VOL. XLVIII.] PHILOSOPHICAL TRANSACTIONS. 3Q5 



3 or 4 weeks. His symptoms were a continual pain in his left side, a difficulty 

 in breathing, and an inability of lying on his right side, or of sitting upright, 

 without greatly increasing his complaints. His pulse was quick, and low ; he 

 had a short cough, was a good deal emaciated, and appeared sallow in his com- 

 plexion. 



On examination, Mr. W. perceived a small tumor, situated on the anterior 

 part of the thorax obliquely, on the left side of the extremity of the sternum or 

 breast-bone. There was not the least discoloration of the integuments. On 

 pressing on the tumor, his pain and difficulty of breathing were increased, and 

 there appeared something like a fluctuation under the fingers. He had n6ver 

 any rigor, which is a symptom generally attending the formation of matter ; 

 but from experience he had found, that the want of this symptom is no proof of 

 the contrary. 



From the foregoing circumstances, and symptoms, he had no doubt of the 

 propriety of the operation, which he performed in the following manner : The 

 patient being properly situated and secured, he began with making an incision of 

 about '2 inches long through the integuments, and tendinous expansion of the 

 oblique muscles of the abdomen on the most prominent part of the tumor ; then 

 he proceeded to make a 2d incision, of an equal length with the former, trans- 

 versely through the upper part of the rectus muscle, which had a perfect healthy 

 appearance, directing his knife forwards, between the cartilaginous portions of 

 the 7th and 8th ribs, into the cavity of the thorax; on which a thick clotted 

 matter, to the quantity of 23 oz. and upwards, was discharged. After the whole 

 of the matter was discharged, he introduced the fore-finger of his right hand into 

 the cavity, with which he evidently felt the lungs quite loose, and free from ad- 

 hesion, the mediastinum, and superior part of the diaphragm ; which last had 

 been pressed somewhat lower than its natural situation by the weight of the in- 

 cumbent matter. Hence it undoubtedly appeared, that this great quantity of 

 matter was contained in the cavity of the thorax. 



After the whole of the matter was discharged, he introduced a linen tent, pro- 

 perly secured, into the cavity ; which was continued to be introduced every day 

 for about 3 weeks; now and then, as occasion required, making use of the prepared 

 sponge-tent. The discharge of matter was considerable for the first week ; then 

 it began to decrease gradually till, at the end of 3 weeks, there was no discharge 

 at all. From this time, superficial applications only were made use of. At the 

 end of 5 weeks he was perfectly well, and soon recovered his former plumpness, 

 and healthy appearance. 



He observes, that, about 2 years before, he received a violent blow on his left 

 side by a fall ; for which he had little or no care taken of him. He had ever 

 after this accident had some complaints in his side at times, but not constantly ; 



3 £ 2 



