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.and this is to be atten led to t:ll the the tooth is perfectly firm. He Ihould also guard against cold and moist air, and live upon spoon meat.

Sect. V. 0/Boils and Excrescences of tke Gums.

488. Gum boils may arise fron cold or from external vio.ence, &c. but most frequently they are the consequence or too:h-ach. The complaint begins with pain attcnde 1 with a-tumor on the parts attested; by degrees the side of the fate swells considerably; the tumor of the gum now begin] to point ; ami if it be not opened, it bursts and gives the patie.it immediate relief. When the boii is owing merely to inllammali in, after the matter is evacuated, the complaint goes off; but when it proceeds from a caries of R to >th, it will continue ?.s long a* the cause remain?; the tooth therefore ought to be extracted. After the abscess has Imrst, if the matter continue to b- discharged, it may simetimes be dried up by injecting some aitringeiit liquor; bus the most effectual method is to lay the absciss fully open, and to heal it from the b-tto.n by dolli.s of lint. So nelames abscesses occur of a more obstinate nature, owing to a carious state of the jaw. In that cafe suppuration ought to be promoted, and th- oart laid open as soon as matter is formed; keeping the pall'ige open for the discharge, being tnc only meap» for effecting a cure.

489. Excrtscencts of various degree? of rai niness sometimes glow upon th<" guilts. Some are soft and fungous, while others are of a wuty nature. In general they are not attended with pain. They often originate from caries of the teeth, or of sheir fockct3; Ib which cale the removal of the spoiled treth, and the subsequent exfoliation of the carious part of the jaw, will often accomplish a cure. B it if n<?!, the tunaor should be removed as soon a* it becomes trouMrfome, otherwise there may he danger of its ending in cancer. The removal miy be effected by a ligature or kn;*e, according as the tumor may have a narrow or broad basis. It is sometime-: necelsary to use a speculum ons to keep the mouth open. After the tumor is extirpited. the wound sti mid be a.lowed to bleed fre.'iy, to prevent subsequent inflammation. When trie htmorrhagy proceeds too far, it should be restrained by the application of spirit of wine, or tincture of myrrh, or solution ot alum, &c. and should these prove unsuccessful, the lunar caustic wiil seldom fail of having the desired effect. No dressings can be applied; but fqr fume days after the operation, the mouth Ibould be frequently washed with a warm emollient decoction; and the cure will he afterwards promoted by the application of some gently astringent liquor, as port wine, tinctuie of roses, &c.

Sect. VI. Of Abscesses, &c. in the Antrum Maxillare.

490. This disease in known by a pain and uneasiness beginning in the cheek, and extending upwards to the ryes, oofe, an I ears, with a swelling, which in the latter stages of the disease tends to a point, often in the cherk. Sometimes a discharge ensues between the roots of the back teeth, when

they happen to penetrate the antruin. Sometimes a discharge of matter from the nostriis occur*, particularly wkrn the patient 1'eson the fide opposite to the tumor. The disease may arise from cold, or whatever produces infl immatiou in general; but the most common caulcs are violent fits of the toothach, occasioning excessive pain and inflammation of the membranes cf the ncs: and antrum.

491. The cure is performed by giving a free discharge to the contents of tht tumor: and thai is done in two ways; either by extracting one ot the two anterior great molares, which arc situated under the antrum, and making a perforation with 1 round trvar {fig. 56. PI. .115.) through the bottom of the socket .; if this has not already been pel sorated by the fangs of the tooth or ered.-d, in which cafe the matter will pass out immediately after the extraction: or the perforation may be rruidsr hj the instrument represented in^i?. Jj. through that part of the antrum whi^-ii projects outwardly over the mo.ares. As mod people wish to avoid the pulling of a tooth, when it does not appear to he absolutely necessary, the perforation is commonly made in the way laft mentioned. Some .author?, however, object to this, as not giving a sufficiently depei ding opening to the matter. As soon at the matter is discharged, a plug may be introduced into the perforation, which may be remold frequently to allow the matter to pass out, and to admit astringent solutions of baik. Sec. 10 b; occasionally thrown into the cavity of the antrum. In this way a cure is obtained, if the b-mes be found; but if they are carious, it is impossible to expect a cure till the diseased portions of the boue exfoliate and -be removed. When clotted blood is formed in the antrum, it is to be removed in the fame manner. Sometime* t^-e tumor of the cheek is owing to a swelling of the bones, and no matter is'found in the antrum: In that case the operatinn doe6 harm. No external application has yet been discovered for removing such a swelling, though .a long continued course of mercury has been found to be of some service.

