108 PRACTICE OP MEDICINE. 



hydrothorax, when it does exist, can have but a very small share in 

 producing the symptoms that have hitherto been ascribed to it. 



Synqytoms. —T\iQ patient feels an oppression and difficulty of 

 breathing, and generally lies on the affected side, leaving the healthy 

 one unencumbered in its functions. When the fluid is in both 

 cavities, the respiration is still more difficult and short ; the patient 

 sits up in bed, and calls in the aid of all the muscles of inspiration ; 

 and his countenance assumes a cast of anxiety. Corvisart describes 

 the chest as being more distended and rounded on the side which 

 contains the fluid ; and as the collection increases, the intercostal 

 spaces are widened, the integuments of this side becoming cedema- 

 tous, and, in a few instances, the arm on the same side. In the 

 acute states of this disease, a feeling of soreness, tenderness, or pain, 

 is often complained of in or over the seat of effusion. Symytomatic 

 hydrothorax will combine with the common signs of pleuritic eflxision 

 those of whatever organic disease it is the consequence ; and this 

 will generally be found to be some lesion of the circulatory appa- 

 ratus, by which its function is extensively impeded. Laennec states 

 that it scarcely ever supervenes earlier than a few days before the 

 fatal termination of such diseases, and may therefore be considered 

 the immediate harbinger of death, the agony of which it increases 

 by dyspnoea. 



Physical signs. — On percussion, a dull sound is emitted, resem- 

 bling that produced by striking the thigh, on the side containing the 

 fluid, or on both sides when the effusion has taken place into both. 

 When the patient sits, or stands up, and the fluid only partially fills 

 the cavities, the lower part of the thorax only will give out a dead 

 sound. This sound generally changes its place with the change of 

 position, owing to the gravitation of the fluid to the depending part. 

 This, as M. Piorry contends, is an important diagnostic between the 

 dead sound of effusion and that produced by hepatization of the sub- 

 stance of the lung, which always retains the same situation. • Upon 

 ausciiltation, the respiratory murmur is found to have ceased in the 

 region corresponding to the fluid collection ; and in its place is heard 

 the bronchial respiration, When the efliision is not very great, 

 (Sgophony is occasionally heard.' Tf the fluid be accumulated only 

 in one cavity, mensuration of the thorax then becomes a useful mode 

 of diagnosis ; but the increased fulness of one side, and widening of 

 the intercostal spaces, may be recognised at sight. 



Treatment.— i::\i^ plan of treatment must depend upon the cause 

 of the effusion, which may be, an organic lesion of the heart or 

 lungs, or inflammation of the pleura ; and these are to be managed 

 on the general principles laid down when treating of those affections. 

 Cathartics and 'purgatives, especially the hydragogues, often afford 

 speedy relief; but they are admissible only when the powers of life 

 are not greatly reduced, and in the more acute cases, not caused by 



