SPUTUM IN BRONCHITIS. 57 



" 2. With (Edema of the lungs. — CEdema of the lungs is almost 

 always accompanied by phlegmorrhagy, which may readily become 

 suffocative, from the accumulation of fluid in the bronchi, especially 

 in weak and old subjects. 



"3. In dying persons. — The last agony, in almost all diseases, 

 is accompanied by a copious tracheal rattle, and consequently by a 

 real suffocative catarrh, except in those cases wherein the rattle is 

 owing to the presence of blood in the bronchi. (Edema, or yet more 

 commonly a sero-sanguineous congestion of the pulmonary texture, 

 accompanies the flow of fluid into the bronchi ; and it is to this cir- 

 cumstance that the infiltration of the posterior parts of the lungs, 

 observable in almost all dead bodies, is to be attributed. 



" 4. Acute suffocative catarrh of adults and children. — This is 

 very rare in adults ; in young children it is more common, and is 

 often in them confounded with croup. It is recognised by the tracheal 

 rattle perceptible by the naked ear, and by the imminent suffocation, 

 and frequent lividity of the face. The stethoscope detects, over the 

 whole chest, a loud mucous (and very liquid) rattle, and a very fre- 

 quent and usually irregular action of the heart. This disease is 

 acute catarrh, affecting the whole, or a very large portion of the mu- 

 cous membrane of the lung; its duration is from twenty-four to 

 forty-eight hours, or at most, some days ; at the end of which time 

 the patient either dies, or expectoration commences, and puts an end 

 to the sufl?bcation, and the disorder then follows the progress of a 

 simple catarrh," 



OF THE SPUTUM IN BRONCHITIS. 



In the first stage of bronchitis, the cough is dry, and as long as 

 the cough continues so, the bronchitis must be considered as still at 

 its commencement. At the end of a time, the length of which varies 

 according to individual peculiarities, and according as the patients 

 are or are not subjected to proper treatment, each fit of coughing is 

 followed by the excretion of a clear, transparent, serous or watery 

 mucosity, which is at first slightly saline, but afterwards becomes 

 tasteless. As the disease advances, the matter expectorated is a 

 glairy mucus, like white of egg ; when it is poured from one vessel 

 into another, it is observed to flow in one mass of extreme tenacity. 



When the patient is attacked with violent fits of coughing, accom- 

 panied by considerable heat within the chest, as also by marked 

 distress and general anxiety, the expectorated matter acquires re- 

 markable viscidity, and resembles a little the jelly-like sputa of acute 

 pneumonia. When the bronchial inflammation is accompanied by 

 much fever, the viscidity of the sputa becomes also greater during 

 the febrile paroxysm, so much so, that an inexperienced practitioner 

 may mistake it for that of pneumonia ; on the cessation of the 

 paroxysm, however, the sputa will be found to have lost their visci- 



