Inflammation of the pleura; may be due to extension of inflammation from some part covered by the pleura, notably from the lung in pneumonia or tuberculosis. It may also occur in acute rheumatism, in some of the specific fevers, and in Blight’s disease. A primary inflammation of the pleura; however, is presumably tuberculosis. The opposing inflamed surfaces of the pleura become covered with a fibrinous exudation which causes friction when the surfaces move over each other. This gives rise to the sharp, stabbing pain felt in pleurisy and increased by coughing and deep breathing, and to the friction sound heard by the doctor when listening over the chest. It is called dry pleurisy.
Often, however, following on this there is the effusion of fluid into the pleural cavity; what is called wet pleurisy. The fluid separates the two layers of the pleura and pain and coughing probably cease. The effusion may be very large, perhaps sufficient to displace the heart, but breathing may not be interfered with as much as might be expected from its size.
The temperature usually rises in pleurisy, though not often above 101° F. When pain is troublesome the patient may prefer to lie on the sound side, as pressure may increase the pain, but when there is effusion he prefers to lie on the disordered side, so that the other side may move more freely in breathing.
The pleura is spread out over the upper surface of the midriff, and pleurisy in this situation is called diaphragmatic pleurisy. In an attack of diaphragmatic pleurisy pain is commonly felt in the pit of the stomach. A person suffering from pleurisy should be confined to bed, whether there is fever or not. Pain may be relieved by poultices, fomentations or a mustard plaster, but sometimes an opiate is required. Iodine, painted on the chest, may also be of value, but is oftener used to promote absorption of the effusion. Diuretics and saline purgatives may be helpful to this end. Should effusion persist for a week, however, it ought to be drawn off, preferably not entirely at a sitting, but sufficient to allow the lung to expand to some extent.
By subsequent tapping, if necessary, the chest may be cleared. Expansion of the lung may be furthered by making the patient blow up balloons or blow water from one bottle into another to which it is connected by tubing.
Thickening of the pleura may remain after pleurisy, and sometimes adhesions between the two layers, interfering with the movement of the lung. Sometimes the effusion becomes purulent, the condition then being called empyema.
As primary pleurisy is likely to be tuberculosis, sunlight, fresh air and other methods of combating this disease should be employed.
During convalescence, deep breathing exercises should be instituted to prevent pleural adhesions. See: Pneumonia.. Bronchitis..
Application and treatment:
It is generally treated as pneumonia. Consult a doctor if improvement does not appear after 3 sessions.