Medical and surgical reports . n rapidly failing since morning; respira-tion was more hurried. Pulse failed and he died at The displacement of the heart and lung was so much greater inthis patient than is found in patients with a permanent opening inthe ch(!Ht, as after an operation for empyema, that llui air in the 194 OBSERVATIONS ON PNEUMOHYDEOTHORAX. right side of the thorax was probably under more than the atmos-pheric pressure, and been pumped into the pleural sac through avalve-like opening. Case IV. —Delia H., twenty-five years old, entered my service atthe hospital, April 3,
Medical and surgical reports . n rapidly failing since morning; respira-tion was more hurried. Pulse failed and he died at The displacement of the heart and lung was so much greater inthis patient than is found in patients with a permanent opening inthe ch(!Ht, as after an operation for empyema, that llui air in the 194 OBSERVATIONS ON PNEUMOHYDEOTHORAX. right side of the thorax was probably under more than the atmos-pheric pressure, and been pumped into the pleural sac through avalve-like opening. Case IV. —Delia H., twenty-five years old, entered my service atthe hospital, April 3, 1898. Alcoholic. Had had much cough andexpectoration. One week ago she had suddenly a sharp pain in theleft side, which increased. She was unable to take a deep breath. Physical examination: cardiac area not determined, chest hyper-resonant. Apex not determined. Ko cardiac sounds heard to theleft of sternum. On right of sternum heart sounds are heard in-distinctly, loudest in fiftb space, sternal border, no murmur Fig. 2. Pneumothorax on left side and Tuberculosis on right side. The heart and left lung are displaced to the right. The right side isdark on account of this, and also from the presence of tuberculardeposit in the right lung. OBSERVATIONS ON PNEUMOHYDEOTHORAX. 195 Lungs Resonance increased over entire left lung, front and back. Tactile fremitus and voice sounds were decreased over this right back there was marked resonance, and respiration wasbroncho^vesicular. Many crackling rales were heard. Over rightfront resonance was fair. Eespiration was here accompanied by-many rales. April 4, physical signs the same as on Apiil 3. X-ray examination was as shown in Fig. 2. After this examina-tion I immediately decided to draw off a part of the air. Knowinghow much relief is obtained in cases of pleurisy with effusion whenthe first part of the fluid is drawn off, I decided to tap the chest anda quart seemed to me a suitable amount to withdraw, for to ta
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