Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    268/976 (page 248)
    less red, less furred, and more moist; thirst diminishes, and appetite returns ; the harsh tracheal siffle will have been replaced by some mucous rales, the normal respiratory murmur will he everywhere restored during this favourable progress, and if uninterrupted, three days may suffice to establish convalescence. A persistence of irrita- bility in the air passages may greatly delay this, and a further ex- tension of disease to the lung endanger it altogether. Auscultation here again becomes the only basis of confidence, as upon the sub- sidence of the more urgent signs, others, less obvious but not less important, may be discovered; it may be found that there are parts of the lung to which air is not admitted ; that there is an accumulation of mucus in the bronchi, or an amount of bronchitis, with the develop- ment of subcrepitant rhonchus, that will seriously impede recovery. An extensive capillary bronchitis, or the existence of pneumonia will not only be indicated by their special characters, and by the accelera- tion of the pulse-respiration ratio, but also by the general symptoms ; the signs of laryngeal obstruction have diminished, but the respiration is as much embarrassed; there is less effort, but there is no relief; and the disease advances to its close as surely and even more hope- lessly than if its advance had been unbroken. The third stage is that of apnoea and rapidly advancing exhaustion: it may come on in the manner just described, but more frequently is the direct sequence of the more urgent symptoms of the second stage, which when about to lead to this result present some additional noteworthy particulars. The tracheal siffle is accompanied by “ trem- blotement,” a laryngo-tracheal mucous rale with a tremulous character heard in both expiration and inspiration, or a click either constant or occasional may also be heard through the stethoscope, and whatever the character of the rale or siffle, it now becomes audible over the trachea in expiration. The voice is whispering or completely sup- pressed, the cough stifled, powerless, or altogether absent; it may however recur in some paroxysm of dyspnoea and afford temporary relief by the chance expulsion of some membranous shreds. The hand may at times be directed to the mouth or throat as if to remove some obstruction, but the paroxysms become more urgent and without remission, there is restless tossing of the body and limbs on the bed, consciousness is impaired, and voluntary power much diminished , the respiratory efforts may continue for a time to lie violent, loud stridor marks both the expiration and inspiration ; with the latter act the larynx is seen to be forcibly drawn towards the sternum, the supra-clavicular and intercostal spaces sink, and though the abdomen descends, the epigastrium recedes; the head is thrown back, the lower jaw fixed, the mouth partly open, the alee nasi dilated and e pressed ; the veins of the neck and temples are distended and t ai v, the eyes starting, and the face livid; the pulse becomes eithei oo rapid or too weak to be counted, the temperature falls and the per spiration becomes cold and clammy, the neck and even the extremi res may be swollen as well as the face, and assume a leaden coloui, o