Physical Signs. Marked dullness of sound on the collar bones, and extending below them.
Inspiratory murmur diminished in duration and intensity; expiratory murmur augmented in both.
In upper lobes of lung s, moist, crackling rattles, succeeded by mucous rattles. Also bronchial respiration, or tubular breathing.
In lower lobes of lungs, puerile respiration.
Sounds of the heart heard under the collar bones.
Bronchophony heard in the same parts as bronchial respiration.
General Symptoms. A quickened pulse; slight fever towards evening, oftentimes amounting to quite high fever.
Great susceptibility to the effects of cold, and liability to take cold easily.
Bowels generally costive; oftentimes seat of pain.
The eye has a peculiar whiteness and luster.
The skin and mouth become dry in the afternoon; chills occur about midday, followed by fever, during which the cheeks are flushed.
As the second stage advances to its close, a dry, burning heat afflicts the palms of the hands and soles of the feet.
Night sweats occur at this time.
Observations. A hollow, elastic body, containing air, gives, when struck, a clear sound. The dullness of sound on percussing the chest, arises from the absence of air in the air cells, these having been pressed together, or obliterated by the deposit of a mass of tubercles. The destruction of these cells causes the cessation of the respiratory murmur.
This stage of the disease is often accompanied by an inflammation of the mucous membrane lining the air tubes. The air, pushing its way through the mucous secretions in these tubes, forms bubbles, the bursting of which causes the rattle. The crepitant rattle is produced by inflammation around the tubercles. The moist, crackling rattle is caused by the softening of the tubercles.
The lungs, rendered more solid by the deposit of tubercles, become better conductors of sound; and this causes the beating of the heart to be beard as far off as under the collar bones.
Bronchial respiration gives the idea of air blown through a tube; cavernous respiration, of air passing into a large enclosed cavity.
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