SCARLET FEVER. Synonyms.—Scarlatina; Scarlet Rash. Definition ...

onchitis, and crepitant and subcrepitant rales are heard. When the
secretion is profuse, there is a loud mucous rhonchus. As cavities form,
the cavernous and amphoric sound is heard. As the pleura becomes
involved, pleuritic friction is heard.
Signs of Cavities.—While large cavities are generally easily recognized,
there may be cavities that have never been discovered during life. \Ve
may be quite sure of a cavity, if persistent bronchial breathing occurs
over a limited area combined with little dullness on percussion. The
cracked-pot sound is heard when a cavity 'connects with a bronchus and
is superficial.
In well-developed cavities gurgling rales may be heard, and the
breathing is amphoric in character. Vocal resonance is frequently
increased. Wintrich first called attention to the increase of the
tympanitic character of the percussion note, when the mouth is opened
and closed, also to change of position. Retraction in the interclavicular
region becomes prominent when the cavity is in the apex. W^here a
cavity is empty and superficially located, vocal fremitus is increased.
Pectoriloquy is often heard with these conditions.
Diagnosis.—It is essential that we make as early a diagnosis as
possible; for, if recognized in its incipiency, there is some hope of
effecting a cure, especially if the patient is in a position to profit by the
suggestions of the physician as to change of environment, change of
climate, etc.
When a patient shows a progressive decline in flesh and strength, with
a daily elevation of temperature from a half degree to a degree and a
half, a hacking cough, more severe on rising in the morning, occasional
pain in chest, particularly over the apex, and if he has had a
hemorrhage, the case is decidedly suspicious. In such a case the sputum
should at once be examined, and if the bacilli are found, the diagnosis is
quite certain.
The presence in the sputum of elastic fibers shows the destruction of the
lung tissue has begun, and is additional evidence of the dread disease.
When the disease has progressed sufficiently for cavities to form, the
chest to become flat, night-sweats to appear, and emaciation to become
marked, the diagnosis is of but little use, as the destructive changes are
so marked that but little if any benefit can be expected from medication.
The Eclectic Practice of Medicine - PART I - Infectious Diseases - Page 203