PLEURODYNIA.
The treatment of this affection must be carried out on the lines indicated in chronic muscular rheumatism. The relief of pain is the chief indication, but obviously in a condition liable to chronicity, opiates are not to he employed at all, or only to be reserved for the relief of rare and severe exacerbations.
Drug treatment is generally most unsatisfactory save for the alleviation of suffering, the usual routine remedies possessing but slight curative action. Salicylates and their derivatives—Aspirin, Diplosal, Salol, Novaspirin, Glycosal, Salophen, Salacetol, Saloquinine and Benzosalin are much vaunted. The best of these is Aspirin, owing to its slow absorp tion and more continuous action. The powdered drug may be given in cachet form; if administered in tablets, these must be broken up by the teeth before being swallowed, and 3o to 4o grs. may be safely administered in divided doses during the day. Antipyrine and Phenacetin are more speedy, but much more evanescent in their action. Perhaps the most lasting results are obtainable by full doses of Iodide of Sodium (co to 15 grs.) ter die in association with 5 to ro grs. Guaiacum Resin in cachets or lozenges the iodide being swallowed in solution after meals.
Ancemic patients often derive much benefit from Iron and Arsenic combined with large doses of Quinine.
Local measures for the relief of pain are always indicated. During acute exacerbations due to a concurrent neuritis which results from the fibrositis having involved the sheath of the sensory nerves, the hest pro cedure is to secure as complete rest as possible by strapping the side. This is also efficacious in those cases where an clement of true neuralgia exists.
Blisters are of undoubted value in many cases; their frequent applica tion hastens the removal of the fibroid indurations which are the main pathological change in the white fibrous tissue. Cantharidin should
always be preferred to mustard or capsicum preparations, which often tend to excite neuritis. Any of the anodyne plasters may be applied when the cuticle is perfectly restored after blistering, or the Liniments of Chloroform, Aconite or Belladonna or undiluted Methyl Salicylate may be selected, these agents being applied on lint and covered with oiled silk. Menthol, Chloral or Camphor in oil or as ointments are favourite applica ti ons.
Much good may be obtained by systematic hydropathy and a change to a warm, but not hot, dry and stimulating inland climate. Flannel underclothing to prevent sudden changes of temperature is essential, but the constant error of wearing heavy garments and of over-clothing should be guarded against.
Massage is valuable in the treatment of all forms of fibrositis. This is less easily carried out in pleurodynia than in lumbago or where the limb muscles are involved, but nevertheless careful and persevering stroking and efileurage movements and gentle tapping or tapotement should be employed assiduously for about is to 20 minutes at a time. Mechanical Vibration is also most useful, and can be employed with advantage, as kneading of the intercostal muscles is impracticable. Electricity may be freely resorted to; the Faradic current gives best results, but the static and high-frequency currents are also useful; these may be employed in conjunc tion with douching, Brine baths and other hydropathic agents.
Aqua- and Acu-puncture have been extolled, and even the cautery has been successfully pressed into the service. For immediate temporary relief the Ethyl spray may be resorted to.