DISEASES OF THE PLEURA : PLEURISY. 133 



lungs is lessened the respiratory bruit is altered. In the earliest 

 stages of the disease the sounds are vesicular, but as the exudate 

 collects the sounds become indistinct or blowing and finally only 

 bronchial, and when the bronchial tubes are affected sound is lost 

 entirely. In the healthier parts of the lungs we have increased 

 vesicular breathing. 



Course and Pkognosis. Primary pleuritis is generally slow 

 in its course; the time taken by the exudate to become reabsorbed 

 is very long, unless it is removed in an operative way. When 

 the exudate commences to be reabsorbed the percussion-sound 

 becomes less dull and the respiration bruit more distinct, and if 

 the exudate becomes quickly reabsorbed the diseased side is less in 

 circumference, or it can ba better described as being flatter. 



Death may occur during the critical period of the disease by 

 collateral hypersemia and oedema of the non -affected sections of the 

 lungs, by carbon-dioxide-poisoning from defective function of the 

 lungs, by total stagnation of the circulation of the blood from 

 pressure of the exudate on the large bloodvessels and the heart ; 

 later on by exhaustion and by secondary diseases. To this class 

 belong dropsy caused by stagnation of the blood circulation from 

 weakness of the heart, and amyloid degeneration of the kidneys, 

 liver, and spleen. Death may also occur from complicating 

 diseases, such as bronchitis and lobular pneumonia. 



The prognosis is generally favorable; as a rule, very severe 

 cases of primary pleuritis make good recoveries. In secondary 

 pleuritis the prognosis depends on the original disease. 



Therapeutics. The treatment of secondary pleuritis is the 

 same as the primary; but in the former we must take into consid- 

 eration the treatment of the original diseas3. In the early stages of 

 the disease, when the exudate is collecting, we must apply counter- 

 irritants, such as liniments or plasters of mustard. When a 

 copious exudate has been formed we try to get its reabsorption by 

 stimulating the kidneys by means of acetate of potassium, acetate 

 of sodium, and juniper berries. When the heart is weak we use 

 digitalis and squills. Small doses of calomel are also useful. 



B. — ^Hydrarg. chlor. mite 0.03 



Digitalis pulv. . 0.05 



Saccharum lactis 0.5 



Fiat pulv. TSo. vi. S. — One powder three times daily. 



