. Physical diagnosis . what you desire is to have him take a 150 PHYSICAL DIAGNOSIS. full breath and then simply let it go, but not blow it forcibly some cases the patient cannot be taught this, and we have to geton the best we can despite his mistakes. When he cannot be madeto take a full breath at all, we can often, accomplish the desired re-sult by getting him to cough. The breath just before and after acough is often of the type we desire. The use of voluntary coughin order to bring out rales will be discussed later on. Another use-ful manoeuvre is to make the patient count aloud as
. Physical diagnosis . what you desire is to have him take a 150 PHYSICAL DIAGNOSIS. full breath and then simply let it go, but not blow it forcibly some cases the patient cannot be taught this, and we have to geton the best we can despite his mistakes. When he cannot be madeto take a full breath at all, we can often, accomplish the desired re-sult by getting him to cough. The breath just before and after acough is often of the type we desire. The use of voluntary coughin order to bring out rales will be discussed later on. Another use-ful manoeuvre is to make the patient count aloud as long as he canwith a single breath. The deep inspiration which he is forced totake after this task is of the type which we desire. I. Respiratory Types. In the normal chest two types of breathing are to be heard: (1) Tracheal, bronchial, or tubular breathhig. (2) Vesicular breathing. Tracheal, bronchial, or tubular breathing is to be heard in normalcases if the stethoscope is pressed agahist the trachea, and as a rule. Fig. 93.—Situation of the Trachea and Primary Bronchi. it can also be heard over the situation of the primary bronchi, infront or behind (see Figs. 93 and 94). Vesicular breathing is to be heard over the remaining portions of AUSCULTATION. 151 the lung—that is, in the front of the thorax except where the heartand the liver come against the chest wall, in the back except wherethe presence of the scapulas obscures it, and throughout both axillae. (1) Characteristics of Vesicular Breathing. Vesicular breathing—that heard over the air vesicles or paren-chyma of the lung—has certain characteristics which I shall try todescribe in terms of intensity, duration, and pitch.
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