Ssct. VII. 0/ranuj.a.

491. This is a tumor under the tongBe, tnoS frequently owing to an obstruction in one of the salivary ducts. Sometimes it contains matter like the synovia of the joints, sometimes a fatty matt.r, now and then stony concretions, but most cortmonly a fluid like saliva. It often acquires such a size as to prevent sucking in infants, or mastication and speech in adults. When the person attempts to speak, he only makes a croaking no:!e; hence the name of the disease.

49.5. The best mode of treatment is to lay the tumor fully open by a scalpel or large lancet, to evacuate its contents completely, and then to wash the cavity with any mild Guid, as milk and water. If the fore be difficult to heal, tincture of hark or other astringents may be used. When the tumor is observed to be filjed with a fatty or any other firm substance, it ought to be removed entirely. The only application necessary in the time of the cure, is the frequent injection of milk and water, orany other mild fluid, by means of a fyr:n>;e.

Sect. Iect. VIII. Of Ulcers in tbe Mouth. 4. When ulcers of the mouth arise from a

r.il affection of the system, this niurt be remo>eforc a curr can lie expected. Whtn they nate from Ihmp points 111 the teeth, these are ■ hied off, and some astringent solution taken

inflammatory symptoms produced By the extirpation of the first lhould be allowed to subside be* ford any attempt be rr.sde to remove the other.

4yil. When the form of the tonsils happens t» be conical, so that the ligature would be apt to flip over their extremities, Mr Clicfelden has recommended a needle (j!g. j8.) with an eye near

Sonally into the mouth. Notwithstanding. the point: a double ligature being put into the

and other remedies, the fores sometimes be; worse, discharging a thin fetid fames, ated with much pain, and putting on every apincc of cancer. In this situation, extirpation c only thing that can effect a cure. Is I he be only superficial, it may pretty readi.y be pated; but when 'kep seated, it may somcs be necellary to cut through the whole sub

e of the-cheek, and heal the sore by the hareaturc. When the tongue is the lubjcct of otton, the operator ought to he reai'y 10 take he bleeding vessels by the teiiaculum or the le. Along with ligature, it may be necessary fe astringent gargle', or a mixture of fulphuicid in water. IF these fail, the potential or 1 actual cautery must be used.

r. IX. 0/tie Division of tbe Frænum Linguæ.

y$. So-metimes the frænum lingiix extends he point of the tongue, and tyes it down; teas, in the natural state, it ends about one -ih of an inch farther back. When this is the , it is to be divided, guarding against woundthe neighbouring vessels', or the ends of the 'ary ducts. The division may be made with a m.on scalpei, but still better with a pair of vein rp scissars with blunt points.

96. The child being laid across the nurse's e, the surgeon should open the mouth, and c the tongue with the two first fingers of the

hand, while with the other he introduces the ar.-, and divides the ft am urn in the middle,

as far back as is necessary.

:t. X- Of Enlargement of tbe Tonsils and Uvula.

97. The tonsils sometimes grow so large and 3 as to become incurable, and even to threaten ocation. The tumors here have commonly n considered to be of a scirrhous nature; they are neither attended with (hooting pain, are they apt to degenerate into cancer; neir do swellings return after the tonsils have been irpated: hence they ought not to be removed by thtir size they impede deglutition or refpi011; but whenever they do this, they may be loved with safety. The only proper method emoving them is that by ligatures, which are only void of danger, but seldom fail to peril a cure. If the base of the tonsil be smaller n the top, the lijatare is to be used as for poi in the throat; but however broad the base of nay be, much difficulty will seldom occur in ng it, for the swelling is always very promtit. In diseases of this kind both tonsils are geally affected; jbut if the removal of one of m forms a sufficient passage for the food, the ier may be allowed to remain. When, howe1 it Is necessary to extirpate them both, the

eye, the instrument is to be pushed through the centre of the base of the tumor, and the ligature being laid hold of by a hook ind puliid forwards, the instrument is to be withdrawn; then it is tobe divided, and so tied that each part may surround one half of the tumor. This method however is scarcely ever found to be necessary.

