INFLAMMATION OF THE PLEURA. 



283 



primary disease at all. In recent cases, where the fever is high, 1 

 usually give digitalis in the form of infusion ( 3 ss to vj) ; in tedious 

 cases, where the fever is of a more latent character, I give it in sub- 

 stance (gr. j for a dose, usually combined with equal parts of quinine). 

 Dyspnoea, when it arises from collateral hypersemia of the uncom- 

 pressed parts of the lung, especially when signs of commencing collat- 

 eral oedema already exist, imperatively demands venesection. Under 

 such circumstances I have often ordered three or four successive bleed- 

 ings, and as I did not bleed to cure the pleurisy, but on account of the 

 danger arising from the hyperaemia, I have not laid myself open to the 

 charge of inconsistency. 



It is far more rare for cyanosis, dropsy, and other symptoms of 

 venous engorgement of the aortic system depending upon disturbance 

 of the pulmonary circulation, to require venesection. 



Especial attention is to be paid to the deterioration of the blood, 

 tvhich often becomes apparent at an early period, owing to the volume 

 of the effusion, and to the wasting induced by the fever. There should 

 je no hesitation about administration of the ferruginous preparations, 

 and of a nourishing diet. The old prejudice, that iron causes conges- 

 tion, is entirely void of foundation. 



Remedies for the promoting of reabsorption of the effusion deserve 

 little reliance. It is, indeed, questionable whether it be possible, by 

 any therapeutic means, to bring about the conditions upon which the 

 absorption of pleuritic effusion depends. If, after the inflammatory 

 symptoms have subsided, the effusion remain undiminished, all medi- 

 cation, both external and internal, is to be rejected, and the applica- 

 tion of blisters is of very doubtful use. The fact that pleuritic or other 

 pathological effusion has been rapidly absorbed during an attack of 

 cholera, when the blood had become thickened by loss of its water, 

 makes it seem rational to attempt to reduce the water of the blood by 

 the administration of diuretics and drastics, in order to promote ab- 

 sorption of the effusion. Unfortunately, the action of the diuretics, of 

 which bitartrate of potash, boracic cream of tartar, and the juniper- 

 berry are the best, is very uncertain, so that we cannot promise our- 

 selves much from their use, and the pernicious effect of the drastics 

 upon digestion and assimilation forms a serious objection to their em- 

 ployment. In one case, which I did not treat myself, but which I 

 watched with attention, a pleuritic effusion, which had withstood all 

 efforts to remove it, diminished rapidly under what is known as 

 Schrotfts treatment ; the physician in charge, conceiving the idea of 

 producing inspissation of the blood by diminishing the supply of water 

 coming to it, instead of attempting to abstract the water from it, fed 

 the patient upon the driest possible diet, and almost entirely deprived 



