Idiopathic pleurisy a frigore is really of a tuberculous nature: sometimes pri m a r y, sometimes secondary to pulmo cases were "idiopatliic,"—that is, bad no discoverable cause. Of the remainder, 21 were certainly and 22 probably tubercu lous (together equal 36.5 per cent.), 7 were post-rheumatic, 8 post-pneumonic, 2 post-influenzal, 12 traumatic, 5 com plicated by morbus cordis, 5 secondary to neoplasms, and 12 complicated in fective diseases. Grober (Sonder-Ab druck aus Centralb. f. inn. Med., No. 10, 1902).
Pleurisy due to the pneumococcus may be primary, but is often secondary, to pneumonia. The exudation into the pleura caused by the pneumococcus may be plastic or fibrinous, such as occurs usually in pneumonia; it is occasionally sero-fibrinous, but more frequently it is purulent. The pneumococcus is usually the cause of empyema in children in many of whom no preceding pneumonia can be demonstrated. The pleurisy is usually primary unless an interval of a day or more occurs after the deferves cence of pneumonia before the symptoms and signs of pleural effusion set in; but there may be no interval, the empyema beginning before the pneumonia ends, or the interval may be protracted even to several weeks.
Parapneumonic pleurisy generally be gins with the pneumonia, or at least fol lows its appearance very closely. In most cases the effusion is discovered on the second or third day of the illness, develops rapidly, and may disappear as quickly. It is exceptional to see a para pneumonic serous effusion become puru lent. In the very rare cases where it does so, it is not due to pneumococci, but to the ordinary micro-organisms of suppuration: streptococci or staphylo cocci. Lemoine (La Sem. Jan. 13, '93).
Streptococcal pleurisy is the typical empyema of the adult. The infection may take place directly from the lung as from broncho-pneumonia, gangrene of the lung, pymmic abscess, or tubercle; or nary lesions. The most certain diag nostic method is the microscopical ex amination of the centrifugalized deposit from the effusion. In cardiac and renal cases there is nothing but scales of endo thelium formed of a few cells and also a few red corpuscles: that is, the con tents of an oedematous exudation. In pleurisies due to the pneumococcus, streptococcus, etc., the chief elements are multinuclear leucocytes; the red corpuscles are more numerous. Finally, in tuberculous cases there are lympho cytes and numerous red corpuscles. The
lymphocytes not looked upon as having migrated from the vessels, but as the locally formed product of the tubercu lous process. The frequent cure of acute idiopathic pleurisy does not disprove its tuberculous nature, for it is the most curable of the tuberculoses of the serous membranes. Dieulafoy (Brit. Sled. Jour., from Gaz. degli Osped., July 4, 1901).
Of 1000 cases of phthisis at all ages, SS were preceded and 68 accompanied by pleurisy. Of the SS in which pleurisy was a forerunner there was a more or less clear family history of phthisis in 40. In S more than ten years elapsed between the pleurisy and the diagnosis of phthisis; in 10 the phthisis immedi ately followed the pleurisy; the average time between the two was 4.3 years. Thus 8.8 per cent. of all the cases of phthisis were preceded by pleurisy—a percentage sufficiently high to justify Penzoldt's dictum that pleurisy should always raise the suspicion of tubercu losis. In the classification of cases of pleurisy clinical data were alone avail able, since specific organisms were found in but a fraction of the total number. Of 210 eases of pleurisy the effusion was probably a transudation rather than exudation in 10. Of the remainder, 148 were accompanied by effnsion,-52 were "dry." The right side was affected in 101, the left in 92, and both sides in 7. Males were affected more often than females (140 to 60). The cases were most numerous in the second and third decades of life; this corresponded to and was consequent on the age of incidence of phthisis. More than half the 200 from more distant parts, as from tion of the esophagus, abscess in the mediastinum, subphrenic abscess, caries of the spine, etc. The germ may come from the blood in general diseases, as septicemia, fevers, erysipelas, etc.
Study of various reports in staphylo coccal pleurisy show that the condition is of extremely slow, irregular, and pro longed course. The fluid is often serous in the early stages, subsequently becom ing purulent, but it does not contain flakes of fibrin. Suppuration is usually free. The staphylococcus is not very specific and only tends to develop in those who are already in bad health or who are convalescing from some serious illness. The diagnosis from tuberculosis is often difficult. Lop and Monteux (Revue de Mad., Apr. 10, '98).