Practical Observations on Dropsy of the Chest (Breslau, 1706)

Dr. Saul Jarcho's several papers on the history of hydrothorax, culminating in the present translation of an authoritative eighteenth-entury 'review article', effectively dispel the idea obtainable from some modem reference works that the history of hydrothorax begins with the introduction of auscultation and percussion. Practical Observations on Dropsy of the Chest was published in Breslau in 1706 by the Leopol-dine Academy of Scientists as a tribute to Leopold I, who had died of hydrothorax in the previous year. The 'senior author' was probably Christianus Helwich (1666-1740), as emerges from the latter's paper on difficulty of respiration (1722), previously translated by Dr. To the translation of the Breslau text of some 20,000 words, the editor has added a commentary, full references to the authorities originally cited, and an index, composed chiefly of nearly 200 proper names mentioned in the text (an indication in itself ofthe scope of the work). After a laudatory dedication to the Emperor Joseph I and a strongly worded introduction to the reader, the treatise is divided into three parts. The first, on the natural history of the disorder, reveals careful observation of the manifestations of cardio-respiratory disease. Limited attempts are made to establish the differential diagnosis of empyema, and also of asthma, or dyspnoea from several causes. Special diagnostic emphasis is given to the occurrence of dyspnoea during 'the first period of sleep', a curious symptom first described by although by this time Corvisart, in his Essay on the Organic Diseases and Lesions ofthe Heart and Great Vessels (first published in 1806) had noted, among numerous features distinguishing 'essential hydrothorax' from diseases of the heart, the absence of 'sudden wakefulness' in the former and the dramatic disturbances of sleep in the latter. Although the Breslau treatise records the frequent association of cardiac irregularities and pericardial effusion, it fails to place heart disease in any causal relationship to hydrothorax. In the second section, on the causes of pectoral dropsy, it places emphasis on lymphatic dysfunction, blood dyscrasia and vascular obstruction, views which reflect current concepts of disease in general as well as some recent researches in these areas. It is curious, in view of the wealth of observation and logic in the first two sections that no distinction is drawn between unilateral and bilateral effusions, which might have directed attention to the significance of 'local' and 'general' causes (it is implicit in Corvisart's discussion-that non-cardiac effusions are likely …