202 PLEURISY. 



We here derive most important assistance from AuscuUatton. , 

 In a case of pleurisy we have no crepitating, crackling sound, 

 referable to the infiltration of the blood through the gassamer 

 membrane of the air-cells ; we have not even a louder and dis- 

 lincter murmur. Perhaps there is no variation from the souud 

 of health, or, If there is any difference the murmur is fainter ; 

 for the pleural membrane is thickened, and its elasticity is im- 

 paired, and the sound is not so readily transmitted. There is 

 sometimes a slight rubbing sound, and especially towards the 

 superior region of the chest, as if there was friction between the 

 thickened and indurated membranes. 



To this may be added the different character of the cough, 

 sore and painful enough in both, but in pneumonia generally hard, 

 and full, and frequent. In pleurisy it is not so frequent, but faint, 

 suppressed, cut short, and rarely attended by discharge from the 

 nose. 



These are sufficient guides in the early stage of the disease, 

 when it is most of all of importance to distinguish the one from 

 the other. 



If after a few days the breathing becomes a little more natu- 

 ral, the inspiration lengthened and regular, and the expiration, 

 although still prolonged, is suffered to be completed — ^if the 

 twitchings are less evident and less frequent — ^if the cough can 

 be fully expressed — if the pulse softens, although it may not dimin- 

 ish in frequency, and if the animal begins to lie down, or walks 

 about of his own accord, there is hope of recovery. But if the 

 pulse quickens, and, although smaller, yet possesses the wiry char- 

 acter of inflammation — ^if the gaze at the flanks, previously by 

 starts, becomes fixed as well as anxious, and the difficulty of 

 breathing continues (the difficulty of accomplishing it, although 

 the efforts are oftener repeated) — if patches of sweat break out, 

 and the animal gets rfestless — ^paws — shifts his posture every 

 minute — is unable longer to stand, yet hesitates whether he 

 shall lie down, — determines on it again and again, but fears, 

 and at length drops, rather than lies gently down, a fatal termi- 

 nation is at hand. For some time before his death the efiusion 

 and its extent will be evident enough. He not only walks un 

 Arilfingly, but on the slightest exercise his pulse is strangely 

 accelerated ; the feeling of suffocation comes over him, and he 

 stops all of a sudden, and looks wUdly about and trembles ; but 

 he quickly recovers himself and proceeds. There is also, when 

 the effusion is confirmed, oedema (swelling from a dropsical hu- 

 uiix) of some external part, and that occasionally to a very great 

 extent. This is oftenest observed in the abdomen, tho chest 

 and the point of the breast. 



The immediate cause of death is -effusion in the chest, com 



