106 CLINICAL DIAGNOSTICS. 



passage of that side. Not infrequently a blozving sound 

 accompanies the inspiration. The passages may be con- 

 stricted by thickenings or swellings of the mucous membrane 

 or by tumors. 



2. The breath has a bad odor. A bad odor from the 

 nostrils is always a sign that putrid decomposition is taking 

 place in the air passages. It may emanate from various parts 

 of the respiratory tract. The odor is either putrid (fetid) 

 or carious. It is observed: 



1. Where stagnant masses of putrefying exudate are in 

 the turbinated bones, sinuses, gutteral pouches, or even on the 

 mucous membrane of the upper air passages and bronchi. 



2. In putrid decomposition of tumors in the air passages. 



3. In suppuration or necrosis of the bones of the head 

 bordering on the air passages : Suppuration in the tooth 

 alveoli, dental caries, necrosis of the turbinated bones. 



4. In gangrene of the lungs. 



It is always important to determine where the odor 

 originates. At first we should be clear as to whether it 

 really comes from the nose or from the mouth. When the 

 mouth is closed, this is usually not difficult ; in doubtful cases 

 the odor of the saliva can be tested. The safest way is to 

 rtaake an examination of the buccal cavity, especially of the 

 teeth. When the alveoli of the upper molars are diseased, a 

 carious smell is emitted from both the mouth and nose. (See 

 Examination of the Mouth). 



If the offensive odor has been found to come from the 

 expired air, it is then necessary to locate the part of the 

 respiratory apparatus at which the decomposition is taking 

 place. For this purpose we should first determine whether or 

 not the odor is equally offensive from both nostrils. When 

 the odor from one nostril is more prevalent than from the 

 other, the process of decomposition *ias its seat in the nasal 

 cavity of that side, and usually'lt is accompanied by a unilat- 

 eral nasal discharge, bulging of the facial bones and swelling 

 of the submaxillary lymph glands. 



