DISEASES OF THE LUNGS 15 



become infiltrated with fluid, and the sheath becomes enlarged from the 

 same cause. The legs fill more or less, the countenance becomes worn 

 and haggard, the extremities cold, and the belly drawn up at each act 

 of expiration. 



The pulse is at first hard and of increased frequency, but as the fluid 

 is effused into the chest it becomes softened and smaller in volume, 

 as well as weak and irregular, and the pain is less severe. The patient 

 persistently stands with protruded head and dilated nostrils, which open 

 and contract in a jerky, spasmodic manner. 



Pleurisy is distinguished from other inflammatory chest diseases by 

 greater pain, harder pulse, catchy breathing, and the short occasional 

 cough which the patient endeavours to suppress, as also by the friction 

 sounds and greater sensibility of the chest to external pressure. 



Treatment. In this disease benefit may be expected from counter 

 irritation to the walls of the chest. Here we have but little substance 

 intervening between the skin and inflamed part, and if mustard is bene- 

 ficial in other inflammatory diseases of the chest it is doubly so in 

 pleuritis. Though bleeding is not so generally practised as formerly, and 

 altogether unsuited to the great majority of cases, there is reason to antici- 

 pate beneficial results from a liberal blood-letting at the commencement of 

 the disease, where the patient is in plethoric condition and the attack is of 

 an acute character. But even here it will be of no use, and probably 

 harmful, if delayed to an advanced stage of the attack. In advocating 

 bleeding for pleurisy it is not at any time to be employed on the aged or 

 the weak, nor should it be resorted to where pleurisy follows upon any of 

 the contagious fevers. 



Particular attention should be given to the patient's surroundings, which 

 should be comfortable and with every inducement to rest. A roomy, dry, 

 and well-littered box is to be provided, so that no restraint be placed on 

 movement, and ample ventilation should be allowed both night and day. 

 The legs should be kept warm by woollen bandages frequently changed, and 

 the intervals employed in hand-rubbing or wisping them with hay or straw. 

 Warm clothing in the form of rugs and hoods is most essential, with the 

 object of keeping up the circulation on the surface and extremities, and 

 thus aidinp- in the reduction of inflammation in the affected part. For diet 

 see Catarrh and Pneumonia. The application of moist heat to the sides of 

 the chest is strongly advocated by some authorities, woollen clothes or rugs 

 being dipped in hot water and applied to the chest by means of rollers or 

 bandages, the heat being retained and evaporation prevented as much as 

 possible by a sheet of oiled silk or gutta-percha, or a dry rug. 



The medicines to be chosen are those most calculated to reduce tern- 



