PLEUR1TIS 63 



(b) Second stage (effusion): In this stage the clinical 

 picture is a good deal modified. The patient becomes more 

 dyspneic, and the character of the breathing changed, 

 depending upon the quantity of exudate in the chest. If 

 a considerable amount of fluid forms rather rapidly in the 

 thorax (25 to 40 liters), at inspiration the ribs are rolled 

 forward ad maximum and at expiration, which is accom- 

 plished by a double-pumping movement of the flanks, the 

 lumbar region is elevated and the anus protruded* the 

 manner of performing the respirations much resembling that 

 noted in pulmonary emphysema. Along the costal carti- 

 lages at each expiration a groove is formed. The nostrils 

 are dilated and often flapping. Percussion: As high up as 

 the fluid in the chest extends, a marked flatness with resist- 

 ance under the hammer is noted. The flat area extends 

 across the ribs in a straight horizontal line. Above this line 

 subdued resonance is heard. Changing the position of 

 the body will shift the horizontal line. (Only feasible in 

 small animals.) Auscultation: When effusion occurs the 

 frictional sound disappears (in some instances it may still 

 be heard above the area of flatness), and, as a rule, no 

 respiratory sounds can be determined below the horizontal 

 line. Above it the vesicular murmur is harsh; tubular 

 breathing is frequently present. 



The heart beat is weakened in this stage and may often 

 be heard more distinctly in the right than on the left side 

 of the chest. The pulse is rapid and softer than in the 

 first stage. The temperature is very irregular. In sero- 

 fibrinous pleuritis, when effusion takes place, it usually 

 drops to nearly normal, but may rise again later. Its 

 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. 



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