DISEASES OF THE RESPIKATOKY ORGANS. 65 



ing, accompanied with a slight whistling or hissing sound, heard on 

 auscultation, at the sides of the chest, or else by a deejaer and more noisy 

 sound in front of the chest. The whistling sound indicates inflamma- 

 tion of the smaller tubes; whilst the deeper sound indicates inflam- 

 mation of the larger tubes. The peculiarity of these sounds arises 

 from the passage of the air over the dry, inflamed membrane in the tubes. 

 During this, or the " dry stage," the pulse is harder and quicker than 

 natural, from 70 to 80 per minute, and as the disease progresses it be- 

 comes quicker and smaller, until in very bad cases it can be no longer 

 felt. The breathing is also much quickened, and the membrane of the 

 nostril is red and inflamed. 



About the second day the dry state of the bronchial membrane is suc- 

 ceeded by a moist stage, with an increased secretion of mucus, accom- 

 panied with a suppressed cough. This change, though it has no partic- 

 ular significance, is yet often indicative of relief, inasmuch as it shows 

 that one stage of the inflammation has passed. The pulse, which during 

 the dry stage had been harder and quicker than natural, now becomes 

 decreased in volume and increased in frequency. Should the lining mem- 

 brane of the nose, which had been red and inflamed, become moist, and 

 at the same time the secretion from it of a more natural character, it is 

 a very favorable symptom. 



If the mucus which is now secreted is not freely expectorated, it will 

 accumulate either in the larger or smaller tubes, according to the loca- 

 tion of the attack. In the larger tubes it affords considerable impedi- 

 ment to the respiration. The sound of the air j^assing through them is 

 known as the "great" mucous rale. If the smaller tubes are attacked, 

 the sound is more subdued and wheezing-like, and is known as the 

 ''small " mucous rale. The distinction between these two sounds should 

 be very carefully studied. 



Increase of the attack is marked by hurried breathing, dilatation of 

 the nostrils, heaving of the flanks, much fever, a highly inflamed state of 

 the lining membrane of the nose, and rapid prostration of the strength.. 

 A peculiarity of the breathing may also be noticed, namely, that the act 

 of inspiration is performed with difficulty, whilst that of expiration is 

 effected with comparative ease. The breathing may also be quicker than 

 the pulse. 



In pure oronchitis the throat is not affected. The disease is in the 

 bronchial tubes, either great or small, but not in the larynx or trachea. 

 5 



