Diseases of the chest and the principles of physical diagnosis . onia de-velops and that in addition the res-piratory symptoms and e\idence oftoxemia are often pronounced. In the fulminant type of the diseasehigh fever, marked cyanosis, rapid andlabored breathing are prominent symp-toms. Marked stupor or even uncon-sciousness is common. In additionthe patient is plainly septic. Theskin may have an icteroid tinge ormay be distinctly j aundiced. In thesecases the characteristic lesion is usuallyan intense hemorrhagic pneumonitiswhich bears a strong resemblance tothe type of broncho-pneumonia see
Diseases of the chest and the principles of physical diagnosis . onia de-velops and that in addition the res-piratory symptoms and e\idence oftoxemia are often pronounced. In the fulminant type of the diseasehigh fever, marked cyanosis, rapid andlabored breathing are prominent symp-toms. Marked stupor or even uncon-sciousness is common. In additionthe patient is plainly septic. Theskin may have an icteroid tinge ormay be distinctly j aundiced. In thesecases the characteristic lesion is usuallyan intense hemorrhagic pneumonitiswhich bears a strong resemblance tothe type of broncho-pneumonia seenin the pneumonic form of bubonicplague. Associated oith these casesof broncho-pneumonia there is nearlyalways some acute emphysema justas in the case of ordinary broncho-pneumonia. In some instances, how-ever, the acute emphysema has be-come generahzed over both lungs andconstitutes the dominant feature ofthe disease. ChnicaUy it is characterized by extreme lethargy, cyanosis,the expectoration of bloody sputum, epistaxis, irregiflar temperature andslow 456 DISEASES OF THE BROXCHI, LUXGS, PLELRA, AND DIAPHRAGM Physical Findings.—Examination of the chest often fails to revealany very stiildng physical signs. There may be no alteration of thetactile fremitus, no appreciable change in the percussion note and ana])sence of bronchial breathing. In other words the usual signs of pul-monary consohdation are wanting. As a result of post-mortem and X-ray examinations, we have come to learnthat the broncho-pneumonic areas startin the great majority of cases about thehilus and that the area about the anglesof the scapulae should be carefully ex-amined. While a diffuse bilateral bron-chitis is almost invariably present inthese cases, it will be noted that the ralesg are, in certain areas, notably near thet angle of the scapula, of a sticky, resonat-I ing character. Rales of this nature areg almost certain evidence of underlyingi consohdation. In addition it has been^ found that w
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