458 THE TREATMENT OF DISEASES. 



PLEURISY. 



Pleurisy is a complaint essentially unsuited for domestic treatment, and the 

 object of this article is not to teach people how to cure themselves, but to place 

 before them certain facts that will enable them to recognise the disease when 

 present, and to indicate the necessity for obtaining medical assistance. 



By pleurisy we mean inflammation of the pleura, or membrane covering the 

 lung. 



The most frequent causes of pleurisy are exposure to cold and wet, sitting or 

 sleeping in wet clothes, &c. Two cases that recently came under our notice will 

 afford examples of its mode of production. The first is that of a young man, who 

 went to a crowded theatre on Boxing night, and what with the heat and crowd 

 and excitement, got drenched with perspiration. At the conclusion of the per- 

 formance he stopped talking to some friends at the corner of the street, until he was 

 thoroughly cold, and, to use his own expression, " all of a shiver." He went into a 

 public-house and had some hot brandy-and-water, but was unable to shake off 

 the feeling of chilliness, and the next day he was laid up with a sharp attack of 

 pleurisy. The other patient was a clown and gymnast in a travelling circus. One 

 night when in the country his " tights " were not sent home from the wash until the 

 last moment, and he found they were quite damp. It was almost time for him to 

 appear, and he had no chance of airing them before putting them on. He went 

 through his performance, but felt cold and chilly from his wet garments, and the 

 result was that he, too, got pleurisy, which finally left him so weak and short of 

 breath that he was hardly able to walk across the room, much less to amuse the 

 public. Sometimes inflammation of the pleura occurs as the direct result of a blow 

 or fall on the chest, and sometimes it is excited by the irritation caused by the 

 splintered ends of a broken rib. There is reason to think that extreme muscular 

 over-exertion, or prolonged public speaking, may produce pleurisy, even in pre- 

 viously healthy persons, but these cases must be rare. Not unfrequently pleurisy 

 occurs as the result of some constitutional affection, as, for example, scarlatina, 

 typhoid fever, or Bright's disease. When it occurs " primarily," that is, as the sole 

 complaint, it usually attacks one side only, but when it is secondary to some other 

 disease, it is commonly bilateral, both sides of the chest being involved. 



The outset of pleurisy is in most cases marked by sharp, stabbing pains, com- 

 monly in the side or beneath one of the breasts, preceded or accompanied by shivering 

 or a feeling of chilliness. These two signs, the stitch in the side and the shivering, 

 are in themselves sufficient to make us suspect pleurisy ; and should there be, in 

 addition, distinct elevation of the temperature as tested by the thermometer, our 

 suspicion will be considerably heightened. The pain is usually aggravated by taking 

 a deep breath, by coughing, by lying on the affected side, and by pressure. The 

 skin is hot and dry, the cheeks are flushed, the pulse is full and quick, there is 

 anxiety with considerable restlessness, and the urine is rather scanty and high- 

 coloured. The breathing, at the outset especially, and .while there is still pain, is 

 considerably embarrassed, the movements of inspiration in particular being short, 

 hurried, and often interrupted or jerking. The temperature of the body gradually 



