PLEURISY. 129 



on or pinching of the sides, the pathognomonic grunt, and 

 the continuance of the respiratory murmur. This form of 

 pleurisy I have found to be the one which ordinarily follows — 

 when pleurisy does prove such a sequel — catarrhal, laryngeal, 

 or bronchitic disease, in the epidemic form, alias that of 

 influenza. Should there be the continuance of cough, it 

 now becomes faint and sore, and now and then gives rise 

 to the afore-mentioned symptomatic grunt. 



Auscultation detects the respiratory murmur, though 

 not so distinctly as in health ; while percussion, which 

 evinces the characteristic soreness of the sides, yields distinct 

 resonance. 



The PROGRESS of acute pleurisy is rapid. Should no change 

 take place within twenty-four hours after the disease appears 

 at its height, we may rest assured another day cannot pass 

 without the issue of the case becoming manifest, either in 

 subsidence of the fury of the symptoms, or in such altera- 

 tion of them as to render it but too evident that — what we 

 have most to dread, namely — eff'usion, is going on. 



The RETURN OF HEALTH is oftcH as rapid and unex- 

 pected as the attack was sudden and unlooked for. We are 

 called to our patient, distressed to the last degree by his 

 complaint ; we take a quantity of blood from him, and in a 

 few hours afterwards we find him to appearance recovered. 



The DIAGNOSTIC or distinguishing characters of pleurisy, 

 are — 1st, The general manifestation of acute, poignant 

 pain. (Dr. Elliotson represents the pain in a pleuritic man 

 to be '^ acute and stabbing.^^) 2dly, The particular or 

 local manifestation of pain in one or both sides, when firmly 

 pressed against, with the elicitation of the peculiar grunt. 

 3dly, The respiration, which is short, catching, painful, and 

 puffy. 4thly, The breath, not feeling hot to the face or 

 hand, presented to the nostrils of the patient. 5thly, The 

 pulse, whose beat is quick, firm and wiry. 6thly, The 

 cough, so frequent an attendant, which is hacking, reiterated, 

 cut in two, as it were. T'thly, The symptoms of colic, 

 which are often present. 8thly, and particularly in the 

 advanced stages of the disease, percussion and auscultation. 



II. 9 



