Pleurisy is inflammation of the membrane lining the chest and enveloping the lungs. Inflammation of the Lungs and Pleurisy frequently exist together. Pleurisy without Pneumonia is, however, much more common than Pneumonia without Pleurisy.

The disease is usually occasioned by exposure to cold, by accidental injuries, and other causes of inflammation.

It comes on with an acute pain in the side, which is much increased on drawing a deep breath, and is accompanied by flushing of the face, feverishness, thirst, shiverings, difficulty in lying on the side affected, with nausea, and a short, dry cough; the pulse is hard, strong and frequent; the tongue is coated, there is great restlessness, and the urine is high coloured and scanty. The pain in many patients is exceedingly sharp, whether it is continued or only occurs at intervals, and is usually increased on moving. The more circumscribed it is generally, the more acute it is. The patients are then in a state of great anxiety: they make very short and imperfect inspirations, through fear of aggravating the pain; they dread the least effort of coughing or of sneezing. There are other patients in whom the pain is moderate, and is only felt when a deep inspiration is made, and is scarcely increased by pressure or by percussion. And there are even some cases of Pleurisy which are unattended with pain from first to last.

But the pain generally exists from the very commencement of the attack. It is sometimes vague and shifting at first, and becomes fixed and permanent after a day or two, and is sometimes mistaken for rheumatic pain. At the outset of Pleurisy the fever is usually high, and the pulse is remarkably hard, much more so than in Pneumonia. In some cases adhesion takes place between the pleura and the lung and the pleura and the ribs, without any outpouring of lymph into the cavity of the chest. In other cases such a quantity of lymph is poured out as to obstruct the action of the. lung on that side, and even sometimes to bulge out the ribs, and make that side of the chest so much larger than the other, that it is easily noticed by the looker on. When that is the case, the patient cannot lie on the sound side.

After a time, when the fever has ceased, the liquid begins to be re-absorbed; but as, in many cases, the lung is more or less bound down by adhesions, or overlaid by a membranous layer of lymph, it cannot expand in proportion as the liquid is removed, and the consequence is the affected side gradually shrinks and becomes smaller than the other, in which case the patient will have little or no use of the lung on that side. Pleurisy may terminate, under proper treatment, in complete recovery, or in adhesion, or it may terminate in death. The effusion into the chest may be so great that the patient may die of suffocation, unless the liquid is removed by tapping the chest. Occasionally an abscess will form in the chest, and break outwardly, but this is not very common. As much as fourteen imperial pints of matter have been drawn from the chest.

Treatment

As soon as possible after the commencement of the attack, apply leeches to the part where the pain seems to be seated, the number to be regulated by the severity of the symptoms. After the leeches have done sucking, a large poultice may be applied over the bites, so that the bleeding may continue for some time. After the poultice we may apply blisters, and continue them, one after another, as fast as the skin heals up, as long as necessary; that is till from the ease with which the patient can draw his breath, there is every reason to believe that the obstruction is removed. At the same time we must do what wo can to remove any fluid, or to prevent its accumulation, by internal remedies. The patient must keep the bowels open by purgatives, and in this case a mixture of Jalap and Cream of Tartar will be a good purgative, as the Cream of Tartar will act upon the kidneys; twenty grains of Jalap and two drams of Cream of Tartar will be sufficient for a dose, which may be repeated as often as is necessary. He may also take the following pills and mixture:

Powdered Squills................................24 Grains.

Powdered Digitalis..............................12 Grains.

Extract of Dandelion, sufficient to make.. 24 pills.

One to be taken three times a day.

Acetate of Potash...............................5 Drams.

Sweet Spirit of Nitre...........................1 Ounce.

Extract of Dandelion..........................Half an Ounce.

Water sufficient to make Half a Pint. A tablespoonful to be taken three times a day.

Of course, as long as there is any inflammation, or feverish symptoms, the patient must be confined to Gruel, Sago, Corn Starch, or Arrow Root, and as he progresses towards recovery, the diet may be gradually changed to Beef Tea, Boiled Chicken, light Puddings, etc.

Should the Cough be troublesome he may take either of the Cough Mixtures recommended in this work. Should his nights be disturbed for want of sleep, he may take 10 grains of Bromide of Potash at bedtime.

He must be very careful to guard against cold, as a little exposure might bring on a relapse.

Should it be necessary to puncture the chest, he must place himself in the hands of a skilful surgeon.