HYDROTHORAX. 107 



pearance ; debility increases ; the secretion of urine becomes more 

 inefficient, urea, and other excrementitious matters accumulate in the 

 blood; and drowsiness and coma, signs of effusion into the head, 

 are sure precursors of death. 



Of the state of the 2irine.—ln the first stage, if examined, it will 

 often be found to contain particles of epithelium, loaded with fat. 



In the second stage, the urine is albuminous, and not only so, but 

 contains sometimes red particles of blood, and Y\\X\q fibrinous shreds, 

 moulds of the tubuli uriniferi, in which they have coagulated. Its 

 specific gravity is generalhj very low ,- instead of 1025^ the healthy 

 average, it sinks to 1016, and gradually gets lower; down, per- 

 ha.ps, to 1004. It will often be found under the microscope to con- 

 tain a large amount of fatty epithelium scales. 



In the last stage, the quantity of urine is very variable ; some- 

 times very scanty, or even suppressed, so that the patient dies 

 comatose, from the urine retained in the blood; sometimes ex- 

 tremely abundant; and sometimes before death the albumen entirely 

 vanishes. 



Co7iseque72C€s.—T\{\s fatty disease of the kidney, besides dropsy, 

 and fatal coma, is apt to induce acute inflammation of the serous 

 membranes, disease of the heart, and obstinate indigestion. 



Causes.— It may be caused by intemperance, privation of air and 

 light, and neglect of proper exercise ; frequent exposure to cold, and 

 the other causes of scrofula and phthisis. 



_ Treatment.— U the disease assumes an acute character, with pain 

 in the loms, fever, and evidence of renal congestion, cupping should 

 be performed on the loins. But in most cases the treatment should 

 be so conducted as to keep the emunctories open, and reduce the 

 strength as little as possible. The skin should be kept open by 

 baths; the bowels by saline purgatives; and in the intervals of pur- 

 gation, the kidneys should be solicited by the milder kinds of saline 

 diuretics, such as tartarized soda. When there is an absence of 

 fever the tartarized iron can sometimes be borne. Lastly, the diet 

 should be plain and as nourishing as the stomach will digest, and 

 tatty matters should be excluded from it as much as possible. 



• 

 HYDROTHORAX {Dropsy of the Pleural Cavities). 



It was formerly the common opinion, and is even now believed 

 by many, that idiopathic hydrothorax is a very common disease 

 producing a formidable array of symptoms, and often causing death 

 by suffocation. In these late years, the erroneousness of this opinion 

 has been shown, on the one hand, by the study of pathological 

 anatomy, which has discovered, in the 'supposed cases of simple 

 hydrothorax, extensive organic disease, without any effusion ; and 

 on the other hand, by auscultation and percussion, which have not 

 only proved the same during life, but have likewise taught us that 



