6/24/2023 0 Comments Copd adventitious breath sounds![]() ![]() ![]() ![]() But when the considerably rewritten second edition hit the press, stethoscopy had already become the standard of chest examination. The first edition of De l’Auscultation sold for 13 francs (16 if purchased with a wooden stethoscope) and sold quite badly. Among such neologisms were stethoscope, but also auscultation, rales, rhonchus, fremitus, crackled-pot sound, metallic tinkling, egophony, bronchophony, cavernous breathing, puerile breathing, veiled puff, and bruit. The book also presented an entirely new terminology, rooted in daily life examples and enriched by Laënnec’s fascination with Greek and Latin language. And since autopsy was the ultimate benchmark for all these conditions, several ended up acquiring a pathological name. There he reported masterly descriptions of several chest diseases, many previously unheard (no pun intended), like bronchitis, bronchiectasis, pleurisy, lobar pneumonia, hydrothorax, emphysema, pneumothorax, pulmonary edema, pulmonary gangrene and infarction, mitral stenosis, esophagitis, peritonitis, cirrhosis (hence the eponym Laënnec’s cirrhosis), and, of course, tuberculosis. Yet, in academic circles the tool came to be known as the stethoscope, from the Greek term for “inspector of the chest.” Whatever its name, the gadget allowed Laënnec to gather over 3 years an astounding wealth of clinical–pathological correlations, which he then published on August 15, 1819-in a two-volume book titled De l’Auscultation Mediate. He dubbed it the cylinder (and this, in turn, gave his students a chance to dub him “the cylindromaniac”). And all of this without even touching her! Being handy (he used to make flutes), Laënnec quickly manufactured a wooden contraption, shaped like a flute, which he started taking regularly on rounds. Imagining that something similar could be tried with patients’ chests, he fetched a cardboard, rolled it into a cylinder, applied it to the lady’s thorax, and to his amazement, was able to hear very distinct lung sounds. He remembered that a few days before, while walking in the Tuileries garden in Paris, he had seen children scraping a stick of wood and listening to the other end. Because percussion was technically difficult (given the large size of the woman’s breasts) and since direct auscultation (i.e., placing the physician’s naked ear over the patient’s naked chest) was, in Laënnec’s own words, “inadmissible” (given the young lady’s age and gender), Laënnec came up with a totally different approach. In the fall of 1816 (a year after the battle of Waterloo), he was summoned to the bedside of a young woman with a chest illness. The hero of this rediscovery was an introverted, diminutive, very asthmatic, very prudish, and very tuberculotic Breton physician, named René Théophile Hyacinthe Laënnec. It took a lot of serendipity (and plenty of shyness) to rekindle it as indirect auscultation, that is, one “mediated” by a newly invented cylindrical instrument, the stethoscope. by the sound they make.” Yet, during the 18th and early 19th centuries, direct auscultation fell rapidly out of favor, being replaced by a newer diagnostic modality: chest percussion. He wrote, “Who knows? It may be possible to discover the motions of internal parts. The hypochondriacal Robert Hooke, an assistant to Robert Boyle and one of the first scientists to use the word cell (1664), even had a good insight in describing heart sounds. Since then, chest auscultation was mentioned by Caelius Aeralianus, Leonardo Da Vinci, Ambroise Paré, William Harvey, Giovanni Battista Morgagni, Gerhard Van Swieten, William Hunter, and many others. ![]() In fact, Hippocrates himself taught and practiced auscultation, advising physicians to apply their ears to the patient’s thorax in order to detect various diagnostic sounds. 1400–1200 BC), and the Hippocratic writings (4th century BC). References to breath sounds first appeared in the Ebers papyrus (c. Auscultation of the direct or immediate variety (that is, without the use of the stethoscope) has actually been around for a long time. ![]()
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