The Thorax 121 



.lower extremities. Mathis saw a complete torsion of the posterior 

 .,lQbe of one lung in an animal destroyed suffering from pleurisy, 

 which he attributed to the varied positions in which it had been 

 placed for examination. 



Symptoms and Diagnosis. Pleurisy is ushered in by an in- 

 termittent chill lasting three or four days. This is followed by 

 fever and dyspnea, thirst, injected mucosae, accelerated pulsations, 

 and anorexia. The urine is scant, and sometimes albuminous. The 

 dysptiea is very apparent, respiration being superficial and painful, 

 and characteristically abdominal. There may or may not . be a 

 ■cough. When present it is short, dry, and painful. The thorax 

 is particularly immobile on the diseased side, primarily from pain, 

 but later from interference by the effusion. Auscultation prior 

 to the stage of effusion and during the course of resolution reveals 

 friction. After effusion has taken place percussion with the animal 

 in .the standing posture shows dullness up to a certain level cor- 

 responding with that of the contained fluid. Above this there is 

 a tympanitic sound. If the position of the animal be changed, dis- 

 placement of the fluid occurs with corresponding shifting of the 

 dull area. The vesicular murmurs become inaudible, bronchial 

 breathing alone being apparent. In the later stages mucous rales 

 may be present owing to pulmonary edema engendered by stasis 

 of the circulation. If the ear is applied to the diseased side and 

 the chest struck sharply, a wave-sound is heard. On the healthy 

 side respiration is labored. 



, The course of the malady is variable and the prognosis must 

 be guarded. In some cases effusion takes place almost at the 

 outset, in others particularly of tubercular origin, friction sounds 

 are audible for several days. The liquid may fill the sac very 

 quickly, or it may take from fifteen to twenty days. The disease 

 may terminate in resolution, the liquid becoming totally absorbed, 

 or it may assume a chronic character, or death may supervene. 

 ■Resolution is indicated by progressive disappearance of the func- 

 tional derangements. It is always slow to take place when the fluid 

 is not removed by thoracentesis. Death may occur through colla- 

 teral congestion and edema, or through asphyxia when both sacs 

 are involved. Syncope may be suddenly produced by secondary 

 pericardial effusion, myocarditis, or metastatic tuberculosis, particu- 

 larly of the liver. Should friction sounds continue, it may be re- 



