File:Principles and practice of physical diagnosis (1911) (14578266449).jpg

Identifier: principlespracti1911daco (find matches)
Title: Principles and practice of physical diagnosis
Year: 1911 (1910s)
Authors: Da Costa, John C., jr., 1871-
Subjects: Diagnosis Diagnosis
Publisher: Philadelphia and London : W.B. Saunders Company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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s increased vocal fremitus, dulness or flatness, and eithersuppressed or harsh breathing are found, while the overdistendedterritories afford hyperresonance and exaggerated breath-sounds.In pleurogenous fibrosis friction is to be looked for, and over areasof great pleural thickening, deadening of the voice and respiratorysounds. The cavernous signs of bronchiectasis are sometimesdemonstrable. Accentuation and ultimate enfeeblement of the pul- DISEASES OF THE BRONCHOPULMONARY SYSTEM 205 monic second sound, with the subsequent development of the mur-mur of tricuspid relative insufficiency, indicates the strain upon, andthe inevitable failure of, the right ventricle. Diagnosis.—Upon the foregoing signs, plus a story of cough,dyspnea, and mucopurulent, perhaps bloody, expectoration, per-sisting for many years without notably impairing the subjects strength,the diagnosis of chronic interstitial pneumonia is based, and theopinion thus formed is made still more tenable when there is a past
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Fig. 100.—Radiograph of chronic interstitial pneumonia (cf. Fig. 70). Note denseshadows of fibrosis through the right lung. (Plate by Dr. W. F. Manges.) history of pneumonia, pleurisy, syphilis, or local damage to thelung, to account for the initial cirrhotic changes. In a doubtfulcase the #-ray generally affords a certain means of diagnosis (Fig.100). The differentiation of pure pulmonary cirrhosis from so-calledfibroid phthisis, which is not always possible when positive bac-teriologic findings and a clear history are wanting, is referred tounder the latter affection. (See p. 223.) 206 PHYSICAL DIAGNOSIS ACUTE PNEUMONIC PHTHISIS (Phthisis Florida; Galloping Con-sumption) Clinical Pathology.—This acute type of pulmonary tuberculosis,popularly known as galloping consumption, consists of a rapidlyspreading caseous pneumonia or bronchopneumonia, which is com-monly secondary to a primary apical focus of infection (Fig. 101). Diffuse infiltrationand softening Infarct

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