A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint.

Austin Flint I

Date:: 1884

Credit: A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

139/1212 page 129

$rule. It will be seen hereafter that it occurs as a complication of pneumonitis and phthisis, but it is generally, under these circumstances, subacute. Pri- mary pleuritis does not lead to pneumonitis, except that the air-cells in imme- diate pi'oximity to the pleura are sometimes involved; nor does it involve any tendency to bronchitis. It is a unilateral disease, that is, it affects the pleura of one side only. The exceptions to this rule are so infrequent, that the dis- ease, when bilateral, or double, may be presumed to be secondary to another pulmonary affection, generally tuberculosis. I have met with a case of double pleuritis, accompanied with a large effusion into both pleural cavities. Death took place by apnoea, in this case, and pleuritis was found to be consecutive to miliary tubercles in both lungs. Such cases are extremely rare. Pathological Character—The disease is an example of acute inflam- mation affecting a serous membrane, and may be regarded as a type of all acute serous inflammations. The general pathology of inflammation has been considered in the first part of this work, together with the local varia- tions when different structures are inflamed. Pleuritis and other serous in- flammations are characterized by fibrinous exudation as a constant event [tnde page 37). This event, the accumulation of liquid in the closed cavity, and the development of connective tissue, are characteristics of these inflam- mations. The accumulation within the pleural cavity of a purulent liquid, is the anatomical feature of a variety of pleuritis to be considered under a dis- tinct heading (empyema, jiyothorax, suppurative pleuritis). The form of the disease under consideration may be distinguished as a serofibrinous pleuritis. Causation.—Acute pleuritis may be produced traumatically by contusions, especially if accompanied with fracture of the ribs, and by penetrating wounds. It is remarkable, however, that severe injuries of the chest often occur with- out giving rise to general pleuritis. The disease is attributed, in certain cases, to the action of cold. This has so long been considered as a frequent source of a great number of diseases, that patients at once are led to refer an attack to some exposure, often, doubtless, when it had no causative agency, or, at most, acted only as an exciting cause. Still, it is probable that the disease sometimes originates in this way. In the larger proportion of the cases in which it is not traumatic, it is spontaneous, that is, it proceeds from an un- known internal cause. It occurs sufficiently often in persons affected with the diseases of tlie kidneys embraced under tlie name Bjcightlsjiisease, to show a pathological connection ; and in these cases it is probably referable to the accumulation of urinary princij)les in the blood. It is developed occasionally in connection with aciit£Lailicular rheumatism. It is an occasional sequel or concomitant of scarlatina, measles, and coniuiued_Jever. It enters into the history of scorbutus, pyaemia, and se]>tica3mia. The liability to the disease is not equal at all periods of life. It is rare in infancy. It is not uncommon in childhood. C^t occurs in youth and middle life much more frequently than in old ag(Q It is as rare in old age as in infancy. The proportion of males over females, among cases of this disease, vastly pre- ponderates. There do not appear to be any causative influences pertaining to constitution, season, climate, or locality. The acute variety of jileuritis is not of very frequent occurrence, the subacute or chronic variety being more frequently met with. It is less frequent than pneumonitis, and, in relative frequency, bears no comparison with acute bronchitis. Diagnosis—Although the symptoms which enter into the clinical history of acute pleuritis are sufficiently characteristic to ])oint to the existence of the disease, they are not sufficient for the diagnosis in all cases. The chai'acter- 9$