84 PRACTICE OP MEDICINE. 



DISEASES OF THE PLEURA. 

 PLEUEiTis {Inflammation of the Pleura). 



It is more usual to meet pleuritis alone, without being complicated 

 with pneumonia, than to meet pneumonia without pleuritis. The 

 most striking difference existing between cases of pleuritis consists 

 in the presence or absence of effusion. The form occurring without 

 liquid effusion is rarely severe, unless it is very extensive ; it is the 

 dry pleuritis of authors. 



Sym.ptom-s. — Fever, acute pain in the side, hurried and interrupted 

 respiration, dry cough, and a hard resisting pulse, are the marked 

 symptoms of this disease in its early stages. The pain is often in- 

 tense, all motions of the thorax increase it, and the affected side is 

 fixed and motionless. The patient complains of intense heat within 

 the chest, and there is occasionally an extreme tenderness of the in- 

 teguments. The pain is usually felt below the breast ; but it may 

 be felt in the shoulder, the axilla, the lumbar region, or lower portion 

 of the right hypochondrium. Sometimes the pain is wandering and 

 fugitive, and it is not till the lapse of some days that it becomes fixed 

 and continued. In this case it is often taken for a mere rheumatic 

 pain. The pain, after continuing for forty-eight or sixty hours, in 

 general diminishes or ceases altogether; and this coincides with an 

 effusion. But in some severe cases the pain continues, with slight 

 remissions, long after copious effusion has occurred, or even remains 

 unabated up to the period of death. Sometimes, after having disap- 

 peared, it shows itself anew with great violence ; this is a sure sign 

 of the return of the inflammation. During the first stage, the patient 

 seldom lies on the affected side, in consequence of the position 

 causing increase of pain. The rule generally is, that in the first 

 stage he lies on the healthy, in the second, on the diseased side. 

 When the diaphragmatic pleura is affected, there is generally orthop- 

 noea; as might be expected, the respiration is more hurried and dif- 

 ficult during the persistence of the pain. 



This disease, when established, runs one of two courses. The 

 effusion may increase rapidly, and between the first attack and fatal 

 termination no interval of ease is afforded the patient ; or more fre- 

 quently, as in other visceral irritations, a change of symptoms occurs, 

 characterized by diminished suffering, and a transition from the in- 

 flammatory to a hectic, or nearly apyrexial, condition. The symp- 

 toms vary, according as the effusion is on the increase or stationary. 

 In the first case, we observe the cough continuing, with increase of 

 dyspnoea on motion ; thp patient emaciates ; the countenance becomes 

 pale, or sallow, and contracted ; palpitations are often complained of; 

 and the feet or ankles become slightly swollen. In this condition, 

 the side will be found extensively dull ; the mediastinum displaced ; 



