PARACENTESIS THORACIS. 297 



of the thorax. But, not long after I had made these experi- 

 ments, the following case occurred, which fully satisfied me. 



A young man, when the house was on fire, to save his life, 

 threw himself out of the window of a second floor, but frac- 

 tured his skull by the fall. He was taken up insensible, and 

 immediately put under the care of an eminent surgeon. In 

 the evening of the same day, my friend Dr. Stark (CLIII) ac- 

 quainted me that, the patient having become emphysematous, 

 and breathing with difficulty, I might now have an opportunity 

 (which he knew I wanted) of seeing such a case. Being at that 

 time engaged, I could not go till the next morning, when I 

 found that he had expired in the middle of the night. His 

 head had just been opened, and a considerable quantity of ex- 

 travasated blood had been found between the skull and dura 

 mater. On examining the chest, I found the external emphy- 

 sema but just perceptible, and that only on the right side. 

 On laying open the abdomen, the diaphragm was observed to 

 be depressed and loose on the right side, nearly as it appears 

 when in a dead body a wound is made into the cavity of the 

 chest. This I showed to the gentlemen present, and desired 

 that the body might be left in that condition till I could send 

 for Dr. Hunter, and when he came, the examination was con- 

 tinued. Upon puncturing the thorax, some air rushed out; 

 on laying the chest fully open, the lungs were found to be 

 much collapsed, but there was not any extravasated blood nor 

 lymph ; so that it was evident there had been a considerable 

 quantity of air in the cavity. We next examined the con- 

 taining parts of the thorax, and found the first rib (reckoning 

 from above) fractured near its middle, and the pleura there a 

 little lacerated. We then turned to the lungs, expecting to 

 find them wounded opposite to the fractured rib ; but, to our 

 surprise, no wound was discovered in that part. We then 

 looked over the surface of the lungs, and could see no wound ; 

 but observed on the concave under part of the lungs, where 

 they are applied to the diaphragm, two or three extravasations 

 of blood, and as many more of air, which had raised the mem- 

 branous coat of the lungs into vesications about the size of 



(CLIII.) Dr. William Stark and his works are mentioned in Note LX. 



