General discussion about pain in the chest and side

Pain due to pleurisy. Sometimes very painful painful tumors are formed in the membranes, bursae and muscles of the chest, ribs and adjacent areas, which are called shusa, barsam and zat aljanb. It also happens that pain in these organs does not come from a tumor, but from thickened winds, but doctors think that the pain arose from this cause, although this is not so. Pleurisy is a hot swelling in the chest area or in the internal muscles and membrane lining the chest from the inside, either in the dividing barrier, this is a purely pleuritic tumor, or in the external, external muscles, or in the outer shell, with or without the participation of the skin.

The most terrible and terrible tumor of all is the one that forms in the dividing barrier itself; this is the most severe tumor. The matter of such a tumor in most cases is bile or bile blood, because only rarefied bile substance and pure blood penetrate into the organs surrounded by bags; Therefore, intensification of attacks of fever with such a tumor most often occurs every other day, and such a tumor rarely forms in someone who mostly belches sour, for such a person has a mucous nature. However, it is sometimes formed from burnt blood, and sometimes from putrefied mucus; in rare cases, such a tumor arises from rotten, inflamed black bile.

We have already explained in the Book on General Issues that the conditions for the occurrence of a hot tumor do not include the impossibility of its formation from mucus or black bile. On the contrary, a hot tumor is sometimes formed from mucus or black bile, but it is acute only if it is formed from yellow bile or blood; if the tumor is formed from other juices, it is chronic. This is something that many people have not learned.

Since every tumor either resolves, or collects pus, or becomes hard, this is the situation with pleurisy, but hardening with pleurisy is rare. Thus, the pleuritic tumor either resolves or collects pus, that is, in most cases. When pleurisy resolves, the lung most often accepts the matter of the resolved tumor and removes it by expectoration and excretion, but sometimes the matter resolves in the other direction; when the tumor collects pus, then, of necessity, it needs to mature and be able to open.

Sometimes the lung ejects pus in the sputum, and sometimes the vena cava takes it up and comes out in the urine; sometimes pus pours out in the stool passage and is ejected in the feces. It often happens that pus gets into the “empty spaces” and into the glandular flesh and forms tumors, for example, in the groins, armpits and behind the ears. Often matter rushes to the brain and other organs, as we will say later, and danger arises or the patient even dies, and sometimes matter suffocates the lungs with its abundance, filling the respiratory tract. Sometimes the amount of matter is not so great and all of it is mature, be it pus or sputum, but the patient’s strength is weak and he is not able to cough up. Therefore, it is necessary at such times to strengthen the forces so that they are capable of significant compression of the lungs for a cough that spews phlegm. The fact is that such expectoration is an action carried out by two forces; one of them is natural and it brings to maturity and also expels, and the other is arbitrary and also expels. If both forces are not strengthened at once, they may not be able to cleanse the lungs.

Know that difficulty in expectoration occurs either because of the forces, if they are weak, or because of the organ, if the organ suffers from its own movement or from the movement of its neighbor, or because of the matter, if it is very liquid, or, conversely, thick and viscous. Under such circumstances a kind of boiling sometimes occurs in the lungs, as the air mixes with matter resisting expulsion, which is poured into the lungs and into the tube. If the lungs with pleurisy are not cleared by expectoration within fourteen days, then the tumor has accumulated pus, and if they are not cleared of pus after forty days, then the person develops pneumonia and consumption. Sometimes the pus is completely removed on the seventh day, but in most cases this happens on the twentieth day or on the fortieth or sixtieth. Often the opening of a tumor occurs before ripening, since nature expels harmful matter due to its abundance or pungency, or due to excessive warmth of nature, and also depending on age, season and locality, or due to the premature intake of a ripening drink due to a doctor’s error ; We will talk about substances that cause ripening later. This also happens from excessive, tiring movement of the patient or from screaming, and this is dangerous.

