282 DISEASES OF THE PLEURA. 



symptoms demand it. I am convinced that it neither cuts short the 

 malady, nor prevents the effusion ; and, as this disease, owing to its 

 tedious course, is always liable to lead to deterioration of the blood, 

 and to consumption, I regard the practice of bleeding as still more dan- 

 gerous in pleurisy than in pneumonia. 



At the commencement of an attack of pleurisy, however, I cannot 

 sufficiently recommend the use of cold and of local blood-letting. It is 

 highly essential that the proper moment for employing this impor- 

 tant treatment should not be neglected, as much evil may then be pre- 

 vented, which, at an after-period, is difficult to repair. When the pa- 

 tients dread the application of cold compresses, or if the latter do not 

 relieve the pain and dyspnoea in an hour or two, a tolerably large num- 

 ber of leeches, or cut-cups, should be applied ; ancl, if the pain, which 

 is almost always relieved by the depletion, recurs in the course of a 

 day or two, we should not hesitate to repeat the local blood-letting 

 until the relief becomes permanent. 



Besides this, and for want of remedies of more certain action, half 

 a drachm of mercurial ointment may be rubbed into the affected side 

 of the chest twice daily, but the inunction must be at once suspended 

 the moment that signs of mercurial sore mouth appear. As a decided 

 benefit is sometimes obtained from the inunction of mercurial ointment 

 in inflammation of other serous membranes, particularly inflammation 

 of the articular capsules, its efficacy should always be tested in cases 

 of recent pleurisy, although its action is then far less easy to observe. 



Having convinced myself, from my own observation and from the 

 cases reported in the work of Meyer above alluded to, that the fever 

 is not materially aggravated by the use of blisters, I now retract my 

 former advice not to resort to vesication while fever lasts. Indeed, the 

 application of large vesicatories seems to be of service in certain cases, 

 but, when used at all, they must be used early. 



In protracted cases, large hot poultices, which, however, must not 

 be too heavy, do good service. 



Internal medication, save when called for by special symptoms, is 

 unnecessary in treatment of pleurisy. The antiphlogistic action of 

 nitrate of potash, of tartar emetic, and of calomel, I regard as highly 

 problematic ; and, moreover, the exhibition of calomel is not without 

 its dangers, as it tends to augment the impoverishment of the blood, 

 and the tendency to exhaustion which already exists. 



Indicatio Symptomatica. Antipyretic treatment is always proper 

 when the fever is very high at the commencement of the attack, or 

 when it is so persistent that there is reason to fear that it will exhaust 

 the patient. With this object in view, the very customary use of 

 digitalis is to be recommended in certain cases. It does not affect the 



