AND -HIS DISEASES. 197 



cast. The skin is divided over the part for about three 

 inches in length, when the muscles are separated from their 

 cellular connexions, either by the finger or the handle of the 

 scalpel, while the gullet is pushed up with the hand under- 

 neath, a longitudinal incision is made sufficiently large to 

 allow the removal of the foreign body ; this done, the part 

 being carefully wiped clean and the edges of the gullet 

 brought together by sutures of fine catgut, as recommended 

 by Dick, and a few stitches of wire suture to bring the muscles 

 and skin together, and a carefully adjusted pad supported by 

 a bandage, cold water must be freely applied to moderate the 

 inflammatory process. 



He must be restricted to gruel, linseed tea, and other 

 bland fluids. Great care is necessary to keep the part clean 

 and promote adhesion, which is sometimes very difficult to 

 produce, and death often results. 



TAPPING (PAEACENTESIS.) 



In cases of extensive dropsical efl'usion into the chest or 

 belly, it is sometimes found necessary to remove it by opera- 

 tion. 



In tapping the chest (paracentesis thoracis) the puncture 

 may be made in the intercostal space, anywhere between 

 the seventh and eleventh ribs, . near their junction with the 

 cartilages. The space between the eighth and ninth is 

 usually recommended. An incision is first made with a 

 lancet through the skin, the trochar and canula is carefully 

 pushed through the muscles and pleura, directed slightly 

 upward and backward, keeping it close to the anterior border 

 of the ninth rib, so as to avoid wounding the intercostal 

 artery ; when the trochar is withdrawn, the fluid flows freely 

 through the tube, sometimes it gets obstructed by coagula 

 of lymph, which should be cleared by inserting a small whale- 



