Diseases of the chest and the principles of physical diagnosis . insidiously, dyspnea maybe absent or noticed only on unusual exertion. Effusions of this type oftenfill the pleural sac without attracting attention. This is due to the fact 578 DISEASES OF THE BRONCHI, LUNGS, PLEURA, AND DIAPHRAGM that the lung on the unaffected side has had time to accommodate itselfto the increased work put upon it. Under such circumstances the patientseeks relief because he feels that he is gradually losing health, but isunable to localize his trouble. His symptoms are as a rule general, suchas malaise, weakn
Diseases of the chest and the principles of physical diagnosis . insidiously, dyspnea maybe absent or noticed only on unusual exertion. Effusions of this type oftenfill the pleural sac without attracting attention. This is due to the fact 578 DISEASES OF THE BRONCHI, LUNGS, PLEURA, AND DIAPHRAGM that the lung on the unaffected side has had time to accommodate itselfto the increased work put upon it. Under such circumstances the patientseeks relief because he feels that he is gradually losing health, but isunable to localize his trouble. His symptoms are as a rule general, suchas malaise, weakness and some perversion of the gastro-intestinal func-tions. If the effusion has persisted for some time, loss of weight isusually a prominent sjmiptom. It has been noted also that with the development of an effusion theurinary secretion is commonly reduced in amount and that the urine isconcentrated and of a high specific gravity. With absorption of thefluid the urine becomes increased in amount. Purulent effusions will be considered under a separate Fig. 336.—Acute tuberculous pleurisy. Physical Signs.—In the great majority of cases our attention isdirected to the pleura, because of the location of the pain. Examinationwill show that the pleural inflammation is either the result of some ob-vious pulmonary affection, or that the pleurisy is either primary or sec-ondary to pulmonary disease which is masked, as for instance, tuber-culosis. On the other hand, definite signs of pleural inflammation maybe present in some cases without the presence of pain or other symptoms,the finding being purely accidental. In still other instances well-markedpain indicative of pleural inflammation may not be associated with anyphysical signs whatsoever. Dry Pleurisy.—Inspection.—If the pain is at all severe objectivesigns are usuall}^ present. The breathing is shallow and hurried. The DISEASES OF THE PLEURA 579 patient may lie on the sound side, or sit up and be inclined toward
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