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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    sometimes, of the Pectorals. At the same time there will be noticed an excess of movement in the wall of the chest as a whole, as well as in the wall of the abdomen, an exaggerated thoracico-abdominal type of breathing. Further evidence of respira- tory labour may be found in the sympathetic working of the Alae Nasi; and in the marked upward and downward movement of the box of the Larynx, which descends with Inspiration often to the extent of three-quarters of an inch, and ascends with Expiration ; in the sucking in of the intercostal spaces during inspiration ; and, when the patient is young, in the drawing in of the lower costal margin and lower end of the sternum by the action of the Diaphragm. If there be marked Emphysema, the apices of the lungs will bulge upwards into the root of the neck when the patient coughs. On Percussion the note obtained is usually quite normal. But, if there be marked Emphysema, the percussion note over the Emphysematous areas—usually the sternal region and about the apices—may be Rightly byp^-resonant. Bronchitis of itself can never produce dulness, and does not cause any alteration of the Vocal Resonance. If there be dulness, evidence of Phthisis, Pneumonia, Pleurisy, or of Basic Oedema, must be looked for. On Auscultation there is generally the same harsh type of breathing with prolonged A expiration ( / ^ ) as was observed in the slighter varieties, but the accompaniments are much more marked. These accompaniments are the characteristic dry and moist sounds. The dry sounds may present all varieties of pitch, from tbe low-pitched sonorous rhonchi ( /// /// the pitch being dependent on the size of the tube in which the sound is produced. In a severe case of “Capillary ” Bronchitis there is a full chorus of high-pitched sibilant rhonchi all over the chest, in front and behind. The moist sounds are of the medium variety, “subcrepitations ” ( ). As they are produced by flupdynyicus, and as fluid tends to seek the lowest level, the moist sounds will generally be found to be most abundant at the bases of the lungs posteriorly. It should be specially noted that, in ordinary Bronchitis, these physical signs are developed equally in both lungs, and that, except for the preponderance of moist sounds at the bases, there is no tendency to concentration of the physical signs in any particular area. Should Bronchitic rales be found concentrated at the apex, the possibility of Phthisis must be considered. Should the moist sounds be more abundant at one base than at the other, and should there be any dulness on percussion in that locality, evidence of Oedema, or of Pneumonia, or of Basic Phthisis must be looked for. Bronchial Breathing is never produced by Bronchitis, the type of breathing being vesicular, though harsh with prolonged expiration, as already explained. Often the type of breathing cannot be made out at all, as the breath-sounds are drowned in the accom- paniments. Vocal Resonance and Fremitus are generally normal in Bronchitis. II. Croupous Pneumonia. In this acute affection the signs rapidly develop from day to day. On Extra-auscultation, the only thing to be noted is the frequent, short, “suppressed ” cough, which is associated with a sticky, gelatinous and rusty sputum. On Inspection, etc., there will be observed marked acceleration of breathing, the respirations running in a severe case as high as 50 or 60 per minute ; but, although accelerated, the breathing is not usually laborious or difhcult. there being no impediment in the air-passages. Orthopnoea and marked labour of the extra- ordinary muscles are only occasionally met with, in very bad cases. There is often sympathetic working of the Alae Nasi, and frequently a little upward and downward