The whole of the left lung is found performing its functions healthfully. Nor is any disease found in the upper portion of the right lung; but, on searching the lower two thirds of this side, there is found an entire absence of all sounds of respiration; and, under percussion, no normal resonance due to the presence of spongy lung-tissue is heard—the sound is non-resonant, A partial resonance would be dullness; in this case it is "flat."
These data prove the absence of all healthy lung-tissue in the lower two thirds of the right side of the chest. What, then, occupies this region? The lung solidified by morbid changes may be there; or it may be displaced by a tumor, or by fluids; and each of these morbid conditions has nearly the indications mentioned. On carefully examining the upper limit of flatness of sound, while the patient is sitting or standing, it is found to extend exactly horizontally around the chest. Next, requiring the patient to recline backward, the physician finds the boundary-line of flatness to have changed to two or three inches lower on the front, while upon the back of the chest it will be higher than before; yet the line is still strictly horizontal.
The significance of this test is that, though the chest has changed its position, its movable contents, obeying their physical law, tend to preserve a horizontal surface.
Certain complications may prevent the availability of this "hydrostatic test"; but when found it is infallible, and in this case excludes all of the supposed conditions.
The diagnosis now is, that the right lung has been compressed into a narrow compass in the upper part of the chest by the gradual accumulation of from thirty to forty ounces of fluid; and this fluid has also so encroached upon the heart as to cause some displacement and to embarrass its action as well as that of the left lung. These conditions account fully for the symptoms mentioned, and for the distress of the patient.
Negatives, exclusions, and probabilities alone are inadmissible; a diagnosis is required. The examiner may not guess from the symptoms; his tests must be objective, and as positive as the laws of physics. They must not fail, for the life of his patient is at stake; and the treatment to follow will prove his skill, or, may be, his fatal error. If a small hollow needle be pressed through the chest-walls into the suspected region, the outpouring fluid will bring the needed relief and will verify the predictions of the ear by actual sight, weight, and measurement. This case is one of no uncommon occurrence, the treatment almost painless, and very satisfactory as to present relief and the prospect of permanent cure; the lung may expand to its normal size, and resume its functions healthfully. And the case is one requiring only the ordinary and easier means of diagnosis.
The acutest ear and the most practiced discernment are required in meeting the difficulties arising from complications of diseases, and
