The aetiology, immediate and remote prognosis of primary pleurisy with serous effusion / by C.E. Hedges.

  • Hedges, Charles Edward, 1866-
Date:
[1900]
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Licence: In copyright

Credit: The aetiology, immediate and remote prognosis of primary pleurisy with serous effusion / by C.E. Hedges. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tunately a rare occurrence ; and even if the inflammation does extend to the fibrous covering of the pericardium, as denoted by a pleuro-pericardial friction sound, it progresses no further. We may find on examination the total or partial collapse of the lung, with corresponding falling in of the chest wall of the same side, and perhaps the lung bound down by firm adhesions, and thus for ever restricting the expansion of that lung. In spite of all this, the patient is discharged as cured, and is thus registered in the hospital statistics at the end of the year. It was first impressed upon me during my term of office as house-physician under Sir Lauder Brunton at St. Bartholo- mew’s Hospital that these patients would well repay one for further observation and watching through several years, and that one could arrive at more correct statistics with regard to the prognosis of the so-called “idiopathic pleurisy” or pleu- ritis a frigore; in fact, it would be well to follow all cases of pleurisy with effusion whether the abnormal physical signs have disappeared or not. I have often heard Dr. Gee state, when going round the ward, that you never know what lies at the bottom of a pleural effusion; and I have often heard it stated that it is “ much less grave to have an attack of pneumonia than to have a pleurisy with effusion,” and this in spite of the fact that the annual death mortality from pneumonia is stated at 1089 per million, and that of pleurisy as only 42 per million. This dictum which I have just quoted shows the necessity of considering the prognosis of pleurisy with effusion from an immediate and remote point of view, i.e. one must consider the mortality not only due to the pleuritic effusion itself, but also due to the complications which follow it, or to the causa causans of the pleurisy, and with which it must be intimately connected. The point was also all the more impressed upon me by the report of a lecture by Dr. Kingston Fowler in the Clinical Journal of February 3, 1897, tending to show that all, or nearly all, these cases terminated sooner or later in the development of tubercle in some part of the body. One knows that in all cases of phthisis in some part of their course pleurisy always arises as a complication, and probably acts as a conservative element, in that it must check the formation of pneumothorax by, as it were, gluing the two surfaces of the pleura together, and thus closing, or partially closing, the potential cavity of the pleura. It is still a debated point as to whether even these cases are really due to the action of the tubercle primarily, or simply to the spreading of inflammation from the periphery of the lung in