508 AUSCULTATION. 



laryngeal murmur, while close to its entrance into the thorax 

 there is a blowing sound, resulting from the rushing of air 

 into and out of the bronchial tubes. This sound, which is 

 most prolonged in expiration, is called tracheo-bronchial 

 respiration. Should liquids be effused into the bronchia, 

 this changes to a mucous rale, which may be accompanied 

 by a hissing or gurgling rale. When the bronchia contains 

 blood, the rale is spumous or frothy. 



Chest. In the healthy chest two distinct sounds may be 

 perceived in ordinary respiration. These are the vesicular 

 and bronchial or tubal. 



The vesicular sound, or respiratory murmur, as it is 

 sometimes called, seems to result from the passage of air 

 through the narrow ultimate bronchia in their entrance into 

 and exit from the somewhat larger air sacs, and also from 

 the dilatation of the latter. It is a soft diffused murmur, 

 compared to the rustling of a gentle breeze among green 

 leaves, but must be heard to be fully appreciated. It is 

 found in greatest purity at a distance from the position of the 

 large bronchial tubes, when in short it is not interfered with 

 by the tubal sound. The sound is loudest during inspiration, 

 the vesicular sound of expiration being invariably feeble and 

 sometimes quite imperceptible. Its intensity is increased 

 by exercise, or any other cause which activates the process of 

 respiration. It varies, likewise, with the form of chest; 

 thus, in a deep and wide thorax, the respiratory murmur is 

 much stronger than in a flat chest of little depth. In 

 individuals of excitable temperament, and without any 

 superabundance of flesh, the sound is louder than in dull 

 lymphatic animals, or in a state of obesity. With an 

 empty stomach it is relatively stronger than when that organ 

 is in a state of repletion. This no doubt depends on the 

 diaphragm being pushed forwards by the ample gut, and 



