298 OPERATION OF THE 



one's nail. Next we blew into tfie lungs, and found that the 

 air escaped readily; and upon examining their surface once 

 more, whilst the air was getting out, we discovered a laceration 

 among the vesications just described, that is, on the middle of 

 that surface of the lungs which lies upon the diaphragm ; this 

 wound therefore was not only at a considerable distance from 

 the fractured rib, but remote from the other ribs also. These 

 facts were shown to several gentlemen then present, and seemed 

 to prove what I had supposed. 



Now, from considering what the effects of a wound of the 

 lungs must be, from attending to the symptoms of the emphy- 

 sema, and from our having actually found air in the cavity of 

 the chest, may we not conclude that air is sometimes in em- 

 physematous cases so confined in that cavity as to compress 

 the lungs, disturb their functions, and even to be the cause of 

 death ? 



And as the paracentesis thoracis has been frequently per- 

 formed with success for water, and for pus in the cavity of the 

 thorax, in both which cases the parts contained are generally 

 much diseased, may we not propose the same remedy for air; 

 and the rather, as we know that this fluid can be collected 

 there without any previous disorder of the lungs, and conse- 

 quently that the operation will be attended with a greater pro- 

 bability of success? We shall be confirmed in this opinion 

 when we consider that wounds penetrating the chest, without 

 doing much injury to the lungs, are far from being mortal ; 

 insomuch that many instances of cures of such wounds have 

 been observed within our memory, not to mention the numerous 

 cases of this kind related by authors. 



In wounds of the lungs, therefore, whether occasioned by 

 fractured ribs or other causes, when symptoms of tightness and 

 suffocation come on, so far should we be from dreading the 

 emphysematous swelling of the cellular membrane, that we 

 should rather consider it as a favorable symptom, showing 

 that the air is not likely to be confined in the thorax ; and so 

 far should we be from compressing the wound, to prevent the 

 inflation or emphysema, that we should rather dilate it, (if not 

 large enough already,) or perform the paracentesis thoracis ; 

 and we may judge of the necessity of this operation from the 



