The following case of hydrothorax will shew, that water may
exist in the chest without the symptoms, which we have
attributed to organic diseases of the heart.
Mrs. T----, aged 56 years, of an excessively corpulent habit, had been
affected for a great number of years with a scirrhus of the right
breast. Finding her health decline, she at last disclosed it, and in
coincidence with the opinion of Dr. WARREN, sen. I amputated it on the
30th of May, of the present year. We however informed her friends,
that the probability of eradicating the disease was extremely small.
The skin was in many places hardened and drawn in, and in others
discoloured, and ulcerated at the nipple, so that it was found
necessary to remove, not only what covered the breast, but some
portion of that which surrounded it. A long chain of diseased glands,
extending quite to the axillary vessels, was also extirpated. She bore
the operation well, lost no great quantity of blood, and recovered her
appetite and strength surprisingly in a few days, while the wound
healed rapidly. At the end of twenty days a difficulty of breathing
commenced, and soon became so oppressive, that she could no longer lie
in bed; partly, no doubt, on account of her extraordinary obesity. The
pulse was small, quick, and commonly feeble, but sometimes a little
hard, when any degree of fever was present. The countenance became
pale, the lips of a leaden hue, the eyes dim. We were surprised at the
change, and conjectured that the cancerous action had suddenly
extended to the lungs. Yet she had not the slightest cough; and it was
remarked by Dr. WARREN, sen. that he had never observed that diseased
action to increase, while the wound remained open. At last the lower
extremities swelled, which might be attributed to the upright posture,
and the pressure on the absorbent vessels in that posture. The
appetite failed; she complained of a constant sense of depression at
the stomach, and, without any remission of the difficulty of
breathing, died on the 1st of July.
On the next morning the body was examined. The pleura in both cavities
of the thorax was studded with small, white, and apparently
homogeneous tubercles; the lungs contained a great number of similar
bodies. The right cavity of the pleura was entirely filled with water,
of which we removed at least three quarts. The heart was of the usual
size, very flaccid and tender; but not otherwise disordered. The liver
was enlarged, of its usual colour, much hardened, and had on its
surface, and in its substance, many tubercles like those in the
thorax. It had also a great number of encysted cavities, each about
the size of a hazle nut, which contained a thin yellow fluid. The gall
bladder was wanting, and in its place there was a small, but very
remarkable depression, without a vestige of any former gall bladder,
for the coat of the liver was as smooth and perfect there as in any
other part[15]. The pancreas was in a scirrhous state. The abdomen did
not contain any water.
[Footnote 15: See Soemmerring de corporis humani fabrica,
vol. 6, pag. 188 and Baillie's morbid anatomy, pag. 248.]
It seems, then, that water may exist in the cavity of the thorax,
without any remarkable symptoms, except dyspnoea and difficulty in
assuming the horizontal posture. But in organic diseases of the heart,
there is a long train of frightful symptoms, distinguishable by the
most superficial observers. We infer that these disorders have been
unnecessarily confounded.