499. Enlargements of the uvula* from inflammation or from other causes, may generally be removed by the frequent use of astringent gargles, as of strong infusions of red rose leaves or of Peruvian bark. lint when these fail, and the enlargement is so considerable as to give great uneasiness by impeding deglutition, irritating the throat, and so causing cough, retching, and vomiting, extirpation is thit only thing upon which any dependence can be placed. Excision is the readiest method when the uvula is only elongated; but when the size is considerate, dangerous 1 emorrhagies sometimes attend this method; 011 which account a ligature is preferable. The operation may be readily performed by those of the common kind; some prefer the curved probepoiiited bistoury.

coo. In performing the operation, the speculum arii {fig. 59. PI. 315.) is necessary to keep the mouth sufficiently open, and the uvula should be laid hold of by a pair of forceps or a small hook, so as to keep it firm, and prevent it from failing, into the throat. After the operation, if the bleeding be considerable, it may be checked by astringent gargles, or by touching the part with lunar caustic; but this will seldom be necessary.

coi. When the ligature is to be employed, it may be readily done according to the method recommended in the extirpation1 of polypi. A~ double canula with a ligature may be passed through the nose, or the ligature may be applied according to Cbtselden's method 111 extirpation of the tonsils.

Sect. XI. Of Scarifying and Fomenting the Throat.

501. In inflammatory affections of the throat,, the means commonly employed are gargles,*fomentations, scarification, or topbleed"ig. Gargles are useful for cleaning the fauces from thick mucus or other lbrdcs; they may likewise be useful in cases of ulceration. In relaxation of the parts, they are employed to advantage when made of astringent materials. Fomentations may be of some use externally applied ; but the steam of water, &c. drawn into the thioat, by means ot Mudge's inhaler, is preferable. (See Inhaler, Medicine, Index ; and pi. CXClll'jSg. 14. Sometimes it is necellary to draw blood Iro n the part affected. Here recourse may be had to scarifying with a common lancet, the tongue being depressed with a spatula. It may still be more readily donu by the scjiificator, Jig, 60. plate 315.) Aster a sufficient number of puncture;, have been made, the Row of blood may be promoted by the patient's frequently applying warm water to the punctures. When abscess forme, notwithstanding the use of these remedies, the matter may be discharged with the scarisicator already mentioned.

CHAP. XVI. Of DISEASES Of The EAR And OPERATIONS Upon It.

503. Sometimes a thin membrane is spread over the mouth of the external passage* while at other times a considerable part of the passage it tilled up with a fleshy looking substance , occanoning deifness. When the first circumstance occurs, the skin is easily divided by a simple incision, and the accretion of its tides may be prevented by a dossil of lint or a bit of bougie inserted between the edge? of the wound, and daily cleaned and returned till the part be rendered callous.

3C4. When the other cause in present, the incision mult be continued considerably deeper, till the resistance be removed, or till the instrument reach near to the membrane of the tympanum, when the operator shouH desist, least the membrane should be wounded ; then the same kind of treatment may be formed as in the former cafe. The proper time for performing the operation is when children usually begin to speak; for previous to this the patient may be too weakly to bear it, and after this speech would be impeded. Sometimes the meat us externus is entirely wanting in the temporal bone. For this an opening through the mastoid process has been proposed; but the operation has not been performed, at ltaft in this country.

505. Children sometimes push hard bodies into their ear, or different kinds of infects occasionally creep into it, so as to cause considerable uneasiness. Substances lying near the outer end of the passage may generally be extracted by the same forceps (Jig. 61.;) but round, hard bodies situated deeper in the callage are more readily removed by a crooked probe. When infects are deep seated in the ear, they ought first to be killed, by silling the passage with oil, or any other fluid ■which proves noxious to them, without hurting the tympanum. They "may ihen be washed out by injecting warm water trequently by means of a syringe.

506. Wax is one of the most frequent causes of Deafness, and it may be readily detected by looking into the ear in a clear sunshine. Various methods have been proposed for removing wax from the ear; but one, not inferior to any, is to throw in frequently, by means of a syringe, (fig. 61.) warm miik aud water, or water in which a little soap has been dissolved. Assistance may likewise be given here, by using along with the i njection a blunt probe 01 fine hair pencil, by which the bottom of the passage may be cleat cd out. After the wax is removed, the patient ought to guard against the effects of cold by introdu i' g a little woo! for some lime into the meat us. When deafness is owing to a deficiency of wax in the ear, a little oi! of almonds, or even oil* of a hotter nature, or soap, or galbanum, &c. have been of service. Purulent matter \* now Jih'.. then form

ed in the ears of adults, but ofrener in those of children. Sometimes it is produced by ulcers situated in the lining os the meatu-, or upon the membrane of the tympanum. It seems to be merely a local affection, and does not, as many have supposed, oiiginate from morbid huœouis of the system. The remedies best calculated for removing it are such as are of a moderately astringent nature, as aweak solution of acetite of lead. A little of this may be dropped in » or 3 times »day, but it is better to use a syiinge. If the discharge has continued long, it may be proper, in addition to the other application^, to keep c-pen a smail blister for some time in the neck or arm.

