. A practical treatise on medical diagnosis for students and physicians . ar assolid masses of sputum; their arrangement into cylinders may not besuspected until they are agitated in water. The size of the cylindervaries from that of the little finger to that of a bodkin, but they do notoften exceed the size of a goose-quill. The larger casts may be hollow,but the smaller ones are solid, and are arranged in layers. They arewhitish or gray in color, and firm in consistence, but become softer as thedisease improves. Microscopically, the casts are nearly structureless,consisting of a fibrillated
. A practical treatise on medical diagnosis for students and physicians . ar assolid masses of sputum; their arrangement into cylinders may not besuspected until they are agitated in water. The size of the cylindervaries from that of the little finger to that of a bodkin, but they do notoften exceed the size of a goose-quill. The larger casts may be hollow,but the smaller ones are solid, and are arranged in layers. They arewhitish or gray in color, and firm in consistence, but become softer as thedisease improves. Microscopically, the casts are nearly structureless,consisting of a fibrillated base, with pus and mucous corpuscles, a fewgland-cells, and, occasionally, blood-cells in the outer layers. Charcot-Leyden crystals and Curschmanns spirals are found. The acute form is rare, and out of ten cases accepted by Biermer sixproved fatal. The disease begins with fever, dyspnoea appears early,severe paroxysms of cough occur, sometimes hemorrhage. Death results 1 Virchow, Handbuch der spec. Path. u. Ther., Bd. v., Abth. 1. PLATE XIX. FIG. 1. —Anterior FIG. 2.—Posterior Aspect. r^t (T9%^ K//V Capillary Bronchitis (early stage). Rough or sharp breath sounds-expiration in places prolonged. Sonorcsibilant and small moist rales. Local increase of fremitus. HAY FEVER. _ 887 from asphyxia. Grave symptoms are excessive dyspnoea, scanty expec-toration, and drowsiness. Copious expectoration is a favorable sign. Physical Signs. The casts obstruct the bronchial tubes. There isless air entering the part, hence there are diminished fremitus and respira-tory murmur over the portions of lung supplied by the obstructed collapse ensues, there is dulness on percussion; if the casts arc dis-lodged, the murmur becomes normal or but slightly roughened. In un-affected portions of the lung resonance is clear or exaggerated, and therespiratory murmur remains unaltered. Fuller says1 that the upper portions of the lung are often er affected thanthe lower portions. Fetid or P
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