HAMORRHAGIC EFFUSIONS are occa sionally met with and are usually due to tuberculosis of the pleura, less often to carcinoma. They may occur also in Bright's disease, cirrhosis of the liver, and in malignant cases of the eruptive fevers. They are also occasionally met with in persons apparently free from any of these diseases, although even these may be tuberculous.
Prognosis.—The pleura not being a vital organ, disease of it can prove fatal only (1) from septic absorption, (2) from extension of disease to other structures, or (3) from the volume of the exudate interfering with the functions of neigh boring organs.
The liability to sepsis depends on the nature of the infective organism. Strep tococcal infection is the most grave, as even after free drainage is established it may give rise to general sepsis. Pneu mococcal cases usually run a favorable course, a few cases recovering after aspi ration alone. In tuberculous cases the exudation is often sterile; if the infec tion is confined to the pleura, they do well.
After-history of 300 cases of pleu risy with effusion, the diagnosis being confirmed in each case by tapping. It was possible to trace but 152 of the cases and upon these the report was based. In none of these cases was there evidence of tuberculosis of other organs at the time of tapping. Of the 152 cases, SO were found to be in good health at the end of from 5 to 21 years; 37 were well at the end of periods under 5 years; 23 had contracted tuberculosis; 14 had died of other causes. The conclusions based on the report were that SO per cent. of uncomplicated cases of pleurisy with effusion are well at the end of 5 years and that more than half of them are well at the end of 10 years or more. Only 15 per cent. developed demonstra ble tuberculosis and in many of these only after long periods of time after the pleurisy, as high as 16 and 14 years in some instances. only 3 per cent. showing that disease after 2 years. The type of tuberculosis was a mild one. A study
of the clinical records :showed that only one-fourth of the cases well at the end of 3 years or over had any family or past history of tuberculosis. The family history is considered to be of great value in determining prognosis; in fact, of more value than the physical signs at the time of the pleurisy. The fact that no attempt was made to discover what pereentag,.e of the cases of effusion was due to tuberculosis means that the prog nosis is good whatever be the cause. In discussing this paper Osier said that most members of the profession had held the idea that serous effusion was a very serious condition. This paper put it in a much more favorable light. Harris said that the statistics in England were much more unfavorable than these, the effect of pleurisy being regarded very Se o usly. There it is the rule of insurance companies not to accept cases of pleu risy until after a lapse of 5 years, tuber culosis being feared. Jacobi said that the fact that most people of advanced age showed signs of previous pleurisy proved that prognosis was not so un favorable in that disease. 11. C. Cabot (Ame•. Medicine, May 17. 19021.
In sero-fibrinous pleurisy the danger is from the bulk of the fluid, the occur rence of double effusion, and from the occurrence of pericarditis. Even large effusions may absorb rapidly, but are more likely to do so after aspiration of part of the fluid.
In children and young adults, acute primary sero-fibrinous is rarely fatal, ab sorption taking place within a few weeks. Tuberculous cases are, of course, less favorable, as the bacilli usually invade other structures, especially the thoracic glands.
In advanced age serous effusions are much less frequent and the prognosis is less favorable.
Treatment.—In all cases rest in bed is necessary, and should be continued until the acute symptoms abate. In mild cases this care is necessary on account of the frequency of the tuberculous origin of this disease.