ACUTE BRONCHIAL CATARRH. 69 



whistling, wheezing sounds are heard in the narrower tubes from par- 

 tial thickening of the mucous membrane. When secretion becomes 

 more free, rattling sounds, or rdles, are produced, and, as large bubbles 

 cannot form in the small tubes, the subcrepitant rdles are heard. In 

 adults, catarrh of the finer bronchi also usually subsides in from eight to 

 fourteen days. The fever ceases, the cough, the expectoration, and the 

 slight dyspnoea disappear. In other cases chronic catarrh remains, but 

 the disease rarely is dangerous. 



If catarrh of the finer bronchi develop in an old man, or a younger 

 person in very debilitated condition, and if it be accompanied by violent 

 fever, the latter assumes an adynamic character, and symptoms attend it 

 which indicate the assumption of a " nervous condition " (a very com- 

 mon term among the people). The sensorium becomes involved. De- 

 lirium or coma sets in ; we notice the ominous dryness of the tongue, a 

 symptom upon which we lay great stress, both for diagnosis and prog- 

 nosis. The pulse is small, irregular, and very frequent ; the skin, pre- 

 viously dry, flows with sweat ; rattling noises arise in the chest (which 

 may be coarse or fine, according as they occur in the greater or smaller 

 bronchi), but which do not cease after coughing. At last the sound of 

 still larger bubbles, tracheal rales, can be heard even at a distance. 

 This gurgling (Jcocheri) in the chest, which has also been called the 

 " death-rattle," and during which the patient usually lies unconscious, 

 indicates the approaching end. The older physicians applied the term 

 "pneumonia notha" to attacks occurring in marasmic subjects, and 

 which, originating usually in chronic disease, rapidly progressed to a 

 fatal termination. Here the patient, in a few days, succumbs to a sim- 

 ple bronchial catarrh ; and it is not the pernicious nature of the malady, 

 but the peculiar condition of the patient, which leads to the danger. 

 In old or enfeebled persons there is no disease, especially no inflamma- 

 tory one, which may not threaten life. Fever, with its constant symp- 

 tom of elevated temperature, the immediate cause of which is augment- 

 ed combustion, or greatly accelerated consumption of tissue, rapidly 

 consumes the scanty remnant of vital force which yet exists in these 

 cases. There is nothing specific in any of these symptoms. They are 

 repeated in exactly the same manner, wherever a febrile disorder is con- 

 suming the organism, and the physician does well in promising to the 

 non-professional in these cases "that he can save the patient if ' nervous ' 

 (typhoid) symptoms do not arise." For hours and days before the end 

 the function of the brain is disturbed, its nutrition being vitiated by 

 overcharge of the blood with excrementitial products. The tongue be- 

 comes dry, the elevated temperature of the body causing an increased 

 evaporation from the surface. 



In almost all acute diseases, the pulse, toward the end, becomes 





