_Pleuritic_ symptoms may show in the same connection. The breathing becomes more hurried and shorter, friction sound may be heard but it is very transient and soon superseded by an absolute flatness on percussion, rising to a definite horizontal line, representing the boundary of the effusion in the lower third or half of the chest, and usually rising to the same height on both sides. Tenderness of the intercostal spaces may or may not be present. As the disease advances creaking sounds may be heard from the stretching of the consolidated false membranes. The combination of double pleuro-pneumonia constitutes a very fatal type of the disease. The symptoms of _pericarditis_ and of cardiac disorder usually accompany those of pleurisy. The tumultuous heart beats, often associated with soft, weak or even rapid pulse, and later, a deadening or muffling of heart sounds, as in hydropericardium are characteristic when present. With _endocarditis_ the early tumultuous heart beats, with small weak pulse, irregular and sometimes intermittent, become complicated by a blowing or hissing murmur with the first heart-sound. In such cases clots of blood are liable to form in connection with the valves, and may cause sudden and early death. When the heart is involved the tendency to extensive infiltration of limbs and lower aspect of the trunk is much enhanced. (See _diagnosis_ for table of phenomena in influenza, fibrinous pneumonia and contagious pneumonia respectively). _Symptoms_ of digestive disorder are usually in evidence. Even in the thoracic forms the mouth is dry, hot, and has an offensive odor; the tongue coated above, has often red margins and tip; it may even be yellowish; the gums may be swollen and dark red or violet especially around the incisors; mastication may be slow and unwilling; the pharynx maybe swollen; the pharyngeal and submaxillary lymph glands may be tumid and tender; and swallowing may be difficult.