89 



pleurisy being usually felt at the anterior part of the chest, though 

 in the majority of cases the inflammation is in the back part of the 

 pleura, because it is there that the nerves are in contact with the 

 inflamed membrane, and in virtue of a well known law, the pain of 

 a diseased nerve is felt at its point of distribution. If these remarks 

 be true, the height at which the pain is felt anteriorly will point out 

 the seat of the disease posteriorly, by tracing back the course of the 

 nerve. All the nerves in contact with the inflamed pleura are 

 equally affected, but those give most pain which correspond to the 

 most movable ribs — the sixth and seventh. Pain is sometimes felt 

 at the back part of the nerve. This is usually the consequence of 

 pressure made on the part, and is not spontaneous. It is the effect, 

 as in the other case, of radiation to the distributive terminus of the 

 dorsal or muscular branch. In some cases little or no pain is felt, 

 and the pleurisy or pneumonia is latently developed. This results 

 from the absence of sensibility peculiar to certain individuals. Old 

 pleuritic pains, attributed usually to adhesion, depend on the neuritis 

 becoming chronic. The pain under the clavicle is due to inflamma- 

 tion of the posterior part of the nerves near the seat of the tuber- 

 cles, the upper part of the chest, in consequence of secondary 

 pleuritis. This affection is to be distinguished from intercostal 

 neuralgia, which may depend upon dyspeptic or rheumatic causes.* 



The Committee will here notice a few of the diagnostic symptoms 

 of certain diseases, which have been dwelt on latterly by writers in 

 the journals. 



77. Dr. Bolingf of Montgomery, Alabama, describes "a fine 

 mucous or crepitant rhonchus, seemingly seated in the larynx, loud 

 enough to be heard distinctly at the distance of two or three feet 

 from the patient, and so persistent, that it is not removable, or but 

 momentarily, by any effort to expectorate which the patient may 

 make, while at the same time there are present none of the signs of 

 bronchitis or laryngitis." The patient seems indifferent to its pre- 

 sence. On applying the stethoscope just above the clavicles, it is 

 found to proceed from the apex of the lung. This is diagnostic of 

 pneumonia of the apex of the lung, a disease of most dangerous 

 character. 



Noticed in Medico-Chirur. Rev., 1847. f American Journal, July 1847. 



7 



