had been found in some vessels, while they had not existed in others. In the present case there appeared to be a disposition in the blood of the second bleeding to undergo the same change, but in that of the third and fourth all tendency to it appeared to have been lost.' On the Cephalic Ganglion, commonly called the Pituitary Gland, and on ils connections with the Nervous System of Organic Life. By M. BAZIN. -After an historical account of the researches relating to the connections of the pituitary gland with the filaments of the sympathetic, the author passes to the facts which he has observed. "The filaments by which the cephalic ganglion or pituitary gland is connected with the organic nervous system arise from the anterior and posterior aspects of the ganglion, from which they pass laterally to proceed immediately to the internal carotid artery, around which they wind, giving filaments to the carotid plexus. Several filaments thus anastomose with the net formed by the cavernous plexus. "The filaments arising from the anterior aspects of the cephalic ganglion, are the largest: they form a fasciculus two millimetres wide, which is produced by the union of the two principal trunks. Arrived at the internal carotid, in the level of the concavity of the curve which it makes to go to the brain, they form a small gangliform plexus. A filament given off by the anterior trunk turns round the anterior and external aspect of the internal carotid, and divides into two filaments, each of which passes to one of the opposite extremities of the carotidian or cavernous ganglion. This ganglion furnishes several filaments, which pass to the third pair, and go to the ophthalmic ganglion. Behind, the cavernous ganglion sends several filaments to another ganglion situated between the external surface of the carotid and the first branch of the trifacial. The last ganglion gives several filaments to the outer surface of the carotid; others go to unite with a plexus situated between the third pair and the ophthalmic branch of the fifth; and this plexus gives two filaments to the sixth pair. The others go backwards, to what appears to us to be a true ganglion, situated in the internal surface of this first branch of the trifacial. The ganglionic plexus resulting from the union of the nerves coming off anteriorly from the cephalic ganglion, sends two moderate-sized filaments over the concavity of the last curve of the internal carotid, which are connected on the one hand with the nervi molles of the cavernous plexus, and on the other with the large filament which the superior cervical ganglion sends under the lower and outer surface of the internal carotid. Other filaments proceeding from the anterior surface of the cephalic ganglion, and others still which arise on its posterior aspect, embrace, and twine round the carotid, and are also continued to the filament we have just pointed out. "I have discovered the same relations, only less complicated, between the cephalic ganglion (pituitary gland) and the superior cervical ganglion, in the eagle and the ostrich."--Comptes-Rendus, Oct. 21, 1839.3 A Peerage refused by a Physician.-At the late creation of peers in France, the name of M. Double was decided on as that of one fit to be raised to the dignity in question. The offer was then made to him, on condition that he should renounce the exercise of his profession! To this proposal M. Double refused to consent, not choosing to purchase the honour at so dear a price; and we cannot but remark, that the spirit evinced by the French government on this occasion is very different from that which actuated Napoleon, when he constituted Cabanis, Berthollet, and Fourcroy, peers of the empire.3 'London Lancet, Sept. 21, 1839, p. 936. Medical Convention for Revising the Pharmacopoeia.-This convention assembled at Washington on the first Wednesday of January. Owing to a mistake made in convening it on the first Wednesday, instead of the first Monday, of January, the delegates from the University of Maryland and New Hampshire did not reach Washington until after the convention had adjourned. We shall publish the account of the proceedings of the body, of which we formed a part, as soon as we receive it from the secretaries. Nothing could have passed off more harmoniously and satisfactorily in all respects. The Maryland Medical and Surgical Journal.—We have received the first number of this new periodical, of neat appearance, and well "got up" in all respects. It is intended to appear quarterly, at the rate of $2.50 in advance, or at one dollar per number. The editorial committee are Drs. G. C. M. Roberts, Nathaniel Potter, James H. Miller, Robert A. Durkee, John R. W. Dunbar, and Samuel G. Baker. We wish it every success. NECROLOGY. [We regret to observe in one of the latest foreign journals,' the death of an old and venerated preceptor.-Ed.] Dr. Hamilton.-Dr. Hamilton, whose illness we announced last week, died on the 14th instant, at his house in St. Andrew's Square, Edinburgh. He had been for a great number of years Professor of Midwifery, and was the last of a generation now completely gone by. He was a very animated lecturer, and we believe, an energetic practitioner, retaining to the last the utmost vivacity in the maintenance of his opinions, as some papers published only last year, in the pages of this journal, [Lond. Med. Gazette,] will sufficiently demonstrate. We have already heard of various candidates, both in Edinburgh and London, who are anxious to succeed him. BOOKS RECEIVED. Remarks on some of the Medicinal Springs of Virginia. By George Hayward, M. D. (Read before the Boston Society for Medical Improvement Sept. 23, 1839.) From the Author.-Introductory Lecture before the Surgical Class of the College of Physicians and Surgeons, Fairfield, N. Y. Delivered Dec. 3, 1839. By Frank H. Hamilton, M. D., Professor of Surgery. (Published at the request of the Class.) 