PLEURISY. 



89 



which present so many varieties with respect to their organization, 

 form, colour, extent, consistence, and thickness. 



Gangrene sometimes takes place in the pleura, presenting itself in 

 the form of circumscribed spots of a dark-brown or greenish colour, 

 penetrating the substance of the membrane, and extending in some 

 cases to the sub-pieural cellular tissue, or to the surface of the adja- 

 cent parts, which become infiltrated with a serous fluid. 



Treatment. — The treatment of pleuritis rests on the same basis 

 as that of peripneumonia. When the patient is of a robust habit, 

 and the inflammation runs high, free bloodletting must be employed. 

 As soon as the pain appears, and there is as yet no eflusion, leeches 

 or cups applied over the painful side often remove the disease. 

 This effect is obtained with more certainty if general bloodletting be 

 premised. The combination of both is extremely useful. Large 

 emollient cataplasms should be applied to the affected side. After a 

 full bloodletting, a brisk cathartic may be given, so as to act freely 

 on the bowels, and also produce derivative effects. In most cases, 

 it will now be advisable to bring the system under the influence of 

 mercury ; and this may be effected in various ways. Some prac- 

 titioners give blue pill and opium, others prefer calomel and opium : 

 and again, some rely on mercurial inunction. Three grains of 

 calomel, half a grain of opium, and a quarter of a grain of tartar 

 emetic, made into a pill, to be taken every third or fourth hour; or 

 the same proportions of calomel and opium, and one grain of digi- 

 talis, instead of the tartar emetic ; the pill to be taken in the same 

 way. As long as the fever is high, we should not have recourse to 

 revulsives ; but when it is lowered, and no signs of violent reaction 

 are observed, a large blister should be applied to the affected side. 

 The violent symptoms having been subdued, the effusion may be 

 rapidly absorbed, and the sonoriety of the chest be restored. But in 

 most cases, the constitutional symptoms and local sufferings only are 

 removed, while the efflision continues stationary, or perhaps ^^^ 

 on the increase. It is at this period that, by small local bleedWffe, 

 repeated counter-irritation, diuretics, and diaphoretics, we can gene- 

 rally succeed in effecting a cure. 



In chronic pleurisy there is but little constitutional distress : yet 

 the patient emaciates rapidly, the pulse is quick, and the breathing 

 hurried. On examining the chest, one side is found dull and en- 

 larged, the heart is displaced, and the respiration is puerile in the 

 opposite lung. 



In such cases, the patient must be confined to bed, his bowels be 

 freely acted upon, and his diet consist of farinaceous substances. A 

 few leeches are to be opcasionally applied to the affected side, and 

 mild mercurials are to be exhibited, so as to induce slight ptyalism. 

 Counter-irritants are now to be employed. M. Andral recommends, 

 " that the blister to the chest should be replaced either by a seton, 



