RESPIRATION. 
589 
Pulmonary Emphysema produces frequent, large, irregular, 
difficult, and laborious respiration : the whole of the respiratory 
agents are called into active exertion, in order to accomplish the 
expulsion of air from the lung, inspiration being readily affected as 
compared with the expiration. Auscultation gives a weak respira- 
tory murmur, and the wheezing crepitating rale, sometimes 
humid, at other times dry. Expiration is generally attended by 
the rale sonore, like unto the cooing of a dove, or the whining of 
a small dog : this is the place to describe the characters of respi- 
ration when the lungs are tuberculated. In cases where the 
lungs are extensively affected by this disease, the breathing is 
accelerated, slightly irregular, with a little catching of the respi- 
ratory muscles early in expiration, a proportionate rise and fall of 
the costae, and inspiration and expiration equally short and limited. 
Auscultation presents a humid gurgling sonorous rale in the 
trachea. The chest gives a bronchial sonorous rushing rale, by 
which the respiratory murmur is obscured at all points. 
Pleuritis . — Early in the disease, when both sides are affected, 
the respiration is painful and limited; inspiration quick, irregular, 
and interrupted, and expiration slow and prolonged. As the dis- 
ease advances, the respiration is accelerated, inspiration full, ex- 
piration difficult and painful. If one side only is pleuritic, the 
movements on this side are much enfeebled, or altogether want- 
ing, while on the sound side they are readily observed. Auscul- 
tation early in the disease gives slightly exalted respiratory 
murmur, certainly not fainter, and rarely a little rubbing sound 
is heard at some point, commonly at the superior part of the 
chest. As the disease advances, and the pleuritic membrane be- 
comes thickened, the respiratory murmur grows more feeble and 
less distinct. When effusion takes place, the respiration is ac- 
complished with more difficulty, the inspiration larger, the ex- 
piration more prolonged ; the inspiratory murmur grows indistinct 
at the inferior part of the chest, and louder upward. As the fluid 
increases in the chest, the respiration becomes more difficult, la- 
borious, and extensive; the costae elevated to their utmost in in- 
spiration, and the abdominal muscles contracting in a laborious 
and jerking manner to their greatest degree in expiration — both 
movements, taking up a longer period, reduce the number of respi- 
rations considerably. The respiratory murmur now grows very 
loud at the superior part of the thorax, provided the pulmonary 
substance continues entire; but the great pressure of the fluid 
will probably inflame the lining membrane of the bronchial tubes, 
and sanguineous effusion take place into the inter-lobular tissue 
of the lungs, and produce a sonorous humid rale, so powerful as 
to obscure every other sound. The gurgling of fluid is not often 
