of impure humors, and prevent the collection in the chest; otherwise 
the cure will be tedious, if at all accomplished. a6. oes 
Air, collected in eitiier of the cavities of the chest, excites : the 
same symptoms of oppression on the lungs and heart, as those 
arising irom water, blood, or matter ; its removal, therefore, is equally 
necessary. BRET 
Air may pass into the chest from a rupture of the investing mem- 
brane of the lungs, which may oecur in coughing, &c.; or, from 
an erosion of the surface of the Jungs by ulceration ; or, by wounds 
penetrating the lungs; or from the point of a fraetured rib, lacera- 
ting the lungs, which is the most frequent cause. oe 
The symptoms produced by effused air in the chest, differ o1 3 
from those of water, in their arriving more quickly to an alarming 
heizht: instances have occurred of death being induced in the 
space of a few hours, from the fracture of a rib, merely by air co! 
Jecting in large quantities between the pleura and the lungs. In 
some, perhaps, in the greatest proportion of all that oceur, along with 
this collection of air in the chest, the cellular substance of the breast 
becomes inflated ; and if means are not soon employed to prevent _ 
it the air insinuates through ev ery part of the body. It is truly as- 
tonishing to observe how quickly a fractured rib, when it wounds 
the surface of the lungs, will in some instances induce the most 
alarming symptoms... The patient at first eomplains of a tightness 
in the breast, attended with oppression in breathing, along with pain 
in the parts ehiefly affected. This difficult respiration becomes — 
more distressful. The patient cannot breathe in a recumbent pos- 
ture, and is always easiest when erect and leaning somewhat for- 
ward ; the face becomes flushed aad swelled ; the pulse is common- 
ly feeble, and at last it becomes irregular; the extremities become 
cold, and if relief is not obtained, the patient is at last carried off 
with every mark of suffocation. om eis Be 
Windy swellings of the external parts of the chest sometimes take 
place here, which may be easily distinguished from watery effusions 
by the crackling noise produced on pressure. 
The practice I would incline to follow, is this. In the first place, 
make several mcisions in the course of the «welling, each half an 
inch in length, and of such a depth as to pass entirely thi the 
skin into the cellular membrane ; and if these do not afford relief, 
which, however, they frequently do, proceed immediately to perfo- 
rate the cavity of the chest in the manner I have advised, as near as 
possible to the injured part if this be not near the back bone; in- 
which case the perforation should be made in the most depending 
part of the chest, as I have advised in collections of serum, &ec. 
# 
TAPPING OF THE ABDOMEN. : 
_ Atisthe effect of various diseases to produce collections of fluids 
in the cavity of the abdomen. Commonly these collections can be _ 
‘emo by internal medicines, particularly if taken in due time; — 
e cases, from the pressure of the accumulated fluid 
: 5 i 
» We are obliged to employ the operation of tapp 
Baturally secreted into the cavity of the ab 
