HYDROTHORAX 69 



is simple: In the seventh intercostal space, close to the 

 anterior margin of the rib, and about 1 inch above the 

 union of the cartilage and rib, shave, disinfect, and puncture 

 the chest with a small sterile trocar. It is recommendable 

 to first cut through the skin with a bistoury and draw the 

 incision to one side that the skin and muscle woimds do not 

 cover each other when the puncturing instrument is with- 

 drawn. Care should be taken to prevent air entering the 

 thorax during the" operation. The fluid should be removed 

 slowly and if the dyspnea become worse, coughing induced 

 or the pulse become weak, the cannula should be instantly 

 withdrawn and the opening covered with tar or collodion. 

 Thoracentesis should be performed early and repeatedly to 

 be of curative value. 



HYDROTHORAX. 



Definition. — The presence of an effused fluid in the pleural 

 cavity. It is never of inflammatory origin and therefore 

 occurs quite independent of pleuritis. 



Etiology. — In a general way hydrothorax is due to a 

 congestion in the venae cavee or its tributaries. It is most 

 commonly noted in chronic heart, lung and kidney diseases 

 and is usually associated with ascites, anasarca, and hydro- 

 pericardium. 



It may also accompany general anemia, hydremia and 

 prolonged cachectic conditions following parasitism, carcino- 

 matosis, etc. 



Symptoms. — Same as the effusion stage in serofibrinous 

 pleuritis. 



Diagnosis. — ^History, finding organ primarily attacked 

 (heart, lung, kidneys) and the prolonged, feverless course 

 generally suffice to secure a diagnosis. In doubtful cases, 

 the thorax may be tapped and fluid withdrawn and examined. 

 It is usually much clearer, less flocculent and more watery 

 than pleural exudate. It is straw-yellow in color and has 

 a specific gravity of 1016, the albumin content below 2 per 

 cent. Leukocytes are only sparingly represented. 



Digitized by Microsoft® 



