6T3 



PLEURISY. 



PLICA POLONICA. 



674 



' De Loc. in Horn.,' pp. 123, 124) ; but it ia now known that no sound 

 can be heard unless air be present in the chest at the same time that 

 is, unless empyema be combined with pneumo-thorax, which is a rare 

 occurrence. 



With respect to the anatomical characters of pleurisy, they agree 

 with what may be observed in inflammation of all serous membranes, 

 and consist partly in morbid alterations of the pleura itself, and partly 

 of the secreted fluid. Inflammation of the pleura, says Laennec, is 

 always accompanied by an extravasation on its internal surface ; the 

 matter effused being either coagulating lymph termed a fahe membrant, 

 or else serosity, or a sere-purulent fluid. The false membrane, or 

 exudation of lymph, is gradually changed into cellular substance, or 

 rather into a true serous tissue, like that of the pleura. The serous 

 effusion is absorbed, the compressed lung expands, and the false mem- 

 brane investing it and the pleura costalis become united into one 

 substance, which afterwards becomes vascular and organised, and 

 constitutes permanent adhesions. A severe pleurisy that has termi- 

 nated by numerous adhesions, renders the part so affected much less 

 liable to subsequent attacks of the same disease ; and when it occurs, 

 the inflammation and effusion do not extend to the adherent parta. 



Among the occasional causes of pleurisy, enumerated by Laennec 

 (after Celsus), are, long exposure to cold after violent exercise; metas- 

 tasis of gout, rheumatism, and cutaneous diseases ; blows on the chest ; 

 and fracture of the ribs. " The winter season," says Areteeus, " is most 

 liable to produce this disease, and next to it the autumn ; the spring is 

 less so, unless it chance to be a cold one, while the summer is the least 

 BO of all." In reference to the period of life, he remarks that old 

 people are more liable to it than those who are in the prime of life, and 

 these again than children. Among predisposing causes, Laennec 

 mentions a slender frame, narrowness of the chest, the immoderate 

 use of spirits, and tubercles in the lungs. 



Pleurisy terminates either in resolution, suppuration, or gangrene. 

 The former is the ordinary and most favourable issue. The last occurs 

 rarely, and Laennec has seen only one instance of it from acute inflam- 

 mation. Suppuration, however, is by no means uncommon, in which 

 case, says Areticus, " shivering fits ensue, and lancinating pains, accom- 

 panied with a desire to sit in an upright posture ; the breathing gets 

 worse, and there is great fear lest the lung, by suddenly drawing in the 

 purulent matter, should produce suffocation, after the previous and 

 greater danger has been escaped : should the matter, however, burrow 

 between the ribs and separate them, and either point externally or 

 burst into the bowels, the patient usually recovers." 



With respect to the treatment, perhaps there is no disease in which 

 profuse bleeding from a large orifice has been so generally recom- 

 mended by practitioners of all ages and all nations ; the only question 

 which has ever arisen upon the subject being, whether the blood 

 should be taken from the side affected, or from the opposite. Hippo- 

 , and most of the earlier Greeks, recommended the former, while 

 the latter method was practised by Archigenes (' ap. Aetiuin,' tetrab, 

 ii., serm. 4, cap. 68), Avicenna (' Canon.,' lib. iii., fen. 10, tract 5, cap. 1), 

