132 : - BOTANIC PHYSICIAN. 
thus be prevented to the external air; and-by this being frequently 
Rbciind-alaain all the air. thus collected; will be expelled ; after 
which the skin must be drawn over the wound, and with dressings, 
the incision will close up without further trouble. Air may also be 
drawn from the chest, by means of an exhausting syringe. : 
_ Air collected in the cavities of the chest may not only prove hurt- 
ful, by impeding the motion of the lungs, but it must likewise do 
harm by that tendency to inflame, which it creates in parts naturally _ 
secluded from the air.. This circumstance, therefore, merits parti- 
cular aitention. : he 
_ When the disease is seated in the membrane of the heart, it ism 
_ Some instances, so much disterided; that it is easily distinguished on . 
examination. Upon making an opening in the left side; between 
any two of the ribs, from the third or fourth to the seventh or eighth, 
_ and within five or six inches of the breast. bone, we can never iail 
__iew by the pleura being freely divided for the space of av inch or two, 
© the best method of finishing the operation is to push a small trocat 
into the membrane. If the quantity collected is small, it may all be 
drawn off at once; but when considerable, the discharge should be 
frequently stopped for a few minutes together, in order to prevent 
the inconveniences of too sudden and free a flow of the whole quan- 
tity. 
These general directiotis ate applicable to the evacuation of all 
Watery collections in the chest A few additional directions therefore, 
for the different cases, may be necessary. ES 
,, When blood is collected in the chest, produced by a ruptured — 
blood-vessel, from a fractured bone, or some extraneous body press- 
ed into it, the incision should be made as near the part affected as 
possible, that the opening may serve not-only for discharging the | 
blood, but for extracting such portions of bone, as are found to be 
detached, or any foreign bodies that may be met with. And, again, 
when a wound made with a sharp pointed instrument is the cause of 
the collection, it will generally be. sufficient merely to enlarge the 
wound if ni ry: 
_ When pus is collected in the chest, or abscesses formed, it may 
be remarked, that when the seat of an abscess is pointed out, either 
_ by a long continuance of pain in any one point, or by matter being 
distinguished between two of the ribs, that this is far the best direc 
tion for the place of incision. But when no suck mark is observ@ 
ble, the place advised in the general direction is the most proper. 
in abscesses in these parts, the matter is commonly first fo. 
‘in the substance of the Jungs, and afterwards discharged into one Of 
other of the cavities of the chest. It sometimes happens, however, 
_ that large quantities of pus, form between the pleura and surface of — 
the lungs, without any apparent affection of that organ ; and seem 
to proceed from any inflamed state of the surface of the pleura — 
These collections, however, seldom continue long without producing 
ulceration ; and when ulceration has taken place, the discharge of 
matter that succeeds to the operation of tapping, generally continues — 
for a length of time. : OF eee 2 
~ In this disease medicines should be used for cleansing the syste™ 
