It is not uncommon, during the performance of this operation, for the water suddenly to stop iong before the full quantity is drawn off. Sometimes this happens from a piece of intestine or omentum obstructing the canula, which may be removed by introducing a probe or other blunt instrument through the tube. If the water happens to be very viscous, the only thing we can do is to introduce a larger trocar; but, when hydatids are the occasion, it is to no purpose to continue the operation in that place, though we may renew it on the opposite side, or in any other part where it seems likely that there is a collection of water.

In the cafe of a dropsy of the ovarium, we are to follow the same method; only it is to be remembered that the fluid is not so distinctly perceived to fluctuate, and the swelling is commonly consined to one side of the abdomen, excepting when the disease of the ovarium is combined with an ascites, or when it is of such a size as to sill the whole abdomen, which frequently happens.

Sometimes, though rarely, the operation of paracentesis is necessary for giving vent to collections of air in the abdomen. Air, when pent up in this manner, is generally contained in the bowels, which it blows up to an enormous size. Instances, however, are related of quantities of

has air being contained between the peritonæum and intestines; but, in some of those, this air has been known to have escaped thro' a small hole in the intestine itself, and it is probable that all the rest were of the fame kind. At any rate, when the symptoms become very urgent, there is as much necessity for the paracentesis in this disease, (called the tympanites, or tympany), as in the true dropsy. Neither are we to delay or omit the operation because we suppose the air to be contained in the intestines; for, by puncturing them, the patient has a chance for his life, which must undoubtedly be lost, if the disease be suffered to go on. The operation is to be performed as directed for the dropsy, and the patient to be treated exactly in the same manner. In this cafe, however, we must take care to employ a very small trocar, and use the same means for pressure on the patient's belly as already directed ; for, the smaller the wound is, so much the better, as the air can easily be expelled through a small as well as a great one, and the pressure on the intestines, from the distension of the integuments, is the fame whether they be distended by air or water.

CHAP, CHAP. IX.

PARACENTES1S OF THE THORAX.

The paracentesis of the thorax, though often equally necessary with that of the abdomen, is much less frequently performed. The necessity of it is apparent in many cafes, where the respiration is much impeded by pus, serum, blood, or air extravasated into the cavity. The fluid most commonly met with in the cavity of the thorax is pus ; and we know that it is deposited there, when an inflammation has previously taken place, which, instead of being quickly resolved and terminated, has continued for a long time, and brought on those symptoms which indicate suppuration in other parts of the body. Sometimes, indeed, in cafes of this kind, the matter is expectorated in great quantities; but, in a great many more, the patient has a tickling cough, an oppressed respiration, cannot lie upon one side, nor has any inclination to lie down in any posture. He is likewise frequently attacked with flight rigors and stiiverings, and sometimes the affected side is swelled, or has a kind of œdematous feel very different from that of the other.

These

1

These symptoms may be accounted a certain indication of pus contained in the cavity of the thorax. A serous, or watery tumor here is frequently accompanied with dropsy in other parts of the body, and the signs of it are pretty much the fame with those of pus; only we may conclude that the fluid is serous rather than purulent, from the absence of those pre-dispqsing causes already mentioned. Sometimes the patient, upon being hastily moved, will perceive a kind of undulation in his chest, and when the quantity is considerable, the undulation will even be heard by the by-standers if the patient be smartly shaken backwards and forwards. Sometimes, however, the water, instead of being contained in the cavity of the thorax is inclosed in the pericardium. The symptoms are much the fame as in the other cafe, only, according to M. Senac, when much water happens to be contained in the pericardium, there is a sirm undulatory motion perceptible, at every pulsation of the heart, between the third, fourth, and sifth ribs. There are instances, however, of the water being collected between the plates of the medrastinum. In this cafe, though the pain and oppression are equally great, they are felt more in the middle of the breast, but as the feat of the disorder is then directly under the sternum, the paracentesis cannot be performed in the fame manner as in other cases. y When blood is collected in the thorax, the symptoms are still worse than those we have yet mentioned ; for, in addition to the oppression and debility occasioned by collections of pus or serum, there is a very great feebleness and irregularity of the pulse, and all the other complaints are much more severe than when any other kind of fluid is" collected. The reason of this is evident, because there can be no considerable collection of blood in this cayity, without a wound in some of the blood vessels, either by a foreign body, by the erosion of ulcers, or a rupture from violent efforts in coughing, &c.; Air occasions symptoms very little less alarming than those arising from an effusion of blood. It may be occasioned by wounds in the lungs ; by a mortisication of any internal part, for it is the nature of mortisications to produce an elastic vapour resembling air ; by a rupture of the membrane of the lungs from violent coughing, he. by the erosion of ulcers ; or by the laceration of their membranes by the point of a fractured rib, or vertebra. The symptoms are the fame, whatever be the cause, viz. a straitness of the breast, and oppression of the breathing, attended with pain, an inability to lie down ; a fluming and swelling of the face; a feeble and irregular pulse; coldness of the extremities ; all of which, gradually increasing, soon terminate in death, if the Vol. II. N patient

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