By consulting the chapter on Anatomy, (See Anatomy and also plate 5) an idea will be obtained of the position of the lungs and their investing membrane, which will aid materially in a correct understanding of the character of this disease.

Diagnosis

Pleurisy consists of an inflammation of the serous membrane covering the lungs, which is also reflected over the inner wall of the chest, forming as we have already explained a shut sack. Thus it will perceived, one part of the membrane covers the soft and compressible lung, which is suspended in the chest, the firm walls of which are lined with the other part of the membrane. These opposed surfaces freely moving upon each other, of course when inflamed produce a train of symptoms not only exceedingly painful, but unless promptly and carefully treated often highly dangerous.

This inflamed membrane may pour out from its diseased surface a large amount of serum, or a watery fluid, or coagulable lymph, pus or blood. Thus the pulmonary pleura, or the membrane which invests the lungs, may by this coagulable lymph be firmly glued to the costal pleura or the membrane which covers the walls of the chest, thus attaching the lungs to the chest, preventing all lateral movement between them and obliterating the pleural cavity. Or the lung may be compressed to a very small compass, and the chest distended by the large amount of serous fluid, sometimes amounting to several pints, which has been poured out by the inflamed membrane into the pleural cavity, or one portion of the pleura may be united by coagulable lymph in some places, and separated by the effused fluid in others.

Diagnosis

The pain, which is frequently preceded by chill and fever, generally commences in a spot just below one or other of the breasts, from whence it radiates to other parts, but is sometimes felt in other places, as along the sternum, beneath the collar bone, and not unfrequently extends over the whole side of the thorax. The pain is sharp and stabbing, as if at each inspiration a sharp instrument were thrust into the chest at a particular point, the patient is unable to take a long breath, being able to fill the lungs only to a small extent, the breath is quick and hurried, the face flushed, the skin hot, the pulse feverish. Pressure on the side increases the pain; the patient is at first unable to lie on the side affected, and as the disease advances, if much serous ef-8 fusion has taken place, he is also unable to lie on the other side, from the fluid passing round to the side, compressing the healthy lung, so as to produce suffocation. The urine, at this stage, is generally offensive, and has a sediment. Cough is also present, small, dry, half-suppressed and ineffectual; the expectoration, if any, is very slight. Should much frothy mucus be expectorated, the disease is complicated with bronchitis, and if rust colored sputa be brought up, it is complicated with pneumonia.

Causes

The most common cause of pleurisy is exposure to cold and dampness. It is, however often occasioned by mechanical violence or by the accidental extension of disease from other parts. Thus it may be excited by the splintered ends of a broken rib, by a wound penetrating into the chest, or by a perforating ulcer of the pulmonary pleura, the extension of a tubercular excavation. Of course the cause should be taken into consideration in the treatment of the disease.

Treatment.* - Aconite and Bryonia are the two great remedies in this disease. If the attack is violent, they may be given two or three doses of each in alternation, twenty or thirty minutes apart, afterwards one hour apart, gradually increasing the intervals to two or three hours, as the symptoms become better. Two drops of the tincture, or twelve globules, may by mixed in a tumbler of water, and a tablespoonful given at a dose. After the pain has been removed by Bryonia, or the fever still continues, notwithstanding the use of Aconite, a few doses of Sulphur will generally complete the cure. Sulphur may also follow the above remedies, if after twenty-four hours, no relief has been obtained by them, or if the disease is complicated with pneumonia, and there is danger of solidification of the lung taking place. A powder or three globules may be given once in two or three hours Mercurius is of great benefit, where the fever has been subdued, but the pain and shortness of breath still continue, and the patient is becoming exhausted by copious night-sweats.

• For general directions as to the administration of remedies, see page 12.

Dose

Give a powder, or six globules once in two or three hours. If during the night the patient should by very restless and sleepless, a few doses of Coffea or Belladonna. given at intervals of one hour will generally produce relief.

Arsenicum is of use if considerable effusion has taken place, and there is prostration of strength, impeded and asthmatic respiration.

Dose

A powder or three globules, once in two or three hours.

Pleurisy, as we have already said, may be complicated with pneumonia (pleuro - pneumonia), or with bronchitis, in which cases Hepar-s., Phosphorus, Carh.-v., Belladonna, Rhus, Lachesis, Sulphur, Lycopodium, China, or Sepia may be indicated. Consult also those diseases.

The external application of the wet bandage over the painful spot will also be of benefit.

Diet And Regimen

As in fevers.