Sometimes pleurisy turns into pneumonia, because the lungs take matter from the tumor and cannot remove it well, so the matter is retained in the lungs and a tumor forms there. It also happens that pleurisy turns into consumption, sometimes through pneumonia, in a way that we will talk about below, and sometimes without pneumonia, due to the fact that matter or pus oozing from the tumor ulcerates the substance of the lungs its severity and malignancy. Often pleurisy develops into spasms and cusis, since matter rushes into the nerves adjacent to the organ in which the tumor has formed, and this organ is rich in nerves. This transition kills and no good treatments help with it.

It happens that after pleurisy and pneumonia, a kind of numbness occurs at the end of the upper part of the patient’s arm from its inner side, and in the forearm up to the end of the fingers. Sometimes matter is transferred towards the heart and because of this, interruptions begin, followed by fainting, and also towards the brain during resorption, before the accumulation of pus or during the accumulation of pus; sometimes the matter spreads to external organs and forms abscesses. Sometimes such a transition of matter occurs through its penetration into the substance of nerves, tendons and even bones. When the matter deviates to the lower parts of the body and then the tumor opens and forms fistulas, this turns out to be the cause of relief from the disease. However, such fistulas are malignant, transitional fistulas.

If the matter has deviated towards the joints and fistulas have formed there, then this is also one of the reasons for salvation, but in this case the organ often suffers chronically, especially if there is no other type of emptying, excretion of feces or thick, very mature urine. If something like this occurs, then the situation is better; this indicates a small amount of matter causing the abscess, which can be corrected by bringing it to maturity. When such abscesses are hidden and deep, it is a sign of trouble and an abundance of abscesses, especially if the matter has returned to the lungs. Often, due to a strong fever, breathing becomes rapid, and frequent breathing causes the phlegm to become viscous, since the phlegm dries out with rapid breathing. Due to the viscosity of the sputum, severe, continuous pain occurs and the burning intensifies; intensified burning makes breathing even more rapid, and the frequency of breathing creates the viscosity of sputum, and these phenomena constantly and mutually help the development of the disease.

As for which type of pleurisy and pneumonia is worse: the one that occurs on the left side, next to the heart, or the one on the right side, some believe that the first is worse, and others that the second is worse; the truth is that it is pleurisy. close to the location of the heart is worse, but it matures more quickly and is more easily absorbed, if it has the ability to be absorbed at all. And pleurisy, far from the location of the heart, is more benign, but it is more resistant to resorption and maturation. Sometimes pleurisy occurs from overflow of juices, if it occurs in the head or chest area, and sometimes it is caused by drinking copious amounts of cold water, which locks the matter, or by severe cold; Pleurisy is also caused by extreme heat or drinking pure wine, which sets the juices in motion and raises them.

Inflammation of the lungs rarely turns into pleurisy, more often it happens the other way around, but this still sometimes occurs; in this case, the difficulty in breathing becomes somewhat easier. Pleurisy most often occurs in autumn and winter, especially if the spring was “winter”; Cases of pleurisy also become more frequent in the “winter” spring. When the north wind blows, the excesses multiply, or it locks in the excesses, and at the same time the pain in the side and ribs becomes more frequent, especially with the south wind. In the summer, when the south wind blows, cases of pleurisy are very rare, but if the summer was “southern”, rainy, and the autumn was the same, pleurisy becomes more frequent at the end of autumn in people with yellow gall nature. To put it another way, we can say that pleurisy rarely occurs in “southern” weather, in southern countries and with southern winds; It is also rare in women who have menstruation, because their nature is rather moist rather than bilious; when pleurisy occurs in pregnant women, it turns out to be fatal.

Pleurisy rarely occurs in old people, but if it happens, it kills, because their strength is too weak to expel phlegm and clear the lungs. Pleurisy is sometimes confused with a tumor in the liver. The fact is that if the suspensory ligaments are stretched due to a tumor in the liver, then the tension reaches the thoraco-abdominal obstruction and the membrane, so that pain is felt in it and shortness of breath occurs. You must be able to distinguish between these two diseases. Pleurisy is often confused with inflammation of the meninges. Pleurisy sometimes kills by the force of its manifestations, sometimes it kills due to suffocation, and sometimes it kills by turning into pneumonia, consumption, fainting, or other ailments that have already been mentioned.

