The physical signs of dry pleurisy are impaired motion on the affected side and a friction sound caused by the rubbing together of the inflamed surfaces. When the effusion has occurred, this sound disappears, there is a loss of pulmonary resonance, and dullness or flatness on percussion over the area occupied by the effusion. The side involved is larger than the other, the intercostal spaces are obliterated or bulge. The heart may be displaced upward or to one side, so that the apex beat is felt out of its normal place, or entirely hidden behind the sternum.
A sero-fibrinous pleurisy may persist for months, and the lung, from the long-continued pressure, become permanently contracted. so that when the fluid is absorbed or drawn otr it fails to return to its normal dimensions and to till the whole cavity. Adhesions may help to pro duce this condition.
The treatment of dry pleurisy comprises rest in bed, saline catharsis. and relief of pain by the administration of sedatives or by counter irritation in the form of a mustard plaster or the application of the electro-cautery. Strap ping the chest with long strips of adhesive plaster gives comfort by limiting respiratory movements. Pleurisy with effusion requires a somewhat dif ferent plan of treatment. To favor absorption of the exudate, the diet is made light and dry, and daily concentrated doses of Epsom salt are given to promote elimination. The skin and kid
neys are also kept active with diaphoretic and diuretic medicines. Mild counter-irritation with mustard or iodine is useful in the later stages. When the effusion is large and resists all ordi nary methods of treatment, aspiration of the fluid or part of it is practiced. This is accom plished by puncturing the chest wall with a hollow needle attached to a suction pump. The operation is simple and not painful, and is some times done merely to determine the nature of the exudate. The fluid is withdrawn slowly, the amount depending on the size of the effusion. In some cases a quart or more can be abstracted with safety. Frequently the withdrawal of a small amount will be followed by spontaneous absorption of the remainder. Purulent pleurisy —empyema—is treated by making an incision into the chest wall and allowing the pus to escape. washing out the cavity and draining it. This operation dates from the time of Hippo crates and is not a serious procedure. The cavity is gradually filled by the expansion of the lung and the falling in of the chest wall. some times it is necessary to remove portions of one or more ribs. Expansion of the lung is promoted by systematic breathing exercises.