ACUTE DISEASES OF THE ORGANS OF EESPIRATION. 221 



the blister, seton, or firing iron must then be applied to the neighbour- 

 hood of the part affected. 



In Bronchitis the throat and windpipe as far down as the chest, in 

 Pneumonia, Pleuritis, and Pleuro-pneumonia both sides and chest, are 

 usually acted on. 



The injurious effects likely to result from the application of cantharides 

 over a large surface have been already noticed. In Pleuro-pneumonia, 

 therefore, where the parts affected are very extensive, it is better to use 

 mustard if any such treatment is decided on. 



Bleeding, formerly so much in repute in the treatment of these dis- 

 eases, is now seldom resorted to. 



444. Unfavorable terminations. 



Some cases however in spite of all our care will terminate unfavorably, 

 and we shall then have to deal with those results which have been men- 

 tioned above, namely effusion or water on the chest } exudation of lymph 

 causing either condensation of the connecting tissue of the lungs and also 

 of the air cells, or extensive adhesion of the pleura of tl\e ribs to the 

 pleura of the lungs; or more rarely suppuration and the formation of 

 abscesses ; or sometimes gangrene or mortification of the parts attacked ; 

 and not uncommonly roaring. 



445. Effusion, 



When Effusion takes place from the overloaded vessels, the acute 

 symptoms are at first greatly diminished, and the inexperienced may be 

 led to think that the patient is going to recover. Warmth returns to the 

 extremities, the pulse though still quick is less frequent and it becomes 

 soft, the appetite partially returns, and the general appearance indicates 

 that the acute pain has subsided. The fact is, that the tension is taken 

 off the coats of the blood-vessels by reason of the effusion, and thus for 

 a time, until the water occupies some considerable space in the chest, 

 the breathing is not so much laboured. 



As soon however as that result takes place, the breathing becomes 

 more laboured, and the difficulty increases with the increasing amount of 

 the effusion. The degree to which the water has formed may be ascer- 

 tained by careful auscultation, as no respiratory sounds will be heard 

 from that part of the lungs which is surrounded by water ; whilst above 

 that point the usual sound will be plainly perceptible. 



From the commencement of the effusion, although many of the urgent 

 symptoms at first subside, yet others remain throughout, which distinctly 

 negative the idea of a real recovery. The pulse is still quick and wiry, 

 the breathing quick in number, although at first less laboured, the 

 extremities, which had temporarily regained their warmth, again become 

 cold, the coat is harsh and dry, and there is a want of pliability in the 

 skin. The most marked feature, however, consists in the patient still 

 standing persistently with his fore-legs wide apart. 



As soon as the effusion has taken place to any considerable extent, 