Know that when pleurisy is combined with hemoptysis, it is similar to dropsy, which is combined with fever. The first, that is, pleurisy, needs treatment with astringents in connection with hemoptysis and emollients in connection with pleurisy itself, just as the second needs treatment with warming and drying or moderate drying due to dropsy, and cooling and moisturizing due to fever. Often the cause of pleurisy and pneumonia is the ingestion of food that provides a coarse nutrient that thickens the blood, such as cauliflower, and the blood rushes to the nipple area and to the side. This is treated by liquefying the matter in a bath, and when the patient comes out of there, he drinks shikan-jubin. In this case, you should avoid rubbing oil, because oil attracts matter. Often a bath eliminates the need for bloodletting.

Signs of pleurisy. True pleurisy has five signs, namely, firstly, a constant fever due to the proximity of the heart and, secondly, a stitching pain under the ribs, since the diseased organ is membranous, and the pain often appears only when inhaling; tingling is sometimes accompanied by distension, which is often stronger than stabbing. Distension indicates an abundance of matter, and stabbing indicates that it penetrates deeply into the pleural area and burns strongly. The third sign is constriction due to the pressure of the tumor, short and rapid breathing. The fourth sign is a sawtooth pulse, the cause of which is its unevenness, and the unevenness of the pulse increases and its value decreases at the end of the disease due to weakness of strength and abundance of matter. The fifth sign is a cough. Sometimes at the beginning of this disease the cough is dry, and later with sputum, but often when coughing there is sputum from the very beginning of the disease; This is a very commendable sign. Cough occurs only from damage to the lung due to the proximity of the tumor. The leaking pathogenic matter enters the lung and must be vomited out; if all the matter has resolved or leaked out, then the lung is cleared of accumulated pus. With true pleurisy, there is no beating, since the diseased organ is not replete with arteries.

Since pleurisy is like a tumor in the liver due to the presence of cough, fever, shortness of breath, tension in the suspensory ligaments and the spread of pain to the inner lining of the chest, you need to be able to distinguish one disease from another. Pleurisy is also similar to pneumonia for the same reasons and the presence of sputum; these two diseases should also be distinguished. The difference between pleurisy and a liver tumor is that the pulse with a liver tumor is wavy and the pain is severe, not stabbing; the patient's complexion turns into a bad yellowish color and there is no sputum when coughing; on the contrary, the cough is dry and intermittent. Sometimes the tongue turns black after being yellow, the urine becomes thick and watery, and the stool becomes liver-like. There is a feeling of heaviness in the right side, but palpation does not detect the tumor, although pain is felt. With a liver tumor, stool sometimes looks like water in which fresh meat was washed, this is a consequence of weakness of strength. If the tumor is in the convexity of the liver, it can be felt by touch, and if it is in the concave part, it is detected by difficulty breathing, indicating the presence of something hanging and heavy in the internal organs. Restriction in breathing due to a liver tumor is sometimes dubious and not very strong.

As for the patient with pleurisy, he has a cough with sputum, a stitching pain, the urine is better in composition, its color is more advanced, and the difficulty in breathing is greater, and it continuously increases, so that every six hours a large difference is noticed in the direction of increase.

The difference between pleurisy and pneumonia is as follows: the pulse with pneumonia is wave-like, the pain is severe, the difficulty in breathing is stronger and the breathing is hot. There are also other signs. If a patient has pleurisy, then sometimes there are bad signs of inflammation of the meninges, such as confusion, delirium, increased breathing, interruptions, fainting or less severe disorders, as well as severe melancholy, great irritability, severe thirst, changing complexion, acquiring different colors, severe fever and vomiting of bile; The reason for these signs is the participation of the breast with the dominant organs and proximity to them. Therefore, one should distinguish between these two diseases, that is, inflammation of the meninges and leopards.

