OBSERVATIONS 
ON 
Amphoric Respiration 
AND 
AMPHORIC RESPIRATORY ECHO. 
BY M. D., 
President Richmond Academy of Medicine, \From the Southern Clinic.] 
PROCEEDINGS 
RICHMOND ACADEMY OF MEDICINE. 
Observations on Amphoric Respiration and 
Amphoric Respiratory Echo. 
Reported by C. K. GARDNER. 
The president of the Academy, Dr. M. L. James, presented 
a pathological specimen of a lung, which, in life, had afforded 
a very marked amphoric respiration, occupying nearly one 
entire side of the chest. The lung showed a very large 
phthisical cavity, with a smooth internal surface, the front wall 
being made of a much thickened pleural membrane, closely 
adherent to the parietal walls, as it was nearly throughout the 
whole extent of that cavity, the result of adhesive inflamation. 
The rear wall was composed of a like adherent pleural 
membrane, with about an inch thickness of lung, which had 
lost its characteristic pulmonary structure, and was left in a 
carnified condition. 
Dr. James expressed his conviction that such adhesion of 
the pleural surface of a cavity with the chest wall, was the 
usual condition by which amphoric respiration is produced, 
and has been surprised to see no mention made by the au- 
thorities of such a condition, as the occasion of the produc- 
tion of this abnormal sound. The authorities recognize 
the existence of a large cavity with firm walls, as the occa- sion of amphoric respiration, but lie lias no where seen any 
account where pleural adhesion has been the particular cir- 
cumstance by which those walls were made thus firm. Dr. 
James believes that this, though not the exclusive, is the 
usual mode. 
Dr. James also reported a case of liespiratory Amphoric 
Echo, which had occurred in a case of chronic pleurisy with 
empyema, in which pneumo-thorax of the affected side had 
been established by a free opening made through the parietes 
of the chest to allow the escape of the large amount of pus 
which had been formed. In this case there had been no com- 
munication between the pleural cavity and bronchial tubes, 
there being no phthisical cavity, or other perceptible disease 
of the lungs, except the pleurisy referred to. The amphoric 
sounds occurred after the pneumo-thorax had been established 
by the operation, and were clearly produced by the com- 
municated vibrations, from the passage of air along the 
bronchial tubes to that contained in the pleural cavity. 
Tt differed from the amphoric sound produced by the direct 
entrance of air into phthisical cavaties, in the fact that it 
occurred at a short, but appreciable interval, after the in- 
spiratory act, was more prolonged in its utterance, being 
indeed, rather a succession of reverberations, and susceptible 
of recognized by its echoing quality of sound. For that 
reason, Dr. James described it as an amphoric respiratory 
echo. 
The case was interesting as demonstrating the fact that 
sounds of an amphoric quality ma}' be produced without the 
direct passage of the air of inspiration into a cavity, and that 
they are marked by distinctive characteristics, susceptible, 
under close attention, of recognition.