Bronchitis. 185 



with some dullness, impaired appetite, hot, dry mouth, redness 

 of the visible mucous membranes, a moderately strong, resonant 

 cough, attended with slight pain, slight rise of temperature, 

 accelerated breathing and pulse, and mucous discharge from the 

 nose. Such an attack passes over in a few days and without any 

 medicinal treatment if ordinary precautions are taken to avoid a 

 repetition of its causes. 



In severe cases the symptoms are more intense from the first. 

 Besides the dullness and inappetence, hot, dry mouth, generally 

 increased temperature of the body (102° to 104° F. ), accelerated 

 and labored breathing, and other manifestations of fever, there 

 are more specific symptoms. The cough is dry, hard, pain- 

 ful, often paroxysmal, and appears as if it came from the very 

 depth of the chest. A strong, harsh, bronchial sound is heard 

 over the lower end of the trachea and the upper border of the 

 middle third of the chest just behind the shoulder. Percussion 

 detects no change from the natural resonance of the chest, nor 

 auscultation any crepitating sound. Pressure in the intercostal 

 spaces causes no suffering. The expired air feels hot. The 

 pulse though accelerated is moderately soft and sometimes even 

 weak, a condition which marks inflammations of mucous mem- 

 branes as contrasted with those of the serous. The mucous 

 membrane of the nose has a dark red hue, especially when the 

 inflammation extends to the smaller ramifications of the bronchial 

 tubes so as to impair the aeration of the blood. In the same state 

 there is excessive dullness and prostration because of the supply 

 of partially venous blood to the brain. The head is held low, 

 the nose often supported upon the manger, and the eyelids are 

 semi-closed and injected. 



From the second to the fourth day a free exudation takes place 

 from the surface of the mucous membrane, and the symptoms are 

 materially changed. The cough becomes more frequent but 

 softer, looser, and attended with a rattle from the air passing 

 through the abundant mucous secretion. The cooing or tubal 

 sound heard at the lower end of the windpipe and behind the 

 shoulder has now given place to a miicoiis rale. A nasal dis- 

 charge appears at first watery, thin, of a whitish, glairy froth, 

 but .soon becoming more opaque, white, milky and flocculent and 

 having little tendency to stick to the nostrils. This is often ex- 