507. It sometimes happens, particularly in old people, that, fiom exposure to a stream of told air, the tympanum becomes affected, and a noise is heard by the patient like the rulliii/g of water. In other cafes the patient is incapable of accurately distinguishing the woids of some persons speaking in a loud tone of voice; or, in mixed companies, he hears only a confusion of found-:. Complaints of this kind frequently originate from a relaxation of the soft parts of the tympanum: and though a complete cure is not very frequently pe>formed, yet considerable advantage is sometimes derived trom the use of hot stimulating oils, and from keeping the part warm at the lame time with a little wool. When deafness arises from affections of this nature, some assistance may be derived from collecting the found, so as to make a stronger impression upon the internal ear. A variety of instruments have been invented for ft is purpose. Some use a convoluted tube, called an Ear-trumpet, jig. 63. ; others a fort of cup. £%. 64. which is concealed under the bair, aud f.liJ to the head with straps.

508. Mr P. Martin, surgeon at Dunning, ha» been very successful in curing deasoes., by introducing the electric fluid into the meatus aadit:rius. To assist the passage of the electric fluid into the ear, he uses tube' maJe of elastic gum. The meatus internus, or Eustachian tube, may sometimes be affected by inflammation, or swelling in the throat, so as to produce deafness. In such cases it has been advised to introduce a p pc, fig. 65. fl. crooked at the end, through the mouth or nose, and thereby inject any oniiJ fluid into the Eustachian tube: but little depcndir.ee Can be placed on this method. In scrophulous habits, when fuppuiation occurs in the tyaipnum, and the small bones become carious, a degiee of deafness ensues which can never be removed; in which case all tint can be done is to keep the parts clean and free from a pu'ritl soici1, by washing with milk and water, injected lukewarm every mcrnii g and. evening by a syrirge.

509. Korrr.erly piercing the lobes of the ciri was recommended in complaints of the he*;, tar» and eyes; but is now leldorn practised, except for oinameiit, when earrirgs are in fashion j in which cases, the expert jeweller generally performs the operation with more expciition and lest pain and Ceremony, than the rcr:t experienced surgeon. Corks, lead mint, at.i moveable points, &c only increase the pain aril tumble. Piain silver piercers, madeof small wire-, pushed through the lobes in the ii.T.psest man' r,

ata Chap. XVII. XVIII. SUR

and left in the lobes of the ears for 3 or 4 days, answer every purpose, and the young lady is generally surprised to find tlie pain so trifling, and that she does not lose a drop os blood. All that the surgeon or jeweller has to do, is to take care that be does not prick his own fingers, and that the lobes be pierced at equal heights, nearly in the middle, so that they may not be in danger of being worn through, or torn down by heavy ear-rings.

CHAP. XVII. Of The WRY NECK.

510. A Wry neck way be owing to different causes; as contraction of the (kin in consequence of burns, or other kinds of lores; relaxation of the muscles of one fide of the neck, particularly the mastoid, while those of the other tide continue to act with vigour; preternatural contraction of the muscles of one side of the neck, the others having their usual power; or, a bend in the vertebræ of the neck.

jll. When the disease is owing to a contraction of the (kin, this is to be divided through the whole of the contracted part, guarding against cutting the external jugular vein. When the contraction of the mastoid muscle is the cause of the disease, the muscle should be divided by gentie strokes, so as to run no risk of wounding the great vessels situated under it. When an incision is made either with a view to divide the muscle or the (kin, the head is afterwards, by means of a machine, (fig. 66. pi. 326.) to be kept in a proper posture during the cure, until new granulations form and fill up the empty space. When the disease is merely owing to a curve of the bones of the neck, the fame kind of machinery may be useful with that recommended for cure in the other parts of the spine. But sometimes the d'soase arises from an affection of the bones of a more serious nature. Here the disease in the vertebrx commonly begins with a slight pain, which gradually becomes" worse, and the head is turned over to the sound side. As the disease becomes worse, a fulness can be observed very painful to the touch; and moving the head becomes so distressing as to be almost impracticable. The only method which has been found effectual in this case, is the insertion of a pea-issue on each side of the tumor, and retaining it till the pain and stiffness are entirely removed.

