The treatment of acute pleuritis ending in empyema will be found detailed under Empyema.
Chronic pleuritis is to be treated upon the same lines as the acute affection, and the probability being that the infection in these cases is of a tuberculous origin, it is necessary to take active steps regarding open-air treatment. The opsonic index should be determined, and in suitable cases tuberculin should be employed and repeated tapping performed as the fluid reaccumulates, or one tapping followed by air and Adrenalin injection should be carried out.
Chronic dry pleuritis is best treated by blistering, and after the relief of pain respiratory gymnastic exercises may advantageously be employed. Iodides in large doses may be given.
The acute pleuritic rf children runs a more rapid course than that of adults, and it must always be remembered that there is a greater liability of the effusion becoming purulent owing to the greater frequency of the pneumococcal infection. This is very likely to occur in those cases of pleuritis which follow upon pneumonia. Hence the necessity of an early resort to exploratory puncture. When pus is found the aspirator should be employed without delay, and there is a very fair chance that in a child a purulent pleuritic effusion may be successfully treated by tapping once or twice without resorting to the free incision and drainage necessary in the case of adults.
Though the purely fibrino-serous effusions of childhood are prone to be absorbed quickly without thoracocentesis, the same 'danger of delaying operation as maintains in the case of adults must always be kept in mind. The physician who puts his faith in blistering and drug administration will usually have his patience rewarded by seeing resolution finally set in, but too often this will be at the cost of finding permanent retraction of the chest wall, caused by the imperfect expansion of the lung through im prisonment by adhesions. Therefore the risks of procrastination in the evacuation of the fluid in every case of serous effusion must be always kept prominently before the attendant's mind, and where there is the slightest doubt about the rapidity of absorption the decision should be made in favour of early tapping, whether the patient be a child or adult.
In the form of pleuritis which attacks patients suffering from Bright's disease the same line of treatment should be pursued, but blisters, if at all employed, should be of very small dimensions, and the effects of the absorbed cantharidin upon the kidneys carefully watched. The risks of full doses of Morphia by the hypodermic syringe must be avoided, pain being more safely relieved by strapping or local anodynes.
The acute pleuritis which sometimes complicates rheumatic fever is best treated by Salicylates in full doses.