This is a form of congestion where there is a transudation of serum into the air-cells. I have never seen more than one case. This case, however, I diagnosed pleuritic effusion. The attending physician had diagnosed it edema. I insisted on drawing the water out of the pleura, and the doctor kindly held a vessel for me into which to aspirate the fluid. After taking out about half a gallon of fluid, he was as satisfied as I was that it was hydrothorax and not edema. I presume there are cases of edema of the lungs manifesting in the last stages of Bright's disease, heart disease, angina pectoris, valvular lesions, etc. Any disease that will break down the patient and cause an effusion in any part of the body is liable to appear in the air-cells. The cavity of the pleura and the cavities of the pericardium are more liable to fill up with fluid than the air-cells of the lungs. Such cases as have been described by Osler have not fallen under my observation; hence I take pleasure in enumerating the symptoms as set down by that author:

Symptoms

The onset is sudden, with a feeling of oppression and pain in the chest, and rapid breathing which soon becomes dyspneic or orthopneic. There may be an incessant short cough and a copious, frothy, sometimes blood-tinged, expectoration, which may be expelled in a gush from the mouth and nose. The face is pale and covered with a cold sweat; the pulse is feeble and the heart's action weak. Over the entire chest may be heard piping and bubbling rales. The attack may be fatal in a few hours, or it may persist for twelve or twenty-four hours and then pass off. Steven, of Glasgow, has reported a case which had seventy-two attacks in two and a half years. I have seen this recurrent form in angina pectoris, each paroxysm of which was associated with intense dyspnea and all the features of acute edema of the lungs.

Treatment

Should I meet with a case presenting such symptoms, I should give a hot bath, preparing the bathroom so as to have as much fresh air in it as possible. Have the outside window and the door open. Then have cool water on the patient's head, and allow frequent sips of cold water. I would not dare give such remedies as morphine; for morphine produces passive congestion of the lungs, and if that should be added to edema, it appears to me that the chances for the patient's recovery would be greatly lessened. The hot bath should continue as long as the patient can safely be kept in the tub, and the water should be as hot as can be borne. I should expect this to relieve the breathing. If necessary, the patient should be returned to the hot bath in three hours, again continuing as long as possible; and then again returned to the hot bath, if necessary, until permanent relief is secured. Certainly no food is to be given, and the bowels should be washed out with copious enemas.