- 

 ture is rendered a good conductor by condensation, the voice is 

 transmitted in the most perfect and unmodified manner, and seems 

 to be produced in that spot of the chest,, seemingly distinct from the 

 oral voice. This is perfect pectoriloquy. If heard with the stetho- 

 scope, the sound of the voice seems to come through the tube, and 

 enters the observer's ear louder than that which, coming from the 



