INFLAMMATIOM OF THE PLEURA. 271 



ing totally within a few hours. This depends upon a rapid abatement 

 of the fever. In fortunate cases the reabsorption of the effusion also 

 begins immediately and progresses rapidly. As already stated, the 

 absorption goes on most rapidly at the outset, and, as the volume of 

 the liquid decreases, and its concentration becomes greater, absorption 

 grows slower and slower, so that, even weeks after the patient has 

 apparently entirely recovered, a remnant of the exudation can still be 

 found. 



Next to these cases, which are acute from beginning to end, come 

 those which, being acute at the outset, afterward take on a slow and 

 tedious character. The fever moderates at the end of the first week, 

 or a little later. The exudation makes no further progress ; but we 

 wait in vain for a complete subsidence of the febrile general disturb- 

 ance, and for absorption. At last the exudation begins to diminish ; 

 the air once more enters the compressed parts of the lung ; but, in the 

 midst of this apparently favorable prospect, we again one day find the 

 patient short of breath, coughing hard, anew spitting bloody froth. 

 The fever, too, has grown worse ; and, if we now examine the chest, 

 we find that the effusion has increased by a hand's breadth, and ex- 

 tends higher than ever. In this way the disease, originally acute, 

 drags on with fluctuating symptoms for months, and, as a rule, termi- 

 nates fatally. 



Thirdly and lastly, there are a great many patients in whom this 

 form of pleuritis develops slowly, and often without attracting atten- 

 tion, its subsequent progress being of an equally tedious character. 

 There is no inflammatory fever, and often no pain, at least none of 

 that severe pain which ushers in all varieties of the disease hitherto 

 described. Not unfrequently the comparatively slight shortness of 

 breath under which the patient labors escapes the notice of the patient 

 himself, and he only seeks assistance of a physician because he " for 

 some time past has become aware of a falling off in strength, and of 

 having become pale and thin ; " or he perhaps may think that he has 

 some chronic disease of the abdomen, the more so as, in pleurisy of 

 the right side, the depressed position of the liver may cause the right 

 hypochondrium to bulge, and create tension in that region. Every 

 physician in good practice must have seen cases of this kind, in which 

 the patient has never been confined to the house, where he is unable 

 precisely to fix the date of the commencement of his attack, and in 

 which physical examination demonstrates the existence of enormous 

 quantities of effusion in the pleural cavity. The extreme prostration 

 and debility of these patients are easy of explanation, when we con- 

 sider that they are seldom free from fever, and that their pleurae are 

 filled up by an exceedingly albuminous effusion, which may amount to 



