. Diseases of the heart and arterial system; Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. leural fluid,was left an open question. Inthe absence of a definite his-tory of pleurisy and of othersigns of dropsy, the nature ofthe liquid in the pleural cavity, whether an exudate or transudate,was a matter of doubt. The liver was evidently cirrhotic. Exam-ination of the urine was negative. In spite of physical rest, digitalis, diuretics, and cathartics,the amount of intrapleural fluid remained stationary for the nextthree weeks. Paracen
. Diseases of the heart and arterial system; Designed to be a practical presentation of the subject for the use of students and practitioners of medicine. leural fluid,was left an open question. Inthe absence of a definite his-tory of pleurisy and of othersigns of dropsy, the nature ofthe liquid in the pleural cavity, whether an exudate or transudate,was a matter of doubt. The liver was evidently cirrhotic. Exam-ination of the urine was negative. In spite of physical rest, digitalis, diuretics, and cathartics,the amount of intrapleural fluid remained stationary for the nextthree weeks. Paracentesis was then performed, and the fluid rap-idly reaccumulating, the operation was repeated within a the second aspiration the fluid mounted to the upper levelof the third rib and symptoms of pressure increased. It was thendecided to try the efficacy of baths (Bad Xauheim). These wereendured so badly, however, that they were discontinued after fourdays. By February 6tli the actual embarrassment had become sopronounced that this fact, together with the failure of paracen-tesis to permanently reduce the amount of pleural effusion, led the. Fig. 23.—Showing Apex-beat, CakdiacDulness, and Liver Border in Case(p. 114). 116 DISEASES OP THE HEART consulting surgeon to advise resection of a rib in the hope thatjDermanent drainage would afford time and opportunity for theheart to regain its former vigour. The proposal having been laidbefore the patient and her husband, and their consent obtained,the operation was done the next day. Everything seemed to pro-gress favourably for a few days, when suddenly symptoms of pro-nounced fibrinous pleuritis developed in that side. Temperaturerose to 102° F., strength waned rapidly, and the patient died tendays after the operation. I may say here that the infection wassubsequently proved to be a pneumococcus one. The autopsy was made by Dr. Hektoen twenty-four hours afterdeath, and the findings may be briefly stated to have been a tot
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