PLEURISY. 461 



Cases of simple pleurisy without effusion usually terminate favourably, and the 

 danger to life is small. When effusion has occurred, and there is fluid in the chest, 

 the prognosis is far less favourable, and the danger may to some extent be estimated 

 by the occurrence of attacks of shortness of breath. Secondary pleurisy is always 

 more dangerous than primary. 



Now as to the treatment of pleurisy. Practically it may be summed up in these 

 words : " Put the patient to bed and send for the doctor." But as medical 

 assistance is not always forthcoming at a moment's notice, there are other measures 

 that may be adopted pending its arrival. A light diet of gruel, arrowroot, beef-tea, 

 and broth, with occasional sips of cold water to allay thirst, will be found beneficial. 

 When there is effusion some doctors consider that little or no fluid should be given, 

 and cases have recently been published which seem to bear out this view. It is 

 important to avoid draughts, but if in bed the patient may be allowed to assume any 

 position that is to him most comfortable. Linseed-meal poultices, or flannels wrung 

 out of hot water and applied to the chest, often give relief. A flannel bandage 

 attached round the chest will moderate the pain by restraining the movement of the 

 ribs. Strapping the chest on the affected side, as one would do for broken ribs, 

 often affords immediate relief, and the most favourable results have in many cases 

 followed this procedure. Ordinary sticking-plaster may be used, and if spread on 

 some thick material so much the better. It should be cut into strips from three to 

 four inches wide, and sufficiently long to extend from the spine behind to the middle 

 line in front These strips should be warmed before being applied, either by 

 holding them in front of a fire for a few seconds, or what is better, by drawing their 

 backs over a large jug of hot water. Some people dip them bodily into hot water, 

 but this is not a good plan, for the patient is very apt to catch cold after it. The 

 strips should not be applied horizontally, but somewhat obliquely, the alternate 

 layers running in opposite directions. It is best to make the application from below 

 upwards, and the patient should be directed to expire deeply as each strip is being 

 put on. Each layer should overlap the preceding by about a third of its breadth. 

 Finally, it is often desirable to apply over the whole two or three strips horizontally, 

 so as to form a superficial layer, and one or two may also be passed from behind 

 forwards over the shoulder, these being kept down by another fixed round the side 

 across their ends. It is of course necessary to make this application only on the 

 affected side. When this plan is not adopted the chest may be well painted with 

 iodine liniment. When the pain is agonising, and resists other and simpler 

 treatment, it is quite justifiable to give a hypodermic injection of morphia say two 

 drops of the pharmacopreial solution. 



There are two drugs which may be advantageously administered internally, and 

 these are aconite and bryony. Aconite is most useful in quite the early stage of the 

 complaint. A drop of the tincture should be given in a tea-spoonful of water eveiy 

 ten minutes for the first hour, and subsequently hourly, or Pr. 38 may be used. After 

 two or three doses the skin becomes moist, contrasting favourably with the hot dry 

 skin, urgent thirst, quick pulse, and general suspension of the secretory functions which 

 previously existed. Bryony is especially indicated when there are stinging, shooting, 

 or burning pains in the side, aggravated by breathing or movement ; painful dry cough, 



