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If a sinus passes through a muscle, the repeated contractions tend to prevent healing until the muscle is kept at rest by a splint, or put out of action by division of its fibres. The sinuses associated with empyema are prevented from healing by the rigidity of the chest wall, and will only close after an operation which admits of the cavity being obliterated.
It usually occurs in connection with tuberculous conditions, such as bone or joint disease, psoas abscess, or empyema, which have opened externally, and have thereby become infected with pyogenic organisms. It is gradual in its development, and is of a mild type throughout. [Illustration: FIG.
#Hypertrophic Pulmonary Osteo-Arthropathy.# This condition, which was described by Marie in 1890, is secondary to disease in the chest, such as chronic phthisis, empyema, bronchiectasis, or sarcoma of the lung. There is symmetrical enlargement and deformity of the hands and feet; the shafts of the bones are thickened, and the soft tissues of the terminal segments of the digits hypertrophied.
Wasting of the muscles, especially the extensors, in the vicinity of the joint is a constant accompaniment of arthritis. On account of the involvement of the articular surfaces, arthritis is apt to be followed by ankylosis. The term empyema is sometimes employed to indicate that the cavity of the joint contains pus.
A bibliography of his writings on the subject will be found in a 'Study in Early Renaissance Anatomy' in C. Singer's Studies in the History and Method of Science, vol. i, Oxford, 1917. As a clinical author his reputation stands high, perhaps too high, his descriptions of pneumonia, empyema, diabetes, and elephantiasis having especially drawn attention.
When the main incidence of the infection affects the synovial membrane, the clinical picture may assume the form of a hydrops, or of an empyema in which the joint is filled with pus. It is well seen in joints which are superficial such as the knee, ankle, elbow, and wrist.
Hillier speaks of an instance of congenital diaphragmatic hernia in which nearly all the small intestines and two-thirds of the large passed into the right side of the thorax. Macnab reports an instance in which three years after the cure of empyema the whole stomach constituted the hernia.
But when her deck is all soot and nastiness, when she has quartered her vermin on her passengers, and goes gurgling along, as if she had an Empyema under her pleura costalis; when she pitches into the waves, as if to punish them, and tramples on their crests, as if to crush them under her keel, why all the brass you want is "ÆS TRIPLEX;" and there is no varnish in the world that will enable you to put a good face on it.
In the departments of general medicine not as yet entirely appropriated by specialists it will suffice to mention scrofula, pleurisy and pneumonia, hemoptysis, empyema, phthisis, cardiac affections, diseases of the stomach, liver and spleen, diarrhoea and dysentery, intestinal worms, dropsy, jaundice, cancer, rheumatism and gout, small-pox, measles, leprosy and hydrophobia, all of which claim more or less attention.
Peripneumonia and pleurisy are both inflammations of the chest, the former affecting the lungs, the latter the diaphragm and the pellicle which lines the ribs. The prominent symptoms of both diseases are pain in the chest or side, cough and fever and dyspnoea. Accidents or sequelae are hemoptysis, empyema and phthisis.
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