 Avenzoar (' Tutor,' lib. i., tnict 10, cap. 3, p. 23, D., ed. Venet, 154U), 

 and their 'followers in the middle ages. The dispute, which is one of 

 those that have been settled by the discovery of the circulation of the 

 blood, was before that time (as may easily be imagined) considered to 

 be of the greatest consequence, and at the beginning of the 16th 

 century raised a kind of civil war (as Bayle says) among the Portu- 

 guese physicians on account of the controversy between Denys and 

 t, the particulars of which are too curious to be altogether 

 omitted. The dinpute was brought at last before the tribunal of the 

 university of Salamanca, where it was canvassed in a most profound 

 manner by the body of physicians ; but in the meantime the partisans of 

 Denys, who were the more powerful, obtained a decree from the civil 

 authorities forbidding physicians to bleed on the same side on which 

 the pleurisy was. At last the university of Salamanca gave judgment, 

 anil decided that Brissot's opinion was the pure doctrine of Hippocrates 

 and Galen. The other party removed the cause before the Emperor 

 Charles V., 1529, and were not satisfied with exclaiming against the 

 doctrine of Briasot as false, but declared it to be impious and deadly, 

 and that it was no less pernicious to the body than Luther's schisms 

 to the soul. Unluckily for them, just about this time Charles 111., 

 duke of Savoy, happened to die of a pleurisy, after having been bled 

 pursuant to the practice which Brissot had opposed. This put a stop 

 to the appeal to the emperor ; but books were written on the <( 

 in :ill parts of Knr|n', and the practice of the Arabians was generally 

 condemned. A lint of these treatises is given by Kene' Moreau, in the 

 Life of Brissot, prefixed to his edition of his work ' De Incisione Ven;c 

 in Pleuritide Morbo,' Ac., Paris, 1622, 8vo. (See Bayle, art. ' Brissot,' 

 from whom the above account is abridged.) But after all this absurd 

 discussion, there are some cases of pleurisy that will not bear bleeding, 

 and the lancet is now much less had recourse to than formerly. 



Besides blood-letting, which may assume the form of cupping and 

 leeches, the usual antiphlogistic remedies, such as saline diuretics, 

 diaphoretics, purgatives, mercurials, blistering, Ac., may be employed ; 

 '. of acute pleurisy, the operation of paracentesis thoracis is very 

 eldom had recourse to, and is hardly ever attended with more than a 

 temwrary relief. ^ 



Chronic pleurisy is either the continuation, as it were, of the diseasi 

 in it* acute form, or else exhibits at no period either the intense fever, 



the violent pain, or energy of reaction which characterises an acute 

 disease. In this latter form it creeps on very insidiously, without 

 much acceleration of pulse or heat of skin ; the pain in the side 

 amounts to no more than a mere soreness ; and the difficulty or hurry 

 of breathing is sometimes so inconsiderable as not to attract the indi- 

 vidual's attention. However, his unhealthy pallid appearance, his loss 

 of appetite, and languid look, emphatically tell of mischief going on ; 

 and upon close examination it is found that the absence of fever is not 

 constant, but that towards evening there is a febrile movement. 



The anatomical characters of chronic pleurisy do not differ very 

 widely from those of the acute form, especially when it has been a 

 mere transition of one form of the disease into the other. The fluid 

 effused, however, partakes more of a purulent character, and the false 

 membrane is firmer and more condensed, owing perhaps to the longer 

 time it has been under the pressure of the effused fluid. The lung too 

 ia more compressed than in acute pleurisy, so much so that there is 

 sometimes a complete annihilation of its vesicular structure, and -the 

 organ itself is reduced to a thin lamina, not exceeding six lines in 

 thickness, lying down along the spine. 



The prognosis of chronic pleurisy is, generally speaking, very 

 unpromising : in the ordinary course of the disease a slow wasting 

 fever seta in ; there is a gradual emaciation ; the appetite fails ; the 

 pulse is languid, although not much quickened ; the legs swell, and the 

 face becomes puffed; the expectoration often has a disagreeable 

 alliaceous smell. Under these symptoms well-defined hectic fever soon 

 supervenes, and rapidly wears down the patient. 