One of the differences is that with inflammation of the meninges, confusion first appears, then other symptoms intensify. Breathing with inflammation of the meninges is healthier and respiratory distress occurs later than clouding of consciousness; At the same time, there are clear signs of inflammation of the meninges, such as redness and upward rolling of the eyes. And with barsam, clouding of consciousness occurs later, and sometimes it does not occur almost until death, or consciousness generally remains healthy; in any case, with leopard, a change and disturbance in breathing precedes clouding of consciousness. With barsam, you feel a tension in the abdominal walls upward, as if they are being pulled towards the tumor, and a stabbing pain. One of the distinguishing signs is that with inflammation of the meninges the pulse is large and somewhat rare, and with pleurisy it is small and somewhat rapid to compensate for the smallness. When pleurisy intensifies, then the mentioned symptoms also intensify; the tongue becomes dry and hard. As pleurisy intensifies, redness of the face and eyes, severe anxiety, confusion, respiratory distress and intermittent perspiration occur. Sometimes pleurisy leads to malignant indigestion.

Signs of varieties of true and false pleurisy. If pleurisy is false and occurs in the membrane covering the ribs or in the external muscles, it has special symptoms, and the pain and damage reach a certain limit. Pleurisy that occurs in the outer shell is detected by touch; sometimes the skin is involved in the disease and it becomes obvious to the eye, and sometimes the tumor opens up and the disease does not cause expectoration. This opening sometimes occurs naturally and sometimes is induced artificially. With pleurisy arising in the external muscles, a painful beating occurs; if a beating is felt when inhaling, it means the tumor is in the dilator muscles, and if it is felt when exhaling, it means the tumor is in the constrictor muscles; you already know that both muscles are present in both the outer and inner lining of the chest. By pressing you can also detect a type of pleurisy, which is not true pleurisy. Such false pleurisy does not cause stabbing pain and constricted breathing, does not make the pulse so hard and sawtooth, and does not give rise to such a strong fever with all its manifestations, which happens with true pleurisy. Sometimes the pulse with false pleurisy is soft, and sometimes fever occurs due to a tumor outside the above-mentioned places or for some other reason, such as catarrhal hemoptysis and the like. There is no pleurisy if there is no stabbing pain, sawtooth pulse and other mentioned signs. In most cases of false pleurisy, pain is felt below the crest of the scapula, and with true pleurisy in the dividing barrier, the pain extends to the cartilage of the false ribs. Stupefaction with true pleurisy occurs more often and all symptoms, pain and difficulty breathing intensify; severe fever does not occur as quickly as with other types of pleurisy; on the contrary, it sometimes lags until the muscles begin to rot, and then the fever becomes very intense. If the tumor has formed in the membrane lining the chest from the inside, then the pain spreads to the collarbone. The degree of pain is not the same due to differences in the degree of contact of the parts of the shell with the collarbone, as well as due to the different sensitivity of its parts.

With true pleurisy, there is absolutely no painful beating. Pain extending towards the cartilages of the false ribs sometimes comes from a tumor in the dividing barrier, and sometimes from the formation of a tumor in the fleshy organs that are found in the ribs. There is no great danger in this.

Signs of benign and malignant pleurisy. The benign quality of pleurisy is indicated by easy and quick expectoration of mature sputum, that is, white, soft and homogeneous sputum, the pulse is not very hard and not very sawtooth, the insignificance of pain and other manifestations, as well as good sleep and breathing, susceptibility to treatment, ability the patient can easily endure the illness, the warmth in the body is even and soft, there is little thirst and slight melancholy. The quality of perspiration, feces and urine is commendable. Maturity of urine is an excellent sign of pleurisy, while bad urine is a very bad sign. Bad stool, foul-smelling and bright yellow, is a bad sign; the appearance of nosebleeds is one of the good signs and useful phenomena of pleurisy.

Pleurisy is malignant if its manifestations and signs are very strong and definite, if the sputum is delayed or discharges slowly and at the same time it is immature, or purely red, or leaden, or black, or more usually viscous, suffocating and making breathing difficult, and all its qualities opposite to those we listed above. Bad signs include urine with significant sediment, opaque and bloody; such urine is not good and indicates inflammation of the sutures of the brain. A bad sign is also a strong fever, especially if there is a feeling of coldness in the extremities, pain extending backwards, and an increase in pain when the sufferer lies on the painful side.

