Surgery in World War II. Thoracic Surgery

what he would say about a patient who had a purulent pleural effusion, and received the smug and tautological reply that the patient had an empyema. Perhaps our present-day student-physician would be more sophisticated, but he still tends to be casual in his attitude toward this highly significant manifestation of disease. A monograph on the subject is, indeed, needed. A somewhat unusual organization in which chapters describing the rarer causes of pleural effusion-pancreatitis, systemic lupus erythematosis, rheumatoid arthritis, and cirrhosis of the liver-come first has the pedagogic value of arousing interest in the dramatic possibilities of pleural effusion, and reminding us that it occurs in a wide gamut of diseases. These chapters are followed by others on eosinophilic and cholesterol pleural effusions; findings which are not infrequent, yet all too often misinterpreted. The final chapter on general considerations summarizes the differential diagnosis in terms of common disorders, and provides a rational and positive approach to the diagnostic use of pleural effusion. In addition to the usual study of cell type, specific gravity and cultural and cytological characteristics, the monograph emphasizes the value of amylase and lipase determinations in questions of pancreatitis, and, when indicated, "LE cell" studies and glucose levels-the last because they are often much lower than blood glucose levels in rheumatoid arthritis. Finally a cogent argument is made for needle biopsy of the pleura, and its technique is discussed. Although the tone of the text is factual and practical, an excellent reference list at the end provides the student with a wide field for further study.