292 OPERATION OF THE 



brane that is on the outside of the chest, and from thence it 

 is diffused through the same membrane over the whole body, 

 so as to inflate it sometimes to an extraordinary degree. This 

 inflation of the cellular membrane has been commonly looked 

 upon as the most dangerous part of the disease ; how justly, 

 will appear in the sequel. 



It is natural to suppose that the wound of the pleura and 

 intercostal muscles may sometimes be too small to suffer the air 

 to get readily into the cellular membrane and to inflate it, but 

 may confine a part of it in the cavity of the thorax so as to 

 compress the lungs, prevent their expansion, and cause the 

 same symptoms of tightness of the chest, quick breathing, and 

 sense of suffocation, which water does in the hydrops pectoris, 

 or matter in the empyema. So far we may conclude from 

 reasoning on the consequences of a wound of the lungs, and 

 from analogy. 



And that it sometimes really happens that air is confined, and 

 produces these symptoms, appears probable from the histories 

 of such patients as have been emphysematous : of these, the 

 most remarkable that I have met with in my reading, are one 

 by M. Littre, 1 another by M. Mery, 2 a third by Dr. Hunter, 8 

 and a fourth by Mr. Cheston.* 



In M. Littre's case few symptoms are mentioned; we are 

 only given to understand that the patient, who had received a 

 wound in the side by a sword, could not breathe without 

 making the most violent efforts, especially during the latter 

 part of his disease : he died on the fifth day. 



In M. Mery's case, we are informed that the patient had 

 the fourth and fifth of the true ribs broken by a coach passing 

 over his chest, that his respiration was much impeded from the 

 first, and became more and more difficult till he died, which 

 was on the fourth day after the accident. 



In Dr. Hunter's case, the symptoms are more particularly 

 mentioned. This patient had received a considerable hurt on 

 his side by a fall from a horse. He had a difficulty of breath- 

 ing, which increased in proportion as the skin became elevated 



1 Mem. de 1'Acad. Royale des Sciences, pour 1'annee 1713. 

 a Ibid. 



3 Medical Observations and Inquiries, vol. ii. 



4 Pathological Inquiries. 



