68 PRACTICE OF MEDICINE. 



degree, the patients complain of having on their chest, as it were, a 

 weight which smothers them ; when observed, they seem to be ab- 

 stracted from all that is passing around them, and are entirely 

 occupied with respiring ; the face, of a violet red, or livid pale 

 colour, expresses intense anxiety; the nostrils are dilated in a marked 

 degree ; the respiratory movements are very frequent and short, as 

 if the air could not penetrate beyond the first divisions of the bronchi. 

 When the difficulty of breathing amounts to this last degree, the 

 termination is seldom favourable. After most of the symptoms of 

 inflammation of the lung have ceased, the breathing still remains 

 embarrassed, and this is particularly observable on the slightest 

 effort. As long as this residue of dyspnoea exists, the resolution of 

 the inflammation is not complete. 



Of the sputum. — At the commencement of pneumonia there is 

 frequently no expectoration, or it is simply catarrhal, being com- 

 posed of mucus of moderate tenacity ; but as the small crepitation 

 becomes marked, the sputa assume their characteristic form. When 

 the small crepitation becomes evident, which occurs about the 

 second or third day, the sputa become bloody, that is, they consist of 

 a tenacious matter intimately united with blood ; not merely simple 

 strise of blood, as in bronchitis ; neither is it pure blood, as in hse- 

 moptysis. According to the quantity of blood which they contain, 

 the sputa are either yellow, of an iron-red colour, or of a marked 

 red. They are at the same time tenacious and viscid ; they adhere 

 together so as to form a homogeneous whole ; at this period of the 

 disease, the sputa adhere firmly to each other, but they are not yet 

 sufficiently viscid to adhere to the sides of the vessel. Frequently 

 the sputa retain the above characters all through the disease ; in 

 this case, the inflammation of the lung does not ordinarily pass the 

 first stage, but oftentimes the sputa acquire still greater viscidity, 

 they are no longer detached from the vessel when it is turned upside 

 down. 



We should, under these circumstances, have cause to apprehend 

 that the second stage is advancing ; in fact, as the viscidity of the 

 sputa increases, the chest, when percussed, yields a duller sound, 

 and the murmur of pulmonary expansion is either gone altogether, 

 or is changed into bronchial respiration. In fine, the degree of vis- 

 cidity announces with tolerable precision the intensity of the inflam- 

 mation ; and whenever, after having become thinner in the course of 

 cure, the sputa regain their former viscidity, a relapse is indicated. 



In the suppurative stage of pneumonia the sputum is generally 

 characteristic. It then occurs under two forms ; in the one, we 

 observe a purplish-red muco-puriform fluid ; while in the other, the 

 matter expectorated has all the characters of true pus. In some 

 cases, pneumonia runs through its different stages without its exist- 



