The medical diseases of children . r. Where a child has been watched through an attackof pneumonia, and the pleural effusion develops under observa-tion, it is safe to diagnose it as purulent. But when, as so oftenhappens, the child is seen for the first time after a weeks illness, andis then found to have an effusion, it is almost impossible to go by thehistory of the case ; for as has been said, a tuberculous effusion mayoriginate suddenly with high fever, dyspnoea, cough and pain in thechest, so that what seems to be an empyema following pneumonia,may easily turn out to be serous effusion.
The medical diseases of children . r. Where a child has been watched through an attackof pneumonia, and the pleural effusion develops under observa-tion, it is safe to diagnose it as purulent. But when, as so oftenhappens, the child is seen for the first time after a weeks illness, andis then found to have an effusion, it is almost impossible to go by thehistory of the case ; for as has been said, a tuberculous effusion mayoriginate suddenly with high fever, dyspnoea, cough and pain in thechest, so that what seems to be an empyema following pneumonia,may easily turn out to be serous effusion. The localized bulging ofa pointing empyema is of course definite evidence of pus, but a diffuseoedema of the affected side may occur in tuberculous cases. A signwhich Dr. Still has pointed out to the author is that of enlargementof an intercostal gland on the affected side (Fig. 27). This is morecommon in serous than in purulent cases ; but as it is often absent inthe former, its absence is not an indication of an empyema. Such an. Fig. 27.—Tuberculous Fleurisy : showing enlarged Inter-costal Gland. (Note, the glandular swelling was emphasized byshading for photographic purposes.) 136 INFECTIVE DISEASES enlarged gland is often better felt than seen. The examination of theblood gives the best guide ; but even this is not infallible. A highleucocytosis, especially where the polymorphonuclear cells are propor-tionately increased, is very strongly in favour of the effusion beingpurulent. Rapid disappearance of the fluid is in favour of a serouseffusion. As a rule then, even if the diagnosis of fluid in the pleural cavityis easily made, it is wisest to explore the chest to ascertain the natureof the effusion. The cells present in the fluid should be tuberculous cases the majority of them are lymphocytes. Prognosis.—In a child the prognosis is not so good in the case ofa tuberculous pleural effusion as in empyema. Although the acutesymptoms as a rule pass away quickly
Size: 1579px × 1583px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1910, booksubjectpediatrics, bookyear1
