Even in these enlightened days the truth that empyema is a surgical disease is not as generally recognized as it should be. The fact that a few patients have recovered after simple aspiration of purulent effusions from the pleura has apparently encouraged many physicians to wait for some time and try medical measures before deciding on operative measures. The belief seems quite general that certain purulent effusions, for example, those following pneumonia, are more likely to disappear spontaneously than are those in which some other organism is present.
Some ground for this is found in one of the first careful studies of the bacteriology of pleural exudates by Prince Ludwig Ferdinand1 of Bavaria, who found that infections with pneumococcus run a much milder course than do those by the streptococcus, for example, and reported several spontaneous recoveries in pneumococcus empyema. Bearing on this subject the study of 135 cases
THE BACTERIOLOGY OF EMPYEMA AND ITS BEARING ON SURGICAL TREATMENT. JAMA. 1902;XXXIX(21):1324. doi:10.1001/jama.1902.02480470034003
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