204 DISEASES OF THE PARENCHYMA OF THE LUNG. 



cyanosis in the pulmonary induration which accompanies consumption, 

 although in such cases there is a double hinderance to the pulmonary 

 circulation. This is attributable to the circumstance that, simultane- 

 ously with the destruction of the pulmonary capillaries, the volume of 

 the blood is reduced by hectic fever. 



Easy as it often is to recognize bronchiectatic cavities of the lung 

 with certainty, the diagnosis in other instances is extremely obscure. 

 The signs usually described as pathognomonic of bronchiectatic cavi- 

 ties are only met with in cases which are uncomplicated with tubercu- 

 losis or cheesy infiltration, and where the cavities are situated in the 

 lower lobes of the lungs. Bronchiectatic cavities at the apex of the 

 lung, lying side by side with tuberculous cavities, cannot be distin- 

 guished from the latter even upon dissection, to say nothing about 

 recognizing a difference between them during life. The manifestation 

 afforded by a bronchiectasis in the lower lobes of the lungs is readily 

 explicable, if we only know the extreme difficulty of discharging the 

 contents of cavities in such dependent positions. The liquid contents 

 of a vomica at the apex of the lung has no difficulty in flowing away 

 through the obliquely descending bronchi, but the discharge from a 

 similar cavity situate in one of the lower lobes, through bronchi whose 

 direction is obliquely upward, is either quite impracticable, or, at least, 

 only practicable while the body is in particular attitudes. (Cases occur 

 in which copious volumes of the thick, yellowish-green fetid contents 

 of a bronchiectatic cavity pour from the mouth of a patient, even be- 

 fore he has coughed, whenever he stoops forward or allows the. upper' 

 part of the body to sink laterally while lying in bed.) 



Owing to the difficulty and incompleteness with which bronchial 

 cavities in the lower lobes of the lung are emptied, and to other un- 

 known causes, the contents of the cavities often undergo putrefaction. 

 This putrid sputum has an extremely penetrating, fetid odor (particu- 

 larly at the moment of its expectoration), and is less viscid than most 

 catarrhal sputa, often containing caseous plugs, in which clusters of 

 margarine crystals are found. When collected and allowed to stand, 

 it separates into three strata, an upper frothy layer, a middle layer of 

 whitish-gray liquid, and a thick grayish-green sediment ; in short, it 

 completely resembles the sputa of diffuse bronchial dilatation, and of 

 putrid bronchitis. Nevertheless, in most cases, it is easy to decide 

 whether we have to do with the latter form of disease, or with a sao 

 culated bronchus. In the former, the coughs follow with short inter- 

 vals, and all the sputa which the patient ejects are of similar quality. 

 On the other hand, patients with a bronchiectatic sac often announce, 

 of their own accord, that they " have two kinds of cough." Indeed, 

 half a day, or even a whole day, may pass, and the patient will cougb 



