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Pleurisy Symptoms and Treatment

Pleurisy is an inflammation of the pleura. It may occur as a secondary complication of pneumonia or as a separate condition. It may also be a complication of tuberculosis and other diseases. Pleurisy may be of the "dry" form, in which case there is no fluid present in the pleural cavity.

This form is accompanied by a stabbing pain or "stitch in the side" every time the patient takes a breath. The moist form is called "pleurisy with effusion" or "wet" pleurisy, in which case there is an oozing of serum from the inflamed pleural surfaces and the cavity becomes filled with serum.

In this type there is no stitch in the side because the fluid prevents the sore surfaces of the inflamed pleura from rubbing against each other. In a wet pleurisy the pleural cavity may be filled up with clear serum or, especially when it complicates pneumonia, it may be filled up with pus (empyema).

In every case of pneumonia the doctor has to watch out for the development of empyema. He can easily discover it by examining the chest with the stethoscope and by percussing it. There is a definite dull sound when striking the fluid-filled chest and the breathing sounds disappear from that part of the lungs, usually the lower part.

If a pneumonia patient continues to run a temperature when the crisis is expected, it often means the development of pleurisy. In most cases there are chills and sweats when pleurisy develops. The heart and lung are often pushed away from their normal positions by the accumulated fluid in the chest.

An X-ray will also show pleurisy fluid in the chest, but will not tell whether the fluid is just serum or pus. To determine the presence of pus an aspiration with a needle is often necessary. The cause of wet pleurisy with pus is the same infection as the disease in the lungs of which the pleurisy is a complication.

And that may be pneumonia, tuberculosis, influenza or any other infectious disease which may give rise to pneumonia and pleurisy. Penicillin and the sulfa drugs are administered in large doses; but while these drugs prevent the spread of the infection (septicemia), it is often necessary to open the pus cavity and drain the pus.

As soon as this is done, the patient's temperature goes down and he begins to improve and regain his appetite and his good health. Dry pleurisy is mostly caused by exposure to wet and cold. There is the familiar stitch in the side, especially on inspiration. There may or may not be a little fever.

It is advisable to tighten the chest with a sturdy flannel binder, apply heat to the painful side by hot water bag or electric pad or lamp, and rest in bed for 2 or 3 days. The binder should ex-tend from the armpit down to the edge of the ribs at the base of the chest and should be tightened while the patient expires the air from his chest.

The patient with pleurisy should take an aspirin tablet and a tablespoonful of milk of magnesia every 3 hours for 3 doses and have a light diet. The bowels should be kept open daily by an enema if the milk of magnesia is not effective.

A person may experience a stitchlike pain in the side from sitting or lying in a twisted position; but this pain will pass in a few minutes if the person will stand up, stretch and straighten the painful side. A similar pain in the side may be caused by an inflammation of muscles between the ribs.

The treatment is the same as for dry pleurisy. A dry pleurisy with fever lasting longer than a couple of days, with the patient feeling worse instead of improving, may mean the formation of fluid or the development of pneumonia, and in that event no chances should be taken and a doctor should be called in promptly.

A dry pleurisy with fever should receive large doses of penicillin as a preventive of pneumonia. A 50,000- unit tablet of penicillin every 3 hours, with two such tablets taken as the first dose, is advisable. This should be continued for 2 days and if the patient is entirely recovered the tablets should then be discontinued.

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