DISEASES OP THE CHEST AND AIR-PASSAGES. 121 



febrile pulse of the latter ; the difficult convulsive explx-ation of 

 the one, the peculiar respiration of the other; the intensely red 

 hue of the eyelids and nostrils in pneumonia, the absence of this 

 in pleuritis ; the freedom from pain on pressure in the former, 

 and its exhibition in the latter ; the coldness of the extremities 

 in the one, the variable temperature in the other; the obstinate 

 standing in the one, and the frequent lying down and getting up 

 in the other. 



The post mortem appearances are sometimes merely inflam- 

 mation of the pleura, with patches of lymph, but more frequently 

 a considerable collection of fluid, pale or yellow, or reddish or 

 bloody, in all three cavities, with adhesion of the lungs to the 

 sides of the chest, and other morbid changes; sometimes the 

 pleura appears in a state of gangrene. 



Treatment. — Mr. Field recommends the immediate abstraction 

 of blood, to the quantity of from ten to twenty pounds, to be re- 

 jDeated as the case seems to require. The bowels to be mode- 

 rately relaxed by a small dose of aloes, assisted by injections 

 (we prefer doing this, however, by means of linseed oil — Ed.) ; 

 and he wau then in the habit of giving white hellebore, in doses 

 from one scruple to half a drachm, combined with spirit of 

 nitrous ether, nitre, and tartarized antimony. 



A blister on the thorax and sides should be applied, and a 

 rowel in the brisket inserted. 



When the inflammatory symptoms evidently abated, vegetable 

 tonics, as gentian and ginger, were advised ; and to which, when 

 the possibility of hydrothorax was suspected, mild diuretics were 

 added. 



When effiision has evidently taken place, the operation of 

 ■paracentesis, or tapping, is called for. — Ed.] 



\Hydrotliorax, 



As the deposition of water in the chest is termed, although an 

 eflfort of nature to relieve inflammation, is yet generally attended 

 with a fatal termination. 



The only chance of relief is aflPorded by an operation called 

 paracentesis, or tapping, which consists in plunging an instru- 

 ment called a trochar between the ribs into the cavity of the 

 chest, and leaving the canula, or tube which encases the trochar, 

 and withdrawing the latter, by which an exit is aflforded to the 

 fluid contained within the chest throuoh the canvila. 



The best situation for the operation is between the eighth and 

 ninth ribs, and near the cartilages ; and the skin should be pre- 

 viously drawn tightly forwards, by wdiich means the opening 

 will be closed after the operation. It should be performed on 



