ADDITIONS TO THE REVISED EDITION OF 1880. 297 



the blood. E. Wagner in rare instances has demonstrated micro- 

 scopically an immediate connection between the fibrinous filaments 

 and the contents of the superficial lymph-vessels of the pleura, and 

 has even obtained casts from them analogous to those found in the 

 urine. 



In the mildest pleurisies the fibrin can undergo fatty resolution 

 and disappear, leaving no trace behind. In a more persistent case 

 organic processes arise in the exudation, not in the fibrin itself, but 

 in the cells and nuclei which it contains. The cells appear partly 

 to originate from the epithelium, partly ( Cohnheim) to be white 

 emigrating blood-cells. According to JRindfleisch, the cells, origi- 

 nally round, now become elongated. These prolongations connect. 

 Soon blood-vessels appear, first on the surface, parent vessels push- 

 ing up here and there from the serous membrane. Since the in- 

 flammation of a serous surface always is followed by inflammation 

 of the opposing surface, two membranes form, which as they or- 

 ganize readily coalesce, forming permanent adhesion. Pleurisies 

 propagated by contiguity from a neighboring seat of irritation are 

 apt to be of this class. 



2. P. 274. 



Abnormities in the movements of the chest may be gauged much 

 better by means of one of the measuring apparatus than by mere 

 inspection. JKiegel has thus shown that in a moderate exudation 

 the region above it may expand unnaturally. Since we are able at 

 will to breathe either more by the diaphragm or more by the ribs, 

 Riegel explains that if the natural motion be cramped in one direc- 

 tion it will be increased in the other. In large effusion all motion 

 is sometimes arrested. Effusions of equal size do not affect the re- 

 spiratory motions of different patients in equal manner. This may 

 be 1. Because in the one case the compressed lung may still retain 

 some dilatability and in the other not ; 2. That the upper parts of 

 the lung, which in moderate effusions escape compression, sometimes 

 retain their mobility downward and forward, while sometimes they 

 do not ; 3. That the muscles of inspiration which lie in the sphere 

 of the effusion at first retain their contractile power, but afterward 

 lose it. 



3. P. 277. 



There is a space described by Traube as the semi-lunar space on 

 the left anterior surface of the chest, bounded below by the margin 

 of the ribs, above by a curve three to three and a half inches in 

 width, which normally gives a tympanitic sound of the stomach and 



