Epidemics. 245 



as the base is reached indeed, before it is reached it is, in a 

 healthy state, almost inaudible ; but in these cases of chronic 

 congestion the graduation stops suddenly, usually below the 

 the fifth or sixth rib, and is reduced to a fine, thin, soft, and 

 equal breeze, neither distinctly murmur nor distinctly 

 bronchial, but soft, equal, and finely breezy, and from this 

 point it rapidly gets less and less distinct. This is the 

 beginning of chronic congestion. 



When it is non-resonant under percussion, and no sound 

 can be elicited by auscultation, how then is it to be dis- 

 tinguished from pure pneumonia, or consolidation from an 

 old attack of broncho or pleuro-pneumonia, or from 

 syphilitic infiltration, which may in rare cases begin at the 

 lower half, though this is not usual ? This is a point of 

 great difficulty at first sight ; but there is a very simple 

 method, which can be given in few words. 



A given portion of lung is apparently perfectly solid. 

 Auscultation gives no sound percussion gives a dull heavy 

 thud, and not the distinct pitch of tubercle. What is going 

 on beneath ? Request the patient to take several forced 

 inspirations, and during this time keep the ear, or stethoscope, 

 against the chest ; if it is consolidation from inflamma- 

 tion there will be no result, or only a few unequal harsh, 

 half-crackling, bronchial pipings ; if syphilitic infiltration 

 the same will be heard, but somewhat freer in certain 

 portions or patches (besides which, there is a great deal of 

 previous history to guide in syphilitic infiltration) ; but if the 

 infiltration is recent there is a harsh breeziness, and dry piping 

 under forced respiration. But where there is true congestion 

 there will be, with forced inspiration, very fine, equal, and soft 

 piping, which is invariably present in all cases of pure conges- 

 tion of much intensity. If there is a spot where it is entirely 

 absent, there will be found, as the case goes on, some in- 

 dications to show that change of structure was the real 



