4f)0 THE TREATMENT OF DISEASES. 



loud voice. On the side on which there is effusion nothing of the kind is felt, for the 

 fluid fails to conduct the vibration to the chest-wall. Then the doctor percusses 

 the chest ; in other words, taps it with the tips of his fingers, interposing perhaps 

 one or two fingers of the other hand, to prevent the patient from being hurt. On 

 the healthy side the blow gives out a clear sound, just as you get when you tap 

 with your finger on the upper part of your bared chest. When there is fluid 

 present, the note given out is a dull one, similar to that you obtain when you 

 strike your thigh in the same way. Often enough the fluid is only sufficient to 

 half or a quarter fill the chest on one side, and then the dulness on percussion will 

 obviously be only at the lower part of the lung. Finally, the doctor listens to the 

 chest with his stethoscope, and hears the air entering the lung on the healthy side, 

 but little or nothing where the fluid is. We have described these different modes 

 of examining the chest, not that you may practise them yourself, but rather to 

 impress upon you the necessity for having the chest thoroughly examined in any 

 case in which there is the slightest suspicion of lung disease. Many people put 

 absurd difficulties in the way of the doctor, and he is sometimes wrongly, we are 

 sure afraid to push his point, for fear of offending his patient. Remember that 

 in any case of suspected lung mischief it is impossible for the doctor to do you 

 justice unless he has an opportunity of thoroughly examining your chest; and 

 remember, too, that often enough he will require to make several examinations 

 before giving a positive opinion. Many people seem to think that a physician can 

 find out what is the matter with them by listening through their clothes, but it 

 cannot be done. You might as well ask him to listen through a brick wall. 



The amount of effusion may to some extent be estimated by the shortness of 

 breath, but the best test is the extent of dulness on percussion. In some cases the 

 whole of one side of the chest becomes filled with matter, and this is most likely to 

 arise in weakly constitutions, or when the inflammation has resulted from injury. 



The disease with which pleurisy is most likely to be confounded is inflamma- 

 tion of the lungs. In both affections there are fever, cough, and shortness of breath. 

 In pleurisy, however, the temperature is rarely very high at first, whilst in inflam- 

 mation of the lungs it may reach 103 or 104 within the first twenty-four hours. 

 The feeling of shortness of breath is usually much more distinct in pleurisy than 

 in inflammation of the lungs. The cough in pleurisy is short and hacking, but 

 attended with no expectoration, or with only the discharge of a little mucus ; 

 whereas, when the lungs are inflamed, the expectoration which is present in almost 

 all cases soon becomes rusty in colour, and veiy thick and tenacious. Sharp, stitch- 

 like pain in the side is a very frequent characteristic of pleurisy ; whereas, in in- 

 flammation of the lungs there is commonly no pain, or it is of a duller and more 

 diffused character. It must not be forgotten that the two affections pleurisy and 

 inflammation of the lungs may coexist. Should a difficulty be experienced in 

 making the diagnosis, it is not a matter of any very great moment, for in either 

 case the attendance of a doctor is absolutely necessary. 



There is no difficulty in distinguishing between pleurisy and a purely muscular 

 pain. In the former case there is distinct elevation of temperature, in the latter 

 there is none. A simple thermometrical observation will settle the question. 



