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Show 13% or 'IAPI'ING THE ABDOML‘N. OF THE PARACENTESIS TIIORAFIS. hesive plaster, which should be supported by a compress of lint, and one of the extremities of the roller, or bandage. It is possible to mistake a tympanitic state of the intestines for ascites. Some of 'my pupils have spoken of the dry tap~ ping, as they choose to call it, as no rarity to them. The feeling is so diiferent, though the distinction is not to be described, that I am somewhat astonished at the fact. I be‘ be very diiferent. has been mistaken by the surgeon as well as the pupils. bility of vessels, and diseases of viscera, which may produce collections of fluid secretion into the peritoneum, without an affection of the 1mmediately vital parts. A disease of the by the surgeon introducing the probe, not water, but pelieles of membrane, like the omentum, presented. I resolved, if possible, to ascertain the nature of the second case, as the woman died. I found that it was a dropsy of the ovarium, which had been considered as an ascites ; and that while the ll -.‘.. \wr- "1" u-‘ liklkklllm WATER in the chest is a much‘more alarming and a more generally fatal disease than ascites. The operation of evacu~ ating this is done in very different circumstances froin that of the tapping the belly, and the disease itself I believe to lieve that in some instances, a diseased state of the ovarium Having seen it happen on two occasions, very closely following each other, that, on the surgeon withdrawing the stilette, a very little fluid flowed, and then the canula was stopt; and, v warm»; OF THE \VA'I‘ER IN THE CHEST} distended ovarium filled the whole belly, it consisted of distinct compartments of irregular sizes, and within them shreds of membranes, loose and floating. One of these cells being pierced by the trocar, after discharging a little fluid, some of the membranous-like substance had fallen before the stream, and, hurrying through the canula, had been mistaken for the omentum. In the ascites of women, we should recollect that there is a possibility of their being pregnant; if of an age, and in circumstances to allow of this suSpicien, we should examine by the vagina, before deciding on the operation. ‘Vhat has been said by some authors, of the operation of paracentesis, for air in the cavity of the abdomen, had bet~ ter be all fin‘gottenis. And as to perforating the intestines for a tympanitic state of the intestine, it has, unquestionably: been proposed in temerity and folly. 7* In experiments on animals, when air is blovm into the cavity of the peritoneum, it is absorbed. So it would happen, if air had cscap= ad from‘ the intestinal canal, and if'it escapes by an ulcer (as I have seen upon dissection), still the operation would be of no service. In the belly there may be a partial de- liver, or a debility in the venous system of the membranous viscera, and of the larger glands, may produce the disease without the participation of the heart and lungs in the complaint, or but indirectly. In the thorax it is different. The dropsy must be preceded and accompanied by derange~ ment in the function of the heart and lungs. The distension of the cavities of the pericardium and pleura must further oppress and disorder the function of these important parts; but the drawing off of the water does not relieve them: on the contrary, it must leave a relaxation in the membranes which ought to support the vessels, and the heart's action, and the play of the lungs. It has always appeared to me, that the treatment of the dropsy of the chest was, peculiarly, the province of the physician. OF THE PARACENTESIS THORACIS. Tnocen not for water in the chest, yet for matter, it may be necessary for the surgeon to puncture the side of the chest. A collection of purulent matter in the cavity of the chest (EMPYEMA) is formed in consequence of wounds and foreign bodies remaining in the thorax ; or by inflammation, as in pneumonia; by the bursting of abscesses or vomicze in the lungs. Then while there is remission of the more acute pain, there remains dyspnoea and cough, and succeeding to the inflammatory state, quick pulse, fixed pain in the chest; . ' wom M09917") |