1000000031

n1attcr is

llrually Cric

u::, ,as

faa

gener:ued; and

the

ddf,élion cf (ueh \\'ho have dicd of th" (pecios or

eor,ful~p

t¡('In, \Ve rarely fiod much extravaf;ttcd

PUl

in the

cavity,

though :\ grC:;1t portion of (he lungs be deHroyed .

H o·.\'c.:vc:r,

there al'e a tew examp lcs which n'quire! the operat:oD:

and

thcJe m;ty be

rli(llO~u :fhed

the rollowing

fymploms.

The

p¡uient is obligcd

lie

upon

,he

oileaft:d

lid

or, in

care

thcre is

r.UHer

in bOlh ca\'itifS o( the

~bo'

ax, 09 his back;

becG.ufc the

flJrdi,¡flinufIl

can (ddom fupport lhe weigh t of

th e in·;umbent fluid , wi thout fuficring

c!:tl

pain ; bUl

chis

rule i5 Dal ccnain, it romrtimes h"ppeiling lhat the patient

C-2.n

lie with

eaf'! on

th at fide wh'!re there:

is no

nu~d .

A no

ot·her

rymptom

extra",afated

m?tter,

<I n

cvíden t un–

duf:uion

it,

thu in tenal n Olorioos

nld.y be nC:lrd tO

quafh . For the moa part too, upon carefoJ ir.qlliry, ao

te'~1"'IJ

or at leall a

thickeni n~

of fome portian of lhe íoter–

con, 1 murcies, will be difeo.ered. And I.niy. ir rherc be

rnuch fl1lid, it wiU bc au ended wlth a prelcrnal'jfál cxpan–

fion of th:u {jde of lhe chell where jt hes. \Vhen lhere–

{ore thcre Cigm .appear afler a pre'fiOllS plcurilie or pulmona–

r y dif()rder, aod the cafe has bl!cn attenc.Jed with lhe fymp –

t oms of a fuppuration , it is mon p:--ob..

bly

oWl ng tO a eollee·

tion of manee, though the p:uient will alfo 1.!Joue under a

eODtinuallow (c,,"cr, aod a pan icular anxiely írom the

lo.ad

of Buid.

T he lan fort o( fluid f.1I.I to require i{fue from this opera–

tion is water, which howeve r 'fery felJOOl colle8s in fuch

m anoer as tO become the proper fubj etl of the operation :

{or if lhe ¿ ropfy of Ihe thorax becomplicated with 410

allafar–

e",

or e\'en

ajcilu,

it is certainly improper; and indeed it

hardly cver takes plaee. bu, whcre the diHemper ii fingle,

a.nd

taku iu rife from lhe fame fon of,éliforders in Ihe Iympha–

Hcs of the pleura, as the hydroecle dou from thofe of tbe

l uni.-a voginalis

The fymptoms of this dropfyare, a (mlll

cough without fpitting. a linle Oow rever fr om the

dinur~

bance of refpiratioo; \fomctimes

tOO

the

w~ter,

by a fudden

j erk. m.y be heard tOquafh; and , generall y fpe. king, its weight

u pon the

diaphrag m

i nd

tnediaflinu1IJ

a re fa trouble(omc as

to oblige the patieO( to lloop forward, and

t O

turo uron lhe

afFctled Cide when he líes down ; fQr tr.e Carne reafoD, when

there is water io both .cavities of the [horax, he is forced to

lie on hi.

b.ek

Toe m:4nner

5'f

opera[in,e, whe!h!.r at be for the difcharge

of matttr or water, ís tO pitch upon lhe 010n depending part

of lhe thorax , which fome ha'f'e fu?pofed to be belwcen Ihe

eigh!h and ninth rib, and others hetwecn lhe n¡nlh and tenfh,

a t fueh a di(bn;:e from the

vult:hrte

thitt the ckpth of [he

ficfh may nOl be: an impe:diment

the ('erforatian. This di–

llanee is dt:lerm:ned tO be about a hand's breadth: and here,

with a knife, fcifEHS, or trocar, we aTe ordered

mOlke

the pedoration;

l-llt

in doio:! lt lhere are a great many djffi·

euhies. In fat perfons,

is oot eafy tO count the ribs, and

~he

wound

U!II!

h: >very dtt'p, and troublefome to make ; it

bardIy poffible

efcape wou ndíDg rhe interconal :\ncry,

whiclt

filOS

in , his pl4lce betweeo

Ihe

ribs. But

the ooly

advantage propcfed by the fit uatlon of the wound be. de–

riv:-d fro:n its

I.~,

pcnciency

the~purpcfe

of dif...:harging the

fh!!J

~"iJi

<lS

wdl :mfwcrt':d by <In opening bt:t\Veen lhe

fixth .nti {cventh rib. h ..lf way from lhe flcrnum tOVJ3rds

the (pio!; ,ph:ch. by layiilg ourfelves down . bccomcs in effeél

dC'~(ndlng

Oln orifice, 41S the olher io liuing up; and

openin~

m:lde in ,his m_nner we :.void al1 the inconven:cn–

eies in lhe other melhod: For in this part of lhe tht'rax

VOL .

lIl. N"_ 96.

th~rc

is 'fcry liulc: depth of

Iliufc!es;

t!¡e ..nery líes conec¡ l·

ed uadcr the rib; and l hc

t!¡2.phr~gm

is at

JjfCat

d¡flance.

