68 DISEASES OF THE PLEURA 



usually only in the beginning of pleuritis; in pneumonia the 

 fever is of the continuous type and lasts five to nine days, 

 to fall by crisis. In cases complicated with pneumonia 

 the recognition of the pleuritis may be difEcult. Weakening 

 of the heart sounds and edema of the ventral part of the 

 thorax are significant. In doubtful cases the use of the 

 exploring needle to determine whether effusion is present 

 or not is advisable. By drawing off some of the fluid and 

 subjecting it to chemical (albumin), microscopic (pus cells, 

 specific bacteria), and bacteriological examination (inocula- 

 tion of animals) the form of pleuritis may be determined. 



Prognosis. — Should be guarded. In fibrinous forms com- 

 plicating pneumonia, the outlook is usually good. With 

 great effusion affecting seriously the pulse, respirations and 

 appetite, the prognosis is bad. If pus infection occur, 

 death may be looked for. In pleuritis relapses are common. 

 In cases which do recover from the prolonged acute attack, 

 "heaves" (adhesions) is a common sequel. 



Treatment. — The hygienic and dietetic treatment is the 

 same as in pneumonia. Local applications to the chest, 

 especially cold water in the early stage (first two to three 

 days, when friction sound is heard) are good. When effu- 

 sion is developed, hot applications (blankets wrung out in 

 hot water) are better. In protracted cases or in chronic 

 pleuritis, employ sharp blisters (spirits of mustard) . 



Drugs. — If there is acute pain (sensitiveness of inter- 

 costal spaces, marked stiffness on turning the patient), or in 

 distressing cough, morphin (grs. v) or tincture of opium 

 (5iij) may be given. When effusion forms, diuretics and 

 physics assist in the elimination of the fluid. Calomel 

 (3j) and aloes (3vj) are given. Small repeated doses of the 

 fluidextract of digitalis (3j) so often recommended, should 

 be administered with caution, watching its effect on the 

 appetite and heart. Acetate of potash (§ j), pilocarpin (grs. 

 iv), arecalin (gr. j), and eserin (gr. j) should be used only 

 when the heart is not too weak. 



If the quantity of effusion warrant (dyspnea) puncture 

 of the thorax should be practised at once. If thoracentesis 

 is properly performed it is not dangerous. The operation 



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