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in a given area, and where infiltration or consolida-
tion is present an increased resistance to the pal-
pating finger is felt. Auscultation greatly aids us
in the recognition of any irregularity of breath
sounds, as roughened breathing, granular, or cog-
wheel respiration, and prolonged expiration. Mu-
cous goldbeard free slot machine and submucous rales further confirm the sus-
picion of an existing tuberculous focus, if the rales
are limited to a definite area.
It is not always possible to demonstrate all of
these signs and sounds, but the goldbeard slot review presence of several
of these with a suggestive history play goldbeard online justifies a tenta-
tive diagnosis of tuberculosis. It is only after re-
peated examinations from time to time that the con-
stancy of the physical signs in the chest, indicative
of free online slots goldbeard a pathological process, helps to establish a final
The von Pirquet tuberculin skin reaction was
jjerformed in all cases in which tuberculosis was
suspected, and never proved negative in any of the
cases in which a diagnosis of pulmonary involve-
ment was made. A positive von Pirquet reaction
free play goldbeard reaction
varying with different individuals.
The general nutritional condition of most goldbeard slot cheat of the
patients did not seem gold beard's treasure slot to be seriously affected, while
others were so acutely ill that it became necessary
to have them admitted to the hospital wards. Most
of the patients showed a slight variation in the tem-
perature, which varied from 0.2° to 0.8° F., either
above or below normal, rarely exceeding 1.5' F.
Under treatment, rest, hygiene, diet, and medica-
tion all of the patients improved to such a degree
that they were able to return goldbeard slot free to their vocations
without further annoyance of the subjective symp-
toms. But the local signs in the chest persisted.
assuring us that the lesion in the lungs, though
lessened in its activity, was the underlying cause of
the frequent recurrence of symptoms.
Catarrhal affections of the upper respiratory
tract, such as nasal, pharyngeal, and bronchial ca-
tarrh, demand their respective consideration and
should not be mistaken for an incipient tuberculous
It is not within the scope of this paper to rehearse
in detail the symptomatology and differential diag-
nosis of these conditions, for these can be found de-
picted with great accuracy in any textbook on prac-
tice of medicine or in a treatise on physical diagno-
sis. It is intended merely to call attention to those
cases of colds which persist beyond a reasonable
time or recur at frequent intervals. In such cases
it is only after repeated examinations that the true
;etiological factor becomes ascertainable. In these,
particularly, the tuberculin skin reaction and rou-
tine examination of the sputum for tubercle bacilli
are means of incalculable assistance in aiding one
to arrive at a positive early diagnosis.
The following cases well illustrate the facts dwelt
upon in this paper:
Case I. M. R. ; female ; fifteen years ; seamstress ; ap-
peared at the dispensary March 28, 1910, complaining of
cough, expectoration, headache, lassitude, and anorexia of
four weeks' duration. Close questioning elicited a his-
tory of several similar attacks for past two years. Pa-
tient is a well developed female of short stature, with ten-
dency to obesity. Temperature, 99.8° F. ; pulse, 108. Phy-
sical examination revealed gold beard's treasure slot machine restricted expansion of right
apex with impairment of resonance over right upper lobe
April 12, 1910. Temperature, 99.6° F. ; cough and ex-
April 22, 1910. Few mucous rales heard over right upper
June 16, 1910. Slight exacerbation of all symptoms.
July 8, 1910. Von Pirquet reaction positive.
"September I, 1910. Patient had a slight haemoptysis.
October free online slots goldbeard 4, 1910. Patient felt herself in good condition,
is employed at her occupation daily. Few rales heard in
upper right lobe.
October 17, 1910. Patient complained of weakness, no
cough, physical signs unchanged.
January 20, 1911. Patient returned to the dispensary
complaining of cough, expectoration. Temperature, 99.3°
F. ; rales under right scapula.
C.^SE II. S. R. ; female; fifteen years; white; cash girl
in a department store.
March 30, 1910. Appeared at dispensary complaining of
nausea, vomiting, headaches, flushes of heat, dyspnoea, and
pain in entire body. Temperature, 100.4° F. ; pulse, no.
.Admitted to hospital wards, remaining there for two weeks.
Physical signs revealed an goldbeard slot game acute bronchitis over entire
chest with greatest intensity in the right upper lobe.
April 28, 1910. Two weeks after leaving hospital, all
■■igns in chest disappeared, except for few moist rales in
the upper right lobe with moderate amount of granular
May s, 1910. Returned to her occupation, gained eleven
pounds in goldbeard slot weiglit since .she first came I'nder observation.
Complained of occ.isicnal night sweats.
May 26, 1910. Von Pirquet reaction positive, physical
■^igns in chest unchanged.
July iS, 1910. Felt herself in excellent condition.
December 19, 1910. Had gained twenty-five pounds in
weight since leaving hospital. Physical sigirs in chest
showed few rales — prolonged expiration and slight im-
pairment in resonance. Complained of night sweats.
C.'kSE III. J. T. ; age, eighteen; white; male; grocery'
April 15, 1910. Presented himself at dispensary com-
plaining of a ".cold" of three weeks' duration, felt
nervous and weak. Temperiture, 99.3° F. ; pulse, 96. Pa-
tient was a well developed, muscular young adult in good
state of nutrition. Physical examination revealed sliglit
impairment in resonance over the left upper lobe, increased
tactile and vocal fremitus, granular breathing, and few
mucous and submucous rales. Two weeks later cough and
expectoration had improved and patient resumed his oc-
May 27. igio. Complained of having contracted another
"cold." Physical signs revealed the same condition as six
weeks previously, but in addition patient had blood tinged
expectorations and night sweats,
June 8. 1910. Von Pirquet tuberculin test positive.
June 28. 1910. Felt himself to be in good condition.
Pliysical signs in left upper lobe persisting.
C.^SE TV. S. F. ; female; twelve years; wJiite school
girl; came under observation .\pri1 8, igio, complaining of
cough, night sweats, headache, weakness of three weeks'
duration." Temperature, 99.4° F. ; pulse, T12. Pliysical
, signs show a generalized bronchitis.