, CUSTOM OP. 



PLEURISY. 



A compendious view of it is contained in Brinkmann's 

 Juria Komani,' Sleaviti. IvJ:.': in Marezoll. ' Lebrbneh 

 _ . do. Kom. Itechtcs,' Leipaig, 1839; and in Ayliffe's Law of 



Hedges or Pawn*.' London, 1731 



-M "I', derived from the French ptnye, a 



wrety or gage. The expression " I'll pledge you," in drinking, U 

 deduced by some of our writers on popular antiquities from the times 

 when the Danes were in possession of England. It U said to have 

 been the custom of that people to seize the moment when a native of 

 the island was in the act of drinking, to stab him with a knife or 

 dagger; whence people could not drink in company nnlnss some one 

 present would be their pledge or surety that they should receive no 

 harm. (Bromptou ; Sir Kichard Baker's ' Chron. ;' Henry, ' Hist. 

 Oraat Brit. :' see also Eric Pontoppidau's ' Oesta et Vestigia Danonim 

 extra Daniaiu.' vol. ii.) 



Others state the custom to have taken rise from the death of 

 King Edward tho Martyr, son to Edgar, who, by the contrivance of his 

 step-mother Elfrida, was stabbed in the back as he was drinking. 



Brand thought the expression meant no more than that if you took 

 your cup or glass, I fUdgt ijf*r// la you that I would follow your 

 example. (Brands ' Popular Antiquities,' edited by Sir II. Ellis.) 



PLKIADKS. [TAl'Hi'S.] 



PLKXAKTY. [QUAHB IMPEDIT.] 



PLKN1POTKNTIABT. [AMBASSADOR] 



H.I.T1IORA (a Greak word, wAi^ayn, plt&tre, fulness, in which 

 sense it is used by the Greek medical writers) signifies a redundancy of 

 blood. By the older writers the term was used to express an imagined 

 superabundance of any of the fluids of the body; and the t. mi- 

 bilious, lymphatic, and milky plethora, Ac., implied the existence of an 

 nnm of one or other of those fluids in the blood. Distinctions were 

 also made, and by a few are still retained between plethora from excess of 

 blood, from insufficient capacity of the vessels, from deficient strength, 

 and so on. By the majority of the physicians of the present day how- 

 ever, the term plethora is used only to express that condition in which 

 the quantity of blood and its nutritive qualities exceed that standard 

 which is compatible with present or the prospect of continued health. 



l'I> thoric penons are marked by a florid ruddy complexion, a full 

 hard pulse, a tendency to hemorrhage from the nose or other parts, a 

 frequent sensation of fatigue and weight in the limbs, a disposition to 

 sleepiness, and by being in what is commonly termed good condition. 

 In this degree plethora cannot be regarded as more than giving a 

 tendency to disease whenever any alight occasional cause is applied. 

 In a greater degree however, it produces effects which are in them- 

 selves important : the complexion is yet fuller and more florid, the 

 face seems swollen, and the eyes blood-shot, there is pain in the head, 

 with giddiness, ringing in the ears, dulnesH, heavy sleep, and a sensa- 

 tion as of flashes before the eyes, inability of exertion, constant feeling 

 of fatigue, and frequent palpitation of the heart. 



Such a condition, to which some persons seem from birth peculiarly 

 ' predisposed, may be produced in nearly all by the constant use of very 

 nutritious food, by gluttony or excess in beer, by indolence, or by the 

 insufficiency or suppression of some habitual discharge. Its principal 

 evil is that it renders the person who U affected by it peculiarly liable 

 to acute inflammations and to hemorrhages in important organs, as 

 the brain, in which the latter produce apoplexy. To avoid such con- 

 sequences, a less nutritious diet, abstinence from exciting drinks, and 

 the regular employment of active exercise are commonly sufficient ; 

 but in more advanced and in extreme cases of plethora, blood must be 

 drawn frucly both from the arm and from the neighbourhood of any 

 organ in which there seems a peculiar disposition to its accumulation, 

 or from which it was once habitually discharged; active aperients 

 should also be administered, and the diet should be reduced to a much 

 lower scale than that which had the chief share in engendering the 

 ; : 



PLEURISY (Plrunla), a word derived immediately from the 

 French PUvrlnr, which comes from tho Greek WACUJUTK, and this again 

 from vAwpor, the title, which is denned by Rufus Ephesius (' be Corp. 

