150 DISEASES OF THE LUNGS. 



cases. The secreting membrane could in neither case be 

 said to have acquired any habit of secretion or any 

 materially altered organism. Age may have some influence : 

 Mr. SewelPs patient was five years old ; Mr. Trapp^s eight. 

 Stamina — healthiness of constitution, and in other respects — 

 must have great influence. All these circumstances — and 

 there are others — ought, I repeat, to be taken into con- 

 sideration in dealing with a case of hydrothorax. 



Are we justified in operating in every case ? — This 

 is a question somewhat difficult of solution. On the one 

 hand, we are told that instances are to be adduced in which 

 re-absorption of the effused fluid has been eff'ected by treat- 

 ment, and that, as there is great danger and but little 

 chance of success attendant on paracentesis, we are cer- 

 tainly not justified in operating until every other means 

 has been tried. On the other hand, the advocates for the 

 operation tell you, that, unless you draw the water off" early 

 in the disorder, you have not the same chance of success. 

 " If," says d^Arboval, " we saw nothing in a dropsy beyond 

 the unusual circumstance of water existing where there 

 ought to be none, it is reasonable enough that we should 

 let out the fluid, and thus perform the cure. But of what 

 use can paracentesis be when the dropsy is dependent upon 

 affection of the heart or large vessels, while the cause 

 remains ? In the case of acute pleurisy, do we not, in the 

 act of puncturing the chest, as well as by exposing a mem- 

 brane, already in a state of intense inflammation, to the 

 contact of air, create fresh irritation? And, should the 

 case be chronic, do we not run the risk of converting it into 

 acute, and thus destroying our patient ? In a word, para- 

 centesis is an operation too perilous, and too often fatal in 

 animals, for us to dare to countenance it. And besides, 

 notwithstanding we may inject, there is the inevitable in- 

 convenience attending it, of the pulmonary organs, in con- 

 sequence of being no longer compressed and sustained by 

 the surrounding fluid, falling suddenly into a state of 

 collapse, a change bordering on death." For my own part, 

 where we have attended a case sufficiently to put our treat- 