If a patient with pleurisy or pneumonia has diarrhea at the end of the illness, this indicates that the liver has weakened, which is a bad sign, while diarrhea at the beginning is an excellent sign and even a beneficial phenomenon. As for diarrhea, which appears later, and difficulty breathing and melancholy do not go away from it, it sometimes kills on the fourth day or earlier. Twitching under the false ribs often indicates confusion due to the involvement of the head in the disease of the abdominal obstruction. This is a consequence of the movement of matter from the thoraco-abdominal obstruction, and its movement in such a disease is mostly an upward movement. Another bad sign is when abscesses resulting from pleurisy lie deep and when the abscess does not subside the fever and there is no good sputum. This indicates the inevitability of death, for in this case matter necessarily returns deeper. As for the good and bad signs that appear after suppuration, we devote a special paragraph to them.

Know that if there is no sputum with pleurisy, then it is either very weak or bad and very malignant. In this case, either there is no such abundance of matter that should be taken into account, or the matter cannot be expectorated and is malignant. Hippocrates says: “Expectoration is often good and easy, like breathing, but there are other signs that are bad and deadly. This happens, for example, with this type of pleurisy, when the pain spreads back and the patient’s back hurts, like the back of a beaten person, and his urine is bloody and purulent. Such a patient rarely survives; on the contrary, it dies between the fifth and seventh days and rarely reaches the fourteenth day. If he survives the seventh day, then most often he will be saved.”

Often such a patient develops redness between the shoulder blades; his shoulder blades become hot, and he cannot sit. If his stomach also becomes hot and yellow stool comes out, then he dies unless he survives the seventh day, and if he quickly develops phlegm of many different kinds and then the pain increases, then he dies on the third day, and if not, then he gets better.

There is another type of pleurisy, in which a painful beating is felt, spreading from the collarbone to the lower leg. The sputum is clean, but such pleurisy kills, because the matter deviates towards the head. If the patient survives the seventh day, he gets better.

Signs of periods of pleurisy. If there is no sputum, or the sputum is liquid, or there is little of it, or it is the so-called “spit”, which we will talk about later, then this means the beginning of the disease. When the manifestations of the disease intensify and the amount of sputum increases, and it becomes less and less liquid and turns out to be thicker and easier to expectorate, becoming redder, then this is a period of intensification of the disease. Then, when the patient begins to easily expectorate mature sputum of such a degree of maturity, as we said, and the pain becomes mild, this is the end of the development of the disease and the complete maturation of the tumor. Then, when the amount of sputum begins to decrease with the same density and ease of expectoration, and there is no pain and the manifestations of the disease decrease, it means that the disease has subsided. When expectoration of sputum stops after the complete disappearance of other signs, it means that the period of decline has ended.

Signs of types of pleurisy in relation to their causes.

The things that are concluded about the cause of pleurisy are sputum, depending on what its color is, whether it is uniform or mixed, pain, the place where it hurts, as well as fever, its strength and frequency. The sputum, when reddish, indicates yellow bile; light red sputum indicates both together, blood, and when yellowish, indicates mucus; if it is blackish or brown and the cause is not due to any external coloring substance such as smoke or the like, it indicates black bile.

And one more thing: the pain with mucous or black gall pleurisy most often goes down and is rather soft, but with both other types it goes up and burns. And one more thing: fever, when it is strong, comes from hot juices, and when it is not strong, it comes from cold juices. The nature of the periodicity of fever sometimes very well indicates the cause of pleurisy.

