CAPILLARY BRONCHITIS. 7 ; 1 



air- vesicles. As the glottis is closed, the contents of the thorax com- 

 pressed, the outflow of the jugulars restrained in this as in every other 

 cough, the countenance becomes red, and even bluish, during the cough- 

 ing-fits, which are exceedingly violent and distressing, seldom bringing 

 up any secretion, and which, even then, is not ejected, but is swallowed 

 by the child. Excepting during the paroxysms of cough, the color of 

 the face remains normal. But, as the disease goes on (often through 

 fault of the physician), if the child, either from exhaustion of its strength 

 and inability to make further and adequate muscular effort, can no 

 longer draw a sufficient supply of fresh air through the obstructed 

 bronchi into the air-vesicles, or else because the obstruction has so in- 

 creased that many of the tubes have become totally impervious to air, 

 the picture changes. The previously full pulse now becomes small, the 

 hot skin cool, the reddened countenance pale, the terror turns into 

 stupor, and the well-known manifestations of carbonic-acid poisoning 

 arise. 



The first threatening of danger is not difficult to recognize, if we 

 pay attention to the following points : As long as the epigastrium and 

 the hypochondria remain prominent, air enough reaches the vesicles. 

 If, however, instead of this, we see, at each inspiration, that the jugular 

 and epigastric regions sink in, and that the lower ribs are drawn inward, 

 we may feel sure that the air in the vesicles is being rarefied upon 

 inspiration (as no new air can reach it), and that the respiratory function 

 is being imperfectly performed. A symptom of imperfect inspiration 

 of quite as much importance, and hitherto too little appreciated, or else 

 falsely interpreted, is the prominence of the supra and infra clavicular 

 regions, and the enfeeblement of the respiratory movement in this por- 

 tion of the thorax. It often attracts the attention of the mother sooner 

 than that of the physician, that a child, during its illness, has " got too 

 high a breast." We must avoid confounding the permanent inspiratory 

 expansion of the air-vesicles, to which this appearance is due, with vesic- 

 ular emphysema. In this case the vesicles remain permanently in a 

 state of expansion, such as they would attain normally at the height of 

 inspiration. In emphysema they are abnormally distended, and it is 

 curious that two such different conditions should hitherto have been so 

 often confounded with one another. The manner in which the perma- 

 nent inspiratory expansion of the vesicles takes place seems difficult of 

 explanation upon a mere superficial glance at the mechanism of respi- 

 ration. We are tempted to assume that the obstruction in the finer 

 bronchi, which could be overcome by the action of the inspiratory 

 muscles, should be still more readily conquered by forced expiration ; 

 since, as daily experience teaches, we are able to expel our breath with 

 greater force than is required to draw it in, or, as the physiologists ex- 