TLe optning is

bdl

made

\l/id}

it knlfc, and lhouId be :tbout

ao inch lor.g Ihrou&h

the fl:in.

~nd

ha!f an iorll thl

cUfh

lhe

fu bj~c(!)[

mufcles: thOllgh, to make lhe ine¡(jon

wi th

It:fs rdk

of \'Iounding lhe

lu~gs,

it may he advifeí'blc to ciilatc il witn

Ihe blunt-pointed knife

(.u

15 praébfed in ,he opcration fu r

the

bubr,noule)

;:tfter ha\'ing made a fmalJ

pun~lure

wlth a

CommOD knife. T he tr e:\tment of the wouod

wdl

be accor..! –

ing to lhe oature of the dlfeh:\rge.

Ir,

:tfler

few days, ,h"re

ap¡>ears no drain, yon

lU;'Iy

It!l the orifice heal

IIp;

but if

con.inües, ir

~may

be kepl opeo with

fhon lilvcr CdllUld,

unlil ruco time as an altc:ration in lhat círcul1\{i:;l.Oce will give

us lea\'e tO cicatrize Wilh

r~.rety.

EnC)fi.d T uMouRs.

. TH.ESE

tumours

borr~w

their names from a eya or bag,

whlch they are conta¡ned; and are fanhcr dlllinguilhcd

by the: o,¡ture of their contcnts: If the malter fo rming them

rc:femblc:s milk-curds, the tumour is called

alhe,.oll/o;

if it

be hke honey,

7llelicerÍJ;

and if compofed of fat, or a

fUCly fubrtancc,

flea/oIlJa.

T he twO firCl are DOt readily di–

fiinguifhed from one aoother, bUl their d:Werenee froOl the

jl~,"ollla

is eafily learol by their {oflnefs and fluétuation.

"r hefe (umours appear in every pan of lhe body, and in pla–

ces where thcre are no glaods.

The .fi~a/omt1

is never painful !.latíl by its weighl it grow$

troúblcfome, nor is

íl

a mark of geneni indifpofi<ion of body ;

fo that the ex tirp,¡tion reldoms falIs of fuc"Cs.

The fize of

fome of them is very large, frequently wtighing

fi"e

or fi x

pounds, aod there bave been inUaoces of the:r weighing élbove

fo"y.

'Vhen the

fl~a/()tlla

irregular in ilS: furface. wilh eml–

nencies and depreffion5. it is fuely; whereas lhe fat one h",,:i

for lhe mon pan a uniform fmoolh outfide. The operar:oll

ror the

jlfa/ollla

will be uDdernood by the delcriptioD of

that for l he fchirrhus.

The_alheroma

is mueh more common than the rndiceri5; at

lean, if all encytlcd tumuurs Wilh maller !jOt cn rd!nl, ma)",

i!l

compliancc with cufiom, be c,died fo: ",,['lu·fe are Icore

[requenl, and grow larger \han Ihofe where the nutter is

curdJed, bciD:! often attend2nl on fcrophu.lous indifpofit¡oo:¡,

wh;ch makes them more difficult of cerC!o

Th¿ cylls of there tumours, wilh lhe

fKin

ecvering them,

after a ccnai n period of growlh, rdif1ing ar.y

(Uf

,her

enbrge~

mcnt, do frequent1y inflame and bre;;.k: bUl lhit oper.ing is oo't

fo adv:tntf\geous fo r lhe cure 41S extirpalion by lhe koife, which

Ihould be done in the infaney cf the (wdling. \;rhen the

t umours art;

bi~ger

than a fmall goldcn pippen. they m"y

be dilfeéted away from uDder the lkin,

making a

finiSht

¡Deifioo ooly through it; but if they exeeed

\1:115

bulk. ao

oval piece of Ikin muO be cut through

f¡rft,

makc room

(or the m?Dagcment of the knife: and tak.iog away th: tla!lour;

in wbich cafe,

",iJl

be advireable

lakc: ufF

~he

uppcr por·

tion of the cya with the (ki n, and (hen. by lhe help of a

hook,

dilTc-(l aw?y;;5 mueh of lhe remajndl¡' of

as c..n

be convenic:ndy. which is 41lefs palnrul ard more feeule

ro ...·.

lhod

th~n

dcClroying il aflerwuds \....ilh ef(;Í1i\lo,icks. "( nis

rule is tO be o!.>fer\lcd, when lhe cyH

filOS

fo dcep

21110fl~H

tbe intcrriices of the mufcles,

OI S

tO mdkc:

imroni~)le

rt.......

move ,IIe whole of il, wherc, if we CUt off a grei\t G,uJ.ntity,

the ren uf\l1l1y comes away io {1ouZhs and mallero

1 'he

g~nglion

of thc tendon is \ln cr.cyacd tumour of lh:

8 E

Ol,Ir;t l:'