In the second stage, when inflammation has already set in, the same general measures of derivation toward the skin and hot bath or soothing derivative compress are still demanded though they may be substituted by more stimulating derivatives. The bleeding of the patient into his own vessels is sought in various ways. On the continent of Europe stimulating embrocations (essential oils, ammonia and oil, mustard, etc.) are applied to the limbs. In America and England similar agents are more commonly applied to the walls of the chest and dry cupping in the same region has been resorted to. Metallic cups with small mouths and having a capacity of about a pint each, have the air rarefied by plunging into each a spirit lamp, and, on its withdrawal, suddenly applying the mouth of the cup on the skin of the costal region previously well coated with lard. Another form of cup is made with a tube and stopcock in its otherwise blind end by means of which it is exhausted with a syringe after its mouth has been applied to the skin. In the absence of both a narrow mouthed glass tumbler may be employed, the air is rarefied by inserting into it a burning spill of paper or wood for a few seconds and on its withdrawal the cup is instantly inverted on the skin. If the animal is very hairy or very thin it may be necessary to shave the part, and smear with oil and even to select a very narrow mouthed cup. When applied the cup is cooled with water or otherwise and owing to the partial vacuum the skin is strongly drawn up into it and the blood accumulates in and under the skin. It may be kept on for half an hour at a time and with ten or twelve cups on one side the patient tends to profuse perspiration establishing a strong revulsion toward the skin, and great relief. In dangerous cases three or four applications may be required in twenty-four hours. Next to this the mustard application is perhaps the safest and most valuable. The best ground mustard (black by preference) is made into a very thin pulp with tepid or cold (never hot nor boiling) water and rubbed in against the hair so as to soak the surface of the skin; it is then closely covered with paper and with a rubber or other impervious covering or, in default of better, with a close blanket and left on for two hours. By this time the skin should be thickened to the extent of at least a quarter of an inch and the derivation and relief will be very manifest. Cantharides is sometimes used but like most other severe irritants, is liable to induce sympathetic irritation in an already severely inflamed pleura, and thus to obviate all benefit. Cantharides is also liable through extensive absorption to irritate the kidneys. To counteract this Bouley gave ½ drachm doses of camphor with alleged good effect. Some practitioners make local applications of hot water and of aqua ammonia (confined) but unless very closely watched these are liable to destroy the hair follicles and produce permanent blemish.