INFLAMMATION OF THE PLEURA. 281 



favorable prognostic signs ; as is also a diminution in the amount of 

 urine secreted, which indicates that the arteries are incompletely filled 

 Still worse are the symptoms of over-distention of the veins, with cya- 

 nosis, dropsy, and the appearance of albumen, casts, and blood in the 

 urine. The longer the effusion lasts, the more persistent the fever 

 which accompanies it, the greater the wasting of the patient, so much 

 the worse should our predictions be. Finally, all sequelae, other than 

 that of reabsorption, must be considered as prognostically unfavorable, 

 although, as shown above, the danger may vary in degree. 



TREATMENT. The causal indications can no more be met in treat- 

 ment of pleurisy than they can in treating pneumonia. In fact, even 

 if we were aware that an attack of pleurisy were caused by " catching 

 cold," if the fever were at all intense, a treatment by diaphoresis would 

 be absolutely injurious. 



Indicatio morbi. The "antiphlogistic system," with its general 

 and local blood-letting, its exhibition of calomel, and inunction of mer- 

 curial ointment until salivation is produced, and its subsequent deriva- 

 tion by blistering, etc., which formerly used to be the general practice 

 in the treatment of pleurisy, but which, in the last ten years, has grad- 

 ually fallen into discredit, recently has again been urgently recom- 

 mended by Joseph Meyer ', in a work which gives evidence of great in- 

 dustry. The arguments of this author in favor of the former method 

 of treatment, and against the less active modes of procedure, are, how- 

 ever, based upon a very slender foundation. Thus great weight is laid 

 upon the fact that a certain number of patients, with large pleuritic 

 exudations, have been received into the Berlin Charit6 Hospital, who 

 have not been bled, and who have never taken any mercury ; and it 

 is inferred that the profuseness of the effusion is a consequence of 

 a neglect of active treatment. The enumeration of such cases as 

 these proves nothing, unless the number of cases who were not 

 bled, and yet who did not have large effusions, and who therefore 

 did not seek admission at the Charite", be also given. But even 

 the somewhat limited number of cases observed by Myer and 

 others, in which recent cases of pleurisy, being treated by copious 

 blood-letting, did not result in effusion, have not converted me. The 

 assertion that pleurisy which is ushered in and accompanied by very 

 acute symptoms, if left to itself, almost always terminates in profuse 

 effusion difficult of reabsorption, I consider as quite erroneous. In- 

 deed, the greatest danger in this respect is to be apprehended from 

 the pleurisies which come on in a manner almost imperceptible, and 

 whose duration is extremely tedious. 



1 still believe that venesection can be dispensed with in the treat- 

 ment of pleurisy, with exception of a few rare cases, where certain 



