Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Dotted line showing position of heart, according to amount of effusion. when the pleural effusion is on the right side than whenit is on the left. They are caused by any kind ofeffusion, whether serous or purulent, and in lie absenceof effusion they are not caused by tumor or by any vari-ety of pneumonia, or by plastic inflammation of thepleura. The importance of Greeces sign is that it fur-nishes an additional means of diagnosis between these DISEASES OF RESPIRATORY TRACT. 2
Physical diagnosis, including diseases of the thoracic and abdominal organs : a manual for students and physicians .. . Dotted line showing position of heart, according to amount of effusion. when the pleural effusion is on the right side than whenit is on the left. They are caused by any kind ofeffusion, whether serous or purulent, and in lie absenceof effusion they are not caused by tumor or by any vari-ety of pneumonia, or by plastic inflammation of thepleura. The importance of Greeces sign is that it fur-nishes an additional means of diagnosis between these DISEASES OF RESPIRATORY TRACT. 231 diseases on the one hand and pleural effusion on the other. 3. Pleurisy- with Adhesion.—Fibrous thickening ofthe pleura with adhesions causes the percussion note tobe impaired over the lower portion of the lung, and isusually associated with retraction of the bony thorax. Auscultation. 1. Dry Pleurisy.—The respiratory Fig. Posterior view of same case as Fig. 37. murmur is jerky and partly suppressed; inspiration isshortened, with expiration prolonged, slow and the early stage the dry. rubbing friction sounds,similar to the sound made when two rough surfaces ofpaper are rubbed together, or when the hand is rubbedover the ear, are heard. With the occurrence of plasticexudation the character of the friction sounds change. 232 THE RESPIRATORY SYSTEM. They become stickier, are superficial, and later mayhave a fine grazing character. They are most abundantat the end of inspiration and the beginning of expira-tion. They may be absent in quiet breathing, and onlybe detected at the end of a deep inspiration, Whenthe pleurisy of the left side involves the portion over-lying the prsecordia, friction rales may be heard syn-chronously with the heart sounds. 2. Pleurisy with Effusion.—The auscultatory signsare variable. The signs typical of effusion of smallamount are slight diminution or absence of b
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