DISEASES OF THE RESPIRATORY SYSTEM. 163 



Give the physical signs. 



Inspection. — First Stage. — There are catching respirations, 

 which are abdominal, with the body bent to one side. 



Second Stage. — Double expiratory act, while in third stage 

 the walls of the flank heave. 



Pebcussion. — First Stage. — At first there is not much 

 change, there usually being resonance. 



Second Stage. — When the exudation and effusion take place 

 there is an alteration; not dulness, as in pneumonia, but flatness, 

 on account of it being a liquid; the line of flatness is uniform, it 

 being on a straight line (horizontal), as liquids seek a level; above 

 this line there is resonance and below it flatness. 



Third Stage. — As the fluid is becoming absorbed the flatness 



Auscultation. — First Stage. — There is a roughness of the 

 pleura, and the rubbing of the roughened surfaces together pro- 

 duces a dry friction sound, which resembles the rubbing of two 

 pieces of parchment together. 



It is called the pleuritic friction sound, and is heard on in- 

 spiration and expiration. 



Second Stage. — There is an absence of all respiratory sound 

 at the affected part. Bronchial breathing above the line of the 

 trouble. The mucous click, or the metallic tinkling sound, can be 

 heard above the line of fluid or at the nostrils. It sounds like a pin 

 dropping in a metallic vessel, or a drop of water going through the 

 mouth of an open bottle. It was formerly supposed to be pathogno- 

 monic of pleurisy, but it may be heard in laryngitis. 



Third Stage. — The pleuric friction sound returning (a rub- 

 bing and sticking sound), and the metallic tinkling sound getting 

 less and less as the fluid becomes absorbed. 



How is pleurisy diagnosed? 



The pulse assumes a wiry character; the respirations are ab- 

 dominal, with a double expiratory act; the temperature at first 104° 

 to 106° F., then oscillating between 103° and 101° F. 



Flatness on percussion in the second stage; on auscultation 

 during the first stage, the pleuritic friction sound heard on inspira- 

 tion and expiration, while, during the second stage, there is an 



