Treatment. 175 



the skin. When hyperemia occurs as an effect of irritation, this is allowed to 

 subside before the application is repeated. In many cases the skin is tolerant 

 enough to permit daily applications; in others marked hyperemia follows after its 

 first use in which event the soap must be diluted (Transl.). 



Narcotics are to be employed in severe tenderness of the 

 thoracic wall and against tormenting cough. Fever requires 

 interference only when it is very high and when the affection 

 has set in in a very tempestuous manner ; then the drugs recom- 

 mended elsewhere (see page 122) are to be considered. 



Diuretics are indicated in the presence of a diminished 

 excretion of urine ; powerfully acting drugs should however be 

 avoided. Aside from those medicines which were recommended 

 for croupous pneumonia (see page 122) the following are to be 

 recommended: digitalis (daily 3-7 gm. or to dogs as an infusion 

 1 : 100 in tablespoon doses, not to be continued longer than one 

 week; liq. potassii acetici (100-180.0 or 5-10.0 per diem, also in 

 combination with digitalis) ; oil of turpentine (10-15.0 or 1-2.0) ; 

 calomel (2-4.0 or 0.03-0.05) must be discontinued at once after 

 diarrhea has set in; common salt. To increase absorption the 

 following drugs are serviceable: pilocarpine (0.1-0.2 and for 

 small animals 0.005-0.01 gm. subcutaneously) ; arecoline (0.08 

 gm. for horses subcutaneously) and the laxatives, especially the 

 salts. Animals vntli cardiac weakness should not receive pilo- 

 carpine or arecoline. 



The most reliable procedure to diminish the amount of the 

 exudate is puncture of the thorax (thoracocentesis), an interfer- 

 ence absolutely void of danger if performed with aseptic and 

 general precautions. Thoracocentesis is indicated especially 

 when there is immediate danger of suffocation and in purulent 

 and ichorous pleurisy. There exist, on the other hand, 

 numerous observations (Alniy, Lienaux, Frohner, Marek), which 

 show that puncture made repeatedly and immediately after the 

 exudate has formed may bring about a speedy amelioration even 

 if only a small amount of fluid has been removed. The often 

 observed favorable influence, even after the removal of a small 

 amount of exudate, may be explained by a diminution of the 

 pressure exerted upon the blood and lymph vessels of the pleura. 

 (There is hope for the absorption of the exudate then only if 

 the molecular concentration of the latter is not greater than that 

 of the blood plasma. This has been demonstrated in the case 

 of man by Ketli and Torday.) The primary affections, of 

 course, influence materially the possibility of successful treat- 

 ment in secondary pleurisy. Frohner is inclined to believe that 

 only those cases offer hope in which the exudate is free from 

 bacteria. A favorable result does not occur after puncture in 

 cases where the lungs have lost the power to expand. 



The puncture is best made in the seventh intercostal space but on the right 

 side it may be made in the sixth space ; in larger animals 3 to 5 cm. above the costal 

 cartilages. The instrument may be simply a hollow needle provided with a long, 

 slender rubber tube, the free-end of which should dip into sterile water. A trochar 

 (Billroth 's trochar is particularly serviceable) is still better adapted which has 

 the canula provided with a stop-cock which should be closed after the withdrawal 



