HYDROTHORAX. 139 



The SYMPTOMS of pleuro-pneumonia, as might be pre- 

 dicated^ are those of pnuemonia and pleurisy combined, the 

 one or other prevailing according as one or other disease 

 predominates. Although some French writers have given 

 descriptions of this, distinct from those of the other two 

 diseases, I do not discover that they have succeeded in 

 eliciting any pathognomonic signs, save such as are obtain- 

 able from percussion and auscultation. 



The TREATMENT must likcwisc be of the same compound 

 character, partaking of what is recommended both in pneu- 

 monia and pleurisy; making it bolder or more active, and 

 modifying it, according as the case shall evince acuteness or 

 chronicity, more of one disease than of the other. 



HYDROTHORAX. 



Hydrothorax, or water in the chesty is, as we have seen, 

 a very common termination of pneumonia with pleurisy ; it 

 may also follow compound bronchitis, or it may occur without 

 any discernible disease or inflammatory action whatever about 

 the chest. As a serous membrane, the pleura may pour 

 forth fluid into the chest in accordance with the same law by 

 which other similar parts become dropsical, either from 

 some constitutional diathesis, or from some local disposition. 

 I repeat, this is possible, and has occurred ; but it is a rare 

 case indeed, compared to those wherein hydrothorax super- 

 venes upon inflammatory action, and that of a sub-acute or 

 chronic nature. There are, again, certain dropsical states 

 of body in which hydrothorax, ascites, and hydrocephalus, 

 all co-exist; and are accompanied by swelled legs, sheath, 

 belly, &c. When inflammatory action within the chest, 

 though subdued, is not removed, but continues creeping on, 

 as is indicated by the pulse and other febrile symptoms 

 remaining, — the patient not rallying as he might be ex- 

 pected to do, but feeding daintily, looking dispiritedly, or 

 spiriting up for one moment (at the approach of anybody, 

 or at the sight of food) to be again downcast the next — there 

 is great reason to apprehend that the chest is filling with 



