220 Vctermajy Medicine. 



or window if any snch is available ; the contraction of the muscles 

 of the face, the dilated nostrils and the retracted angle of the 

 mouth give an anxious expression to the countenance ; the eyes 

 are semiclosed ; the pulse full but ^oi'i— {oppressed)— , beats from 

 48 to 70 per minute ; the bowels are slightly costive, the urine 

 scanty and high colored ; the skin \\\^\2i<i'i\Q— hidebound— \\^xs\\ 

 and dry, though sweats may bedew it in parts ; the loins insensi- 

 ble to pinching ; and if there is any discharge from the nose it 

 consists only in a reddish — rusty — colored mucus. 



Auscultation and percussion complete the diagnosis. At the 

 outset the inflamed portion of lung, usually near its lower part, 

 conveys a crepitating sound to the ear, but as consolidation ex- 

 tends the healthy murmur and the crepitating rale are alike sup- 

 pressed over the whole extent of the hepatised portion around the 

 margin of which a line of crepitation betrays the limit of the ad- 

 vancing inflammation. A similar Hne of crepitation encircles th 

 hepatised mass even when the exuded products are being absorbed 

 and when the lung is being cleared up and restored to its healthy 

 state. Thus the advance of the inflammation, and the progress 

 of recovery can be equally followed by the crepitation which, in 

 the different circumstances, betokens active inflammation or active 

 absorption. When both lungs are involved the posterior parts 

 are chiefly implicated, while if the pneumonia is single it may 

 attack the anterior, median or posterior part, or the entire lung may 

 become consolidated. If hepatisation exists in the anterior part 

 of the lung the thick fleshy shoulder will forbid any satisfactory 

 examination, but if in the middle portion only, while the respira- 

 tory murmur is lost it will be replaced by a strong blowing sound 

 (bronchial respiration) because the noise of the air rushing 

 through the larger bronchial tubes to the posterior healthy part 

 of the lung is conveyed with greater force to the ear through the 

 consolidated lung tissue. This is audible from the lower third of 

 the chest to the upper limit of hepatization. The respiratory 

 murmur in the healthy lung is always louder than is natural. 



Percussion confirms these results. Over the hepatised lung 

 where no respiratory sound remains, a dull, dead sound only is 

 brought out by the impulse of the fingers or closed fist, compar- 

 able to that obtained by percussion over the muscular masses of 

 the shoulder or haunch, and forming a marked contrast to that 



