APPENDIX. {ss) 



\v-"Ha''r.iitL °^ ^^'^ '^^^'^'^ during expiration, ;it the flime time preffing up the 

 vifcera of the abdomen, fo as to make the diaphragm afcend; 

 and thus, by leffening the cavity, while the patient, by flitxtting 

 the glottis, prevents the air from efcaping, but forces it into the 

 collapfed lung, we force out as much of it as polTible. Other 

 ways of evacuating it hath been fuggefted by different writers. 

 Sucking it out by a fyringe, or an elaflic bottle, are common 

 propofiils, but I am afraid can never be put in pra(5lice. The 

 bottom of the wound between the ribs is fo irregular, that they 

 can never be applied when the canula is out; and when it is in, 

 more air would be admitted during the time the fyringe, or 

 bottle, was fitting on, than could be extracted by them. But 

 after all the water is evacuated, the wound inuft be healed up, 

 for if not, fuppuration will come on the wound, and when the 

 canula is then withdrawn, the fkin, that was intended to adl as 

 a valve, will have become fixed by the infiiammation, and will 

 not come down over the hole in the pleura, fo that air muil be 

 admitted, though it was excluded before. 



" Whether common air does hurt to any cavity, I doubt 

 much. Water, with a penetrating wound, would be as bad. 

 The inflammation of the wound is what is moft to be dreaded, 

 as it fpreads from that over the whole cavity. The cantila, there- 

 fore, as inducing inflammation, muft, in my opinion, be very 

 hurtful. 



" In place of the operation defcribed by Mr Bell, I would 

 propofe doing it in the following manner : I would place my 

 patient in the common poflure, and, after the flvin was well 

 pulled up, make my incifion in the ufual place and manner, till 

 I came down to the pleura. I would^. then make an opening 

 through it, aboiit half an inch in length, merely dividing the 

 membrane. In cutting into the cavity, great care ihould be ta- 

 ken not to do it rafhly, lefl: an adhefion of the lungs to the pleura 

 be over the incifion. At the fame time we muft exped to find 



the 



