PLEURISY 33 



Where the effusion is great in amount the inter- 

 costal spaces may be seen to bulge outward and 

 the whole side of the chest is thus altered in ap- 

 pearance. If empyema supervenes, the pulse be- 

 comes rapid and weak, and the temperature is inter- 

 mittent but always high. Sometimes, however, the 

 first indication of the empyemic condition is the 

 expectoration of pus or a pointing in an intercostal 

 space ; as the evacuation of the pus in empyema 

 must not be delayed, every endeavor should be 

 made to diagnose it early. If the presence of pus 

 is at all suspected, an exploratory puncture should 

 be made. 



Cough may or may not be present in pleurisy; 

 when present it is always painful, dry and sup- 

 pressed. 



Treatment. — At the onset of the disease there is 

 hardly any drug that will combat the pain and 

 fever and equalize the circulation better than 

 aconite or its alkaloid aconitin. Either may be ad- 

 ministered in small doses every fifteen minutes for 

 two hours, and then hourly, until the effusion takes 

 place. The tincture of aconite in two minim 

 doses, or 1-800 grain of aconitin, or a defervescent 

 compound (aconitin, 1-800 grain ; diditalin, 1-64 

 grain; veratrin, 1-128 grain), is perhaps the most 

 useful. 



Aconitin, it must be remembered, is a powerful 

 drug, and its frequent administration must be 

 stopped as soon as either the desired effect is pro- 

 duced or the physiological action of the drug 

 brought about, as manifested by the softening of 

 the pulse, champing movements of the jaws, and 

 general relaxation of the patient. When this has 

 been attained the dose is given at longer inter- 

 vals to maintain the effect. Counter-irritants should 



