The evening world. [volume] (New York, N.Y.) 1887-1931, 1921-02-26
WILL CARUSO SING
AGAIN. SPECIALIST
DISCUSSES HIS CASE
Admissions, a Result of Pleurisy,
Likely to Impair Lung
Power.
WHAT PLEURAL SAC Is.
Extremely Rare for Membrane
to Return to Normal
Condition.
WHAT PLEURAL SAC is.

Is Caruso still In danger and, II he
RECEIVERS, will he ever sing again?
This question is causing considerable
discussion in the musical world at the
present moment An eminent author
ity on the lungs and heart, but who
for obvious reasons desired to have
his name withheld from publication,
considered the case for The Evening
World. He said:
To answer this question we must
know something Of the malady from
which Mr.. Caruso is suffering before
we can say with any certainty what
are the various possibilities in the
case. What is pleurisy7 An infiam-
nation Of the pleura. And what
causes the Inflammation?
Tho pleura is a closed sac which
under normal circumstances contains
nothing. Take a handkerchief and
double it over so as To represent a
sack. Then fold it doubled up over
your fist. There you have the pleural
sac folded over the lungs. The out
side layer of this sac is attached in
the human body 70 the inner surface
Of the RIBS. The inner layer Of the
sac is attached to the lungs. There
is an empty space between the two
layers Of the pleura, between the
lungs and the ribs.
The pleura is a thin, slippery, moist
membrane. AS the lung with Its IN
side layer OF pleura contracts and ex-
pands, 1t slips to and fro in the pleu-
raj sac. The diaphragm, which is a
great bel-shaped muscle separating
the chest from the abdomen, acts like
a piston which sucks the lungs down
into the thoracic cage. 1t is the dla-
phragm rather than the expansion of
the chest wall which causes the lungs
10 fill with a great volume OF air.
Each time the dome of this bell
shaped muscle fiattens out, the intes-
tines are pushed down, and the abdo-
men enlarges. Hence the term used
by singers-'abdominal breathing
NOW, inflammation of the pleura
can be either chronic or acute. II
it is chronic, that is, II there are
several attacks, usually without much
pain, 1t is in the great majority OF
cases caused by tuberculosis. When
il is acute-when there Is one sudden
attack, usually accompanied with
great paint is caused by some pus-
forming bacteria 1t - a local in
lection, Just as a pimple or a boil or
acute appendicitis Is a local in
lection.
TN Mr.. Caruso's case about three
plnts OF us-infected mud was drawn
from the pleural cavity. This would
tend to show that the case was due
to an acute infection rathUf than to
tuberculosis; although the case may
originally have been one OF tubercu-
losis, and a secondary Infection by
pus- forming bacteria have taken
place which would mask the primary
condition. AS far as is known, how
ever, Mr.. Caruso had no previous
attacks of pleurisy, nor of anything
which might be confused with It.,
such as lumbago or neuritis. There
fore, although il is not entirely pos
sTble to rule out tuberculosis from the
data given, it Is not a probable
cause.
What is the final outcome OF pleu-
risy? The pleura may eventually re-
\ turn to normal condition. This is
extremely rare when there has been
an active infection. Usually, II the
patient RECEIVERS. the pleura are left
greatly thickened and roughened. AS
soon as an infection occurs in the
pleural cavity, adhesions Immediately
form between the two membranes.
This is "A protective act OF nature
which tries to wall Off the infection
rom the rest OF the chest. II the in
'oction spreads, the man Is almost
Invariably doomed. In Mr.. Caruso's
ase the Infection was confined to the
u pleural cavity.
The adhesfons have also another
notion. They prevent the lung from
owing, and. as 1t were, put 1t in
mts. Mr.. Caruso has been X-rayed
Il fuoreScoped. The len side oil
diaphragm has not It's normal
pansiou. This might be due to pain
might also be due to adhesions
The diaphragm Is glued to the chest
a nv adhesons, II the left lung is
4 To- the ribs, II the pleural cavity
obliterated, or II the pleura are
ckencd. the lung power OF the left
90 will be greatly impaired IL not
tirclv gone. Adhesions at present
st. To what extent the pleura is
,lved Is difficult 10 say at the pres
time, because it is impossible Ia
Ike adequate examinations in Mr.
,ruso's present condition. The pleu'
cavity Is still draining, and the
cotton Is still present as shown
the continued presence OF fever.
is there any immediate danger
4 cases OF empyema there is al
avs danger for some time even af
or the patients temperature returni
10 normal. The poisons which are dis
lributed throughout the system
cause a severe strain on all the othe
organs: especially the heart and TIT
Kidneys. When a great quantity o
0uid forms in the plcural cavity a!
IN Mr. CarthgO's case, the heart Il
pushed several inches out OF place
and often compressed by the fluid
Operations such as tapping the lung
or /. Getting n rib. owe their d. nge
30 th shock on a 2 patient AMI Il
the sudden collapse Of the heart whel
the pressure >is removed. Finally
relapse is always to be dreaded,