PLEURITIS 67 



character is decidedly intermittent or even remittent. 

 Very high fever speaks for purulent pleuritis. General 

 condition: In acute pleuritis the patient often remains 

 standing during the entire attack (horse). If the patient 

 lies down in the first stage, due to the pain, it rests on the 

 well side, or if the condition is bilateral, on the sternum. 

 In the stage of effusion, the patient lies on the diseased side. 

 In pleuritis there is a tendency to edema on pendent portions 

 of the body (under chest, etc.). A total lack of appetite 

 persists. 



Course. — ^Mild cases make a very rapid recovery, and are 

 often not recognized during life. The effusion forms rapidly, 

 in three to four days the thorax may be half filled; the 

 resorption of the exudate, however, takes place gradually 

 and may require two to three weeks or even several months, 

 during which time the life of the patient is in jeopardy. 

 The more serous the effusion, the more likely and rapid the 

 resorption. With much fibrinous exudate present, adhesions 

 between lung and thoracic wall are frequent. These adhe- 

 sions usually persist and cause the patient to be ever after- 

 ward short-winded. Chronic plevu-ites are incurable. Death 

 in acute cases may follow from asphjrxia or exhaustion in 

 two to three weeks. 



Diagnosis. — ^The pathognomonic symptom of pleuritis is 

 the frictional (rubbing) sound on auscultation. A sensitive- 

 ness of the intercostal spaces occurring in a disease (pneu- 

 monia) which pleuritis is apt to follow, is significant. In 

 the second stage the horizontal line, limiting dorsally the 

 extremely flat percussion sound, is characteristic. In pleuri- 

 tis the onset is usually different from fibrinous pneumonia. 

 In the latter the pulse is full, the conjunctiva congested 

 (often mahogany colored), there is a rusty brown nasal 

 discharge and the area of dulness on percussion is not so 

 flat and resistant under the hammer. In pleuritis marked 

 dyspnea is afi early symptom, the pulse is hard and small 

 (wiry) and on palpation muscular tremors over the region 

 of the thorax are felt. Pneumonia is usually unilateral, 

 pleuritis bilateral. Cough is much more easily induced in 

 pneumonia than in pleuritis. The temperature is high 



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