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The diagnosis of active pulmonary tuberculosis by the average clinician depends quite frequently on the finding of fine râles. There are earlier physical signs, but in the absence of bacilli none is of so much significance.
The râles most important in diagnosing pulmonary tuberculosis are not heard during ordinary respiration. A light cough at the end of expiration may reveal, during the inspiration following, fine adventitious sounds, indicating a lesion, before the Röntgen rays will cast a shadow of it, long before the percussion note is impaired, and frequently before the normal respiratory murmur is modified. This simple expedient is described in most text-books on physical diagnosis and is resorted to by all expert clinicians. Its omission is even noticed at once by an experienced patient. But it is believed that the average busy doctor sometimes neglects it. The following description of the technic employed for several years by officers
SMITH FC. COUGH DURING AUSCULTATION IN THE DIAGNOSIS OF PULMONARY TUBERCULOSIS: A PLEA FOR ITS ROUTINE EMPLOYMENT TO ELICIT FINE RÂLES:—TECHNIC AND CONVENIENT SIGNAL. JAMA. 1911;LVI(4):245. doi:10.1001/jama.1911.02560040013004
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