Diseases of the chest and the principles of physical diagnosis . r five days the coughtends to become looser, and the sputum becomes, first mucopurulent,later purulent, and is apt to be profuse. Slight fever, which may range from 100° to 102°F. or higher, occurs inthe severer cases. The ordinary case is not febrile for more than a weekor so. Later than this the temperature becomes a valuable sign in dis-tinguishing the condition from tuberculosis. Most individuals experiencea sense of oppression and languor. Pain in the back and bones, notunlike those encountered in grippe, also occurs with va
Diseases of the chest and the principles of physical diagnosis . r five days the coughtends to become looser, and the sputum becomes, first mucopurulent,later purulent, and is apt to be profuse. Slight fever, which may range from 100° to 102°F. or higher, occurs inthe severer cases. The ordinary case is not febrile for more than a weekor so. Later than this the temperature becomes a valuable sign in dis-tinguishing the condition from tuberculosis. Most individuals experiencea sense of oppression and languor. Pain in the back and bones, notunlike those encountered in grippe, also occurs with varying intensity. Physical Signs.^—Unless the smaller tubes are involved, as in the agedor very young, there is no increase in the respiratory rate. Aside fromthe evidences indicative of an acute febrile state, inspection is shows no changes. On palpation there maj^ be noted a rhon-chal fremitus. The physical signs are almost entirely auscultatory in character. Atfirst the rales are sibilant in character, are heard over both sides of the. Fig. 219.—Intense acute bronchitis due to influenza bacillus. Upper lobe showscavity at apex, great thickening of pleura. Adhesions between lobes. (Jefferson MedicalCollege Museum.) DISEASES OF THE BRONCHI 267 chest, and are very changeable, appearing and disappearing, especiallyafter cough. Later as the cough loosens the rales have a moist sound anda bubbling quality. While the almost universal rule is that acutebronchitis is a bilateral affection, it occasionally happens that the physicalsigns are confined to one side. It is needless to say, however, that such<3ases are unusual and that such a condition is strongly suggestive oftuberculosis. Until the latter can be ruled out positively, a diagnosis ofacute bronchitis is indefensible. Still another variation, and one that is relatively common, is for theinflammation to be confined to the trachea alone. In these cases all ofthe symptoms of acute bronchitis are prese
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