Signs of transition of pleurisy to another disease. If the patient does not quickly cough up good sputum and the lungs are not cleared within fourteen days, then the tumor has progressed to the accumulation of pus. The beginning of the rise of matter upward is indicated by severe pain, difficulty and constriction of breathing, as well as its “doubling” with the expansion of the chest and its small size. This is also indicated by severe fever and, in particular, stiffness of the tongue, dry cough due to the viscosity of the material and compaction of the abdominal obstruction, weakness of strength, loss of appetite, confusion, insomnia, feeling of heaviness in the sore spot. When the tumor has collected pus and the accumulation of pus has ended, the fever and pain go away, but the severity increases, and when it opens, a stunning chill of varying strength begins and an expansion of the pulse is observed with its irregularity; strength falls and the body becomes sluggish. A strong fever often appears, as the matter burns the organs, and the tumor also burns them. If the tumor is opened, but the diseased organ is not cleansed within forty days from the date of opening, then this leads to consumption. Opening of a festering tumor occurs in rare cases on the seventh day or the next, and most often later by the twentieth, fortieth or sixtieth day. The stronger the signs of suppuration, the sooner the autopsy occurs; The milder these signs are, the longer the autopsy is delayed. Of all the symptoms, this is especially true of fever.

If frightening indications appear, and you have previously observed favorable signs regarding sputum and other things, then do not be too alarmed: their appearance is due to the accumulation of pus, and not to another reason.

In all cases when, with pleurisy, the pain does not calm down after expectoration, after bloodletting, relaxation and other measures, expect suppuration or death of the patient even before suppuration, depending on other signs. If you see that the intensity of the pulse is increasing, especially if its frequency is increasing, this portends, when the forces are great, that pleurisy will turn into pneumonia, into suppuration and consumption. In general, when there are signs of strength and well-being, but the pain still does not calm down after hemoptysis, relaxation and compresses, this leads to suppuration. If there are no signs of health such as preservation of strength, preservation of appetite, and the like, this foreshadows that the disease will kill, and indicates that fainting will occur first. However, in most cases, when the tumor is opened, appetite drops and the cheeks turn red, as steam rises to them; fingers also become hot for this reason.

When the tumor opens into the chest cavity, the patient seems to feel better for several days, but then his condition becomes worse. When a tumor is opened into the chest cavity, you observe, as we have already said, that the pulse weakens, expands and becomes slow and rare due to the dissipation of forces due to emptying and feeding the innate warmth. In this case, as we have mentioned, there is a chill, followed by a fever caused by the burning sensation of the juices; if a lot of matter comes out of the opened tumor, and the patient’s strength is weak, this leads to death.

Know that if the patient’s strength is weak and tension and increased heart rate increase, then this, as you already know, portends fainting. If the increase in heart rate is not so strong and less than the increase caused by pleurisy itself, then it sometimes foreshadows hibernation or spasms, or a slowdown in tumor maturation. Hibernation occurs only from the fact that the brain receives moist vapors, which, undoubtedly, should not be too pungent; otherwise the pulse would certainly become very rapid. While receiving these vapors, the brain is at the same time too weak to push them out to the nerves. And spasms occur due to the fact that the brain has the power to push these vapors into the nerves. The signs mentioned indicate a retardation of maturation due to the density of the matter and because it does not pass to another place, for the brain and nerves are strong and do not accept it. Sometimes they foreshadow spasms, namely, if the difficulty of breathing increases significantly, but the fever is not severe.

If you see that the disease has calmed down a little and has become easier, but there is no sputum, then this often means that the matter has come out with urine or feces, and there is a liquid release of bile or thick urine comes out. If this is not visible, then an abscess appears. When there is tension in the walls of the abdomen and in the false ribs and a feeling of heat and heaviness, this portends an abscess in the groin area or on the legs; deviation of the abscess towards the shins is a sure sign of well-being. In such cases, Hippocrates, may Allah be merciful to him, prescribes inducing relief with a harbak.

If at the same time you observe difficulty breathing and tightness in the chest, as well as headache, heaviness in the area of ​​​​the collarbone, nipples and forearm and heat spreading upward, this portends that the matter will deviate towards the ears and head. If the situation is as we said, but no tumor or abscess appears in this area, it means that the matter will deviate towards the brain itself and kill the patient.