272 DISEASES OF THE PLEURA. 



a weight of twelve or fifteen pounds. Such an effusion, under the most 

 favorable circumstances, would only be very slowly reabsorbed ; but it 

 is very apt, as before said, alternately to decrease and to be repro- 

 duced, and finally, as we shall see, it terminates in most cases in con- 

 sumption of the lung. 



Pleuritis with purulent exudation, empyema, pyothorax, when 

 it occurs by the gradual multiplication of young cells (which are never 

 entirely absent in any case, in effusions of the form already described), 

 can hardly be diagnosticated otherwise than by the long duration of 

 the disease. The symptoms of compression, etc., are just the same as 

 in effusions containing little pus. As already mentioned, pleuritic 

 effusions often form during septicaemia and other diseases arising from 

 blood-poisoning, in which an abundant cell-formation takes place from 

 the commencement. However, it is not on account of its insidious 

 attack, but owing to the serious implication of the system and to the 

 blunted condition of the sensorium, that patients frequently make no 

 complaint whatever, so that all subjective symptoms are wanting, and 

 we must rely upon the objective ones. 



With regard to the termination of pleurisy, all forms of the disease 

 may end in recovery. Adhesions of the pleural surfaces, which always 

 or nearly always remain, are hardly to be regarded as rendering the 

 recovery incomplete, as patients may attain a very great age without 

 suffering any serious inconvenience on this account. It has already 

 been mentioned that the reabsorption of large effusions, even if rapid 

 at first, is apt to be extremely tedious toward the last. We must be 

 careful of diagnosticating a diminution of the exudation in all cases 

 where the line of dulness sinks in the chest. A decrease of the dul- 

 ness may also be due to the fact that the thoracic wall and intercostal 

 muscles have become more yielding, or that the diaphragm has become 

 relaxed and forced farther downward. These facts must always be 

 borne in mind in judging of the condition of the patient. An obstinate 

 exudation, which is very hard of reabsorption, should not be despaired 

 of too soon, as its absorption may at last take place after we have 

 given up all hopes of such an event. 



When the compressed lung, either being enclosed in a firm fibrin- 

 uus sheath, or its alveoli being occluded or adherent, is no longer able 

 to admit air and to expand, and when the thorax collapses, the neigh- 

 boring organs being employed to fill up the vacancy arising from 

 absorption of the effused liquid, the pleurisy must be regarded as ter- 

 minating in incomplete recovery. In persons thus affected, if other- 

 wise in good health, the remaining portions of the lung can always 

 oxygenate the blood sufficiently, and eliminate the carbonic acid, as 

 long as the patient abstains from an overactive bodily exertion ; and, 



