Diseases of the chest, throat and nasal cavities : including physical diagnosis and diseases of the lungs, heart and aorta, laryngology and diseases of the pharynx, larynx, nose, thyroid gland, and œsophagus / by E. Fletcher Ingals.

  • Ingals, E. Fletcher (Ephraim Fletcher), 1848-1918.
Date:
1892
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the chest, throat and nasal cavities : including physical diagnosis and diseases of the lungs, heart and aorta, laryngology and diseases of the pharynx, larynx, nose, thyroid gland, and œsophagus / by E. Fletcher Ingals. Source: Wellcome Collection.

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    In other subjects of bronchitis, cough and expectoration are more constantly present, but are variable in character. In certain cases, aptly termed bronchorrhoea, expectoration is very profuse, amounting some- times even to two quarts in twenty-four hours, more or less serous in quality, but occasionally purulent. On the other hand, in so-called dry catarrh, expectoration is scanty and viscid; small, tough, trans- lucent masses are expelled with extreme diificulty during severe par- oxysms of cough accompanied with great muscular effort, reflex laryn- geal spasm, choking, venous congestion of the face and neck, and perhaps vomiting. The signs of chronic bronchitis differ from those of the acute affec- tion principally in the greater abundance of mucous rales and in the scarcity of dry rales. Differential Diagnosis.—The different varieties of bronchitis may be readily distinguished from each other by the history. They are liable to be mistaken for asthma, emphysema, pulmonary hemorrhage, and phthisis. From asthma, bronchitis is distinguished by the symptoms and by the history. The spasmodic character of asthma, its sudden appearance, the great dyspnoea, and the history of former attacks are sufficient to estab- lish the diagnosis. The physical signs in these two diseases differ rather in degree than in kind, as shown in the following table: Bronchitis. Asthma. In the early stage, dry rales, compar- During the paroxysm, sonorous and atively few in number. Later, during sibilant rales are very abundant. The the second or third day, tliese give following day either the respiratory place to large and small mucous rales. murmur may be normal, or an abun- dance of moist rales, due to the atten- dant bronchitis, may be present. Simple bronchitis can be easily distinguished from well-marked cases of em2)liysema, but the latter disease is usually associated with more or less inflammation of the bronchial mucous membrane. The distinctive points in the two diseases are as follows: Bronchitis. Emphysema. Inspection. Form and movements of the chest Prominence of the upper portions of natural ^''^ chest, barrel-shaped, with more or less constant expansion of the su- perior ribs, which are elevated in in- spiration as though united in a single bone. Depression of the soft parts in inspiration, notably above the clavicles and sternum and at the lower portions of the chest.