PHYSICAL DIAGNOSIS. 
503 
cult at ion finds a variety of sounds. In a general way we may 
say the sounds are of a crepitant, sibilant and sonorous 
character. 
Broken Wind .—This name is applied to a condition of dif¬ 
ficult respiration closely resembling that of pulmonary em¬ 
physema, a spasmodic breathing with a short inspiration and 
a prolonged and double expiratory movement. The malady 
is of nervous origin and asthmatic in character, lacking the 
recurring paroxysms, but exhibiting a more or less continu¬ 
ous dyspnoea. In this disease the structural changes have 
taken place in the circular fibres of the smaller bronchial 
tubes. This muscular fibre is in a state of constant contrac¬ 
tion, having become paralyzed from continuous irritation of 
the nerve filament supplying the muscle. This irritation is 
of gastric origin. The integrity of the aveolar passage and 
air cells is impaired in time through innutrition. Degenera¬ 
tion follows with production of pulmonary emphysema. 
Pleurisy .—This is an acute inflammation of the serous 
membrane lining the chest cavity, forming the mediastinum 
and covering the lungs. It may be partial or general. The 
first pathological character is congestion of the blood vessels 
of the pleura and the sub-serous connective tissue. At first 
the membrane is dry. This is followed by a fibre-serous ex¬ 
udate. The pleura becomes cedematous in patches. It be¬ 
comes thickened, loses its polished appearance, becoming 
dull and rough. The fibrinous lymph of the exudate forms 
membranes or deposits on the pleura. The serous portion 
of the exudate falls to the bottom of the cavity. The false 
membrane may build up and form thick fibrous structures. 
1 hese may be cartilaginous or osseous in structure. Such 
structures are raw and are not due to a simple exudate, but 
a proliferation of the cell elements of the pleura. The liquid 
exudate is absorbed by the lymphatics. Inspection in the first 
stage of pleurisy notes that the respirations are short and 
thick, especially the inspiratory act. Evidently the act of 
respiration causes pain. The abdominal type of breathing is 
increased. The chest is enlarged in the latter stage and may 
be unhyed. Auscultation in the first stage gives the friction 
