PLEURITIS, Acute Fibrino-serous.
The patient should be at once placed in bed on a hair mattress in a well-ventilated room. The first indication for treatment in all cases is the relief of pain. When this is severe there is nothing so reliable as a dose of Morphia hypodermically, but in the majority of cases the drug by the mouth meets all requirements, or after one hypodermic dose of gr., mouth administration may be employed to keep up the analgesic effect by small and oft-repeated doses. As soon as the severity of the pain is alleviated the narcotic should be suspended, but coughing being an un necessary phenomenon it may be resorted to again should this symptom become troublesome.
Local measures should be always preferred for the relief of pain when this is not severe and intense, and they should be resorted to in the most severe cases before the action of the narcotic has been allowed to pass off.
A time-honoured routine which still holds a high place in the treatment of the early stage of pleurisy is poulticing the affected side of the thorax with hot linseed. The first cataplasm may advantageously consist of half-crushed linseed and half-powdered mustard, linseed only being employed afterwards till the pain disappears. There is no advantage in persevering with any form of poultice once the presence of fluid effusion has separated the two inflamed layers of the affected pleura. A convenient method of applying a uniform soothing heat to the surface of the chest is to cover the skin with a thick layer of .\.ntiphlogistine or of the U.S. Cataplasma Kaolini, which consists of kaolin, boric acid, thvmol, methyl salicylate, and peppermint oil, made into a paste with heated glycerin. Spongio-piline, or a thick layer of cotton-wool or Gamgee tissue covered with thin mackintosh dressing, acts in the same way. Poulticing is preferable to Turpentine or other forms of stupe or fomentation, which are liable to produce vesication if not skilfully employed. Often an excellent pain-relieving application may be extemporised by causing the patient to lie upon a rubber bottle partially filled with very hot water.
Cold applied in the form of Cold Compresses, Ice-bags, Leiter's Tubes, or Ether Spray may be employed when heat fails, and some authorities maintain that this treatment should always be preferred to hot applica tions, but the feeling of the patient may be safely trusted in all cases to decide the routine merits of the two plans. Lin. Chloroformi, Lin. Bella donnas, Lin. Aconiti, &c., are preferred by some physicians; when employed they should be covered with oiled silk, absorption of contained alkaloids being watched for.
Blisters have been employed as a routine for the relief of pain much more commonly in the past than in modern practice. Though their beneficial effect is undoubted, they interfere with the use of other applica tions or methods which may afterwards be indicated, and they prevent accurate physical exploration of the chest. At a later stage they may advantageously be employed to hasten the absorption of effused fluid, and they should always be resorted to early for the relief of the pain of dry pleurisy.
Leeching, like blistering, was formerly resorted to frequently for the relief of pain, and it may be employed still with advantage in severe cases. The effect can be heightened by the application of a cupping-glass over the bites.
Some physicians adhere to the old routine of dry cupping, but this is often impracticable in patients with thin chest parietes.
Venesection is now seldom resorted to for the relief of pain in acute pleuritic, but in some very severe cases it may be the only means of saving life. In the acute traumatic form of the disease, often complicated with a fractured rib, there should be no hesitation in freely opening a large vein in the forearm and permitting to to 20 oz. blood to escape. Cupping over leech bites is generally a futile procedure for the relief of pain and urgent dyspncea in such cases, and when blood-letting is clearly indicated venesection should always be selected. A brisk saline purge intensifies the action of the operation, and may with advantage be substituted in mild cases.