DISEASES OF THE EESPIRATORY ORGANS. 589 



if permanent in a given spot, it may arise from the pressure of 

 a tumour or other cause which may flatten an air-tube. Ehon- 

 chus essentially belongs to the larger tubes, denoting partial 

 narrowing ; is a dry sound, and, if uncomplicated, indicates a 

 condition of no great danger. It is also called vibration, sonorous 

 rhonchus, and sonorous rale, and is generally associated with 

 bronchitis. 



(b.) Sibilus, Sibilant Bale, Sibilant Rhonchus. — A high-pitched 

 whistling, hissing, clicking, wheezing sound of variable intensity 

 and duration, coexistent with both respiratory movements, but 

 more especially marked during inspiration, arising from tume- 

 faction or accumulation of viscid mucus in the small bronchial 

 tubes. I once heard a dairyman call this a " chaining sound," 

 from its resemblance to rustling of an iron chain. It is asso- 

 ciated with bronchitis situated in the smaller tubes, and is best 

 heard over those regions where the vesicular murmur is most 

 audible in health. It indicates greater danger than rhonchus, 

 and if present over a large surface of both sides, a condition of 

 great gravity. 



2. Moist sounds. — The dry, bronchial sounds are succeeded in 

 bronchitis by moist ones, termed rales, rattles, or bubbling sounds. 



(a.) Mucous Hhonchus or Bale. — The bursting of bubbles of 

 some size, unequal and varying in number, modified by coughing 

 and expectoration, coexisting with both respiratory movements. 

 It is due to the bubbling of air through liquid — mucus, blood, or 

 pus — in bronchial tubes the size of a crow quill, heard in those 

 regions where the tubal sound is most apparent in health. 

 Succeeding dry rhonchus, it indicates the moist stage of 

 bronchitis. 



(&.) Small bubbling Bhonchus or Battle, suhcrepitant or snb- 

 mucous Bales or Bhonchi, succeeding sibilus, coexistent with 

 both movements, but loudest during inspiration, and due to the 

 bubbling of air throuoh a more or less viscid fluid in the minute 

 bronchial tubes at their peripheral distribution ; heard in bron- 

 chitis affecting the smaller tubes, and during the resolution of 

 pneumonia. 



(c.) Gurglinr) Battles, cavernous Bhonchi or Bales. — The burst- 

 ing of bubbles, obviously of a large size, with a hollow, gurgling 

 sound, or a metallic sound if the bubbles be small, coexisting 

 with both respirator}' movements, is associated with vomicre or 



