BRONCHIAL DILATATION. 77 



held in suspension by the decomposed mucus, which has lost its tenacity ; 

 if, finally, we find in the sputum a few inspissated whitish, cheesy plugs, 

 of particularly evil odor, we may infer the existence of a bronchiectasis 

 with great confidence. The microscopic examination of this sputum, 

 which, curiously enough, is often less offensive in the vessel than at the 

 moment of its ejection, shows it to consist in part of young, well-pre- 

 served cells, in part of cells in a state of fatty metamorphosis, with 

 some masses of detritus, an appearance which is found elsewhere, where 

 pus cells have long lain stagnant. Not uncommonly, too, we find very 

 delicately-shaped objects in the cheesy masses, tufts of fine needles, 

 which prove, upon employment of ether, etc., to be fat-crystals (marga- 

 rine and stearine), and which are observed in the sputa of gangrene of 

 the lungs, as well as in that of bronchial dilatation. Absolutely certain 

 diagnosis, however, of one form or other of dilatation of the bronchi 

 (of whose differential diagnosis we shall treat hereafter), cannot by any 

 means be established by the character of the sputa. In some instances, 

 as has been proved by Traube, the bronchial secretion takes on a similar 

 character, without the existence of any bronchiectasis. This putrefactive 

 decomposition of the bronchial contents often has a very prejudicial 

 effect upon the wall of the tube, and the adjacent parenchyma of the 

 lung. In treating of gangrene of the lungs, we shah 1 find that this 

 putrescence of the contents of the bronchial tubes is one of its most 

 common exciting causes. In other instances, which, indeed, are even 

 more common, it results in the development about the bronchus, or even 

 throughout an entire pulmonary lobe, of an extensive pneumonia, with 

 a soft, easily-liquefying exudation. 



DIAGNOSIS. The distinction between simple acute bronchial catarrh 

 and catarrh of the larynx is easy. Hoarseness of the voice and of the 

 cough always indicates the latter, and that swelling of the mucous mem- 

 brane has extended to the vocal chords. 



The points of distinction between acute bronchial catarrh and acute 

 disease of the pulmonary parenchyma can be discussed to greater ad- 

 vantage after we have studied the symptoms of inflammation of the 

 substance of the lung. For the present, we shall merely indicate a few 

 important diagnostic points, which we already have had occasion to 

 speak of while detailing the course and progress of the disease. 



1. Simple acute bronchial catarrh is never accompanied by darting 

 pain in the side. The only painful sensation proper to it is a feeling of 

 soreness and burning in the chest, and sensibility at the points of inser 

 tion of the abdominal muscles upon the thorax. When other pain? 

 arise, complications always exist. 



2. Acute bronchial catarrh, of itself, never changes the sound of 

 percussion, so that the presence of the physical signs which indicate 



