Symptoms 43 



sion, and muffling of the natural breathing sound with a 

 very slight, sometimes almost inaudible, creaking due to 

 the existence of false membranes (solidified exudations) 

 on the surface of the lung or connecting it to the inner 

 side of the ribs. This is often mistaken for a mucous 

 rattle that can no longer take place in a consolidated 

 lung in which there can be no movement of air nor burst- 

 ing of bubbles in breathing. The mucous rattle is only 

 possible with considerable liquid exudation into the 

 bronchial tubes and a healthly, dilatable condition of the 

 portion of lung to which these lead. In rare cases there 

 will be splashing sounds in the chest, or when the patient 

 has just risen to his feet a succession of clear ringing 

 sounds becoming less numerous and with longer intervals 

 until they die away altogether. These are due to the 

 falling of drops of liquid from shreds of false membrane 

 in the upper part of the chest through an accumulation 

 of gas into a collection of liquid bslow. It has been lik- 

 ened to the noise of drops falling from the bung-hole into 

 a cask half-filled with liquid. Peculiar sounds are some- 

 times heard as wheezing in connection with the superven- 

 tion of emphysema and others which it is needless to 

 mention here. 



In lean patients pressure of the tips of the fingers in 

 the intervals between the ribs will detect less movement 

 over the diseased and consolidated lung than on the op- 

 posite side of the chest where the lung is still sound. 



As seen in America, in winter, the great majority of 

 cases fail to show the violence described in books. The 

 patients fall off rapidly in condition, show a high fever 

 for a few days, lie always on the same side (the diseased 

 one), or on the breast, and have a great portion of one 

 lung consolidated by exudation, and encysted as a dead 

 mass, and yet the muzzle is rarely devoid of moisture, 

 the milk is never entirely suspended and may be yielded 

 in only a slightly lessened amount as soon as the first few 

 days of active fever have passed. 



