. Physical diagnosis . ma, for example a non-compensatedheart lesion, and the absence of fever orleucocytosis materially aid the diagnosis. (2) Bronchial asthma or spasm of the finerbronchi produces dry squeaking and groaningsounds similar to those heard in the earlierstages of many cases of bronchitis. But inbronchial asthma fever is usually absent, therales are chiefly expiratory, and expiration isprolonged and intensified. Moreover, theinhalation of a few drops of amyl nitrite willtemporarily dispel rales due to bronchialspasm, while on the rales of dry bronchitis ithas no effect (Abrams).
. Physical diagnosis . ma, for example a non-compensatedheart lesion, and the absence of fever orleucocytosis materially aid the diagnosis. (2) Bronchial asthma or spasm of the finerbronchi produces dry squeaking and groaningsounds similar to those heard in the earlierstages of many cases of bronchitis. But inbronchial asthma fever is usually absent, therales are chiefly expiratory, and expiration isprolonged and intensified. Moreover, theinhalation of a few drops of amyl nitrite willtemporarily dispel rales due to bronchialspasm, while on the rales of dry bronchitis ithas no effect (Abrams). (3) Broncho-pneumonia. In many casesof lobular or broncho-pneumonia the physicalsigns are exclusively those of the coexisting bronchitis. In such cases the diagnosis of bronchitis is not wrong,but does not cover the whole ground. Indeed I am doubtful whetherit ever does. There is to my mind no proof that acute bronchitiswithout bronchopneumonia ever exists. (4) Muscle sounds. Under certain circumstances (cold, nervous-. FiG. 182.—The Dots arePlaced over the Area whereAtelectatic Crepitation isOftenest Heard. BRONCHITIS, PNEUMONIA, TUBERCULOSIS 277 ness), the rumbling noises produced by muscular contractions in thechest wall may simulate rales so closely that the diagnosis of bronchitismay be strongly suggested. The differentiation between rales andmuscle sounds has already been discussed (see above, p. 145). (5) Atelectatic crepitation. Crackling rales heard over the thinmargins of the lungs at the base of the axilla or along the edges of themanubrium are often due to atelectasis (see above). From bronchitisthey are distinguished by their situation and by the lack of are best heard at the point shown in Fig. 182. Chronic Bronchitis. So far as the bronchitis itself is concerned, there may be no differ-ence in the physical signs between the acute and chronic forms of thedisease; but in the latter one almost invariably finds associatedwith the bronchitis itself a c
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectdiagnos, bookyear1912
