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PLEURISY, or PLEURITIS (Gr. srXeiipc ...

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Originally appearing in Volume V21, Page 838 of the 1911 Encyclopedia Britannica.
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PLEURISY, or PLEURITIS (Gr. srXeiipc =ribs)  , inflammation of the pleura, caused by invasion by certain specific micro-organisms . (See
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RESPIRATORY
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SYSTEM: Pathology.) Secondary pleurisies may occur from extension of inflammation from neighbouring
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organs . The morbid changes which the pleura undergoes when inflamed consist of three chief conditions or stages of progress . (I) Inflammatory congestion and infiltration of the pleura, which may spread to the tissues of the
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lung on the one hand, and to those of the chest wall on the other . (2) Exudation of
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lymph on the pleural surfaces . This lymph is of variable consistence, some-times composed of thin and easily separated pellicles, or of extensive thick masses or strata, or again showing itself in the form of a tough membrane . It is of greyish-yellow colour, and microscopically consists mainly of coagulated fibrin along with epithelial cells and red and white
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blood corpuscles . Its presence causes roughening of the two pleural surfaces, which, slightly separated in
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health, may now be brought into contact by bands of lymph extending between them . These bands may break up or may become organized by the development of new blood vessels, and adhering permanently may obliterate throughout a greater or less space the pleural
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sac, and interfere to some extent with the
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free
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play of the lungs . (3) Effusion of fluid into the pleural cavity . This fluid may vary in its characters . The chief varieties of pleurisy are classified according to the variety of the effusion, should effusion take place .

(1) Some pleurisies do not reach the

stage of effusion, the inflammation terminating in the exudation of lymph . This is termed dry pleurisy . (2) Fibrinous or plastic pleurisy . In this variety the pleura is covered by a thick layer of granular, fibrinous material . Fibrinous pleurisy is usually secondary to acute diseases of the lung such as pneumonia, cancer, abscess or
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tuberculosis . (3) Sero-fibrinous pleurisy . This is the most
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common variety, and produces the condition commonly known as pleurisy with effusion . The amount may vary from analmost inappreciable quantity to a
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gallon or more . When large in quantity it may fill to distension the pleural sac, bulge out the thoracic wall- externally, and compress the Iung, which may in such cases have all its air displaced and be reduced to a mere fraction of its natural bulk . Other organs, such as the heart and liver, may in consequence of the presence of the fluid be shifted away from their normal positicn . In favourable cases the fluid is absorbed more or Iess completely and the pleural surfaces again may unite by adhesions; or, all traces of inflammatory products having disappeared, the pleura may be restored to its normal condition . When the fluid is not speedily absorbed it may remain long in the cavity and compress the lung to such a degree as to render it incapable of re-expansion as the effusion passes slowly away .

The consequence is that the chest wall falls in, the ribs become approximated, the

shoulder is lowered, the spine becomes curved and
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internal organs permanently displaced, while the affected side scarcely moves in respiration . Sometimes the unabsorbed fluid becomes purulent, and an empyema is the result . The symptoms of pleurisy vary; the onset is sometimes obscure but usually well marked . It may be ushered in by rigors, fever and a sharp pain in the side, especially on breathing . Pain is felt in the side or breast, of a severe cutting character, referred usually to the neighbourhood of the nipple, but it may be also at some distance from the affected
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part, such as through the
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middle of the
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body or in the abdominal or iliac regions . On auscultation the physician recognizes sooner or later " friction," a superficial rough rubbing sound, occurring only with the respiratory acts and ceasing when the breath is held . It is due to the coming together during respiration of the two pleural surfaces which are roughened by the exuded lymph . The pain is greatest at the outset, and tends to abate as the effusion takes place . A dry cough is almost always
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present, which is particularly distressing owing to the increased pain the effort excites . At the outset there may be dyspnoea, due to fever and pain; later it may result from
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compression of the lung . On
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physical examination of the chest the following are among the chief points observed: (I) On inspection there is more or less bulging of the side affected, should effusion be present, obliteration of the intercostal spaces, and sometimes
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elevation of the shoulder . (2) On palpation with the hand applied to the side there is diminished expansion of one-
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half of the thorax, and the normal vocal fremitus is abolished .

Should the effusion be on the right side and copious, the liver may be felt to have been pushed downwards, and the heart somewhat displaced to the

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left; while if the effusion be on the left side the heart is displaced to the right . (3) On percussion there is absolute dullness over the seat of the effusion . If the fluid does not fill the pleural sac the floating lung may yield a hyper-resonant note . (4) On auscultation the natural breath sound is inaudible over the effusion . Should the latter be only partial the breathing is clear and somewhat harsh, with or without friction, and the voice sound is aegophonic . Posteriorly there may be heard tubular breathing with aegophony . These various physical signs render it impossible to mistake the disease for other maladies the symptoms of which may bear a resemblance to it, such as pleurodynia . The absorption or removal of the fluid is marked by the disappearance or diminution of the above-mentioned physical signs, except that of percussion dullness, which may last a long time, and is probably due in part to the thickened pleura . Friction may again be heard as the fluid passes away and the two pleural surfaces come together . The displaced organs are restored to their position, and the compressed lung re-
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expanded . Frequently this expansion is only partial . In most instances the termination is favourable, the acute symptoms subsiding and the fluid (if not
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drawn off) becoming absorbed, sometimes after reaccumulation .

On the other hand it may remain long without undergoing much

change, and thus a condition of chronic pleurisy becomes established . Pleurisy may exist in a latent form, the patient going.about for weeks with a large accumulation of fluid in his thorax, the ordinary acute symptoms never having been present in any Zealand and
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Tasmania received it in 1864, but it was eradicated in both countries by the sanitary
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measures adopted . It was carried to
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Asia Minor, and made its presence felt at
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Damascus . It prevails in various parts of
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China, India, Africa and
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Australia, and until quite recently it existed in every country in
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Europe, except Scandinavia, Holland, Spain and
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Portugal . In
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Great Britain cases occurred in 1897 . Symptoms:—The malady lasts from two to three weeks to as many months, the chief symptoms being fever, diminished appetite, a short cough of a
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peculiar and pathognomonic character, with qnickened breathing and
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pulse, and physical indications of lung and chest disease . Towards the end there is great debility and emaciation,
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death generally ensuing after hectic fever has set in .
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Complete recovery is rare . The pathological changes are generally limited to the chest and its contents, and consist in a peculiar marbled-like appearance of the lungs on section, and fibrinous deposits on the pleural membrane, with oftentimes great effusion into the cavity of the thorax . Willems of Hasselt (Belgium) in 1852 introduced and practised inoculation as a protective measure for this scourge, employing for this purpose the lymph obtained from a diseased lung . Since that time inoculation has been extensively resorted to, not only in Europe, but also in Australia and South Africa, and its protective value has been generally recognized . When properly performed, and when certain precautions are adopted, it would appear to confer temporary immunity from the disease .

The usual seat of inoculation is the extremity of the tail, the

virus being introduced beneath the skin by means of a syringe or a worsted thread impregnated with the lymph .
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Protection against infection can also be secured by subcutaneous or intravenous injection of a culture of Arloing's pneumo-bacillus on Martin's
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bouillon, and by intravenous injection of the lymph from a diseased lung, or from a subcutaneous lesion produced in a calf by previous inoculation .

End of Article: PLEURISY, or PLEURITIS (Gr. srXeiipc =ribs)
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