In Acute Sthenic Pleuritis, active treatment is of the highest importance, as, from the extent of serous membrane generally involved, there is great probability of much effusion of lymph into the thoracic cavity, unless the inflammation be rapidly subdued. For this purpose, after such local or general depletion as the age, constitution, and condition of the patient render advisable, Calomel, in combination with Opium and Tartar Emetic, may be given in repeated doses, until slight tenderness of the gums is produced. The sooner the system is brought under the influence of Mercury, the sooner may the urgency of the symptoms be expected to subside. Should, however, the inflammation have been allowed to progress for a considerable period, and any amount of lymph be effused into the thoracic cavity, Calomel will generally fail in effecting its removal, even though the system be thoroughly brought under its influence. In the early part of the attack, an antiphlogistic regimen should be enforced, and, in the later stages, blisters in succession may be applied. The same treatment, with some slight modifications, is applicable to Acute Sthenic Bronchitis.
* Med. Gaz., July 20, 1849. Lib. of Med., vol. iii. p. 354.
Cyc. Pract. Med., vol. i. p. 149.
The Opium should he omitted from the above formula, if any signs of venous congestion are present. In these cases, it is a remedy of greet value.
1386. In Acute Sthenic Pneumonia, Calomel, combined with Antimony, is held by many to exercise a powerful influence. Dr. "Watson* considers that Tartar Emetic is best adapted to the first degree of inflammation, namely, that of engorgement, and the mercurial plan to the second, to that of hepatization. Dr. Walshe. on the other hand, asserts that no scientific demonstration of the view that Calomel is a more valuable medicine than Antimony in the stage of led hepatization exists. He thinks that mercurials are desiiable in those cases only, where, for some cause or other, Antimony is inadmissible. In the Pneumonia of Children, Dr. West observes, that a very high rank as a remedial agent must be given to Calomel. " I have been accustomed," he continues, "after due depletion, to administer it in doses of two grains combined with gr. j. of Tartar Emetic, and gr. 1/2 of Dover's Powder, and to repeat it every four hours, to children of four years of age; diminishing the Antimony after the lapse of twenty-four hours, if distressing sickness were occasioned by it; but persevering in the use of Calomel, provided the patient were not overpurged, until the disease began to yield, or the gums showed signs of mercurial action. The latter occurrence is by no means frequent, and in no instance have I met with dangerous affection of the mouth from its use." When it caused purging, Dr. West speaks highly of the value of mercurial inunction. "Under its use," he states, "recovery has taken place, even when circumstances had seemed to warrant none but a most unfavourable prognosis." He adds that he has employed it in the proportion of 3j. of Ung. Hydrarg. rubbed into the thighs and axilla; every four hours, in children of four years of age, and that he has seen the symptoms gradually subside under its use, although he never observed salivation produced by it.