The pleural sac is kept in its normal condition of simple moisture by a definite lymph circulation; the stomata both on the visceral and parietal layers, in health, keep this fluid down to certain limits. The thorax being a closed sac and the pressure within being negative, it follows that the aspirating qualities are usually most efficient. Samuel West1 speaks of this as "the lymphatic pump," and shows that with any collection of fluid within the pleura there must be some mechanical obstruction to the operation of this pump. It is probable there is always more or less absorption of fluid through these minute mouths, and that the attempt of Nature in an inflammatory reaction to block them completely, is ineffectual.
In the last few years the bacteriologic examination of exudates in the thorax, systematically carried out, has shown to a certain degree the prognosis, and also the methods
BILLINGS FT. PURULENT PLEURITIS: PATHOLOGY AND TREATMENT. JAMA. 1909;LII(4):266–268. doi:10.1001/jama.1909.25420300006001b
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