All the cases of primary pleuritic which occurred in the clinic at Zurich in ten years amounted to one hundred and sixty-three cases. It often commenced like an infectious disease. Engster (Deut. Archiv f. klin. Med., B. 45, A. 3-6, '90).
Acute rheumatic polyarthritis is very frequently associated with inflammations of the pericardium, endocardium, and pleura.
The infectious element of rheumatism after entering the circulation causes, primarily, certain general disturbances of the organism, then locates itself upon and in the serous membranes. Fiedler (Schmidt's Jahrbilcher, No. 1, '92).
During the secondary stage of syphilis a specific form of pleurisy may develop, being frequently bilateral, arising and disappearing rapidly, the recovery being perfect and influenced by specific treat ment. The affection generally makes its appearance two or three months after the appearance of the chancre, and rarely as late as from eighteen to twenty-four months afterward.
The onset may be insidious and un marked by any symptoms; or acute, and accompanied by pain, cough, and dyspnma; the former being probably the more frequent. When the latter is the case, the pleurisy may possibly be diaphragmatic. Fever is, as a rule, moderate, and the rise of temperature so frequently seen at this stage of syphilis is probably often due to a pleurisy which is undetected because of the ab sence of suggestive symptoms.
Of the 14 cases studied, 3 were ex amples of dry pleurisy and 11 of serous effusion; half were unilateral and half bilateral. Duration is generally about two or three weeks if specific treatment is adopted, and prognosis is good, perfect recovery being the rule. Chantemesse (La Presse Mad., June 30, '94).
Pleuritic effusions in connection with ovarian tumors are to be regarded not as an independent complication, but as a direct result of the presence of the neoplasm. The effusion develops gradu ally and is unaccompanied by pain or fever. The accumulation of fluid is not due to the presence of the tumor or to changes in the blood, but is really an evidence of metastasis to the pleura, less frequently of peritoneal irritation trans mitted through the diaphragm. It is, accordingly, strong evidence of the ma lignant character of the tumor, provided that torsion. suppuration of the cyst,
etc., can be excluded.
A pleuritic effusion, instead of furnish ing a contra-indication to operative in terference, may show the necessity of an early operation, provided that the peri toneum is not too extensively involved. Resinelli (Annan di Ostet. e Cinecologia, No. IS, '97).
Two cases of pleuritis occurring in the course of typhoid fever, in which the typhoid bacillus was secured in pure culture from the aspirated fluid. The fluid was serous in one case, and sero sanguinolent, becoming purulent later, in the other. Achard (La Sem. Med., Oct. 19, '9S).
But in the majority of cases pleurisy occurs quite independently of any of the foregoing conditions. Examination of the effusion has shown that in many eases the disease is due to irritation of the pleural membrane by microbes, of which those most frequently met with are the tubercle bacillus, pneumococcus, and streptococcus.
Forty-four cases of pleurisy — 37 serous, 7 purulent — investigated. In most sero-fibrinous effusions there were no micro-organisms. The presence of staphylococcus pyogenes in a serous effusion does not mean that it will neces sarily become purulent. Absence of or ganisms in empyemata points most prob ably to a tubercular origin. Presence of diplococcus in metapneumonic serous effusions does not prove that they will become purulent. Exclusive presence of Fraenkel's pneumococcus usually justifies a good prognosis, notwithstanding the radical operation is the best. Levy (Archie f. exper. Path., etc., July, '90).
In the bacteriological study of cases of sero-fibrinous pleurisy there were found pneumococci in 4 (20 per cent.); staphylococci in 6 (30 per cent.) ; Eberth's bacillus in 1 (5 per cent.); tubercle bacilli in 3 (15 per cent.); and unatermined organisms in 6 (30 per cent.). The pneumococcic cases are frank, sthenic, and benign in tendency. Those due to staphylococci are more in sidious in onset and less frank in their symptomatology. The cases due to Eberth's bacillus occur in the course of typhoid fever, are latent in their symp tomatology, and are often somewhat hmorrhagic. The tuberculous forms tend to be dry and fibrinous. Fernet (La Trib. Med., Feb. 27, '95).