PLEURISY.

Auckland Star, Volume LVII, Issue 204, 28 August 1926, Page 21

PLEURISY.

FOUND IN VARIOUS FORMS. BAD, WORSE, AND WORST. (By PERITUS.)

There are six definite and separable forms of pleurisy (disease of the covering of the lung), or manifestations of remote disease with demonstrable local signs. The number of diseases with which pleurisy is associated is almost beyond belief. To name a few of the most important: Pneumonia (of which pleurisy is a common companion and symptom), rheumatism, kidney disease, influenza, enteric fever, meaeles. and tuberculosis. I have selected these from twenty-eight diseases with which pleurisy ie often associated, the lastmentioned being by far the most frequent, pneumonia probably coming next. The half-dozen varieties consist of dry, acute, "diaphragmatic," "quiet," and fibroid. The first form is common in elderly persons, and may be accompanied by slight pain and a feeble annoying cough, which is the eymptom, rather than the pain in the chest, which brings the patient to the doctor. Acute pleurisy is a more important illness. There is more or less severe pain in the eide (generally the left) of the chest, accentuated by deep breathing; there is fever and troublesome cough, which increases the pain,' and breathing is difficult. The inflammatory process affecting the pleura roughens its surface, and the movements of respiration, causing this surface to rub against the inner side of the chest wall, cause the friction pain. Soon there is a quantity of fluid secreted, and thie effused fluid, coming between the chest wall and the covering of the lung, acts as a watery cushion, stops the friction, and reduces or obliterates the pain. If only sufficient secretion to per form this natural comforting service remained until the inflammation and its other effects subsided, all well and good, but eometimes the flirid accumulates, until even the heart is displaced and pushed over towards the opposite side An old writer, describing the appearance and conduct of a patient with acute pleurisy, says; "The fixed wings of the nose, which are dilated (as in mental excitement or after great physical exertion), the parted. lips, the bright eyes of fever, the flushed cheeks, the apprehensive expression, the stooping posture, shallow breathing, fixed chest wall, hand upon side, curt, abrupt speech and stifled dry cough, make a picture once eeen not easily forgotten."

After four or five days, perhaps as early as the third, the pain lessens, and by the end of a - week, in a favourable case, the worst is over and repair, commences The effused fluid is slowly absorbed and the period of convalescence may be expected. This in what I call a clean case of pleurisy uncomplicated by tuberculosis, pneumonia, typhoid, or other troubles Should the effused fluid be excessive it is usual to consider it» removal by a slight operation, in which a hollow needle is inserted between two ribs and the fluid withdrawn by suction. In the old days this was never done without considerable thought, because it sometimes happened that the needle, or the air within it, conveyed infection,

and a comparatively harmless collection of serous fluid was converted into a quantity of dangerous pus — an objectionable and poisonous yellow discharge. With the precautions now taken to guard against this accident the operation is not serious.

When, as sometimes happens, the pleurisy is abscess-like from the first (a condition not easily diagnosed with certainty), the prospects of the patient are not bo bright, and maybe, after drawing off fluid and finding pus, it may be necessary to shear out a small section of one rib and drain the cavity thoroughly, even wash it out—a "toilet of the chest," as Dr. Duke used to call it. It is possible, too, to have a relapsing pleurisy, or a chronic pleurisy, following the acute condition resulting from a .chill and previous infection, it is worth remarking that a simple chill cannot alone produce the disease, and it must be understood that in pneumonia (of which the pain is due to pleurisy) scarlet fever, typhoid, tuberculosis, etc., there is not the same simplicity of character and treatment. As my old writer of the long ago said: "The physician must regard with anxiety and precaution all pleurisies, however frank in attack, however happy in their resolution, or however free the subjects may seem to be from any taint of consumption." A wise old boy, that!

Medical treatment of simple, uncomplicated pleurisy is of less value than medical watchfulness, for apart from efficient strapping of the affected side, to limit the motion of the chest wall in breathing, there is little of real use that can be given or done. Painting the surface with iodine was once popular, but is, I think, of do value, less so than painting with opium and covering with a hot poultice. Lijrht diet and the usual precautions and fare adopted in cases where there is fever and inflammation, rest in bed, and a mild aperient, comprise all that is necessary at first, but a careful and thorough examination by a man of experience daily (if not twice daily) is advisahle, because, as the 'ad who was hanging by his finger-tips to the cliff edge said: "Something may happen at any minute."

Diaphragmatic pleurisy is particularly confusins in its symptoms to those who have not previously seen a ease. The last I attended was that of a motorist who bad staggered into a country store and called for help. The symptoms are most alarming, the onset sudden, and the pntient appears to be in mortal agony. Severe pains starting at the lower ribs suggest pleurisy, but of an uncommon kind. Both sides of the chest may move with equal freedom, yet terrible and absorbing are the frantic efforts to obtain sufficient breath. The respirations run up to forty, fifty, or more per minute; the face is congested, the eyes suffused and starting from the head, and there is a dread of beins touched, or anything done to. interfere with the concentrated "ffnrt to remain erect and keep the fhest muscle* in full action Jt is a rnlief to the -doctor to find the puls" , normal and oteady. end if he suspect* that alcohol may have had aometninsr to do with th?p suffering he may not bp wrong. Quiet pleurisy with effusion is seldom noticed .until shortness of breath compels a visit to the doctor. Sometimes an enormous quantity of fluid has collected unobserved, this slowly increasing pressure within the body

being met by the yielding of adjoining parts and their gradual accommodation to it. Fibroid pleurisy is usually a sequel to repeated attacks (or maybe one attack) of the acute form, the membranes becoming thickened and inactive. There 's what is known as "false" pleurisy, which causes the sufferer to believe himself "in for it" with lung trouble, for the symptoms are not unlike from the patient's point of view. This is really muscular rheumatism which has attacked the muscles between the ribs, causing a cramp. It may be a mere "stitch in the side" or last for many days. It should be treated on the same lines as that advised in these columns *or lumbago (rheumatism), but first it will cost you a medical fee, as nothing but a doctor's word will set your mind (re pleurisy) at ease.