PLEURISY. 
7 
2d. — Pulse 62, and rather hard. Respirations, however, 
down to 32, and inspiration is now distinctly longer than 
expiration. Perfect dulness extends fifteen inches high on 
both sides. She eats moderately well, and is not unnatu- 
rally thirsty. Medicine continued. 
3d. — Dulness (on auscultation) has extended to fifteen 
inches on the right side, and within a little of same height on 
the left. The pulse is 63 ; respirations 36. Emaciation 
becomes more obvious. 
Tapping was again repeated on the right side, between the 
seventh and eighth costal cartilages, and four inches outside 
the sternum. About nine quarts (imperial) of fluid came easily 
away. The left side was also pierced, but only about four 
ounces of liquid were obtained. Although the amount of 
fluid abstracted was comparatively small, yet the respiratory 
murmur was heard five inches lower down than before the 
operation. On standing twenty-four hours, the fluid coagu- 
lated more firmly than after the first operation ; there was 
also less sediment, and but very little tinge of blood. 
4th. —Pulse 66; respiration 32. There is no visible im- 
provement in her general appearance. The fluid has again 
slightly increased : treatment continued. 
3th and 6th. — No material change in the symptoms, but 
emaciation becomes more and more evident. 
7th. — Pulse 70; respiration, however, still 32. Dulness has 
become as extensive as before the last operation. Ordered 
three quarts of strong ale daily : all medicine discontinued. 
9th. Pulse 74. Respiration 33. Appetite better than 
for some days past. The ears and legs are now uniformly 
cold. 
1 1th. Pulse has reached 80, and is again weak as well as 
irregular. Respiration 40. Anasarcous swelling increasing 
at the breast and involving the legs. The patient is decidedly 
worse in every respect. I abstracted ten quarts more fluid 
from the right side ; none could be obtained from the left. 
She died during the night. 
She was dissected on the 13th. The right costal pleura 
was inflamed from the sternum to the vertebral column. Its 
lower third was covered with lymph half an inch thick in 
many places, and a pailful of loose lymph w T as lying in the 
chest. There were no adhesions between the right pulmo- 
nary and pleural surfaces. About tw r o quarts of actual fluid 
were found in this side, and a pint in the left. There was a 
very free communication between the right and left pleural 
sacs, as the inferior mediastinum was extensively areolated. 
The left side presented appearances of the same nature as the 
