Sel ar a 
"BOTANIC. PHYSICIAN. A 
> “When diood is collected in lar tities in any part ofthe chest, 
the breathing ea tapened abi tie motion of the heart and 
arteries feeble and irregular. ‘These, indeed, are symptoms which — 
occur in every collection seated in the chest; but they arrive at ee 
_greater and more distressful height from blood, than from other fluids. — 
The other symptoms are similar to the dropsy, above described, and 
need not be repeated. : ee 
_ Blood may be effused into the cavity of the chest, by wounds, splin- 
_ters of fractured ribs, eating ulcers, or they may be ruptured by any ~ 
_ violent exertion, particularly in coughing. 3 ee 
In collections of blood, a quantity of it is often brought up in coug 
ing, which sometimes affords relief. But when the action of the 
heart and lungs becomes impeded by it, attempts should be made te 
draw it away by tapping. When the blood is found to be coagulated, 
S90 as not to pass off by a perforation, the case is difficult ; and, pet 
vould be best to trust its being absorbed, or coughed up; 
it may be attempted to be discharged by injecting warm water, 8 
“as to dissolve the coagulated blood, sufficient to allow it to pass. 
In empyema, or collections of pus, in the chest, the marks of op- 
pression, &c., are very similar to the dropsical affection ; but we are 
enabled to judge of the presence of this disease by its cause and the 
accompanying circumstances. — - 4 
It may be laid down as a fixed principle, that infammatién is a ne 
‘cessary fore-runner of purulency ; so that a collection of pus in the 
chest must be preceded by an inflammation of some of the parts. 
When, therefore, the symptoms of a fluid in the chest have not been 
preceded by inflammation, we conclude that they are not induced by — is 
purulent matter. But when a patient has previously suffered an ate 
tack of the pleurisy, inflammation of the lungs, or any other part 
in the chest; if he has for some time complained ote teed. pan im 
some part of the chest, attended with heat, a quick pulse, and other 
symptoms, and is at last seized with oppressive respiration; an ile — : 
clination to sit in an erect posture ; with a toial inability of lying on 
the sound side; a constant tickling cough; frequent rigors or Shi- 
verings ; and especially if these symptoms are accompanied with an 
enlargement of the affected, or with a soft fulness of the part, in which. 
the pain was first seated ; we may conclude with much certainty 
that a large collection of matter is formed. Shrek om 
_« ‘The-existence of these collections in the chest being ascertained, 
and their seat discovered ; and if the medicines employed in the eure — 
‘shall fail; and if it is evident that the patient must die, if the opera 
tion is delayed, it ought certainly to be advised without further delay} 
tapping in the chest is no donbt an important operation, and ous : 
not to be advised but in real danger. But there should be no hesita- 
tion in resorting to it, when the symptoms are hazardous, and can be 
removed by no other means; and the method of doing it, is this} 
The patient should be laid in a horizontal posture, with the side 
in which the perforation is to be made laid over the bed; when » 
this situation, the skin upon that side should be pulled upwards b 
an assistant, and held in that situation during the operation ; an — 
the surgeon should now, with a scalpel, make an incision two in 
in Jength between the sixth and seyenth ribs, im the direction 
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