Water in the Chest. Hydrothorax.
The disease consists in a collection of water in the cavity of the pleura.
Physical Signs. There is a dull sound over the effusion.
The breathing murmur is diminished, and gradually disappears altogether over the space occupied by the effusion.
Bronchial breathing is beard in the same part.
When the amount of fluid is small, egophony is heard in the middle regions of the chest.
Bronchophony is heard when the effusion is larger.
General Symptoms. Either upon lying down, or using active bodily exercise, the patient finds his difficulty of breathing increased. When in bed, he lies with his head and shoulders raised, which, by causing the fluid to settle at the bottom of the cavity, prevents in a measure, its pressure upon the lungs, and gives him a little rest. His sleep is interrupted by sudden starts with alarm and terror. The pulse is hard, the thirst great, the urine scanty and high colored, and has a sediment. After a time the feet swell, the face is pallid and livid, and the countenance expresses anxiety and alarm. There is a short, dry cough.
When the quantity of fluid in the chest becomes large, the patient cannot lie down at all, and only gets short and disturbed naps in the sitting posture.
Of all the symptoms, the starting in sleep is the most certain sign of the , disease.
Causes. In some rare cases, this may occur as a primary disease, that is, as a disease not dependent upon any other as its cause. The greater number of cases, however, are secondary. They arise from organic disease of the heart, or liver, or stomach. Inflammation of the pleura is a very frequent cause.
A plethoric, or full state of the system, predisposes to this complaint, particularly in those persons who indulge freely at the table.
It may arise, too, from the striking in of skin eruptions; from the free use of liquors; and from frequent excessive bleedings or purgings.
Treatment. The chest should be painted with the tincture of iodine, and a good degree of substantial soreness be kept up.
The internal remedies are purges (31), (14), (30), and diuretics (128), (129), (130), (131) when the patient is not very weak.
The iodide of potassium, in doses of five or six grains, once in three or four hours, is an excellent remedy. The following is a good form of taking it: iodide of potassium, one ounce; fluid extract of pipsissewa, two ounces; water, half a pint. Dose, one teaspoonful.
The skin should be bathed and rubbed daily, three or four times, with much friction. Tapping the chest should be done when the fluid persists any length of time, otherwise a simple hydrothorax may become a doubly serious empyema or pus in the chest.
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