58 PRACTICE OF MEDICINE. 



dity. At other times, every species of expectoration is suppressed 

 during the paroxysm ; which indicates an increase of irritation of 

 the mucous membrane. Some patients present, towards the end of 

 the perspiration which terminates the paroxysm, a copious expecto- 

 ration of thick, opaque sputa, such as is observed in the last stage of 

 bronchitis ; but this is only a temporary state, and the patient soon 

 expectorates anew a clear limpid mucus, as before the febrile exacer- 

 bation. The sputa, in this stage, are frequently marked with some 

 streaks of blood, arising from small vessels which are ruptured in 

 the midst of an effort to cough. The blood is then mixed with 

 mucus, but it is not combined with it, as happens in the reddened 

 sputa of pneumonia. It often happens that in the midst of the trans- 

 parent mucus, there are found, in greater or less numbers, small clots 

 of a dull white ; they do not come from the lung, but appear secreted 

 in the pharynx and posterior part of the mouth, by the numerous 

 cryptse with which the mucous membrane of these parts is supplied. 

 These clots have been erroneously considered as portions of pulmo- 

 nary tubercles, and consequently as one of the pathognomonic signs 

 of phthisis. 



As long as the sputa present the appearance above described, the 

 symptoms of bronchial irritation do not improve ; but according as 

 the inflammation proceeds towards resolution, the sputa change their 

 character. The mucus which forms them gradually loses its trans- 

 parence ; it is mixed with opaque, yellow, white, or greenish masses, 

 which, scanty at first, continually increase, and ultimately constitute 

 the entire sputa. Such an expectoration is ordinarily accompanied 

 by marked remission in the different symptoms of bronchial inflam- 

 mation. 



PHYSICAL SIGNS OF BRONCHITIS. 



Dr. Latham and Dr. Watson, have, with characteristic good sense, 

 cleared away the phraseology and minute subdivision, which have 

 overloaded the phenomena of auscultation. They now recognise 

 two great divisions of morbid respiratory sounds ; the dry and the 

 moist. The dry are caused by the obstruction of the bronchial 

 tubes by a swelling of their lining membrane, or by plugs of tough 

 mucus. The moist are caused by the presence of liquid — whether 

 mucus or blood, through which the air passes in bubbles in its 

 entrance into and exit from the lung. The dry sounds are called 

 rhonchus^ when grave or deep because situated in the larger tubes ; 

 and sibilus, when of an acute whistling character because situated in 

 the smaller tubes. The moist sounds are called crepitus ; which 

 may be large or small, according to the size of the tube in which it 

 occurs. 



The first physical signs of bronchitis (and these sometimes are 

 present before the cough comes on, and while the local feelings only 



