In mild cases of dry pleurisy little treatment is needed. If pain is trouble some, hot applications or mild counter irritants may be sufficient to give relief; if more severe or if cough is trouble some, small blisters over the seat of pain may suffice. Much relief in these as well as in more severe cases may be ob tained by immobilizing the side by ap plying overlapping strips of adhesive plaster extending from the spine to the sternum, the first strip being applied at the end of a forced expiration.
In cases of more severe pain six to ten leeches may be applied if the patient is in ordinary robust health; but they should not be used in the young or the aged. The bleeding may be encouraged by hot fomentations or a large poultice. After the bleeding has ceased, a firm bandage applied, to restrain the move ments of the chest may give relief, or even the adhesive plasters may be used.
Ice-bags applied over the affected area and kept in place by a bandage often give equally good relief, but heat is more agreeable to many.
In the more severe cases hypodermic injections of morphine are the most effective means of obtaining relief.
If cough is troublesome, it may be re lieved by small doses of morphine or codeine. For the fever, if high, spong ing with water as cool as can be borne usually suffices.
When there is moderate sero-fibrinous effusion, in addition to these means, purging with concentrated saline solu tion may be tried in ordinarily robust patients. For this purpose half an ounce or more of saturated solution of mag nesium sulphate is given in the morning before food is taken, the object being to excite copious liquid evacuations from the bowel in order to deplete the blood and thus lead to rapid absorption of serum from the lymph-spaces generally and among them, the pleural cavity especially. During the administration of the saline, the food should be dry and the quantity of liquid taken very small.
At a later period potassium iodide is recommended, but is of doubtful effi cacy. Painting the affected side with iodine or the application of a succession of small blisters is advised and some times does good.
Should absorption not begin at the end of ten days or two weeks, aspiration of the fluid is the most rational and ef fective method of dealing with it. In the case of purulent exudation removal of the pus should, of course, be resorted to by aspiration, or incision and free drainage at once it is known to be present. Neither should there be any
delay in aspirating very large serous ef fusions with evidences of intrathoracic pressure or with dyspncea, lest symp toms of heart-failure suddenly set in.
Serous pleurisy which has not been tapped is recovered from better and more completely than one which is tapped.
Even at the end of two months or more after paracentesis, some dullness, dimin ished vocal resonance, and feeble respira tion persist. The cases of serous pleurisy are tubercular and it is thought that paracentesis withdraws from the organ ism a fluid which is its principal defense against the invasion of the bacillus. It favors the absorption of the residue of this liquid, and together with this the germs which it contains. In this way it hastens tuberculization of the lungs. Talamon (La M6d. Mod., Mar. 9, '9S).
Attention called to the neglected Levaschoff method of treating pleurisy by irrigation with normal salt solution. Despite the fact that the method was proposed eleven years before at the In ternational Congress and an account of it was published in German, it received but little attention outside of Russia. The objections to it are mainly theo retical, and those who tried it consider it a valuable adjunct in the treatment of pleurisy with effusion. The author employed saline irrigations in a consid erable number of cases of serous pleurisy with very good results. The normal salt solution was injected by means of a Potain syringe into the pleural cavity, the solution taking the place of the effusion which was withdrawn at the same time. The solution as well as the apparatus was rendered sterile by re peated boiling, and the entire operation was performed under strict asepsis. The fluid at the time of irrigation was heated to 35° C. (95° F.). Only a portion of the effusion was withdrawn,—as a rule, not more than 1000 cubic centimetres,— and of the injected saline solution only a portion remained in the pleural cavity, the object being to dilute the remaining effusion rather than fully replace it. With two exceptions, the operation caused no inconvenience to the patient. The irrigations with normal salt solu tion were followed by prompt ameliora tion of the distressing symptoms and final recovery. Tanfilieff (Vratch. Dec. 15, 1901).