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that of the contracting true respiratory murmur in this, that it is only heard during dilatation, while the other is continu- ous, because owing to active muscular contraction. Dr. Hyde Salter says, after speaking of the occupancy of the true re- spiratory system by residual air, and that about twenty cubic inches of atmospheric air are added at each inspiration : " Each air-cell is, therefore, a tenth larger at inspiration than at expiration. ISTow, it is inconceivable that this slight varia- tion in the capacity of these shallow open concavities should be attended with any sound. I cannot conceive it possible. For, be it remembered that the air-cells are not nearly-closed cavities communicating by constricted orifices with the general cavity of the lobular passage, but wide-mouthed and patu- lous like a teacup. And be it remembered, too, that in res- piration the air is not pumped out of and into the cells, but, as they undergo this slight change of volume, a small part of EESPIRATORY MUEMURS. 501 tlieir contents passes just without them, and then again, on their recovering their capacity, from without just within them, if one can speak of ' within ' and ' without,' in ref- erence to such slight interchange of situation. For, really, the renovation of buy prednisone online the air in the tissues of the lung does not depend on its actual removal, but upon the law of the diffu- sion of gases." This reasoning is cogent and unanswerable. It proves beyond cavil that there is prednisone cost no motion in the air-sacs prednisone 10mg and alveoli to produce air- and tube-friction sound-, and yet he attempts to show that there is such motion in the smaller bronchia© and intralobular passages. He says : buy prednisone " But prednisone 20mg while the movement of the air at each alveolus would be so slight, so almost inap- preciable, the collective expansion of all the alveoli common to a lobular passage, and the consequent abstraction of air from the general cavity, would be considerable, and would create a considerable rush of air into the lobular passage to prednisone price supply its place, for the modicum of air, however small, appro- priated by each dilating air-cell, would of course be multiplied by the number of cells communicating with the common axial cavity of the lobular passage." Dr, Salter's able reasoning shows that there is not enough motion in the alveoli or air-sacs to cause sound, and the same reasoning applies with equal force to the purchase prednisone air in the bronchioles and intralobular passages. buy cheap prednisone The residual air occupies these passages just as well as it does the air-sacs; one-tenth is added at each inspiration to the whole body of residual air, and Dr. Salter himself has said that these small bronchial tubes were largely distensible, consequently the velocity of motion in these passages where alveoli are developed must be too little, if there be any at all, to produce any sound. There certainly can be no rush ; order prednisone online indeed, I have already shown that there can be no motion, except the molecular. But, for argument's sake, if there should be motion in these minute tubes, as Dr. Salter prednisone online claims, it could not possibly have the velocity necessary to cause sound. Dr. Salter's argument to prove that the seat of crepitant rale and the seat of respiratory murmur are the same — " The rale supplants purchase prednisone online the true respiratory murmur, the two do not coexist " — heretofore quoted, is convincing. Had 502 EE&PIRATOET MUEMUES. he placed tlie seat in the air-sacs and alveoli as well as in the terminal bronchioles, he would have been correct, for then lie must have acknowledged that it could not be by tube- and air friction, and he would have been forced to accept the true ex- planation, that of dilatation and contraction. Crepitant rale indicates the commencement of cheap prednisone the process of inflammation, and it supplants the true respiratory murmur. Let us study the evidence in the light of the true respiratory murmur. If you have lately examined the chest of a person in health, and have noted the murmur in its fulness and perfec- tion, and should be called to see him suffering from a chill, with pain in the head, back, limbs, etc., and should again examine the respiration carefully, you will still liear the true respiratory murmur, but it will be obscured or muffled. All the capillaries of the lung are crowded with blood, and this generic prednisone is the explanation of the muffled murmur. If prednisone mg you wait a few hours, and again examine him, you find the true respiratory murmur absent, and, in place of it, the fine crepitant rale. The congestion of the capillaries of the lung still remains ; there is scarcely a perceptible difference in the percussion- note ; the residual air still occupies its seat in the true respi- ratory system, and it still continues to dilate the air-sacs, al- veoli, and terminal tubes. Whatever change has taken place, must have been at the seat of the true respiratory murmur. In tissues that may be seen, what is the first result of in- flammation prednisone tablets ? Is it not that plastic material is thrown out into the connective tissue ? This, also, must take place in the lungs. Tlie connective tissue of the lungs, delicate as it is, has been filled with plastic material. It has become thickened and stiffened, it cannot contract, and the true respiratory murmur is gone, but it must yield, though unwillingly, to the dilating force of the residual air, increased one-tenth at each inspiration, separating newly-formed plastic exudations, causing sound, which we hear as fine crackling, and call it crepitant rale. If we wait a few hours more, and examine again, we will find that crepitant rale as well as true respira- tory murmur has gone, and all is silent, or there may be bronchial or tubular breathing. Exudation order prednisone has been poured into the true respiratory system, and consolidation is the re- EE3PIRAT0RY MUEMUES. 503

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