 Hum. Part. AppelL,' pp. 30, 51, ed. Clinch) to mean war r)> foro rf> 

 tuurxilj, " 11 that |rt which in under the arm-pit." As this is one 

 of the diseases of which both the nature and the treatment were 

 understood by tho ancients almost as perfectly as by ourselves (except 

 of course that they had not the assistance of auscultation and per- 

 cussion to help them in forming their diagnosis), it may be as well to 

 give in their own words those paasages which have been repeated with 

 more or less alteration by every succeeding writer on the subject, 

 omitting those which are either erroneous from their less accurate 



Tb* word ri-orinc U generally aald to be derived from 'fe(, f */ plrura, 

 but (ti far aa the writer U swan) the word > u{ la never ued by the ancient 

 SMdical writer* la that suss. That which la c .lied ikr plrura by modern 

 analomUU U called >iU**c w, or Min|.ly *ri^>aw bj AraUeua ( Uo Cam. et 

 Sign, ilurb. Atut.,' lib. I., cap. 10, p. ,'u, cd Kdhn), Aetlua (lib. viiL, cap. 76, 

 p. 17), II., ed AM.) ; Alexander Trjiliat ti. (lib. vi., cap. 1, p. Hi. id. Steph.}, 

 and l-aiiin. .1,,-irM i.i ii>, 111., cap. 33, p. 4|, H., ed Aid.). Galen uc the aame 

 word In more than one place, and with regard to tt meaning uyi (' De Anatum. 

 AdminUtr.,' lib. ;, cap. i, p. JK1, cd. KUbn), " A the other membram 

 lh pnitonatum ("'), btcau-c It i. extended around ( TO j.ni.) 

 tho alimentary vessels, so tola (that it, tin flair*) la called *n>*j, bccaoae 

 It iasteu tofMs** internally (in*. M<^) Uu wool* of UM ribs." 



knowledge at anatomy, or which rest only upon some fanciful theo- 

 retical speculation, and adding whatever may be necessary to bring 

 Uu article as far a* possible up to the level of the present state of 

 : .: 



" Pleurisy, properly so called,'' says Paulus ^Ggineta (loco ril., in Mr. 

 Adams's translation, 8vo, London. 18S4), " is an inflammation of the 

 membrane which lines the ribs, and is attended with diuVulty of 

 breathing, cough, continual fever, and pain shooting to the clavicle 

 and brpaaboodrium," which drimitiun agrees with that given by 

 C Ue Loc. Atii-c.,' lib. v., cap. 3. p. 8l'i. i-l. Kuhn ; ' A I Med. 



lib. ii., cap. l.p. ?7; lntr.nl.,' cap. 13. ; i.mt. Med,' 



t 264 >, Areteus, Aetius, and Alexander Tralliauus (fooj ril.). The 

 disease has been variously divided l.y diti.-i.-nt writeni ; Dr. Good 

 (' Study of Had.') mentions the three following varieties:!, PUuntii 

 r.m. True Pleurisy. Fever, a cauma; pain felt chiefly on one side, 

 the inflammation commencing in that port of the pleura which lines 

 the ril in. 2, I'lruntu nuiliatttiui, I'leurixy of the Mediastinum. 

 Heavy pain in the middle of the sternum, descending towards its 

 ensUorm cartilage; with great anxiety; the inflammation, from its 

 symptoms, being obviously seated in the mediastinum. 3, /' 



Pleurisy of the Diaphragm. Painful constriction 



around the praxordia; small, quick, laborious breathing; manifesting 

 that the inflammation U seated chiefly in the diaphragm. Ho adds, 

 however, that the subdivisions lead to nothing of practical importance, 

 as the causes are nearly alike, and the same mode of treatment in 

 applicable to the whole. A more essential distinction is that a.. 

 by Dr. Law ( Cyclop, of Pract. Med.'), namely, acute and clnoi, 

 this will be followed here, because it seems almost impossible to treat 

 either of the nature or the treatment of these two forms of pleurisy 

 under one and the same head. 



