PLEUBITIS 65 



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 sequela. 



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 or 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 (gr. 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 (5vj) 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 (gj), pilocarpin (gr. 

 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 

 is simple: In the seventh intercostal space, close to the 

 anterior margin of the rib, and about 1 inch above the 

 union of the cartilage and rib, shave, disinfect, and puncture 

 the chest with a small sterile trocar. It is recommendable 

 to first cut through the skin with a bistoury and draw the 

 incision to one side that the skin and muscle wounds do not 

 cover each other when the puncturing instrument is with- 

 drawn. Care should be taken to prevent air entering the 



' thorax during the operation. The fluid should be removed 

 slowly and if the dyspnea become worse, coughing induced 

 or the pulse become weak, the cannula should be instantly 

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