Auscultatory Sign of Enlarged Liver.—Br. Walshe has described in
the Lancet, a stethoscopic indication of enlarged liver, under the name
of “ hepatic compression rhonchus.”
“It coexists with inspiration only, or indeed, seems to be rather
superadded to it, not commencing until the inspiration-murmur appears
almost at an end. Its evolution is peculiarly slow, drawling, and (if I
may be allowed the expression) lazy, being, in this respect the exact
reverse of that of the crepitant rhonchus of pneumonia. It consists of
a variable (but commonly a great) number of excessively fine, dry
crepitations, rather superficial than deep-seated; is rendered audible by
forced inspiration only, and may be heard in front, at the side, and in
the back of the right half of the chest (least commonly in front, how-
ever,) at or near to, the upper edge of the liver. Its existence is com-
pletely independent of any lung-affection ; and 1 have never found it on
the left side, in these cases of liver-enlargement. The characters of
this rhonchal sound are so peculiar, that a mere tyro would be able to
distinguish it from all varieties of rhonchus,—it differs essentially, as I
have just proved, from crepitant, subcrepitant, and dry crackling, pul-
monary rhonchi, and from pleural rhonchus. Of its mechanism I am
not prepared, at present, to offer any demonstration ; but it appears to
me to be most feasibly explicable as follows ;—The lower portions of
the lung, pressed upon by the enlarged liver, undergo a sort of creasing,
or condensation, which, in ordinary breathing, interferes with their ex-
pansion. By forced inspiration, the portion of lung implicated will
readily be understood to be uncreased, and so conceivably a series of
sounds, such as I have described, is produced. Another fact strongly
corroborates this hypothesis—namely, that it often ceases to be audible,
for a time, after from one to five or six forced inspirations : the lung
seems to require rest and time to be again creased up. Should further
experience confirm this view of its mode of production, we shall have
collateral support given to the doctrine I have long taught (and which,
so far as I know, has not been refuted,) that the crepitant rhonchus of
pneumonia is formed, not in the air-cells or capillary bronchi, but in
the pulmonary parenchyma itself. I am not able, as yet, to make any
positive assertion concerning the frequency with which the rhonchus
under consideration attends enlargement of the liver; but, on the other
hand, I am in a position to affirm, that in no single case of notable in-
crease of bulk of that organ which has fallen under my observation,
since my first discovery of the rhonchus, have I failed to substantiate
its existence. The sound may, it is true, escape detection on one or
more occasions, but has never been absent for a series of days. On the
other hand, I have not met with it in otherconditions of disease; though
doubtless, if my theory concerning its formation be well founded, it will
probably be ascertained to accompany a variety of conditions, causing
slight compression of the lung.”—London Journal of Medicine.