CHAP. XVIII. Of BRONCHOTOMY And OESOPHAGOTOMY.

511. The operation of Broncbotomy is an incilion made in the trachea, to make way for air into the lungs, when respiration is obstructed to such a degree that life is in danger. If the patient's breathing be already stopped, the operation ought to be done with the greatest expedition ; .Using any Instrument which will most readily make an opening in the trachea, as the delay of a few moments will often put a period to the pei son's existence. Experience has shown, indeed, that in by much the greater number of cases, by a total stoppage of respiration for only five or fix minutes, life is irrecoverably destroyed.

j 13. In performing the operation, where, fi«im the nature of the case, sufficient li.ne ib allowed, Vol. XXI. Paut II.

G E R Y. . 67$

the patient is to be laid on his back upon a table and properly secured by assistants. A longitudinal incision is to be made, about an inch and an half long, thro' the (kin and cellular substance ; beginning at the under edge of the thyroid cartilage: the sterno-hyoid and thryoid muscles are then to be separated ; the thyroid gland is to be avoided as much as possible, on account of its vascularity. As soon as the trachea is laid bare, the bieeding vessels, to prevent coughing, are to be secured ; then, with a common lance, a puncture ia to be made as high as may be seen practicable between two rings of the trachea, of such a size 3% to admit the introduction of a double canula, (fig. 67. pi. 3»6.) large enough to allow the patient to breathe freely, and of such a length as neither to be in danger of flipping out, nor of irritating the back part of the trachea. Such a canula has long been recommended by Dr Monro in his course of surgery. Previous to the introduction the canula may be put through several plies of linen compress; or these may be first flit half way down, and applied so that any of them may be removed and replaced at pleasure. This double canula is to be fixed by a strap round the neck; and when mucus obstructs the passage of the instrument, the inner tube can be withdrawn, cleared, and readily replaced; while the patient is, during this time, breathing through the outer one; and by means of a screw the tubes can be regulated according to the motions of the trachea. After the canula is fixed, it ought to be covered with a piece of muslin or crape, to prevent the admission of dust, insects, &c. As soon as the causes inducing suffocation are removed, the canula ia to be withdrawn, and the (kin immediately brought over the orifice, and retained there by a (lip of adhesive plaster.

514. By afopbagotomj is understood the cutting open the œsophagus, to allow substances sticking in it, and which cannot be extracted otherwise, to be removed. It is only to be done, however, in cases of the most extreme danger, as it ia attended with much hazard ; and there are only two instances yet on record of its having been performed with success, though there are several instances of wounds in the œsophagus b-ing hciled. The operation may be rendered necessary, where obstructions of the œsophagus become so complete as to prevent the passage of nourishment into the stomach, or of air into the lungs. But it it evident, that when the obstructing cause is in the under end of the œsiphagus, any illusion becomes useless.

er j. In performing the operation, the patient is to be secured in the same mannrr as for bronchotomy, and an incision made through the (km and cellular substance as directly opposite as possible to the pait obstructed. If it be done with a view to remove an obstruction, the muscles over the trachea are to be pulled to one side, and the trachea to the other, by means of a blurrt hook; by which the œsophagus will be brought into view. If the obstructed part now come in sight, the incision is to be made directly upon the obstructing body, which is to be extracted by a pair of sma.l forceps; but if the obstruction happen to b? tardHqq t:ier tner Hown than we can with safety have access to the œsophagus, the incision is to be enlarged aa much as possible, that the forceps may be able to reach and extract it. When the operation if performed, the wound will be difficult to heal, as the fitfes of it will be frequently separated by the action of deglutition. On this account as great a degree of abstinence a-, possible is to be advised; and nothing but nourishing liquids, in small quantities, are to be allowed. The patient should be prevented from moving his neck; and the wound i« to be healed as soon as possible by the fame methods which are usid with wound* in other parts of the body. On the other hand, if the operation has been done for the purpose of conveying nourishment into the stomach, when the patient was distressed by a tumor either in the œsophagus itself, or in some of the neighbouring parts, it wih be necessary to keep the wound open during the continuance of the tumor, or the life of the patient.

