Volume 1

Diseases of the organs of respiration : a treatise on the etiology, pathology, symptoms, diagnosis, prognosis, and treatment of diseases of the lungs and air-passages / by Samuel West.

  • West, Samuel.
Date:
1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Diseases of the organs of respiration : a treatise on the etiology, pathology, symptoms, diagnosis, prognosis, and treatment of diseases of the lungs and air-passages / by Samuel West. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

    35/450 (page 13)
    8CHOOI Sec. l.J INTR0J3XJCT0RY. 13 Now let us turn to vesicular breathing and analyse what it is that we hear in those parts of the chest which are far removed from the large bronchial tubes. Here there is little noise : the sounds are muffled, blowing, soft, almost sighing in charac- ter, and what is more remarkable is that they are no longer double. We hear the blowing murmur with inspiration, but with expiration we either do not hear any- thmg at all, or we hear the blowing murmur only for a short time during the early part of expiration. Thus vesicular breathing is characterised first by the absence of noise, secondly by its blowing character, and thirdly by the absence, or diminution in length, of the expiratory sound. All the forms of breathing may be represented diagrammatically by lines, the varying thickness of them indicating the amount of noise. Thus vesicular breathing may be indicated by a thin line for inspiration, with a very short thin line for expiration, if it be audible at all (see diagram a); bronchial breathing by two thick lines (diagram e); tracheal breathing by two thicker lines (diagram /). Of course, between the diagram which represents vesicular breathing and that which represents bronchial breathing various transitional forms might be drawn, and these would correspond with the transitional forms of breathing which are actually observed. Laryngeal breathing (g), or, as it is called, cavernous breathing, may be represented by two double lines enclosing a space, instead of two thick solid lines, thus indicating its hollow character. No-w, just as the air tubes pass without a break from one end to the other, the larynx into the trachea, the trachea into the bronchi, the larger bronchi into the small bronchi, and the small bronchi into the bronchioles and vesicles, the lines of division between them being purely arbitrary, so it is with the different kinds of breathing to which the different names are given. The earliest pathological change from healthy vesicular breathing is that expiration becomes audible throughout its whole length {b); the next change is that inspiration be- comes louder than it should be (c and d). By - and - bye both inspiration and expiration are eqiial in loudness and in- tensity, and subse- quently come to have the character to which the name bronchial breathing is given. Between bron- chial and vesicular breathing we have many transitional stages, and the question is how far the term bronchial shall extend. No one who has ever heard true or typical bronchial breathing such as is met with in acute pneumonia can fail to have been struck by it or is likely to forget it. It is so chai-acteristic and peculiai, and it means 80 much pathologically, that it ia evident a special name is required for it. It seems a pity to use the same name which we employ to designate this re- markable phenomenon for a variety of other forms of breathing which have not the same pathological significance. And this is the gist of the whole matter; for while / A A A Vesicular Bionchial Fig. 15. Showing the relation assumed to exist between the altered breatliiug sounds and the amount of pathological lesion.