8vo, pp. 22. Albany, 1839. From the Author.-A Defence of the Cosmogony of Moses, being, 1st, A Vindication from the attacks of Geologists; 2d, An Examination of that portion of Dr. Buckland's Geology, (one of the Bridgewater Treatises,) entitled Consistency of Geological Discoveries with Sacred History; 3d, A Review of an Essay on "Geology and Revelation" by J. G. Morris-an article in the American Museum for Nov. 1838. By J. Horwitz, M. D. 8vo, pp. 31. Baltimore, 1839. Lond. Med. Gaz. Nov. 22, 1839, p. 336. THE AMERICAN MEDICAL INTELLIGENCER. Vol. III. February 1, 1840. No. 21. ART. I.-ON THE SOUNDS OF RESPIRATION AND OF THE VOICE.' BY PEYTON BLAKISTON, M. D.,2 Physician to the Magdalen Asylum, and the General Dispensary, Birmingham. Respiration. On applying the ear to the neck and chest of a person in health, certain sounds are heard during respiration, which vary with the region in which they are listened to. In the trachea, a coarse hollow sound is heard during inspiration and expiration, (tracheal respiration.) At the upper part of the inter-scapular region, the sound during expiration is less intense than that during inspiration, and both are softer and weaker than in the trachea, (bronchial respiration.) At the remaining parts of the chest, the sound during expiration is scarcely perceptible, being in most cases reduced to a short puff; while the sound of inspiration is much softer and weaker than at the inter-scapular region (vesicular respiration.) This description of vesicular respiration differs from that of Laennec, who remarks, "en entend pendant l'inspiration et l'expiration un murmure très legère, mais extrêmement distinct, qui indique la pénétration de l'air dans le tissu pulmonaire, et son expulsion," thus failing to observe the disproportion between the duration of the sounds of inspiration and expiration. Those persons who are in the daily habit of practising auscultation of the chest, will, however, I think, confirm the accuracy of the description here given. I shall now endeavour to ascertain the manner in which these sounds are produced, and the causes of the variations in quality, intensity, and comparative duration, observed at different parts of the apparatus in which they are engendered. This apparatus consists of a tube commencing at the mouth, divided and subdivided until it terminates in the air cells. During inspiration air is passed into it by the weight of the atmosphere, and is expelled during expiration by muscular reaction, and the resilience of the air cells and of the cartilages of the ribs. In thus passing and repassing through these tubes, the air meets with obstacles at every point where their direction is changed. Now when a current of air meets with opposing obstacles, as the wind blowing upon trees, or into a tube inclined at an angle to its direction, it is thrown into sonorous vibration, and therefore noise must be produced in the trachea and its division during respiration. This sound is not sufficiently intense to be heard until the listener places his ear in contact with the 'Read before the British Association for the Advancement of Science, Aug. 27, 1839. 2 Lond. Med. Gaz. Oct. 12, 1839, p. 78. trachea; in the same manner as the noise produced by a gentle blowing on a sheet of paper is not heard until the ear be placed on the paper. The coarse hollow sound, then, heard in the trachea, is produced by the whole air of respiration passing and repassing through this tube, and its upward and downward continuations. At the upper part of the inter-scapular region many circumstances concur to render the sound weaker and softer than that heard in the trachea. This tube has now been divided into at least two branches, one for each lung, and hence only half of the air which enters the trachea can pass through each division; and therefore the sound generated in either of them by the friction of the air becomes proportionably weaker and as regards the sounds similarly generated above and below this point, and respectively carried up to it by the current of inspiration and expiration, those produced in the mouth, fauces, and trachea, are weakened by divergence, and those produced in the bronchial tubes are those of one lung only, whereas the sounds generated in both lungs were carried through the trachea. Besides this, the bronchial tubes are not in actual contact with the walls of the chest, even in this spot, but are separated from them by more or less of the spongy tissue of the lungs, which, being a non-homogeneous substance, and consequently a very indifferent conductor of sound, deadens and weakens the respiratory sounds in their passage from the tubes to the ear of the auscultator. I stated that the sound during expiration was less intense in this region than that during inspiration. This arises from the additional force given to the latter sound by the vesicular respiration of the intervening portion of lung just mentioned, the sound of which is chiefly confined to the time of inspiration. 