64 DISEASES OF THE PLEURA 



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

 often not recognized during life. The effusion forms rapidly, 

 in three or 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 

 afterward short-winded. Chronic pleurites are incurable. 

 Death in acute cases may follow from asphyxia or exhaustion 

 in two or 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 an 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 

 usually only in the beginning of pleuritis; in pneumonia the 

 fever is of the continuous type and lasts five to nine days, 

 to fall by crisis. In cases complicated with pneumonia 

 the recognition of the pleuritis may be difficult. Weakening 

 of the heart sounds and edema of the ventral part of the 

 thorax are significant. In doubtful cases the\use of the 

 exploring needle to determine whether effusion, is present 

 or not is advisable. By drawing off some of the fluid and 

 subjecting it to chemical (albumin), microscopic (pus cells, 

 specific bacteria), and bacteriological examination (inocula- 

 tion of animals) the form of pleuritis may be determined. 



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