J P P E N D I X. - (53) 



for two or three days. The effecfl of tliis praclice is evident ; 

 inflammation may be brought on over the cavity; fuppuration 

 will fucceed, and the cafe will be converted into one of eni- 

 pvema, with an opening in the cheft. The effeds of keeping 

 in a canula in the abdomen v/erc found, by the old furgeons, to 

 be fo bad, that the practice was given xip, even before the faint- 

 nefs, from drawing ofT the water at once, was fo well under- 

 flood as to be capable of being prevented. In our patient, 

 fymptoms of inflammation from the canula were beginning 

 when it was withdrawn, and had it been kept in another day, 

 the inflammation would probably have become fo confiderable, 

 that it might have been expeded to produce the worll confe- 

 quences. 



" The view with which a canula is introduced and kept in, 

 is, to allow the water to run off only when we choofe it, and to 

 prevent air from getting into the cavity. The firft intention it 

 does not anfwer ; as in our patient, though it was introduced 

 tlirough the pleura when only a fmall perforation had been 

 made in it, fo that it might be clofely embraced, the water ooz- 

 ed out by its fides, and more was difcharged in this way than 

 by the canula itfelf. 



" Air is likewifc more apt to get into the cavity by the ca- 

 nula, than if the water was difcharged without it. It is impof-^ 

 fible to flop it fo accurately and quickly with the finger or 

 cork, as to prevent the accefs of air, when there is little water 

 left, or when the lungs are not in a fituation to fill the cavity, 

 and efpecially when the patient is infpiring. This I found to 

 be the cafe, when I drew off the lafl water by it. But before 

 I left the patient, I evacuated the air as completely as pollible, 

 by depreffmg that fide of the cheft during expiration. 



From the ftrudure of the thorax, air is apt to be drawn in 

 by the external wound, and is again not eafily expelled. The 

 mod ready method of evacuating it, is by comprelfuig that fide 



of 



A:coun' t-i 

 W. Ha.uwtoi 



