It is the resemblance to the features of this particular member of the family, which the law has made it incumbent on us, in our office as prescribers, to find in the effects of some one curative agent on the living organism; because it is just in these specific features of disease that Infinite Wisdom and Benevolence has established the domain of the law of cure, so far as the disease itself is concerned.

On the side of the drug there was, of necessity, a similar relation of elements from the sum of the effects produced on the organism by particular drugs and for a similar reason. The generic, or those common to several drugs, were excluded; and those which belong to the particular drug, and characterize it, were selected. And these on the one side, and those which declare the specific character of the disease on the other, were the precise elements of the two objects of the comparison in which Almighty Power and Wisdom placed the law of cure. Resemblance of these is the like which cures. The law of similars requires and accepts no other similarity. of the science of pathological anatomy have been excluded from the requirements of the law by its Great Author in its original constitution; and he who attempts to thrust them in, where they have been thus excluded, is likely to have no great success. follows, also, that their rejection from the prescriptions of our school, so far from being any sin against science, is only in compliance with the reqirements of the great controlling natural law.

Hence the facts

It

But it is often and plausibly asserted that it is certainly our duty to study the nature of disease as disclosed by its results, meaning by this the facts of pathological anatomy. To this there can be no objection, and we do not object when we assert that the light which these facts throw on the nature of disease does not reach at all to its curative relations, as we have shown, but is limited solely to that power to produce in the tissues the changes from which these facts have had their origin. The

nature of disease, thus far, is disclosed by these facts, and here the revelation stops. There is a seeming of scientific wisdom in the assertion of this duty, calculated to mislead the beginner as to the extent of the benefits to be derived from the investigation recommended. If, in its results, he expects, as many seem to have done, a disclosure of the whole nature of disease, he is only to be disappointed. He will simply learn that it is the nature of this or that disease to effect this or that change in the anatomical constitution of the tissues of certain of the organs of the body. Beyond this he can learn of its nature absolutely nothing at all. We have denied that we undervalue the knowledge which this science reveals. We add that it is no contradiction of this denial when we limit its application, as above set forth. We deny that the limitation is ours. It is in the nature of the facts of the science itself, and in that of the general nature of disease, and of the law by which God ordained it should be cured. We simply recognize the fact, and receive it as it has been given into our hands by the Power which has established this limitation, with the other facts of nature. If this Power has limited the proper application of the knowledge of this science to that part of our practical duties which deals with the diagnosis and prognosis of diseases, we have no power to change the arrangement, and we do not see how any benefit could be educed from it if we had. It having been so limited and connected, there can be no wisdom in endeavors to force on this branch of knowledge functions which can never belong to it, or in anticipating any light on other elements of the nature of disease which it can never shed. It is the part of true wisdom here, as in other departments of natural science, to discover the divinely appointed arrangement, to receive it, act upon it, and therewith to be content.

VII.

SUGGESTIONS UPON HYDROTHORAX.

BY S. M. CATE, M.D., SALEM, MASS.

THE aim of the present paper is to present some things connected with the accumulation of fluids in the cavities of the chest, rather than to give an exhaustive treatise on the subject.

If we are called to a patient with short, quick breathing, worse from motion, and which is increased by walking, or going up a hill or up stairs, and in some cases by lying down, we shall at once have our attention called to the organs of the chest. If the examination of the pulse and application of the ear to the chest. shows the heart to be so near a normal state as not to cause the troubled breathing, we proceed to examine the lungs and the chest for the cause of the disturbance. In this way we soon find With pneumonia in the

the nature of the changes in the chest. parts of the lungs that are inflamed, we find increased dullness on percussion, but usually also crepitation, mucous or bronchial râle, and other sounds preternaturally loud. Sometimes, indeed, the lung is inflamed and hepatized to such an extent that all respiratory sound is lost, and then the marks distinguishing between effusion and hepatization are more difficult to recognize. With effusion, the dullness is usually attended by a respiratory sound that is faint and feeble; or the respiratory murmur seems muffled, and farther away from the ear than in other corresponding healthy parts of the chest. Then, too, with effusion, the dullness usually commences at the lower part of the pleural cavity,

and, when the patient is in a sitting posture, extends up to a given line. If the position of the body be varied, this line will vary. Thus by lying down it is sometimes changed so much that some parts, before dull, become clear in sound, and other parts, before clear, are now dull. So also the faintness of the respiratory murmur is somewhat changed by the change in the posture, which alters the relative position of the fluids in the cavity of the chest.

If the fluid is confined to some part of the cavity of the chest by adhesions of the adjacent pleural surfaces, a change of posture does not change the sound. But in such cases the nature of the trouble is usually determined by the respiratory murmur, for, it is clear, and in a measure healthy, but fainter, behind the fluids; while in pneumonia and. pleuro-pneumonia the respiratory murmur is increased in loudness, or supplanted by crepitation, mucous râle, bronchial rhonchi of various kinds, or else entirely lost as in complete hepatization. With effusion these sounds are, as a rule, decreased.

The most marked exception is in cases where the effusion occurs in a person who has disease of the lungs, such as emphysema, tuberculosis, or chronic bronchitis. In such cases the respiratory murmur is increased, and in some cases to such an extent that it is only partially muffled by the fluid pressing upon it. With such a combination of symptoms, the diagnosis is sometimes difficult. But, if all of the symptoms be taken together, we shall usually, after a careful examination of the chest, reach an intelligent opinion of the case.

In most cases of effusion into one cavity only of the chest, that side of the chest is made larger. Thus, in examining the chest of a person who manifests some of the symptoms of hydrothorax, if we pass the hands down the uncovered chest from the apex to the base, one hand on the back part and one on the front, taking first the right and then the left side, we shall easily discover if one side of the chest will outmeasure the other an inch or more

through the base. If we find a case of this kind, and on farther exploration find that the lower part of the enlarged side of the chest is dull on percussion, with the dullness extending up to a given line, and that through the dullness a faint respiratory murmur can be heard, we may feel pretty sure there is serum in the pleural cavity. In some cases the enlargement is so great that the intercostal muscles bulge out; and the affected side measures several inches more from the centre of the lower end of the sternum to the centre of the spine than the opposite.

Exceptions to this rule occur in cases where a previous pleurisy and effusion have bound down one lung, and after absorption of the fluid the chest is shrunk below its normal size, and hence the opposite side is relatively larger. A similar result is produced, but in a less marked degree, by tuberculosis of one lung, whereby it is impaired in its vitality, and atrophied: there is a loss of volume of the external chest corresponding to that of the lung In cases like these, the general symptoms, history, and lack of all evidence of effusion would easily point out the correct diagnosis.

We shall not always find all the signs of effusion in the chest. when serum is abnormally present. In cases of general dropsy, and in cases of effusion that comes on slowly as a sequel to other diseased states, such as tuberculosis, cancer of the stomach, degeneration and other disease of the liver, disease of the kidneys and other organs of the abdominal cavity,—the accumulation is usually slow, and often attended with a gradual waste of other parts, so that the liquid is better tolerated by the system, and produces less marked signs of its presence. But in these cases, also, when carefully examined, a correct estimate of their importance will be reached.

When we have detected an accumulation of fluids in the cavity of the chest, and determined the location and nature of it, we next inquire how it originated.

The membranes which form the outer covering of the lungs,