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• W2044550171 abstract "“When I use a word,” Humpty Dumpty said in rather a scornful tone, “it means just what I choose it to mean—neither more nor less.”“The question is,” said Alice, “whether you can make words mean so many different things.”“The question is,” said Humpty Dumpty, “which is to be master—that’s all.”Humpty-Dumpty, Through The Looking Glass, Lewis Carroll By documenting the variability with which we currently use terms to describe the adventitious (not normally occurring) sounds in the chest, Bunin and Loudon in this issue (see page 690) conclude appropriately that “lung sound terminology clearly requires standardization.” Laennec, the inventor of the stethoscope and “father of chest medicine,” if aware of this chaotic state, must be restless in his grave! Remember that it was he who originated the term “rale” as a generic term for all adventitious lung sounds, translated it into its Latin form “rhonchus,” and described four types on the basis of his personal clinical-pathologic observations.1Laennec RTH De L’auscultation Mediate. Vol 2. Brosson and Chadé, Paris1819Google Scholar It was his English translators who originated the mischief which continues to this day of creating confusion by failing to use the terms used by Laennec or to translate them accurately and by adding terms that had no basis in observations of human pathology. To those with a special interest, I recommend the amusingly written report by A. J. Robertson2Robertson AJ Rales, rhonchi, and Laennec. After an evening with Robert Coope.The Lancet. 1957; 2: 417-423Abstract Scopus (48) Google Scholar of a hypothetical meeting to consider chest terminology between Laennec and a group of his English translators. In this report, Laennec is quoted as pointing out that “it was Condillac who remarked that the art of reasoning lies in a well formed language, and nothing is more injurious to the progress of science than to wrest words from their received acceptation on insufficient grounds or to invent bad ones.” Robertson (heeding his own advice) has proposed the simple terminology of crackles and wheezes for discontinuous and continuous adventitious sounds respectively2Robertson AJ Rales, rhonchi, and Laennec. After an evening with Robert Coope.The Lancet. 1957; 2: 417-423Abstract Scopus (48) Google Scholar and Forgacs3Forgacs P Crackles and wheezes.The Lancet. 1967; 2: 203-205Abstract PubMed Google Scholar has provided strong support in his own classic paper by adopting these terms and providing an experimental basis for their use. One of the pioneers in the recording of lung sounds (Cugell) has now added his recommendation for the use of the term “crackles,”4Cugell D Sounds of the lungs (editorial).Chest. 1978; 73: 311-312Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar as has the ATS/ACCP ad hoc committee on nomenclature.5Report of the ATS-ACCP ad hoc committee on pulmonary nomenclatureAm Thor Soc News. 1977; 3: 5-6Google Scholar The latter group has also recommended perpetuation of the term rhonchus in addition to wheeze for continuous sounds. This could have the effect of perpetuating confusion, but the data reported by Bunin and Loudon suggest otherwise. My own bias is in favor of retaining the term rhonchus because of its strong clinical correlation with tenacious secretions in large airways independent of the presence or absence of airway caliber reduction from structural changes (spasm, fibrosis, mucosal swelling, etc). The early history of lung terminology should teach us to avoid making the same mistake twice. Not only is it desirable for the ATS and ACCP to complete their self-assigned task of standardization, it is also mandatory that their product be applicable internationally. This should not be too difficult to achieve since there now exists an International Lung Sounds Association with its own Nomenclature Committee which hopefully will be broadly representative of the international lung community. Once terminology is standardized, I believe we should follow the lead of our cardiology colleagues in utilizing modern audio-visual devices to disseminate widely what we mean when we use a word to describe a given sound. Bunin and Loudon are to be congratulated in pointing the way in which the achievement of this goal can be tested by “repeat studies” of the kind they have accomplished." @default.
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• W2044550171 title "Lung Sound Terminology" @default.
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• W2044550171 doi "https://doi.org/10.1378/chest.76.6.615" @default.
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