To let out the Matter, the Patient must be oblig'd to lean on one side, stopping his Mouth and Nose, and puffing up his Cheeks, as if he were to blow vehemently; then if Blood appears, a greater quantity of it may be taken away than if it were Matter, in regard that a Flux of Matter weakens more than that of Blood. It is also worth the while to observe, that in making the Incision, the Intercostal Muscles ought to be cut a-cross, that the side of the Ribs may not be laid bare, by which means the Wound will not so soon become Fistulous.
If it be judg'd that purulent Matter is contain'd in both sides of the Breast, it is requisite that the Operation be done on each side; it being well known that the Breast is divided into two Parts by the Mediastinum: But in this case the two Holes made by the Incision must not be left open at the same time, for fear of suffocating the Patient.
The Dressing and Bandage.
The Wound is dress'd with a Tent of Lint arm'd with Balsam, being soft, and blunt at the end, which enters only between the Ribs, for fear of hurting the Lungs; but a good Pledget of Lint is more convenient than a Linnen
Tent, however a Thread must be ty'd to the Pledget or Tent, lest it shou'd fall into the Breast; and Bolsters are to be put into the Wound; as also a Plaister or Band over the whole. This Dressing is to be kept close with a Napkin fasten'd round the Breast with Pins, and supported by a Scapulary, which is a sort of Band, the breadth of which is equal to that of six Fingers, having a Hole in the middle to let in the Head: One of its ends falls behind and the other before; and they are both fasten'd to the Napkin. Thus the Patient is laid in Bed, and set half upright. If the Lungs hinder the running out of the Matter, a Pipe is us'd, and the Wound afterward dress'd according to Art.
C H A P. X.
Of the Operation of the Paracentesis of the Lower-Belly.
This Manual Operation is sometimes necessary in a Dropsie, when Watry Humours are contain'd in the Cavity of the Belly, or else between the Teguments. The Disease is manifest by the great Swelling; and the Operation is perform'd with a Cane, or a Pipe made of Silver or Steel, with a sharp Stilet at the end; altho' the Ancients were wont to do it with a Lancet. The Patient being supported, sitting on a Bed, or in a great Elbow-Chair, to the end that the Water may run downward,
a Servant must press the Belly with his Hands, that the Tumour may be extended, whilst the Surgeon perforates it three or four Fingers breadth below the Navel, and makes the Puncture on the side, to avoid the White-Line; but before the Opening is made, it is expedient that the Skin be a little lifted up. The pointed Stilet being accompany'd with its Pipe, remains in the Part after the Puncture; but it is remov'd to let out the Water; and a convenient quantity of it is taken away, accordingly as the Strength of the Patient will admit. The Stilet makes so small an Opening, that it is not to be fear'd lest the Water shou'd run out, which might happen in making use of the Lancet, because there wou'd be occasion for a thicker Pipe. When a new Puncture is requisite, it must be begun beneath the former; but if the Waters cause the Navel to stand out, the Opening may be made therein, without seeking for any other place.