First Stage of Consumption of the Lungs.
Physical Signs. Dullness of sound on and under the collarbones. Inspiration shortened; expiration augmented both in duration and intensity. This dullness often first perceived in armpits, or at base and back of lungs.
Occasionally a pulmonary, crumpling sound. Dry, crackling rattles.
The resounding of the voice increased at the top of the lungs.
General Symptoms. A sense of weariness and languor.
Occasionally, slight, flying pains about the chest and shoulders.
A peculiar sensitiveness to the effects of cold.
Breathlessness on moving quick, or ascending a hill or stairs.
In many cases a blue lividity of the lips and roots of the fingernails, and coldness of the hands and feet.
Occasionally, in females, even at this early stage, a cessation of the monthly turns. These usually stop later in the disease.
Observations. The formation of tubercles almost always begins at the top of the lungs. Laennee and others thought they appeared oftenest on the right side first; Louis, Andral Watson, Sir James Clarke, and others, believed they appeared more often on the left side. Recent investigations show that they were all mistaken. Tubercles appear first about as often upon one side as upon the other.
The pulmonary crumpling sound is caused by a mechanical obstruction to the expansion of the lungs. It is generally heard only during the drawing in of the breath. The sound is like that produced by blowing upon very fine paper.
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