In acute pleurisy, says AreUcus (loco n't., in Dr. Reynolds's transla- 

 tion, 8vo, London, 1837), " we hare acute pain in the clavicular region, 

 together with a sharp burning heat ; the recumbent posture is easy on 

 the inflamed side, because there the membrane remains in its place, 

 but to lie on the opposite one is exceedingly painful, and from the 

 weight, inflammation, and dragging, the pain extends through the 

 whole continuity of membrane to the shoulders and clavicles, in some 

 even to the back and shoulder-blades. To this succeed dyspnoea, 

 watchfulness, loathing of food, bright redness of the cheeks, a dry 

 cough, difficult expectoration. To this description it may be added, 

 from Paulus yEgiueta, that " the pulse is hard and serrated; " and it 

 should be noticed that the decubitut, or position of the patient, 

 mentioned by Aretaeus and repeated by numerous modern writers, is 

 not constant, and therefore cannot be exclusively relied upon as a 

 diagnostic sign, for it in sometimes observed that the aggravation of 

 the acute lancinating pain caused by the pressure when lying upon this 

 side, makes the patient seek a more easy position either upon the 

 opposite one or upon the back. 



With respect to the diagnosis of pleurisy, it may be distinguished 

 from hepatitis, says I'.tulus ..ttgineta, by the }>oin in pleurisy being pun- 

 gent, and the cough being sometimes without expectoration and some- 

 times with it, and by the pulse being hard and serrated; while in 

 inflammation of the liver the pain is not pungent, nor is the pulse so 

 hard, and the cough throughout is dry and without expectoration, and 

 the face appears pale. (Compare Alex. Trail., lucu rit.) It may be 

 distinguished from inflammation of the external muscles, or pleuro- 

 dynia [PLEITROUYNIAJ, by the hitter all'ection being (according to the 

 same author) unaccompanied with cough and expectoration, nor is the 

 pulse hard. From pneumonia it is haul to distinguish it without 

 calling in the aid of auscultation and percussion ; and indeed Ur. 

 Cullen, in his ' Practice of Physic,' has treated of both tin w atl> 

 tinder one common definition. It may however I* observed (with, 

 Ur. Qood) that in pleurisy the face is comparatively but little Hushed, 

 and far less tumid than in pneumonia ; that the pulse is hard. 

 that the seat of tint i>:un is fixed, while in pneumonia it shifts not only 

 to dillerunt parts of the same side, but often from the one side to tin- 

 other. The characteristic cough of pleurisy (as distinguished from 

 that which follows pneumonia) is a short cough, either dry from the 

 beginning to the end, or accompanied with a thin mucous expecto- 

 ration ; should the sputa be more abundant, or d. i this 



character, we may suspect a complication either of pneumonia or 

 bronchitis. The cough, however (adds Dr. Law), is often wanting 

 altogether, or is so slight as to attract the attention of neither the 

 patient nor physician. For the characteristic signs of pneumonia 

 derived from auscultation and jwrciiMu.ni, the reader must see the 

 article LUNOB, UIHKASK or THE, while only those relating to pleurisy 

 will be given here. Upon auscultation, the inspiration will appear 

 feeble, distant, or inaudible, but will be restored by change of posture. 

 .11 exist when the quantity of fluid ftftiNed in no more than 

 forms a thin layer between the lungs and p.uicte* of the clic.it. The 

 4r.ii df j'fiitlemrnt, or t.,.<n<l ../ j,-i-i/',n, will lie heard when tin n- is 

 |Kirtial albuminous exudation, with little or no eUusiou of 

 U|HJU jwrciifwn.il, there will be more or less of sound, with moderate 

 resistance, decreasing from below upwards; and tliis duluess will be 

 diminished or removed by change of position. It was in cases of 

 pleuritic t-lliision th, it Ilippucrab-x prop. >wd the suce.- ii. iking 



of the chest, as a means of assisting the diagnosis (' De Morb.,' lib. I, 

 p. 178, ed. Kuhn ; ilnd., lib. ii., pp. 266, 258 ; * Coac. Pnonot.,' p. 306 ; 