The treatment of chronic pleurisy differs (as might be supposed) 

 very materially from that of the acute form of the disease. Blood- 

 letting is hardly ever resorted to, for the weakened habit of body will 

 not bear the exhaustion of it. For promoting the absorption of the 

 effused fluid, as well as for preventing its further secretion, external 

 applications, comprehending the different modifications of counter- 

 irritation, for example, blisters, setons, issues, stimulating liniments, &c., 

 appear to be most efficacious. In some cases however the operation of 

 paracentesis thoracis seems to be the last resource, and this so often 

 fails that it is by some practitioners considered an almost hopeless 

 experiment. In trying to improve the habit of body and to relieve 

 the constitutional symptoms, which most commonly accompany this 

 form of the disease, recourse must be had to a nutritious but not a 

 heating or exciting diet, and to the cautious exhibition of such tonics 

 as the patient is able to bear. Change of air is often productive of 

 the most decided benefit, and sometimes effects an almost instantaneous 

 amelioration in the symptoms, by causing the night perspirations 

 to cease, the appetite to improve, and the sleep to become refreshing. 



(See, besides Good, Study of Med., and Law, art. ' Pleurisy.' in 

 Cyclop, of Pract, Med. (from which two works much of this article is 

 abridged), Cruveilhier, art. ' Pleuresie,' in Diet, de M(d. Prat., 1835, 

 and Laennec On DiteaKt of the Chest, translated by Forbes. Besides 

 the ancient authors already quoted, the following references are given 

 by Mr, Adams, in his ' Commentary to 1'aulus ..Eyineti : ' Celsus, De 

 Med., lib. iv., cap. 6 ; Psellus De Vicl. Itutime ; Oribasius, CuUecta 

 Hcdicin., lib. ix., cap. 7, 8 ; Joannes Actuarius, Metli. Mtd., lib. iv., 

 cap. 4 ; Theophanes Nonnus, cap. 12!) ; Caelius Aurelianus, De Morb. 

 A rut. lib. ii., cap. 13 ; Uctavius Horatianus, Her. Med., lib. ii. cap. 4 ; 

 Marcellus Empiricus, De Medicam., cap. 24; Serapion, Pract., ii. 21; 

 Hesue, De ^Er/rit. Pect., cap. 7 ; Alsaharavius, ffract., lib. xii., cap. 8 ; 

 Haly Abbas, Thtar., lib. ix., cap. 21 ; Pract., lib. vi., cap. 13 ; Hhazes, 

 Lib. Divit., cap. 54 ; Contin., lib. x.) 



A very complete list of works on the subject of Pleurisy is given 

 in 1'loiicquct, Littratura Medico, Diyeita, 4 vols. 4to, Tubing., 1808-9 ; 

 and a selection in the Appendix to the Cyclop, of Pract. Mai. 



1'LEUHITIS. [I'LKCiu.sY.] 



PLEURODYNIA (from A/pu, the side, and oSimi, pain pain of 

 the side), called also " false pleurisy." The term includes all those 

 pains of the sides which are unconnected with pleuritic inflammation, 

 whether arising from a rheumatic affection of the intercostal muscles, 

 neuralgia in the same parts, or any other cause not evidently pleuritic. 

 It is a matter of great importance to distinguish pleurodynia from 

 pleuritis, as the treatment of the one is frequently diametrically 

 opposite to the other. Pleurodynia may arise from a rheumatic or 

 gouty tendency of the body, producing derangement of the respiratory 

 muscles, and in these case the remedies for rheumatism and gout must 

 be applied. When the pain arises from pure neuralgia, the treatment 

 nm.-it be adapted accordingly. In hysterical and anremic cases iron 

 should be given, but in the form of paladal neuralgia, quinine is the 

 great remedy. 



PLICA POLONICA is the name given to a disease which is chiefly 

 remarkable for the sticking together and matting of the hair, and 

 which is peculiarly frequent in Poland : a few examplesof it have been 

 met with in Tartary, among the lower orders of the Russians, and ill 

 Hungary, and fewer .-till in Switzerland and France. 



The disease chiefly affects the scalp ; the hair grows to an unusual 

 length, is matted together by a sticky and most offensively-smelling 

 secretion, and is commonly infested with vermin. Indeed, the 

 symptoms of the disease, as far as the hair is concerned, are only those 

 which would result from excessive neglect of cleanliness ; and hence 

 many who have seen numerous cases in Poland, believe that they are 

 only produced by the dirty habits of those affected, who, it is well 



