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much pain. It is distingaished from pleurisy by the absence of fever, 

 cough, the friction-sound, the effusiou into the chest, aud by the exist- 

 ence of rheumatism in other parts. The treatment for this affection is 

 the same as for rheumatism affecting other parts. 



WOUNDS PENETRATING THE WALLS OF THE CHEST. 



According to the theory of some teachers of physiology, when an 

 opening is made in the wall of the chest, suflicient for the admission of 

 air, a collapse of the lung should occur. But in practice this is not al- 

 ways found to bo the case! The writer has attended several such cases, 

 and one in particular was not seen until about twelve hours after the 

 wound was inflicted. It is true the breathing was considerably altered, 

 but no bad effect followed the admission of air into the thoracic cav- 

 ity. The wound was closed and treated according to the method of 

 treating wounds generally, and a speedy and perfect recovery was made. 

 The wound may not i)enetrate the i)leura ; in such cases no great harm 

 is done, but if the pleura is penetrated pleurisy may follow, and even 

 pneumonia if the wound involves the lung. 



The condition called pneumo-thorax means air in the chest. This 

 may be due to a wound in the wall of the chest, or it may be due to a 

 broken rib, the sharp edge of which wounds the lung sufficiently to allow 

 air to escape into the space between the lung and ribs, which is natu- 

 rally a vacuum. Air gaining access to the thoracic cavity through 

 a wound may have a peculiar effect. The wound may be so made that 

 when the walls of the chest are dilating a little air is sucked in, but 

 during the contraction of the wall the contained air presses against the 

 torn part in such a manner as to entirely close the wound ; thus a small 

 quantity of air gams access with each inspiration, while none is allowed 

 to escape until the lung is pressed into a very small compass and forced 

 into the anterior part of the chest. The same thing may occur from a 

 broken rib inflicting a wound in the lung. In this form the air gains 

 access from the lung, and there may not even bo an opening in the 

 walls of the chest. Decomposition of the fluid in hydro-thorax, with 

 consequent generation of gases, is said to have caused the same con- 

 dition. In such cases the air is generally absorbed, and a siiontaneous 

 cure is the result. But when the symptoms are urgent it is recom- 

 mended that the air be removed by a trocar and canula or by an 

 aspirator. 



The treatment of wounds that penetrate the thoracic cavity should, 

 for the foregoing reason, be prompt. It should be quickly ascertained 

 whether or not a foreign body remains in the wound, then it should be 

 thoroughly cleaned with a solution of carbolic acid one part in water 

 forty parts. The wound should then be closed immediately. If it is an 

 incised wound it should be closed with sutures ; if torn or lacerated, a 

 bandage around the chest over the dressing is the best plan. At all 

 events, air must be prevented from getting into the chest, as soon and 

 as effectually as possible. The after treatment of the wound should 



