Diseases of the chest and the principles of physical diagnosis . influenza infection without serious implication of the lungitself. In such cases after a febrile period of three or four clays the tem-perature again rises for a brief period (Fig. 293). If the second febriledisturbance is prolonged, however, it is more than likely that the secondaryrise has resulted from a broncho-pneumonia or a small collection of fluid. An interesting feature of the disease is the slowness of the pulse com-pared to the febrile disturbance. Even with a comphcating pneumonia,the pulse-rate is often unduly slow.
Diseases of the chest and the principles of physical diagnosis . influenza infection without serious implication of the lungitself. In such cases after a febrile period of three or four clays the tem-perature again rises for a brief period (Fig. 293). If the second febriledisturbance is prolonged, however, it is more than likely that the secondaryrise has resulted from a broncho-pneumonia or a small collection of fluid. An interesting feature of the disease is the slowness of the pulse com-pared to the febrile disturbance. Even with a comphcating pneumonia,the pulse-rate is often unduly slow. Dming convalescence a markedbradj^cardia (40 to 50) is relatively common. A study of these caseswith the electrocardiograph showed nothing abnormal other than thewide spacing betw^een beats. Cyanosis is not present in simple uncomplicated influenza. It isvery frequently present, however, in cases with severe pulmonary com-phcations and is usually indicative of severe toxemia rather than circu-latory failure. The blood pressure readings are extremely Fig. 293.—Relapse. Patient taken ill two days before admission. Temperaturedeclined to nearly normal, remained so for two days, and again rose. A few rales at rightbase. (Medical Clinics of North America.) They give but httle indication of the severity of the disease or the stateof the circulation. The respiratory rate even in uncomphcated cases is subject to markedvariations. It may be quite high, but rarely continues so unless there isa complication—lobar or broncho-pneumonia. Marked irregularity inthe curve of the respiratory rate is not infrequent. The urine commonly shows the presence of some albumen and a fewcasts but no more frequently than ordinarily occurs in other acute in-fections. Severe nephritis is occasionally encountered. Free diuresiswas noted in most of the cases but this may be attributed to the fact thatan abundant water intake was encouraged. Retention of urine and anover-distended bladder w^as me
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