Wheezing Respiration in Children

Abstract

The wheezing to which the observations that are to follow refer is that heard at the open mouth of the patient, not by auscultation through the wall of the chest.When in a child the lumen of every air passage is of normal area in cross-section, the child breathes so quietly that either a very close approach or the observation of movements is necessary to make certain that the child is breathing at all.To produce a wheezing audible without auscultation, the lumen of the airway must be encroached on by tissues, secretions or a foreign substance. The wheezing may be described as rattling, bubbling, crowing, harsh, whistling, vibratory, stridorous or merely noisy. The sound may be heard on inspiration or on expiration or on both.The character of the obstruction to the free noiseless passage of air can be determined in practically every case by tripartite conference of the pediatrician, who can tap, look and listen on the outside, the roentgenologist, who can look through the patient, and the bronchoesophagoscopist, who can look inside the patient. CONDITIONS IN WHICH WHEEZING RESPIRATION OCCURSCompression Stenosis.-Compression stenosis may be due to any structure or foreign body outside the trachéal or bronchial wall.A foreign body in the esophagus, as mentioned elsewhere in this paper, may compress the trachea by its bulk or by the secondary swelling or by both.Thymic compression stenosis causes a wheezing well known to all pediatricians. Twenty years ago, John Boyce and I bronchoscopically demonstrated thymic compression stenosis in the living patient, disprov¬ ing the arbitrary dictum of Friedleben that such a condition did not exist and was impossible.Abstract of remarks made in connection with a chalk, lantern and moving picture demonstration at the meeting of the Central States Pediatric Society, Pittsburgh, Oct. 27, 1928.