1 When at length the ear is placed on the remaining portions of the chest, it is no longer approximated to the sides of the bronchial tubes, but to their vesicular extremities. These are so numerous (being not only spread over the periphery of the chest, but also forming the greater part of its internal substance) that only a very minute portion of the air of respiration can reach them at any one spot, and hence very little noise can be produced in them by friction; while the sound generated in the larger tubes, although confined from total divergence in the air, is amazingly weakened and softened by the extent of surface over which it is thus spread. The sounds previously heard at the sides of the bronchial tubes are here effectually prevented from reaching the ear by the great intervening mass of spongy lung. All these causes combining to weaken the respiratory sound, the maximum intensity of which in the trachea can only be heard when the ear is brought into contact with its side, it would not be surprising were no sound detected during respiration at the surface of the chest. Another force, however, is in action. As the wind bears upon it sounds which from their great distance would be otherwise inaudible, so does the current of air during inspiration carry up to the ear those sounds which are engendered in its passage, while that during expiration acts in a contrary direction: hence the sound of inspiration is distinctly heard at the surface of the chest, while that of expiration is barely perceptible. I shall now endeavour to ascertain where the sound of vesicular respiration is produced. Sound must be generated in every part of the trachea and its divisions during respiration, but it does not follow that every portion of it should be sufficiently intense to reach the ear of the auscultator at the surface of the chest. I cannot deny that a fraction of that which is heard in vesicular respiration may be produced by the friction of air against the inte rior of the vesicles, or by that of one vesicle against another, or by that of the pulmonary on the costal pleura, because a slight sound is heard at the commencement of expiration when the force of resistance is at its maximum; but I contend that the principal part of it is not thus produced; otherwise, taking place immediately under the ear, and therefore unaffected by the direction of the current of air, it would be heard as distinctly during expiration as inspiration; nor on the other hand can it be principally formed in the mouth and fauces, otherwise it would be much strengthened by stertorious breathing, which is not found to be the case. The sonorous waves formed in these parts, in passing through tubes, the calibre of which rapidly diminishes, and the direction of which is constantly changing, would seem to be in a great measure broken and destroyed before they reach the vesicles. We seem, then, to have arrived, par la voie d'exclusion, at the bronchial tubes, as the parts in which the sound heard in vesicular respiration is principally generated; and this conclusion derives some confirmation from the fact that sibilous and sonorous râles, which are undoubtedly formed in these tubes, modify, and in some cases, totally mask the sounds of vesicular respiration. When in certain diseases a portion of the lung becomes converted into a solid mass, vesicular respiration is replaced over the spot where that portion is in contact with the walls of the thorax, by bronchial respiration, as it has here been defined, coarse, with prolonged expiration. In endeavouring to account for this alteration, Laennec remarks. "Les raisons de la respiration bronchique me paraissent assez faciles à donner. En effet, lorsque la compression ou l'engorgement du tissu pulmonaire empêche la pénétration de l'air dans les vesicles, la respiration bronchique est la seule qui ait lieu;" and Andral writes, "Elle nous parait dépendre de ce que l'air ne peut pas pénétrer au-delà des gros tuyaux bronchiques." Thus both writers agree in considering the bronchial tubes, which lead to the solidified lung, as the seat of the bronchial respiration which is heard in such cases. It must be remembered, however, that the current of air in the bronchial tubes owes its existence to the expansion of their vesicular extremities, and that when their expansibility has been destroyed by the deposition of solid matter in them, that moment the current must cease in these tubes, and with it the sound of respiration within them. Were the larger tubes sufficiently elastic to keep up a current, then, in a solidification of a whole lung, we should hear loud bronchial respiration, which is not found to be the case. Dr. Jackson, of Boston, was the first to notice prolonged expiration as a characteristic sign of bronchial respiration. He writes, "In some commencing sases of phthisis, where the respiration is not yet truly bronchial under the clavicle, when we still hear the vesicular expansion and naught else on inspiration, I have discovered the bronchial sound on expiration. In other words, as the tubercular deposit advances, the bronchial expiration may be heard before the bronchial inspiration; it may be heard at an earlier period of the disease, and may thus become a very important sign, as making known the disease yet sooner after its origin. This circumstance is very explicable. As soon as tubercular matter is deposited, there exists a solid material around the bronchia, which will transmit the sound made by the passage of the air through these tubes; but thus early a great portion of the lung, even in the part affected (the summit), is permeable to the air, and therefore the murmur of vesicular expansion on inspiration entirely masks the sound of the air passing through the bronchia, which would otherwise have been transmitted through the surrounding denser medium. On expiration, however, circumstances have changed: the air, on passing through the bronchia, produces the same sound as on its entrance, and as now there is no vesicular expansion to mask it, it is easily transmitted through the diseased or condensed part to the ear of the observer." Fully acknowledging the practical value of the prolonged sound of expiration as a diagnostic sign, I cannot admit the correctness of Dr. Jackson's observation that it is heard at a period when the sound of inspiration is purely vesicular. Although it is easier to discover the presence of a sound at a time when ! Vol. i. p. 56, 3d edition. Paris. Vol. i. p. 432, 3d edition. Bruxelles. |