On variations of pitch in percussion and respiratory sounds, and their application to physical diagnosis : prize essay / by Austin Flint.

  • Austin Flint I
Date:
1852
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Licence: Public Domain Mark

Credit: On variations of pitch in percussion and respiratory sounds, and their application to physical diagnosis : prize essay / by Austin Flint. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    The sound is not intrinsically rude, or rough, or harsh. Even a well-marked bronchial respiration, to which the sound under consideration is an approxi- mation, can hardly he said to have the qualities indicated by these term?. The bronchial respiration is not very unlike in character the endocardial sound, which is characterized as a soft bellows murmur. Whatever appro- priateness the designation has, is based chiefly on the fact that, in the rude respiration, the peculiar expansive, breezy attribute of the vesicular respira- tion, which has been referred to as the vesicular qualitij, is more or less impaired. To form a correct idea of the modification usually termed rude, &c, it must be analytically decomposed, and the nature of its elements determined. It is an approximation to the bronchial respiration. It exhibits an incipient development of the character distinguishing the bronchial from the vesicular respiration. One of the most striking of these characters is the change in piich. The pitch is raised. The vesicular quality is diminished; hence it approaches to a tubular or blowing respiration. The inspiration may be somewhat shortened, and occasionally a sound of expiration becomes devel- oped and prolonged, constituting an important rhythmical variation. By- attention to these several points, much will be gained in practicilly recogniz- ing the modification; but it is not easy to find a satisfactory title to be sub- stituted for the names generally in use. Of the several elements mentioned here, as in the case of the bronchial respiration, it seems to me the pitch modification is the most striking, and the most readily appreciated, while it is probably the most constant. The expiration deserves to be distinctly noticed. Considerable importance has been attached to a prolonged expiration, since its occurrence was pointed out as a frequent sign of early tuberculization, by James Jackson, the younger, of Boston, Mass. The best practical authorities have recognized this s.gn as ft valuable contribution to the art of physical exploration. It is not, how- ever, a constant modification. Its absence, therefore, does not furnish ground for the conclusion that tubercle does not exist. Moreover, it may exist as a normal peculiarity, and consequently alone it is not perfectly reliable. In the tew instances'among the cases I have collected in which a prolonged expiration was present, and the pitch noted, it was found to be higher, or as hioh as the sound of inspiration. Now, in health, over the greater part of the chest, if a sound of expiration be appreciable, it is found to be distmctly ]0Wer in pitch than the sound of inspiration. May it not be that the eleva- tion of pitch in expiration has a diagnostic value fully as great, or even greater than when the inspiration is thus modified ? May it not be that, m