. The practice of medicine; a text-book for practitioners and students, with special reference to diagnosis and treatment . of pleurisies begin in this way, a certain nimiberalso begin insidiously. For days and even weeks the patient, while feel-ing uncomfortable and doubtless feverish and slightly dyspneic, continues ACUTE PLEURISY 537 his occupation, and even when the physician is called, scarcely mentionssymptoms which suggest an examination of the thorax. Such pleurisiesare known as latent pleurisies. They are latent only to superficial observa-tion. Closer investigation promptly reveals t
. The practice of medicine; a text-book for practitioners and students, with special reference to diagnosis and treatment . of pleurisies begin in this way, a certain nimiberalso begin insidiously. For days and even weeks the patient, while feel-ing uncomfortable and doubtless feverish and slightly dyspneic, continues ACUTE PLEURISY 537 his occupation, and even when the physician is called, scarcely mentionssymptoms which suggest an examination of the thorax. Such pleurisiesare known as latent pleurisies. They are latent only to superficial observa-tion. Closer investigation promptly reveals the physical signs of a pleuraleffusion. It has already been mentioned that purulent pleurisies may be primaryor secondary. In any event, they are most frequently tubercular, and anexamination of the pus from such a pleurisy not infrequently discovers thetubercle bacillus in it. Physical Signs.—Acute pleurisy is also resolvable clinically into threestages, each of which is characterized by phjsical signs more or less dis-tinctive. They include a dry stage, a stage of effusion, and a stage ofresolution or Fig. -Groccos Sign. Paravertebral Triangle of Dullness on the Left.{After Thayer and Fabyan.) The first or dry stage is characterized anatomically by the presence ofthe so-called lymph or exudate on the pleural surfaces. During this is re-vealed to inspection a restrained expansion of the affected side, often throwninto jerks or catches because of pain suffered in a continuous inspira-tion. The expansion on the opposite side is full and unhampered. Thepatient lies on the affected side. Palpation may recognize a fremituscorresponding to the friction of the two pleural surfaces. Percussion inthis stage is negative, except that it may cause pain, but auscultationrecognizes the friction sound, which will be further characterized in treat-ing diagnosis. It may be at a single spot in the inframammary or infra-axillary space, and hence be overlooked. At other times
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