A system of practical medicine. By American authors. Vol. 3 : $b Diseases of the respiratory, circulatory, and hæmatopoietic systems
Science
A system of practical medicine. By American authors. Vol. 3 : $b Diseases of the respiratory, circulatory, and hæmatopoietic systems
Medicine -- Practice
In cases which do not thus tend to an early fatal result from the
direct obstruction of the bronchi the respirations continue frequent,
in young children sometimes reaching 50 or 60 respirations per minute,
with much dyspnoea and restlessness; the pulse is quick, but not in
proportion to the respirations; the expression of countenance is
anxious and often slightly bloated, with a leaden hue of the prolabia;
the wings of the nose expand and the chest heaves with each
inspiration, giving a great variety of dry, whistling sounds generally
throughout the whole chest, which after the first two or three days
become mixed with sharply-defined submucous râles, and in the later
stages give place to the latter entirely. The cough is frequent and
inefficient, on account of the difficulty of getting sufficient air to
make it satisfactory. The temperature varies from 38° to 39.5° C.
(101-103° F.), seldom rising above the latter figure unless complicated
with lobular pneumonia. The urine is generally scanty and deficient in
the chlorine salts, and the bowels are inactive. The labored efforts of
breathing in many cases make the upper and anterior part of the chest
appear more prominent than natural, and even more resonant on
percussion on account of temporary emphysema from over-distension of
the air-cells in those parts, while in some parts of the lower and
posterior portions there is less expansion and less resonance than
natural from the occlusion of some of the bronchi and the partial
obstruction of others leading to those parts of the lungs.
Between the third and fifth days usually the mucous exudation, which up
to that time had been scanty and tenacious, becomes more abundant and
more opaque, and in two or three days more assumes a distinct
muco-purulent character and is much more easily expectorated. As that
which comes from the smaller bronchial tubes is less mixed with air,
and consequently less frothy than that which comes from the larger
tubes, the two qualities of matter may often be recognized in the same
mouthful of sputa; and if the whole be placed in water, that from the
smaller tubes will drop lower in the water, or sink to the bottom if
detached from the other, which floats freely upon the surface.
In acute cases, at the same time that the expectoration becomes more
opaque and more easily dislodged by coughing, all the more important
{172} symptoms begin slightly to improve, and by the end of the second
week convalescence is fairly established. Many cases, however, are less
acute, slower in progress, and do not reach convalescence in less than
two or four weeks; and many of this class manifest a strong tendency to
continue indefinitely in a chronic form, more especially in persons
past the middle period of life. In some of the cases that do not
continue in a chronic form, the bronchial membrane is left in a
condition of such susceptibility that the attack is renewed on the
slightest exposure to the exciting causes.
Public-domain text, read in full here on John Shaqi.
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