On winter cough, catarrh, bronchitis, emphysema, asthma : a course of lectures delivered at the Royal Hospital for Diseases of the Chest / by Horace Dobell.

Horace Dobell

Date:: 1875

Credit: On winter cough, catarrh, bronchitis, emphysema, asthma : a course of lectures delivered at the Royal Hospital for Diseases of the Chest / by Horace Dobell. Source: Wellcome Collection.

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$XIU Plate I.—Fig. 1.—Section of Lung.—Second Stage of Bronchitis in large and medium-sized tubes. Bronchial mucous membrane red and tumid. Exudation in the bronchi. Rhonchal fremitus occasionally felt over large tubes. Pekcussion, usually normal, but resonance may be slightly increased or slightly impaired. Auscultation : vesicular murmur impaired. Both respiratory sounds harsh, acfiompanied by crepitation of different sizes*, and by rhonchus and sibilus. Expiration prolonged and high pitched, in proportion to the amount of tube- obstruction. Inspiration of lower pitch than expiration, unless there is asthmatic spasm combined with the Bronchitis {See Lect. III., p. 60). Cough gets loose as exudation increases, may be loud, hoarse and occa- sionally paroxysmal. Sputa, at first viscid and frothy, becoming ropy, yellowish or greenish, or deep grey, usually running together, sometimes in opaque peUets, occasionally streaked with fine threads of blood. * In Capillary Bronchitis, crepitation may be so minute that care is needed not to mistake it for the pure fine crepitation of Pneumonia; but fine crepitation accompanies the inspiration only, the minute crepitation of Capillary Bronchitis accompanies both expiration and inspiration. Plate I.—Fig. 2.—Section op Lung.—Chronic Bronchitis. Thickened and indurated vascular bronchial mucous lining. Venous con- gestion. Exudation in the Bronchi. Physical Signs, essentially those of the second stage of Bronchitis, but usually respiration is more laboured, especially in expiration, the expii-atory sounds are more markedly prolonged and high-pitched (^See Lect. III., p. 60). SruTA, less aerated and of more nauseous odour; occasionally (Bron- chorrhoea) copious, watery, glairy, bubbling fluid accompanies paroxysmal cough. In this stage, signs of localised disintegration of lung-tissue or of bronchi- ectasis {Fig. 3) are often combined with those of Bronchitis, and require care for distinctive diagnosis {See Lect. VI., p. 160, and Lect. VII., p. 158).$