Auscultatory SUJus.-11) that stage of the disease in which there is only an accumulation of blood in the part, and whilst air is still admitted, the respiratory murmur is heard on examining the chest with the car or stethoscope, but it is nttended with n crackling sound which resembles that produced by rubbing a portion of hair between the finger and thumb near the car, or by throwing salt into the fire ; thin is commonly called crepitous rattle or rhonchus, erepitous respira tion or rrepitation. A clear Bound is also heard on percussing the chest If the disease has proceeded to the stage of hepat:eation, the lung being in that part solid and impervious to air, percussion will afford only a dull sound without resonance, and the murmur attendant on respiration will be altogether wanting. Should a large bronchial tube pass near the bepatized portion, the resonance of the voice in the bronchus will be heard more distinctly than usual, on account of the solid being a better conductor of sound than the healthy lung.
When suppuration has taken place, the sound on percussion is also dull, and the natural respiratory murmur is wanting, but in its stead a loud gurgling noise is beard, resembling that produced by air passing through soap-suds, called mucous rhonchus. It is perhaps occasioned by pus escaping into the larger air-tubes.
Treatment.—The treatment of inflammation of the lungs must be conducted on the same general principles as inflammation occurring in any other part. The question of bleeding for the inflammation in this disease must be decided on general principles. Many practitioners avoid bleeding in this and other inflammations, unless the symptoms of dyspncea become urgent from an embarrassment of the circulating organs. Even here the question arises, as to whether by weakening the system by bleeding, the congestion of the lungs may not be in creased. At any rate all are agreed that having recourse to bleeding in all stages of this disease, is frequently a dangerous practice. The practice most generally adopted in this country is the administration of small doses of tartarised antimony and calomel every three or four hours. Leeches and cupping to the chest, with blisters, have also been found beneficial. The bowels, skin, and kidneys, should be acted on by purgatives, diaphoretics, and diuretics.
Inflammation is sometimca confined to the bronchial tubes, and is called bronchitis; it may also co-exist with pneumonia. [BRoxcurrts.] Mortification or gangrene of the lungs, though sometimes occurring as a result of pneumonia, most frequently takes place as an independent affection. It is often connected with the tuberculosis condition of the
lungs. Great fctor of the breath, with an expectoration of dark-brown, greenish, and fetid sputa, excessive debility, and a cadaverous expres sion of countenance, are the symptoms by which it is indicated. After death portions of lung are found in a partially decomposed state, of a Clark brown or dirty greenish appearance, with a putrid smell. Occa sionally, under favourable circumstances, the mortified parts have been separated and removed by expectoration, and the patients restored to health ; but this is not a result which can commonly be looked for. The disease has been known to occur sometimes as a consequence of working in cesspools, and of long exposure to the noxious effluvia attendant upon such occupations.
Ileemoptysis ; Spitting of Blood.—Expectoration of blood may occur either by exhalation from the mucous membrane of the air-tubes or from the lesion of a blood-vessel. It generally occurs in early life, from the age of fifteen to thirty-five, and in the former instance may be dependent upon local congestion. This determination of blood to the lungs may be occasioned by the sudden suppression of some natural or accidental discharge from other parts, as in suppressed or impaired menstruation, or the arrest of an hwmorrhoidal discharge. Malforma tion of the chest also, by interfering with the free circulation through the lungs, or an impeded transmission of blood through the abdominal viscera, from the presence of tumours or ascites, may likewise contribute to produce it. Sometimes it appears to be de pendent upon an altered condition of the blood itself, as in purpura and some eruptive fevers; but its most frequent cause is tubercular disease of the lungs, in which it may arise in an early stage from the obstruction to the circulation occasioned by the tubercles, or subse quently from the vessels participating in the ulcerative destruction. An attack of hnmoptysis should lead to an accurate examination of the chest, in order to ascertain whether tubercles exist.
A remarkable sympathy has been observed to exist between the uterus and the organs of respiration, and spitting of blood has some times been known to precede the appearance of the menses, and to cease entirely on their accession. Sometimes it has been found to supersede the discharge altogether, or to make up for a deficiency in its quantity.