{s6) iiisrop.r of ihe so CI Err. 



A-ciiUiuof large qiiaiility tlius evacuated, it will prove the lung of that 



w. HamiUon. r^^^ j.^, {^j, fo^^mj . ^s, au" 1-cing entirely exchidecl, the cavity 

 muft be filled up by that ;ilone, after the v^^atcr is difcharged. If 

 little runs off, it is probably one of thefe cafes where the lung 

 is fo much indurated as to be for ever incapable of performing 

 its funclion. In the firft cafe, the patient may derive benefit 

 from the operation; the difeafe may be prevented from recur- 

 ring. In the other we have done him no hurt ; he will breathe 

 more eafily as long as the oozing continues, by taking away the 

 redundant v/ater, but, as this cannot be kept up long, he mud 

 at laic be ]cft to his fate. 



" Laying the patient on the difeafed fide after the operation 

 mufl be of fervice, as it both allows the water to run off, and it 

 prevents him from enlarging that fide of the chefl, and thus 

 running a rifle of drawing in air by the wovmd. When a canula 

 is kept in, this is imprai?i:icable ; the patient cannot be laid 

 much towards that fide without the canula preffing on the bed- 

 clothes. In the manner I have propofed, the operation will, I 

 think, be more fafely performed, and might therefore be oftener 

 tried. 



" What I have faid applies only to hydrothorax. In em- 

 pyema an opening mufl be kept in the chefl, to difcharge the 

 matter as it forms. The two difeafes certainly require different 

 furgical treatment. In the firft, inflammation has not come on, 

 and is to be guarded againfl In the other, the colleclion of 

 matter is the effe<3: of it, and its being regularly difcharged will, 

 if any thing can, abate it. I fliould therefore follow Mr Bell's 

 plan* in this, though I would differ from it in the other; and 

 as the fleps of the operation in thefe two cafes would be the 

 fame, except leaving in the canula in empyema, v/e n:iay attempt 



it 



• The canu'a recommended by Mr BcLL^has no lip or margin round the opening. 

 By fiich an addition it has a hold of the parts round the opening, and can be kept 

 much lieadier. 



