Diseases of the chest and the principles of physical diagnosis . .—-In systemic blastomycosis the initial symptoms maybe hardly noticeable; more commonly they are those of an acute infec-tion of the respiratory tract. This may resemble an ordinary cold;in the severer cases there is pain in the chest, fever, dyspnea, cough andthe expectoration of blood-streaked mucopurulent material. Sooner orlater the cutaneous lesions appear. As the disease progresses there is a gradual loss of weight and strength,accompanied with malaise, fever, irregular in character, but usuallyshowing an afternoon rise; c
Diseases of the chest and the principles of physical diagnosis . .—-In systemic blastomycosis the initial symptoms maybe hardly noticeable; more commonly they are those of an acute infec-tion of the respiratory tract. This may resemble an ordinary cold;in the severer cases there is pain in the chest, fever, dyspnea, cough andthe expectoration of blood-streaked mucopurulent material. Sooner orlater the cutaneous lesions appear. As the disease progresses there is a gradual loss of weight and strength,accompanied with malaise, fever, irregular in character, but usuallyshowing an afternoon rise; cough is usually present, and often severe in DISEASES OF THE LUNGS 397 character. The sputum is purulent or mucopurulent and often blood-streaked. Occasionally a frank hemorrhage occurs. Owing to thepleural involvement, chest pain is common either in the form of a dullaching sensation, or occasionally a sharp stabbing pain. In the terminal stages of the disease emaciation may be very times, however, the pulmonary lesions are found post-mortem to be. Fig. 271.—Right lung, Case 23. ca, Bronchiectatic cavity in the fibroid upper lobe;ah, abscesses whose contents were inspissated and surrounded by a wall of connectivetissue; no, blastomycotic nodules in the lower lobe, which from their distribution seem tobe bronchogenic in origin; pZ, thickened pleura. {Boughton and Clark.) far more extensive than either the sjmiptoms or physical signs is probably due to the fact that in some cases there is little or noinflammatory reaction about the blastomycotic nodules. Physical Signs.—A thorough inspection is of the utmost may reveal the presence of a swollen and painful joint, or a cutaneouslesion. 398 DISEASES OF THE BROXCHI, LUNGS, PLEURA, AXD DIAPHRAGM Restriction of expansion, flattening and other signs indicative ofpulmonary damage are not peculiar to this disease. And the same is tobe said of the percussion and auscultatory findings which a
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