Notes upon the physical examination of the respiratory and circulatory systems / by John Wyllie.

Date:
[1900]
Catalogue details

Licence: In copyright

Credit: Notes upon the physical examination of the respiratory and circulatory systems / by John Wyllie. 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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    RESPIRATORY f.. 4V- SYSTEM. 4l A f . ‘ 1 1 / ^ (6) The prolonged paroxystn of fully-developed Whooping Cough, with its rapid and long-con- ^ tinned succession of short, sharp coughs, and its final long-drawn stridulous inspiration. A succession of these paroxysms is very often succeeded by vomiting. . (7) The loud Barking Coztgh met with in some cases of Hysteria. Note.— The Sputum shoiild be carefully examined and described. Its more common types are— (a) Viscid, mucoiis, and often pigmented, ht co77t7non Catarrh; (b) Bloody, in Haemoptysis; (c) “ Nummular,” in advanced Phthisis; (d) Copious, frothy, mucous or muco-purnlent, in Bron- chitis ; if) Sticky, gelatino7is, and rusty, in Pneumonia ; and if) Extre^nely foetid, in Gangrene of the Lung and some cases of Bronchieetasis. In special cases a report should be jnade of the Microscopic cha^'acters of the Sp7itum. When, with cough, there is no expectoration, its absence should be noted. PART II. PHYSICAL SIGNS OF THE LEADING DISEASES. I. Bronchitis. In this affection the physical signs vary much in their intensity, according as the case is slight or severe. i^a) In slight cases, in which the catarrhal inflammation has extended only to the large bronchial tubes, there is generally some harshness of breathing, with pro- longation of expiration, more or less over the whole chest, in front and behind ( A ). Along with this, there may be a few sibilations ( ill ) or sonorous rhonchi ( /// ), but there are seldom any moist sounds. There is nothing abnormal to be observed on Extra-auscultation or on Inspection, Palpation, or Mensuration, and there is no dulness on Percussion. {b) In severe cases the physical signs are much more marked. On Extra-auscultation you may hear more or less wheezing in the patient’s chest as you stand by his bedside. In pure Bronchitis this wheezing is not generally very marked, and it is present in about equal degree in inspiration and expiration. It is frequently associated with a crackling noise, which is the equivalent of the moist sounds that can be detected with the stethoscope. When either marked Emphysema or Spasmodic Asthma exists as a complication of Bronchitis, the wheezing is more marked, and preponderates in expiration, which is rendered more prolonged and difficult than inspiration, thus A Extreme difficulty during expiration is more especially marked in Spasmodic Asthma. The cough in severe Bronchitis will be frequent, prolonged, paroxysmal, and often wheezing, with generally a copious, whitish, frothy expectoration. On Inspection, Palpation, and Mensuration, the chief points to be noted are those indicative of the difficulty of breathing, produced by the obstruction in the bronchial tubes. The patient may have orthopnoea, occasionally or continually. If, in a chronic case, there be marked Emphysema, the chest may be barrel-shaped, the sternum and whole anterior thoracic wall being too prominent, and the chest too deep in its antero-posterior diameter. In severe Bronchitis inspection of the Respira- tory Movements will show that the respirations are somewhat accelerated, and at the same time rendered very laborious and difficult. As evidence of this difficulty, the workings of the extraordinary muscles of inspiration and of expiration may be remarked; for example, the working of the Scaleni, Sterno-mastoids, and even,