CHAP. XIX. Of SORE NIPPLES.

516. Women are more generally assisted with fore nipples in suckling their fit ft child than at any period afterwards. This may in some measure be owing to the smallness of the nipples; but very often it arises ftom their being unaccustomed to the irritation of sucking. In some cases, the nipples are so fiat, and so much so"k in the breast, as to render it difficult for the child to lay hold of them. Assistance can sometime*, be given, by the mother pressing back the prominent part of the breast, so as to make the nipple project between two of her fingers. If this prove insufficient, the nipple may be made to project by'applying to it a stout child several months od: but when this cannot be done, breast glajsei, such as PI. CCCXXVI./p. 68. may answer the purpose. Jty applying these to the nipple, and sucking out thea'r, the child will commonly be enabled to lay hoH of it.

517. The nipples are liable to excoriations, cracks, or chops; which, tho' not attended with a formidable appearance, are often more distrefling than large ulcers. Mild, astringent, and drying applications are most to be depended upon in such applications; as port wine, brandy diluted, or lime water ; all to be applied warm. After l-athing the parts with any of these, the nipple lhould be covered with unguentum nutritum, or (ioulard's cerate; the first of which is confidertd al best. Even soft pomatum often rubbed upon the part, and covered with a soft hnen rag, will j;ive considerable relief. But the nipple should be perfectly cleared of these applications, before the child is laid to the breast, by port wine, or equal parts of brandy and vinegar. If attention be paid to these remedies, they will have the di-fired effect; but there is still another which has often civen great r-iief, viz. the application of a thin skin to the ripple, as the neck and part of the body of a swine's bladder with an apeiture in it; which, being properly moistened and fixed to the br-ast, will completely protect it 111 the time of fucking. As long as the nipples remain any <v?y affected, snail cups of glass or tin are useful for retaining the dressings, defending the nipples

fro.Ti the friction of the clothes, and receiving any milk which may fail from the breast.

CHAP. XX. Of PARACENTESIS Of Thb THORAX.

j 18. Whes either the action of the heart or of the lungs is impeded by fluids collected in the ca. vity of the pleura, a discharge of thes- fluids by a perforation is the only chance the patient ha* for rclii-f. The fluids which collect in the pleura are, sernm, blood, air, or pu... A collection of water or serum is frequently found in the thorax, combined with dropsy in other parts of the body; but the affection is often local, and it U then chi-fly that advantage is to be derived from an operation. Besides, in. the two great cavities of the thorax, collections of water arc frequently met with in the pericardium, and are said to be sometimes discovered between the layers of the anterior mediastinum. The disease Is marked by the following symptoms: There i9 a sense of weight or oppression in the thorax, and difficulty of breathing; the patient has frequently a more uneasy stnfat:on in one fide than in the other; has sodden starting! duru.g sleep, with a strife of suffocation; is troubled with a frequent dry cough . the pufc is small and irregular; the (kin dry, ai.d the urine si anty.

519. With these symptoms there are commonly other marks of dropsy; and the patient sometime', upon any sudden motion, is sensible of an undulation within the chest; and when the quantity of water is considerable, the undulation will even be heard by the bystanders, if the body be smartly agitated. For this purpose the patient's body mould l>e uncovered while under examination; and the fuigeon lhould place his hand upon the breast near the sternum ; then an assistant ought to raise the patient suddenly from an horizontal to an erect posture, or to stand behind the patient and make sodden jerks; when, if water be present, the undulation will be felt; but it is necessary to guard against being deceived by the noise sometimes, made by the contents of the stomach.

5 20. When the water is collected in one fide only, if the disease be of long (landing for the most part that side is more prominent than the cither. If the water be in the pericardium, the symptoms are nearly the fame as those above tnutnerated, with this difference, that the pain it generally felt behind, and to the left side of the sternum; and thtr stroke of the heart is as if buried in water, while an undulatrry motion has been said to be felt oopolite to the anterior extremities of the third, fourth, a d fifth ribs.

511. In the treatment of this disease, little advintage can be derived from internal remedies. Squ'lls, cream of tartar,, mercury, and digitalis, are upon some occasions attended with advantage; but the only method fr. m which we can expect any degree of sucetfs is the removing of the water by an operation, which ssiould be performed as soon as ther* is reason to expect tbat danger may arise from delaying it longer. The operation is done in the fame way as shall be afterwards described in the case of rmpycina.

522. Blood collected in th; thorax is jiways

ci'.ra

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