Clinical researches on auscultation of the respiratory organs, and on the first stage of phthisis pulmonalis. Part 1 / by Jules Fournet ; translated from the French by Thomas Brady.

  • Fournet Jules.
Date:
1841
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Licence: Public Domain Mark

Credit: Clinical researches on auscultation of the respiratory organs, and on the first stage of phthisis pulmonalis. Part 1 / by Jules Fournet ; translated from the French by Thomas Brady. 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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    hU in its intensity * ; because the limits of the normal state were not well established. We shall see, in fact, that in the normal state, the murmur of expiration obeys as fixed laws as tliat of inspiration. Some physiolo- gical varieties, or some unnoticed pathological states could alone have led to this admission of the variability of the expiratory murmur. Persons, as it were, hesitated before pronouncing positivelyf. But at present, M. Andral, M. Louis|, &c. recognize the existence of the two murmurs in respiration; each constant, and having a fixed character ; the one strong- er, belonging to inspiration, the other much more feeble, belonging to expiration. M. Piorry in his work on Diagnosis§, sanctions the principle of the auscultation of respiration in its two separate periods. He marks carefully the greater intensity of the inspiratory sound, indicating at the same time clearly, that the expiratory sound is easily appreciable in the normal state. This result, however, has only been arrived at within a very short time, and there are still excellent observers, authors of recent and highly esteemed woi'ks on auscultation, who seem not to be aware of the existence of the expiratory murmur, either in the diseased or the healthy state. Such, for example, is M. Histz of Strasburg, who through- out his excellent thesis||, never uses any expression but respiratory mur- mur. Such is also Dr. James Clarke in his work on Consumption^. The authors of the Compendium de Medicine Pratique (Art. Auscultation) are nearly in the same position. M. Piorry, who carefully points out the principle of the study of respiration in its two separate periods, and who even adds that, in the morbid state, these two murmurs are modified in various ways **, never suggests in the course of his work any serious ap- plication of this principle. In conclusion, the murmur of expiration has been heard and analysed, as well in the normal as in the morbid state, by several observers, but at first timidly, with doubt, with restrictions; for men dared not trust their ears, where Laennec had heard nothing. Besides, those who had been the contemporaries of Laennec, and shared his labours, as well as his opinions, could not believe they had foi'merly overlooked a sound they heard now; urged at once by the past and by * In the study of vesicular respiration, tliere are then two murmurs to be investi- gated, which are more or less marked, according to circumstances. Tliat which is tirst heard is the murmur of inspiration, and tliat which succeeds it, the murmur of expira- tion, note, page 71 of the 1st vol. of the edition of 1837 of Laennec. f In the normal state, the respiratory murmur is audible almost exclusively at the time the air penetrates the pulmonary cells; when it issues from tliem, the sound is much more feeble, and even most frequently quite imperceptible. Note, page 71, 1st. vol. of edition of 1837 of Laennec. X Cliniquc de I'Hospital de la Pitic, de 183G. M. Louis taught at this period that the expiratory murmur was extremely feeble and scarcely recognizable, but constant. § Traitc de Diagnostic, vol. 1, p. 465. II Recherches Cliniques sur quelques points du diagnostic de la phthisic pulmonaire, aout 1836. ^ Traite sur la Consomption Pulmonaire, traduit pw Lebeau. *' Traite de Diagnostic, tome I, page 456.