A Lecture on Diseases of the Chest

J. A. Swett
1846 Boston Medical and Surgical Journal  
The Doctor commenced his lecture to-day, by recapitulating some of the leading characteristics of the physical signs on which he spoke yesterday, and after some remarks on the vesicular murmur, and its various changes, and the importance to be attached to it, he went on to say, as to the supplementary action of the lungs, in the earlier periods of pleurisy, the respiratory murmur is loud over those portions of the chest that remain healthy, while the sound of respiration is feeble over the seat
more » ... eeble over the seat of the effusion. When a large pledget of mucus enters a large bronchial tube, it also becomes very feeble, or ceases entirely, in that portion of lung supplied by that bronchus. This loudness or feebleness, however, is principally valuable as a diagnostic, according as it exists in a circumscribed portion of the lung ; and this is another proof how important it is, to constantly compare the sounds on the opposite sides of the chest, in order to arrive at a correct diagnosis. These changes to loudness, or feebleness, or the entire want of a vesicular murmur, however, are all merely changes in degree from the standard of the natural murmur ; there are some other changes, which are changes in kind, equally important. One of the leading characteristics of this murmur, is the idea of softness and expansion, which is uniformly observed in it; in certain cases there is A peculiar harshness associated with it ; in some cases this is to be heard very distinctly, and it is one of the first and the simplest of all changes that take place in the vesicular murmur, and is indicative of very slight disease ; this change is most marked in the early stage of tubercles, where they exist of a size, and in number, just sufficient to impede the free expansion of the vesicles. Again, in other cases in connection with this harsh respiration, we find it is jerky as it is called ; thus, in healthy respiration, the expansive murmur falls equally upon the ear, but in certain cases of incipient disease it comes by jerks, stopping for a moment, and then coming again. This state also belongs to the early period of tubercles, and is also owing to an impeded expansion of the vesicles. Again, in other cases, we find these three conditions united, viz., the feeble, harsh, and jerky ; the reason of this combination can be easily explained, for the air, on its passage into the vesicles, expands
doi:10.1056/nejm184606100341901 fatcat:keuowlp4zve7xppaj2s4q5e2zq