294 OPERATION OF THE 



tured rib, found a considerable quantity of blood in the cavity 

 of the thorax, and was sensible of some putrid air escaping on 

 his first puncturing the intercostal muscles and pleura. The 

 wounded lobe was hard and black, and the other two of the 

 same side were inflamed. 



In M.MeryV patient there was not any extravasated blood 

 in the cavity of the thorax, nor was there anything preter- 

 natural to be seen except the fractured ribs, the wound of the 

 pleura, and that of the lungs. 



Mr. Cheston, in his subject, observed a fracture of the tenth 

 and eleventh ribs, and a wound of the lungs opposite to these 

 fractures. The lungs below the wound were livid; and, an 

 incision being made into them, their substance was found to 

 be more compact than usual ; but, excepting these appearances, 

 all the other parts were in a natural state, without any extra- 

 vasation, inflammation, or internal emphysema. 



Now, were not the symptoms in those cases such as might 

 be expected to arise from air confined in the cavity of the 

 thorax ? I am inclined to believe they were, notwithstanding 

 that authors in general account for them otherwise, and among 

 the rest Mr. Cheston himself, though in one part of his re- 

 marks he seems indeed to point that way. -,/ 



On comparing these emphysematous cases, I say it seemed 

 probable to me that it was the air which was confined in the 

 chest that was the principal cause of the symptoms ; such as 

 the difficulty of breathing, the tightness of the chest, and the 

 sense of suffocation, which was so much increased by external 

 compression; and as in these symptoms this disease agreed 

 with the hydrops pectoris and the empyema, both of which are 

 relieved by the paracentesis thoracis, I was thence induced to 

 believe that this operation might be performed, for letting out 

 the air, with some probability of success. 



But as in such cases no air had hitherto been actually dis- 

 covered in the cavity of the thorax, it therefore might be 

 doubted whether the symptoms were not owing to some other 

 cause ; such as the mere wound of the lungs (abstracting from 

 its letting out air), or an effusion of blood into the cells of 

 that organ, 1 in consequence of the wound. ^ I thought it there- 



1 This seems to have been the cause of the lividness and compactness which 

 Messrs. Littre and Cheston observed in the wounded lobes of their patients. 



