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By J. Smart (Auth.)

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4. Outer zone of alveoli unchanged, or with evidence of emphysema, oedema, or commencing involvement in focus. M o d e s of O n s e t . — 1. Abrupt onset: following overwork or strain, especially in alcoholics. 2. Following influenza. 3. Cough for a period: tuberculous focus, subsequent spread. 4. Sequel of haemoptysis: whence aspiration of tuberculous matter into bronchi: generally rapid progress. C H I L D R E N . — M a y follow measles and whooping-cough. — O N S E T . — A b r u p t : rigors, dyspnoea, cough, high temperature, rapid pulse.

Later: areas of consolidation, especially at apex; percussion note impaired, breathing loud or tubular, rales. 50 TUBERCULOSIS Acute Bronchopneumonic Tuberculosis, continued R a d i o g r a p h s . — S c a t t e r e d foci throughout lungs, with bronchopneumonic lesion, usually in one or other upper lobes, occasionally both. (Fig. ) A B Fig. —Acute tuberculous bronchopneumonia. A. view. Note: (i) Solid lesion with cavity; (ii) N o displacement at this stage. B, Lateral view showing solid lesion in right upper lobe with cavity in subapical segment.

N u m e r o u s rales and noises. Minimal intake of air. Occasionally almost silent, when prognosis serious. S t a t u s A s t h m a t i c u s . — F o l l o w i n g repeated attacks of ordinary duration, during which increased amounts of ephedrine usually taken, attacks m a y persist and owing to development of resistance to ephedrine, status asthmaticus supervenes, preventing sleep and nourishment: rarely ends in cardiac failure. S p u t u m . — U s u a l l y mucoid and frothy, but at end of attack m a y contain Curschmann's spirals.

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