Les maladies de la poitrine et les principes de diagnostic physique . d'un hydrothorax cardiaque est que l'effu-sion dans la majorité des cas, est limitée à la partie droite ou si bilateralthat à droite est de loin la plus grande. Bien qu'il est tout à fait possible que nosingle facteur est responsable de cette particularité il est certain que le pré-dominance des accumulations droite est trop constante pour être accidentel.Cela a longtemps été apprécié et d'aussi loin que 1863 theexplanation offert que l'Baccelli hypertrophie du coeur, en faisant glisser la veine cave supérieure 1 Lehrbuch der chemischen INRA, 1907. 2 Tran

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Diseases of the chest and the principles of physical diagnosis . of cardiac hydrothorax is that the effu-sion in the majority of cases is limited to the right side or if bilateralthat on the right is by far the largest. While it is quite possible that nosingle factor is responsible for this peculiarity it is certain that the pre-dominance of right-sided accumulations is too constant to be accidental.This has long been appreciated and as far back as 1863 Baccelli offered theexplanation that the enlarged heart, by dragging the superior vena cava 1 Lehrbuch der chemischen Pathologie, 1907. 2 Trans. Clin. Soc, London, 1906, xxxix, 42. DISEASES OF THE PLEURA 615 downward carried with it the vena azygos major thus drawing it tightlyaround the root of the lung and causing it to be compressed. Morerecently Steele and Stengel championed the hypothesis that compres-sion of the azygos vein was effected by extension upward of the dilatedright heart. Largely as a result of these contributions the azygos-veinhypothesis has been accepted as the true explanation.. Fig. 358.—Right-sided hydrothorax. Atelectasis of lung. Dilatation of left auricle. As the result of an anatomical study of this phenomenon Fetterolf andI^ concluded that the azygos vein hypothesis was untenable for the fol-lowing reasons: (1) Only about two-thirds of the parietal membrane isdrained by the azygos vein; (2) the collateral anastomoses of the azygosveins are so free and so numerous that, in the event of pressure, competentbypaths would soon be established and carry away any excess of fluidin the azygos radicles; (3) the vena azygos minor, emptying into the major, is subject to the same influences as the latter, and therefore the effusionshould always be bilateral; (4) it is anatomically impossible for the heart, 1 Fetterolf and Landis: Am. Jour. Med. Sc, November, 1909. 616 DISEASES OF THE BRONCHI. LUNGS, PLEURA, AND DIAPHRAGM either directly or indirectly, to exert pressure upon the azygos majorvein; (5) i

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