IlYPEILEMIA AND CATARRH. 67- 



ganglia from the sensory nerves of the bronchial mucous membrane. 

 The cough is not quite so distressing as that of catarrh of the laryngeal 

 mucous membrane,* which is more fully provided with sensory nerves. 

 It never has a hoarse tone except when the larynx participates in the 

 disease. At first the sputa are scanty, or entirely wanting ; afterward 

 the expectoration becomes more copious ; and, as the secretion only pro- 

 ceeds from the larger bronchi, a few efforts suffice to cough it up. The 

 patients say that the " cough is loose." In the beginning the sputa are 

 transparent and viscid ; at a later period they are turbid and yellowish. 



There is, of course, no real dyspnoea in catarrh of the trachea and 

 larger bronchi ; or, at most, there is but a slight oppression, and the pa- 

 tients say that " their chest is stuffed up." A swelling even of consid- 

 able magnitude, with the most profuse secretion, is incapable of ma- 

 terially and injuriously diminishing the large calibre of these channels. 



Percussion of the chest shows no change of sound during catarrh of 

 the larger bronchi. The vibrations of the thorax, and its capacity for 

 air, remain normal. Auscultation, too, often gives negative results 

 that is, we hear everywhere the whispering sound which the inflowing 

 air creates at the points of division of the finer bronchi, and in the air- 

 vesicles, and which we call vesicular respiration. All thought of the 

 graver catarrh of the minuter bronchi may be excluded, and catarrh of 

 the larger tubes is to be diagnosticated when we hear vesicular breath- 

 ing alone in the chest of a person suffering from cough and expecto- 

 ration. When the mucous membrane of the greater bronchi is much 

 swollen at one circumscribed point, the air, passing through it as through 

 a reed pipe, produces a buzzing, humming sound (the sonorous rhon- 

 chus), audible to the ear applied to the thorax, not only over the point 

 of origin, but beyond, and often with perceptible vibration of the tho- 

 racic walls. If an accumulation of mucus forms within the bronchi, 

 the air sets the liquid in motion, or bursts through it, so that bubbles 

 are formed and broken, causing rattling noises, which, as the bubbles 

 are larger here than they can be in the finer tubes, we call large moist 

 *dles, to distinguish them from the rales in the lesser bronchi. 



Catarrh of the trachea and greater bronchi, which we often hear 

 called a " slight cough " by the laity, as a rule runs its course favorably, 

 and with tolerable rapidity. The fever disappears, when there has been 

 any ; the cough, particularly in the mornings, brings up sputa cocta, 

 nowadays called muco-purulent homogeneous sputum, and finally sub- 

 sides, the perverted sensation of the chest having previously vanished. 



* Noihnagd has proved, by experimenting upon animals, that irritation of the 

 tracheal and bronchial mucous membrane causes coughing ; and has found that at the 

 bifurcation of the trachea in particular coughing-fits may be excited as promptly and 

 of as severe a character as those originating in the larynx. Other regjons evince a 

 lesser susceptibility. 



