584 PLEURISY. 



They are friable, puffy, extremely irregular, soaked in serum, which is 

 more or less turbid or lactescent. On removing the false membrane, 

 the pleura beneath has a rough appearance, and is studded with small 

 red conical prolongations, which are very small and very fragile. They 

 are highly vascular, and attain considerable development within three 

 days from the commencement of the disease. Sometimes the subserous 

 cellular tissue is the seat of exudation. 



" Sometimes about tHe sixth, and generally later, about the eighth or 

 ninth day, the false membrane begins to be vascular, and the formation 

 of blood-vessels goes on rapidly. At this time the adherence between 

 the membranes and the pleura becomes very firm ; the false membranes 

 are more firm, resistant, and less easy to tear. From the blood-vessels 

 of the latter there is a further exudation, and the result is their develop- 

 ment into stratified layers. Such are the changes which may be fol- 

 lowed closely in the course of ten or twelve days from the commence- 

 ment of a pleuritic attack. Ulterior changes are not observed so closely 

 with relation to the time required for their occurrence. 



" From the tenth to the fourteenth day, another stage in the meta- 

 morphoses of the false membranes commences. The organization 

 becomes completed, and the pleuritic patient may for some days remain 

 without much change in its condition. An inflammatory relapse may 

 lead to further effusions, fibrous deposits, and even to the formation of 

 abscesses within the false membranes. This second period may extend 

 over the thirtieth day, and even beyond the sixtieth; but Saint-Cyr 

 cannot speak with precision in this respect. 



" Gradually the irritation subsides, exudation is checked, absorption 

 occurs, and there is an active effort of repair. This is more or less com- 

 pletely effected; but with the complete disappearance of functional 

 disturbance, there is not always as complete a disappearance of signs of 

 the organic lesions, and remnants of fibrous tissue are developed; the 

 false membranes persist for ever. This tissue may afterwards influence 

 the character and severity of another inflammation of the pleura, being 

 vascular, and susceptible of being inflamed, and offering a great extent 

 of surface for the inflammatory process. These pathological products 

 may become the seat of transformations or deposits, whether cartilagi- 

 nous, tubercular, cancerous, or melanotic. 



"Pleuritic Effusion. The pleuritic effusion is a direct consequence 

 of the inflammation, and is as constant an anatomical character of 

 pleuritis as are the false membranes. As such, it deserves the utmost 



