SEKOUS SYSTEM- 3()7 



fl. With peripneumonia. 



Q. How are they distinguished? 



/?. The pain in pleurisy is acute, in peripneumony it is 

 obtuse or deep-seated; in pleurisy external pressure gives 

 pain, but it is not so in peripneumony. The dyspnoea in 

 pleurisy is attended with acute pain, and full inspiration 

 is impossible in peripneumony, owing to the oppression 

 and the obtuse pain. The face in peripneumony is very 

 red, even livid ; in pleurisy it has the ordinary febrile red- 

 ness. The pulse is full, strong, and hard in pleurisy, but 

 in peripneumony it is oppressed, and not necessarily hard 

 or full. Lastly, auscultation gives obscure sound in pe- 

 ripneumony, not so in pleurisy.* 



Q. What does the protracted pain in pleurisy indicate? 



#. The continuance of inflammation ; for inflammation 

 does not suddenly, but gradually subside. 



Q. What are the signs of suppuration in pleurisy? 



/?. Diminution of force and increase of frequency in 

 the pulse; irregular chills, hectic flush, sweats, alteration 

 of pain from acuteness to a sense of weighty pain, expan- 

 sion of the affected side. 



Q. What two modes are important in ascertaining the 

 presence of pus? 



#. Percussion is one; and pressure on the epigastrium, 

 which, by throwing the pus up, occasions a sense of suffo- 

 cation. 



* At the commencement of pleurisy, before any adhesions take place, 

 or fluid is effused, the sound on auscultation is natural; but when the 

 effusion is considerable from the commencement, or becomes so dur- 

 ing the progress of the disease, the sound is dull. If the effusion is 

 moderate, the sound is dull in the lower part of the thorax, both la- 

 terally and posteriorly. 



