588 
RESPIRATION. 
wheezing, and the mucous rale quickly succeeds. In some very 
acute cases, in which the inflammatory action invades the respi- 
ratory mucous surface extensively, the secretion, by its abundance, 
renders the respiration short, quick, difficult, and convulsive; 
the mucous rale at the same time yielding to or being over- 
powered by a roaring suffocative noise in the trachea and large 
bronchi. 
Pneumonia . — There are tw r o distinct kinds of pneumonia; the 
one an accumulation or congestion of blood in the vessels of the 
lung; the other a pure inflammatory action, proceeding in the 
inter-structural tissue, the vesicular, or in both. In the congestive 
form, the respiration at first may be frequent, only a few move- 
ments quicker than ordinary breathing, and gradually increase 
in frequency to quickness, and then to an acceleration of alarming 
rapidity ; or, in a manner, suddenly, the respiratory movement 
may be accelerated, and out-number the pulse ; but in either 
case it is difficult, short, equal, complete or incomplete, com- 
monly the latter. The murmur is exalted in the large bronchial 
divisions, but it diminishes as we auscultate backward to the 
margin of the lobes. In pneumonitis, or true inflammation of 
the substance of the lungs, the respiration in the first stage of the 
disorder is frequent, gradually becoming quick as the second stage 
sets in : it is from the first unequal, the inspiration being prolonged 
as compared with the expiration, which is short and quick. Thus 
it will be observed that the movements of the respiratory organs 
differ much, in inflammatory pneumony, from the congestive form, 
which is, in point of fact, not inflammation of the lungs, but ob- 
struction of blood, and inability of the vessels to carry on the 
pulmonary circulation : this stagnation of blood, if unrelieved, 
produces death much quicker than real inflammation of the 
organs. Auscultation, early in pneumonitis, gives an exalted 
murmur in all those parts of the lung remaining in health, and in 
the parts inflamed it is feeble and weak. As disease advances in 
the lung, the crepitous rale is developed, and, should hepatization 
and consolidation take place, a loud sonorous bronchial rale over- 
powers every other sound, arising from the passage of air in and 
out of the diseased lung. At this stage of the disorder the 
breathing is difficult, limited, and accompanied by a singular 
catching of the chest and flanks early in expiration. 
(Edema of the lung, pneumonitis, occasionally terminates in 
an effusion of serous fluid into the cellular tissue of the organ, 
seriously affecting the respiration : it is frequent, large, laborious 
and difficult, occasionally very quick and suffocative. The sounds 
of the chest are masked at all points, both lungs being commonly 
affected ; and the murmur gives place to a crepitating rale. 
