Clinical researches on auscultation of the respiratory organs, and on the first stage of phthisis pulmonalis. Part 1 / by Jules Fournet ; translated from the French by Thomas Brady.
- Fournet Jules.
- Date:
- 1841
Licence: Public Domain Mark
Credit: Clinical researches on auscultation of the respiratory organs, and on the first stage of phthisis pulmonalis. Part 1 / by Jules Fournet ; translated from the French by Thomas Brady. 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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![(-2.) Tliis proposilion will, I iiavc liUlc douM, startle- tlic re;.<]cr, who most prohahly has bcoii accustomed to consider the respiratory murmur as belonging to the period of inspiration alone, and to look on that of expiration as unattended by sound. In fact, many even of our most practised auscultators appear to be still altogether unconscious of the existence of an expiratory murmur in the healthy condition of tlie lungs, and some who admit its existence arc evidently very imperfectly acquainted with it. Yet its presence in the healthy state, as well as its value as a sign in certain morbid condi- tions of the respiratory organs, have for many years been recognized l)y Andral, Louis, and others of the Parisian school, and so far back as 1836, the attention of the pro- fession in these countries was particularly directed to it by Dr. Cowan of Bath, in an excellent paper in the London Medical Gazette. I am anxious tlms early to call the student's attention to this most important, and, probably to him, novel fact—the constant presence of an expiratory murmur in natural respiration—with the view of inducing him at once to examine and satisfy himself upon the point. This previous study will enable him to follow M. Fournet in his researches with more satisfaction and more profit; I may add that he will in practice find a familiar acquaintance with this sign, a most valuable aid in the attainment of the main object of this work—the detection of phthisis at an early stage. Let him examine and judge for himself. With a practised ear and due attention he will rarely fail to find it. But considerable attention is sometimes required, as well as an ear familiarized with this particular sound. Nor should this surprise any one accustomed to auscultatory studies. Who does not know with what difficulty the ear educated to one class of sounds comes to appreciate a different class with equal accuracy ? The fcetal heart, when audible, produces a very distinct sound, yet I have seen many persons, dexterous enough in the auscultation of the pulmonary organs, unable to detect it for weeks after it was perceptible to one more accustomed to obstetric auscultation. (3.) We have no word in our language answering to timbre. It has been at times translated by tone, but this word is here employed in its proper acceptation. Suppose Iwo different instruments—a violin and flute for example—to sound the same note with the same intensity and for the same length of time ; there will still be a certain peculi- arity in each of the notes produced, distinguishing it from the other—that peculiarity is its timbre (Review of M. Fournet's book in the British and Foreign Medical Review, No. 18). After the example of the able writer I have just quoted, I employ the word quality to express this property of sound, rather than introduce into the text a word so uncongenial to our tongue as timbre. (4.) An account of Dr. Spittal's experiments will be found in his Treatise on Auscul- tation (the Harveian Prize Essay for the year 1829.) They were instituted with a view of showing that Dr. Williams was in error, in supposing the primary crepitant ronchus of pneumonia was produced by the bubbling passage of air forcing its way through a viscid liquid contained in an infinity of tubes of equally diminished calibre—an opinion which seems to have been very generally adopted by the profession. The result from Dr. Spittal's experiments was, as stated by M. Fournet, that a sound very similar to the fine crepitant ronchus is produced by the bursting of minute air bubbles on the sur- face of fluids of about the same density and tenacity as serum; but that this resemblance ceases in proportion as the fluid is more dense and tenacious. In viscid fluids, such as the expectoration peculiar to pneumonia, agitation produces scarcely any crepitus. (6.) Dr. Cowan should not be omitted in this enumeration. In the notes to his translation of Louis on Phthisis, published in 1835, he more than once points out the importance of the study of the expiratory murmur, as a means of diagnosis in the ear- liest periods of that disease. The paper already referred to, published the following year, is expressly devoted to the consideration of this phenomenon, of which he gives a very full and accurate account, examining it under nearly the same poinis of view as 51. Fournet; its existence in the normal conditions of the lung ; th« alterations it suffers](https://iiif.wellcomecollection.org/image/b21700217_0248.jp2/full/800%2C/0/default.jpg)
