

1823.] an Operation for Phthisis Pulmonalis. 433 



violent thrusting outward of the contents of the abdomen was 

 principally, if not entirely, occasioned by the action of the 

 diaphragm, for the force of the protrusion diminished as soon aa 

 its action was obstructed on one side of the mediastinum, and 

 ceased when it took place on both sides. With a little difficulty 

 an opening about an inch in length was made into the left cavity 

 of the chest through the muscular part of the diaphragm, three 

 inches below its attachment to the ribs. When the air rushed 

 in, the diaphragm on that side became relaxed, and its action 

 not only obstructed, but its irritability to all appearance sus- 

 pended. A portion of the diaphragm jutted out towards the 

 abdomen, and formed a pouch, with the aperture in its centre. 

 A similar opening was made into the right cavity of the chest, 

 followed by the same effects. An ivory'tube, 3-10ths of an inch 

 in diameter, was repeatedly introduced into each aperture. The 

 diaphragm seemed to be altogether guided by the action of the 

 contiguous parts, and by the pressure and passage of the air 

 modified by respiration ; at each inspiration it was drawn 

 towards the chest, and expanded by the dilatation of the thorax, 

 but its expansion was not sufficient to obliterate the pouches 

 before noticed, which was a strong proof, together with the 

 quiescent state, compared with the previous violent thrusting 

 outwards of the contents of the abdomen, of its paralyzed condi- 

 tion. Is it not likely that in many wounds penetrating into the 

 cavity of the abdomen, unaccompanied with thrusting outwards 

 of its contents, that the diaphragm is wounded? At each expi- 

 ration, the diaphragm was pushed towards the abdomen, by the 

 pressure and passage of the air from within the cavities of the 

 chest, and the pouches enlarged. The breathing was oppressed, 

 but not so distressing as in the first three experiments, when 

 the apertures were wide open. The external wound was brought 

 together by suture. When the dog was removed from the table, 

 he walked, but tottered a little ; he breathed easy, and three 

 hours after lapped some milk, which was rather surprising, as 

 the first two operated upon would accept of nothing until the 

 following morning. He recovered his strength and liveliness 

 amazingly fast. On the third day after the experiment, he was 

 hanged, together with another dog not operated upon, for the 

 purpose of comparing the appearances of their respective lungs. 

 Each had his trachea secured immediately on being cut down, 

 before the suspending cord was slackened, to prevent collapse 

 of the lungs on opening the cavity of the chest. Dissection : 

 in the presence of Dr. Traill, to whom I am greatly indebted for 

 many suggestions in conducting these experiments. No morbid 

 appearance in the abdomen, with the exception of a few adhe- 

 sions between the liver and peritoneum ; the apertures in the 

 diaphragm were closed by a tender film, which very readily gave 

 way to the probe. On opening the chest, the heart was once 

 observed to contract, and the pericardium was perfectly trans- 

 New Series, vol. v. 2 v 



