The Science of Therapeutics - Classical Homeopathy Online

Full text of "The Science of Therapeutics: According to the Principles of Homeopath...Page 283 of 653elevated a good deal.All these objective as well as subjective symptoms, which we havedescribed, are not sufficient to establish a reliable diagnosis.reliable diagnosis is at all possible, it will have to be based uthe results of a physical exploration, which is even more importain this disease than in pneumonia, for the reason that pleurisy oremains such a latent disease that the objective phenomena alonecan shed light upon its existence and true character.In pleurisy with simple fibrinous exudation or moderately extensive empyema percussion reveals nothing abnormal. As soon, however, as the quantity of the effused fluid becomes more considerait compresses the lungs, and a tympanitic sound is heard over thewhole area filled by the fluid. If the whole or only a portion ofthe lungs is completely compressed, the sound is entirely empty,and the boundary of the effusion is indicated by the tympaniticsound. A dull sound is almost without an exception returned bythe lower portion of the thorax, provided the effusion is sufficicopious. A mistake may occur if the effusion is scanty and thelung is infiltrated as in pneumonia, or if the lower portion of tlung firmly adheres to the costal pleura and the lung can neitherbe pushed backwards nor upwards by the effused fluid. In pleuritia change of position occasions very seldom a change in the dulnesof sound. Generally the upper boundary of the exudation isformed by solidified exudation which resists all displacement. Ifa change of position induces a change in the level of the fluid,it is perfectly safe to infer the presence of an excess of serouseffusion.In pleuritis with plastic exudation auscultation reveals nothingabnormal at the commencement of the disease, sometimes not evenduring its whole course. The friction-sounds of the rough surfaceof the pleura, which, owing to the proximity at which these soundPleuritis, Pleurisy. 881are heard, cannot well be confounded with pulmonary murmurs, arenot generally heard until the exudation has existed for some daysbecause the exudation requires this period of time to become suffciently solidified for the production of those sounds. The pleurifriction-sounds are wanting, if the eftusion is very copious, butoften heard towards the termination of the disease, when absorptiof the fluid takes place. If present, they constitute an infallibof pleuritis. Even if the exudation is scanty, the respiratory muis weakened, because the patients are afraid of drawing a full brIf the exudation is copious, the respiratory murmur is often entiabsent at the lower portions of the thorax, whereas higher upbronchial respiration is heard more or less distinctly, and is moespecially marked near the vertebral column. Bronchophony andfiegophony are often heard together. In the free portion of thecompressed lung, and generally likewise in the non-affected portithe respiratory murmur is heard more loudly, and the symptomsof a more or less considerable catarrh are present.Very seldom palpation discovers any peculiar changes during thepresence of plastic effusion. A difference between the sound andthe inflamed side is often noticed as far as the fulness of the rhttp://www.archive.org/stream/sciencetherapeu00kafkgoog/sciencetherapeu00kafkgoog_djvu.txt