Prophylaxis consists in prevention, i.e., the best possible treatment of the causative diseases. Furthermore, in the care and hardening of the respiratory passages and the lungs, and in the watchful care of the mouth and throat.
attempt may be made to abort a very recent and isolated fibrinous pleurisy by diaphoresis. The patient is kept in bed and on a fluid diet as long as he has temperature. In more severe cases. the application of overlapping strips of adhesive plaster, producing pressure and covering the diseased spot and its vicinity, will be found useful for the purpose of fixation of the affected side and for the relief of pain. The application of iodine to the affected side is a favorite meas ure. It is rarely necessary to administer codeine or morphine even for a short time on account of the severe pain. (See above in the treatment of croupous pneumonia.) Whenever a pleuritic effusion has taken place, rest in bed must be advised even in cases of small effusion and absence of fever. Sitting up and all unnecessary exertion are to be avoided as much as possible. As long as temperature is present a fever diet is indicated (compare with bronchopneumonia). It is perhaps advantageous to curtail the ingestion of water during the stage of effusion. A nutritious diet consist ing of an abundance of eggs, meat, beef juice, butter, extract of malt, etc., is in place in a febrile case, and particularly in cases running a prolonged course. One seeks to stimulate the appetite and improve the nutrition of the patient.
As long as high temperature exists, cold chest compresses changed every two hours are generally useful; the patient in this case, however, should be guarded against active motion and exertion. In older children in cases of high temperature and severe pain, an ice cap ;nay be applied for relief in the beginning; and, if necessary, cold applications to the head. When the fever subsides and in cases of prolonged course warm chest compresses are indicated to facilitate absorption. Many physi cians apply ointments locally, although their value has never been proved (ung. potass. iodide, iodine, or salicylic-vasogen). They had better be used only after the termination of the effusion, at which time inunc tions of green soap act well.
Of the internal remedies salicylates often prove of decided value for absorption (sOd. salicyl., Gni.:150.0 c.c. (30-120 gr.-5 oz. dilu ent) 5 times daily, but better 0.25-0.75 Gni. (4-12 gr.) aspirin in sugar water, 3 times daily, not only in pleurisy based on a true acute articu lar rheumatism, but also in forms of unknown cause. In large effusions, absorption is stimulated by means of diuretics; for instance, infus. digi talis 0.2-1.0 Gm.:100 c.c. (3-15 gr.:31 oz.) if necessary with addition of 2.0-5.0 Gin. (15-75 gr.) of diuretin 10 Gm. (21 dr.) 3 times daily. Decoct. cert. chime repeated several times acts /LS a stimulant to absorption and to the appetite. Camphor or caffeine are employed subcutaneously in weakness and collapse. Rest in bed is to be maintained until complete absorption of the effusion has taken place. In protracted cases sitting up in bed may be cautiously allowed, even when small amounts of effusion are still present; but fever must be absent.
In dragging cases with antenna, preparations of cinchona or the syrup of the iodide of iron, malt extract with iron, or ferrous iodide, levico water and codliver oil during the winter, are adNisable in addi tion to warm chest compresses. Remaining out of doors as much as possible in the fresh air and sunshine with little or no exercise, and brine or sea-salt baths are to be recommended. Fango packs arc also to be considered, and, furthermore, in chronic cases a sojourn in the country, or in a warm climate during the winter, is to be recommended.
Recently good results are reported from injections of thiosinamin and fibrolysin in cases of resulting adhesions and pleuritic thickening (Friedlander, Mendel). According to the splendid results observed even in interstitial inflammation and cicatrization this method of treatment indeed deserves notice. General and pulmonary hygiene, also cornet playing, massage as well as gymnastics, which may be carried out in connection with salt-water baths, as for instance in Kissingen, Ems, Reichenhall, and sojourn in the mountains are the best methods of pre venting contractures and imperfect expansion of the lungs after the termination of a pleurisy.