Physical diagnosis : a guide to methods of clinical investigation / by G.A. Gibson and William Russell.

Date:
1890
Catalogue details

Licence: Public Domain Mark

Credit: Physical diagnosis : a guide to methods of clinical investigation / by G.A. Gibson and William Russell. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    C. DrmoiiKj in, or Retraction. (a.) Drawing in of the intercostal spaces, the epigastrium, and the epistemal and supra-clavicular regions, occurs during inspiration in cases in which there is obstruction to the entrance of air. It occurs from a variety of causes. The ohstruction may be in the upper part of the respiratory passage, as in croup ; it may be lower down from the pressure of an enlarged thyroid, or of an aneurismal or other medi- astinal tumour on the trachea or bronchi, or it may be due to spasm of the smaller bronchi, as in some cases of asthma or bronchitic asthma. (b.) Local drawing in of the intercostal spaces occurs over areas of congenital or acquired collapse : this is frequently seen in children, and is most marked in the spaces between the asternal ribs anteriorly and laterally. In all cases the explanation is that the capacity of the thorax is increased by the movement of its bony and cartila- ginous framework, wliile at the same time the lung tissue does not expand : as a residt the intercostal spaces and other yielding jDortioiis are driven in, for the atmospheric pressure remains constant while the pressure within the lung is necessarily diminished when the capacity of the thoracic cavity enlarges, and the entrance of air is obstructed. D. Alterations in Rhythm and Rate. Di/sprwea. — This term denotes increased rapidity or increased depth of respiration. It is brought on by physical exertion, but also by various morbid conditions. Elevated temperature is usually accompanied by accelerated respiration, while in other conditions there is not only acceleration, but increase in the depth of the respirations. When dyspnoea is caused by any hindrance to the free ingress or egress of air, it is known respectively as inspiratory or expiratory dyspnoea. Inspiratory dyspnoea is present in croup, the paroxysms of