244 ' PHILOSOPHICAL TRANSACTIONS. [anNO 1751. 



LXVI. The Case of the Operation of the Empyema, successfully performed by 

 Mr. Joseph JVarner, F.R.S. and Surgeon to Guy^s Hospital, p. 407. 



Thomas Hines, aged IT, was admitted into the hospital, Dec. IQ, for a pain 

 in his right side, and cough; which he had laboured under for 3 weeks. He 

 was immediately put under the physicians care; but notwithstanding all proper 

 methods used for his relief, his disorder increased till Jan. 13 following, when 

 Mr. W. was consulted. 



On inquiry, he found him afflicted with the following symptoms, a quick, low 

 pulse, frequent cough, and difficulty of breathing, which last symptom was 

 greatly increased on lying on his left side, or on sitting upright. He appeared 

 greatly emaciated, his countenance very pallid or sallow. The right side of the 

 thorax was somewhat enlarged; the integuments were visibly thickened, but 

 without the least discoloration, or perceivable fluctuation. However, being per- 

 suaded from the foregoing symptoms, that there probably was an extravasated 

 fluid underneath, he advised the operation, which was accordingly done on the 

 spot, in the following manner: 



The patient being conveniently seated, he made an incision of about 3 inches 

 long, with a knife, between the 10th and 11th rib, counting from above, and 

 at about 4 inches distance from the vertebrae. The direction of the incision was 

 agreeable to the course of the ribs, and on being made nearer to the superior 

 edge of the 1 1th rib, than to the inferior edge of the 10th rib, the intercostal 

 artery by that means escaped being wounded. On dividing the intercostal 

 muscles, very near 20 oz. of matter were discharged, after which he introduced 

 his finger through the wound into the cavity of the thorax, but found no adhe- 

 sion of the lungs. Whence he conjectured that this- abscess was originally 

 formed in the cellular membrane of the pleura, which had at length made its 

 way into the cavity. What seemed to corroborate this conjecture, was that the 

 violent symptoms, which happened on lying on the sound side, or on sitting up- 

 right, did not occur till within a week before his application to him. From the 

 moment the matter was discharged, he found immediate ease, his respiration 

 became quiet ; his fever and cough gradually abated, till in about 6 weeks he 

 became perfectly well in all respects, and was accordingly dismissed the hospital. 

 The discharge from the wound continued in considerable quantities for the first 

 fortnight ; during which time the wound was kept properly open with tents ; but 

 when the discharge was no more than what might be expected fi-om any superfi- 

 cial wound of the same size, all tents were disused, and superficial applications 

 only made use of. 



