PLEURISY. 459 



rises to perhaps 103 F., but this elevation is not persistent, and it quickly falls 

 again. Disturbances of the digestive organs, headache, and other symptoms asso- 

 ciated with the condition of fever are present more or less. Cough is another of the 

 ordinary symptoms, but it does not occur in paroxysms ; it is small, half-suppressed, 

 ineffectual, and is diy, or accompanied by very little expectoration. If much frothy 

 mucus should be expectorated, it is a sign that there is also bronchitis ; or if rust- 

 coloured sputa be brought up, it is an indication that the complaint is complicated 

 with inflammation of the lungs. 



The symptoms we have enumerated may be regarded as those of a pretty sharp 

 attack occurring in an adult Sometimes, however, pleurisy may come on with 

 scarcely a single noticeable symptom to arrest attention, at all events in the early 

 stage of the malady. The pain may be vague or fugitive at first, and not become 

 fixed and permanent for a day or two. In that case it may be mistaken for simple 

 rheumatic pain, for muscular soreness, for pleurodyiiia, or for what is thought to be 

 merely a nervous pain. In children especially, the febrile symptoms are often incon- 

 siderable, and the cough is not likely to attract much attention in slight cases. 



We have said that by the pleura we mean the investing membrane or covering 

 of the lung, but we ought perhaps to have explained that it is in reality a double 

 bag, consisting of two parts, one of which covers the lung, and the other lines the 

 cavity of the chest on the same side. Ordinarily there is no true cavity between these 

 two lay ei-s, one bag being in contact with the other, and gently gliding over it with 

 every movement of the chest and lung. Now, in pleurisy the adjacent surfaces of 

 the pleura get roughened as the result of the inflammation, giving rise to " friction," 

 a rubbing or grating noise, which may be heard by the physician when he listens 

 to the chest with the stethoscope. The inflammation may subside, leaving the pleura 

 uninjured, or the two layers may become more or less adherent, the patient being 

 left with permanent shortness of breath, little or much as the case may be. Not 

 imfrequently the inflammation results in what may be called dropsy of the chest, 

 a clear fluid being poured out between the two bags, so as to surround the lung on 

 the affected side. When the fluid is considerable in quantity and sometimes it 

 amounts to several pints it compresses the lung, so that it cannot expand properly 

 during respiration. The physician detects the presence of fluid in the chest by 

 means that are simple enough to him, although they may appear somewhat com- 

 plicated to those who have not had experience in such modes of investigation. In 

 the first place he looks carefully at the chest, to see if one side is larger than the 

 other, for it is obvious that if much fluid be present it will cause the chest on that 

 side to bulge out. Should the bulging be not very distinct, he may measure the 

 two sides with a tape, with the view of detecting the enlargement ; but the practical 

 physician, as a rule, trusts rather to his eye and hand than to actual measurement. 

 It should be remembered that in many healthy people the right side of the chest is 

 somewhat larger than the left, from the greater development of the muscles. Then 

 the next thing the doctor does is to place the palm of his hand on the chest, first on 

 one side, and then on the other, making the patient speak at the same time. On 

 the sound side he feels a vibrating movement, just as you do when you place your 

 hand on your own healthy chest, and say, for example, " ninety-nine " in a fairly 



