CONSUMPTION OF THE LUNGS. 



239 



judicial to the patient. I certainly regard catarrh of the apex of the 

 lung as a serious symptom, and the longer it lasts, so much the more 

 have we to fear that it may lead, or that it has already led, to those 

 derangements of nutrition from which consumption so often proceeds ; 

 but, we are not at liberty to conclude that the catarrh has involved 

 the substance of the lungs themselves, until fever, emaciation, pallor 

 of the skin, the presence of elastic fibres in the expectoration, and 

 other evidences of phthisis arise, besides the catarrhal signs. 



Bronchial respiration, bronchophony, and sonorous rdles are heard 

 in cases of consumption, when extensive induration enclosing large 

 open bronchi, or cavities, has formed near the surface of the lung. 

 Indurations of such magnitude never proceed from tubercle or tubercu- 

 lar conglomeration alone. Whether they are the result of infiltration 

 or of induration, whether they contain bronchi or cavities with air in 

 them, must be determined from the other symptoms. When the cavi- 

 ties or bronchi which traverse the solid part of the lung are filled 

 with secretion, no respiration is audible. 



Sounds are heard sometimes which place the existence of cavities 

 beyond all doubt, and which therefore are called cavernous sounds. 

 The cavernous sounds include 1st. Coarse moist rdles, audible over 

 places where there are no large bronchi, where large bubbles can 

 form, as at the apex of the lung. 2d. The sudden transition (called 

 metamorphosing by Seitz) from a sharp hissing or sucking sound to 

 bronchial respiration, or into indistinct murmurs and sonorous rdles. 

 This very common and very characteristic sign is probably produced 

 by the entrance of air into a cavity through an opening which at the 

 commencement of the respiratory act is narrow, but which is enlarged 

 as the chest becomes inflated. 3d. Amphoric breathing, the rale with 

 metallic resonance, a sound like the bursting of single bubbles with a 

 metallic ring, the metallic tinkling. These noises may be produced 

 artificially by blowing over the open mouth of a bottle, or by agitating 

 a liquid in a bottle held before the ear, or by letting fall a drop into 

 the bottle, the ear being placed against it. It is only when there is a 

 similar condition of the lung, when it contains a capacious cavity with 

 symmetrical concave walls, capable of producing uniform reflection of 

 the sound-waves, that amphoric breathing and metallic sounds are 

 audible. 



It but rarely happens that diagnostic information of any value in 

 consumption is obtained by use of the spirometer, and by measurement 

 of the capacity of the lungs, that is, of the volume of air expelled from 

 the chest after drawing as deep a breath as possible. There are cases 

 of obstinate cough, where percussion and auscultation, giving nega- 

 tive results, excite the suspicion of the existence of lobular infiltra- 



