The Symptoms of Pleurisy

ACUTE: Chilliness; fever; sharp pain or "stitch" in the affected side, generally located below the nipple; pain increased by coughing, pressure, or lying on affected side; hot, dry skin; flushed cheeks; hard, quick pulse; frequent, short breathing; great nervousness; usually at first a grating sound heard over affected part; urine scanty and high-colored.

CHRONIC: Increasing debility and shortness of breath; slight pain; hacking cough; small, rapid pulse; slight fever; clear mucous expectoration; accumulation of fluid in the cavity of the chest.

This is a very common disease, though not as common as is generally supposed, since many people are in the habit of calling every pain or "stitch in the side" a pleurisy pain. Transient pains of this character are much more frequently due to intercostal neuralgia than to pleurisy. The disease consists in the inflammation of the pleura, a membrane which lines the chest-walls and covers the lungs. The acute type of the disease occurs in two forms, one of which is termed dry pleurisy, because there is no exudation or effusion. This disease presents scarcely any symptoms at all. It consists in the thickening of the pleura and adhesion of the lung to the chest-wall, and as it usually produces no serious results, it demands but little attention. In the several varieties of the form of the disease in which exudation or effusion occurs, more or less of the symptoms are found. Acute pleurisy usually runs a rapid course and ends in recovery. The exudation is generally very slight. The chronic form of the disease generally begins very insidiously, though it occasionally follows the acute form. It is accompanied by the accumulation of a large amount of fluid in the chest upon the affected side, which causes compression of the lungs and displacement of the heart, the latter organ being crowded over to one side or the other, according as the accumulation of fluid is in the right or left cavity of the chest. As the disease occurs most often upon the left side, the heart is generally found nearer the middle of the chest than it should be. In a patient whom we had under treatment a few months ago, we found the left cavity almost completely filled with fluid, the lung entirely collapsed, and the heart crowded entirely over upon the right side. The fluid in chronic pleurisy may be simply serum, or it may contain a larger or smaller proportion of pus. Cases in which the cavity is filled with pus are termed empyema. Adhesion of the lung to the chest-wall almost invariably takes place in all cases of pleurisy when recovery occurs. No particular harm results from this condition, however. In chronic pleurisy, the chest upon the affected side generally becomes contracted, and the lung rarely becomes fully expanded to its natural size.

The Causes of Pleurisy

The causes of pleurisy are, 1. Injury to the pleura, as from fracture of the ribs; 2. Other diseases of the lungs, as pneumonia, consumption, or cancer; 3. General disease, as rheumatism, blood poisoning, scarlet fever, etc.; 4. General causes of an obscure nature not well understood, but probably similar to those which give rise to pneumonia, among which may be reckoned exposure to cold.