ON PARACENTESIS THORACIS. 
180 
potass, were exhibited three times a day, instead of the medicine 
formerly given. 
1()^A and V7th .—She has become much worse ; looks very dull, 
holds her head down, and eats little or nothing. The pulse is 
60, and the respiration very hurried. Half a drachm of digitalis, 
three drachms of cascarilla bark, and two drachms of the nitrate 
of potass were ordered to be given three times a day. 
18^/i.—Having fully satisfied myself that effusion to a great 
extent had taken place within the thorax^ and that nothing but 
paracentesis would be useful, I proceeded to operate in the fol¬ 
lowing manner:—Drawing back the integuments, I made a small 
incision through them with a lancet, and introduced a trocar and 
canula between the eighth and ninth ribs of the right side, nearly 
as low down as their cartilages, and on withdrawing the trocar 
from the tube, seven quarts of fluid came away in a full stream. 
Care was taken to prevent the entrance of air. As soon as 
the fluid had been abstracted, I withdrew the tube, drawing the 
integuments over the opening, and then operated in a similar 
manner on the leftside. Scarcely half a pint of fluid, however, 
came away. About an hour after the operation she breathed na¬ 
turally, appeared much better, and ate a feed of bran and oats, 
and a fair allowance of grass. She was ordered three drachms 
of cascarilla bark and two drachms of the nitrate of potass, three 
times a day. 
\9th, 20th, and 2\st ,—She continues to feed well, and is, on the 
whole, better. The medicine was continued. 
22(1 .—She is much worse; her appetite is lost, and the respira¬ 
tion very rapid. I operated, as before, on the right side, and eva¬ 
cuated five pints of fluid. In half an hour she appeared to be 
greatly relieved. In the course of the day she began to feed on 
bran and oats, and took a good allowance of grass. A liquid 
blister was rubbed into the sides and chest, and the tonic medi¬ 
cine mentioned above was continued. 
2^d .—She is much better, the breathing is free, and she feeds 
well. The tonic medicine was continued. 
September \^th .—She has continued to improve and feed well, 
and the tonic has been regularly exhibited, as directed above ; and 
she has half an hour’s exercise daily. The medicine was now or¬ 
dered to be given only night and morning. 
October %th .—The medicine was discontinued. 
\2th .—She has lain down for the first time. 
26^?.—She now lies down frequently for an hour or two, and 
has walking exercise for an hour and a half daily. 
November Ath .—Being now perfectly recovered, she returned 
to her duty. 
