19 
We  all  know,  how  difficult  it  sometimes 
is,  to  establish  the  clinical  diagnosis  of  the 
residues  of  old  effusions;  of  course,  we  do 
not  refer  to  the  large  residues,  to  exten¬ 
sive  adhérences  and  symphysis,  but  to  small 
and  minute,  almost  vanished  rests. 
The  patients  rarely  came  in  our  obser¬ 
vation  during  the  first  period  of  the  “mani¬ 
fest  disease”.  They  mostly  arrived  in  an 
advanced  stage  of  the  disease. 
In  the  last  period  of  the  disease  there 
are  cases  with  immense  effusion,  which  may 
attain  one  or  all  the  serosae.  The  experimen¬ 
tation  reproduces  this  fact.  The  inoculated  ani¬ 
mal  shows  only  effusion  in  one  serosa,  or  may 
present  polyorrhomenitis.  The  parasite  is  ob¬ 
served  in  the  fluid  of  effusion  in  man  and  ani¬ 
mal.  These  forms,  attacking  the  serosae,  are  dis¬ 
cussed  in  another  part.  The  most  interesting 
point  in  this  question  of  effusion  is  that  the 
experimentation  reproduces  in  animals  all 
varieties  of  effusions  in  man. 
All  of  them,  sanguinolent,  serous,  fibri¬ 
nous,  serofibrinous,  etc.  were  reobtained  in 
monkeys,  rabbits,  rats  or  guinea-pigs.  We 
went  further  and  succeeded  in  obtaining  in 
chronic  forms,  residues  of  such  effusions 
alike  to  those  of  the  human  cases.  The  spots, 
the  thickening,  the  adhérences,  etc.  are  re¬ 
mainders,  which  may  be  observed  in  animals. 
To  the  silent  or  almost  indiscernible  strugg¬ 
le  of  the  anterior  period  succeeds  a  stage 
with,  mote  or  less,  abundant  clinical  symp¬ 
toms.  The  human  pericarditis,  caused  by  the 
Oidiutn,  has  various  forms.  We  observe 
the  most  varied  aspect,  from  small  attacks 
to  large  collections  of  fluid  with  absolute 
and  extensive  dullness  on  percussion,  abo¬ 
lishing  of  murmurs,  disappearing  of  the  shock 
and  deviation  of  the  apex  of  the  heart,  pro¬ 
trusion  of  the  precordial  region,  with  varia¬ 
tions  of  TRAUBE’S  space,  according  to 
the  position  of  the  patient  etc.,  and  even  the 
sequel  of  dyspnoea,  angina  pectoris,  arrhyth¬ 
mia  of  the  pulse  and  fall  of  the  blood 
pressure  is  not  missing. 
The  pleuresy  may  be  uni-  or  bilateral. 
Cases,  in  which  there  is  no  liquid,  which 
sometimes  may  exist  in  truly  remarkable 
quantity  (our  first  observation,  followed  by 
post-mortem  examination)  are  rare.  The  exa¬ 
mination  of  such  patients  is  today  indicated 
by  clinical  rules  for  the  diagnosis  of  collec¬ 
tions  of  fluid  in  the  pleural  cavities. 
The  inspection,  palpation,  percussion, 
auscultation  and  dislocation  of  some  organs 
in  patients  suffering  from  pleural  effusions, 
caused  by  the  Oidiutn  brasiliense ,  reveal  many 
varieties,  from  small  deviation  of  the  xiphoid 
process  to  almost  complete  disappearing  of 
the  respiratory  movements  and  considerable 
development  of  a  hemithorax;  from  dimini¬ 
shing  to  abolition  of  vocal  vibrations,  not  to 
forget  deviations  of  heart  and  liver  and  ac¬ 
centuation  of  those  vibrations  above  the  re¬ 
gion  of  the  effusion.  The  percussion  furni¬ 
shes,  undoubtedly,  precious  informations  at 
the  level  of  or  above  the  effusion.  In  the 
first  case  we  find  variations  from  the  abso¬ 
lute  dullness,  passing  through  the  diminished 
resonance,  from  the  not-tympanic  infraclavi- 
cular  resonance  to  the  absolute  dullness  of 
the  same  region,  also,  in  the  case  of 
large  effusions,  intercostal  fluctuation  and  in 
those  of  1/3  or  1/2  of  the  pleural  cavity  Skoda’? 
sound.  To  the  variations  in  the  lines  of  dull¬ 
ness  (of  which  DAMOISEAU’s  curve  is  the 
prevailing  figure),  including  those  of  the  tri¬ 
angles  of  GARLAND  and  AUTR1C,  the 
above  cited  signs  of  percussion  are  added. 
There  are,  furthermore,  signs  of  auscul¬ 
tation  :  diminishing  or  disappearing  of  the 
vesicular  murmur  and  the  vocal  repercussion, 
soft  bronchial  breathing,  with  or  without 
egophony,  etc.  and  even  absolute  silence  with 
complete  abolition  of  the  vocal  repercussion. 
We  cite,  also,  coughing,  dyspnoea,  fever, 
tachycardia  (with  weak  pulse),  oliguria,  so¬ 
metimes  albuminuria,  etc.  The  fluid  of  the 
pleural  effusion  shows  various  characters;  the 
fibrinous  aspect,  however,  always  prevails. 
Sometimes  it  contains  blood.  In  animal  ex¬ 
periments  the  same  alternatives  are  obser¬ 
ved.  Cytological  research  reveals  a  leucocy- 
tosis,  which  has  not  yet  been  wholly  studied 
and  defined.  The  examinations  of  these  fluids 
are  negative,  as  regards  KOCH’s  bacillus. 
