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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    lung develops, but rather to pleurisies followed or preceded by a catarrh which passes on to a chronic state. Louis, on the other hand, upheld the doctrine of Lgennec, and even goes farther, and states that all pleurisies are tubercular, and in a great number of cases hasten the fatal termination of phthisis. Legroux in 1850 not only denied the relation between tubercle and pleuritic effusion, but went so far as to say that the pro- duction of the fluid was a process by means of which nature closed up tubercular cavities, and by condensing the tissue of the lung rendered it less liable to the formation of tubercles. In 1854 Engster (Erlangen) :1—“ Idiopathic primary pleurisy is considered as either due to a chill or to some epidemic in- fluence, and appears to admit also of the presence of some specific organised poison, and not merely due to cold.” He states that out of 163 cases only 71 offered any explanation of the onset. In 1868 Trousseau:'2—“ The presence of pleurisy was often followed by tubercular disease through keeping up a congested state of the lungs.” In 1866 Peters:—“ By lowering the resisting power of the organism. ” Thus there were up to 1868 two doctrines as to the nature of the relation between tubercle and pleurisy with effusion. 1. Broussais and his school regarding tubercles as only an inflammatory product, tubercular disease as only a local inflam- mation, chronic to start with or arising from an acute inflam- matory state of the lung or pleura. 2. Laennec, on the contrary, states that pleurisy, even when it precedes phthisis, is only a manifestation or an effect produced by the presence of tubercles and can hasten the progress of tubercular disease. From this survey it becomes evident that these authors, from Stoll downwards, had observed pleurisy in cases which presented no other signs of tubercular disease, and which ultimately died of pulmonary tuberculosis. Such also was the state of affairs when Koch in 1880 made known his great discovery of the specific organisms concerned in the causation of tubercular disease in general. Naturally a fresh impetus was given to the subject, and then commenced the search for the tubercle bacillus in the exudate, both by means of staining reagents and by cultivation on artificial media, neither of which was attended by any positive value, and it was not until 1884 that Chauffard and Gombault, 1 “jEtiologie und Therapie der primaren Pleuritis.” 2 “Clin. Med.,” 1868, iii. 244 et seq.
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