In acute pleurisy, occurring in a robust and previously healthy subject, free blood letting should be at once resorted to. If there is a sharp stitch in the side, and the respi ration is short, quick, and restrained, the patient should be bled, in the upright position, from a large orifice in the vein, until the pain is relieved, and he can draw a full breath without discomfort, or until he is about to faint; and if the pain and difficult breathing should return, and the pulse continue firm and hard, either the venesection must lie repeated, or leeches must be freely applied to the painful side. The bowels should he freely evacuated, after which caleinel should be given, guarded with a little opium, to the extent of producing slight mereurialization, with the view of checking the effusion of fluid. The more rapidly the system can be thus affected, the better, and hence it has been recommended (by Dr. Walsh) that during the first six hours a grain and a half of calomel combined with a sixth of a grain of opium (or more, if the pain continues acute), should be given every half-hour; while mercurial ointment is rubbed into the skin of the side, near the arm-pit, every fourth hour. Care must be taken that neither decided salivation nor narcotism is induced; and as soon as there is any evidence from the breath, or from the appearance of the gums, that the mercurial action has been established, the further administration of the calomel and the ointment must be suspended. After the pain and fever have ceased, we must facilitate the absorption of the fluid by diuretics. A pill composed of half a grain of digitalis, a grain of squills,
and three grains of blue pill taken twice a day, usually acts efficiently; and the com pound tincture of iodine of the London (not the British) Pharmacopceia, in doses of twenty minims, taken, largely diluted, three times a day, has been strongly reconunended.
There has been considerable discussion of late years as to how far the operation of tapping the chest, and letting out the fluid, is justifiable in this disease. The best authorities are of opinion that in simple pleurisy it ought never to be performed unless (1) the life of the patient is ill danger from the continued pressure of the fluid in the sack; (2) unless all other means of getting rid of the fluid having failed, the patient is evidently losing strength daily; and (3) unless there is good reason to believe that the fluid consists of pus, in which case it should be let out. In all cases in which the operation is contemplated, a grooved needle should be introduced into the pleura. By this means, we not only ascertain the actual presence of fluid, but we discover its nature. If it be serious, it will flow readily along the groove, and trickle down the patient's side; if it be purulent and thick, a drop or two will probably be visible at the external orifice, and when the needle is withdrawn, its groove will be found to contain pus. The puncture thus made is quite harmless, and inflicts very little pain.