241 
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ON THE TREATMENT OF PLEURl^iLND^ 
HYDROTHORAX. — 
By Mr. Cupiss, Diss, Norfolk. 
I HAVE perused the article on Paracentesis Thoracis/’ See. 
by Mr. Alexander Black, of the 14th Light Dragoons, with much 
attention and pleasure; and the profession in general will, I am 
sure, feel equally obliged with myself to this gentleman, who has 
kindly laid before the public his mode of treating so important a 
disease as hydrothorax. I wish it to be clearly understood, that 
the remarks which I am about to make are offered not in the 
spirit of controversy, but rather as following Mr. B.’s example, 
and with the expectation that others may be induced to submit 
to our notice their course of proceeding. 
I do most cordially agree with Mr. Black on the necessity of 
an early abstraction of the fluid in hydrothorax: but it appears 
to me that his treatment has not been sufficiently decisive in the 
commencement of the inflammatory attack of the lungs and their 
investing membranes. It is then that the disease may be com¬ 
batted with the greatest chance of success, and the effusion of 
fluid and the consequent surgical operation prevented. In my 
humble opinion, Mr. B., in the three cases detailed, has not 
carried his treatment of the active inflammation to sufficient 
extent. 
When called to a case of inflammation of the lungs, accom¬ 
panied with all the usual symptoms, I would bleed until the 
pulse had risen and fallen again, or as much as I dared without 
producing syncope. This I would follow up by the administra¬ 
tion of a ball containing aloes 5iij, resin 3 vij, digitalis 3 i. This 
would produce great nausea, relax the bowels, and operate pretty 
freely on the urinary organs. If at the end of six or eight hours 
the pulse had resumed its rapidity, I would again open the vein, 
and bleed until the action of the heart was eftectually reduced. 
This second bloodletting, if performed after a short interval, I 
have generally found to produce a decidedly good effect. In 
eighteen or twenty-four hours from the exhibition of the ball, I 
would repeat the digitalis and resin ; to which, if purging had 
ensued, I would add a sufficient quantity of tinct. opii in a 
drink. External irritants would of course be resorted to. 
In some obstinate cases I have given the extract of belladonna 
with advantage, taking care to repeat the resin daily ; for, next 
to bleeding, our sheet-anchor is diuretics. This we must especi¬ 
ally bear in mind ; for if the urinary organs are healthy, and will 
allow of our acting on them with impunity, vve possess an earnest 
