This disease may be divided into the dry, or adhesive, pleurisy, and the wet, or pleurisy with an effusion.

Symptoms

The disease will set in with a chill, boneache, backache, and a sharp cough that nags the patient in the side, making it very painful to cough. This is where the disease commences with very severe symptoms, everything taking on an acute type-fever running high, pulse high, and a little expectoration that is sometimes frothy and colored. This indicates that the lung over which the pleura rests is involved. It would be called pleuro-pneumonia. There is an insidious form which comes on slowly, with no marked symptoms. Children cry and fret, but they will not complain particularly of pain. By keeping their hands over the seat of the pain they may indicate that there is some discomfort in that particular region. The pain is characteristic--in fact, diagnostic. I will say, however, that years ago, when in general practice, many cases of so-called pleurisy I found on examination to be no pleurisy at all. The so-called pleurisy came from indigestion, which developed a great quantity of gas, the pressure of which was so strong on the diaphragm that it interfered with the heart action and caused the patient to cough and complain bitterly of pain in the side. No observing physician should be led into the error of diagnosing such a case as pleurisy; yet I have seen this done many times. Where the young physician is in doubt at any time, he can very quickly distinguish between the pain from below the diaphragm and pleuritic pain by giving twenty to thirty grains of bicarbonate of soda. Put it dry on the tongue, and have the patient drink a glass of hot water. If it is due to acute indigestion, the patient will be relieved in a very few minutes. The soda neutralizes the acid, and relief comes quickly.

Pleurisy sometimes runs in an insidious form and ends in pleuritic abscess. In such cases there will be a decline in the first symptoms. There will be fever, pain, and cough. The patient will appear to get a little better, but will come to a standstill, and will continue in just about the same condition for a week or two weeks. Indeed, he may not present symptoms severe enough to cause the parents to call a physician. But when they find that the child stays about the same, running a slight fever daily, a physician will be called, who will then discover that there is pus in the pleural cavity.

Treatment

Hot applications to the chest; heat to the feet; no food at all; all the water the patient desires; and the bowels are to be washed out every day. When the fever subsides and the cough ceases to be troublesome, the patient may have fruit for two or three days. At the end of that time, if all is going well, fruit may be taken night and morning, and a little broth made from lamb or chicken, with a combination salad, for the noon meal. Then fruit in the morning, and meat and salad at noon, with fruit and teakettle tea in the evening. After a week has passed, toast bread, potatoes, rice, etc., may be taken for the evening meal, with fruit. Other meals as suggested. Meat need not be eaten unless desired.