. Medical diagnosis for the student and practitioner. gy, 1919, Vol. 6, page 211. t This observation was noted early in the epidemic by Lieut. J. Harkavy andpersonally communicated to me. This enabled us to detect a larger number of earlycases than otherwise would have been possible. Time of onset. 1024 MEDICAL DIAGNOSIS Interestingobservations. day after the initial onset of influenza, where the temperature curve wasatypical, in that the characteristic fall did not occur. In a few instances, itwas detected the day after the patient went to bed. Characteristic Roentgen Ray Appearance.—In the e
. Medical diagnosis for the student and practitioner. gy, 1919, Vol. 6, page 211. t This observation was noted early in the epidemic by Lieut. J. Harkavy andpersonally communicated to me. This enabled us to detect a larger number of earlycases than otherwise would have been possible. Time of onset. 1024 MEDICAL DIAGNOSIS Interestingobservations. day after the initial onset of influenza, where the temperature curve wasatypical, in that the characteristic fall did not occur. In a few instances, itwas detected the day after the patient went to bed. Characteristic Roentgen Ray Appearance.—In the earliest stage demon-strable by the roentgenogram hemorrhagic pneumonitis is recognized as afaint filmy haze opposite the level of the lower angle of the scapula. Themesial portion of haze is partially obscured by the outer portion of thenormal hilum shadow. This hazy area enlarges in all directions and fre-quently it is observed that the adjacent portions of the upper and lowerlobe are involved simultaneously. The process may advance so rapidly as. Fig. 492.—Compare with Fig. 491 and note the extent of spread in 48 hours. to include the greater portion of all lobes in the same side of the chest withinforty-eight hours. In fulminating cases all five lobes may become blood-logged and death ensue within forty-eight hours. Hemorrhagic pneu-monitis invariably began as a unilateral process, and in 82 per cent, of ourcases the left lung was primarily involved. It was never seen to begin inany peripheral portion of a lobe, but invariably appeared in the region of thelung roots. It was also noted that the involvement never began simultane-ously in two or more widely separated areas, but it was found to spread fromthe original site. Later it may develop around the roots of a lobe on theopposite side. The peripheral portions were the last to fill with true apex and the lower borders of the lower lobes were never discovered this characteristic absence of apical co
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