APPENDIX. [^^) 



w"Hamiiton. °^ ^^^"-^ cheft duiing expiration, at the fame time preffing up the 

 vifcera of the abdomen, fo as to make the diaphragm afcend; 

 and thus, by lefTening the cavity, while the patient, by fliutting 

 the glottis, prevents the air from efcaping, but forces it into the 

 collapfed lung, we force out as much of it as pofTible. Other 

 ways of evacuating it hath been fuggefted by different writers. 

 Sucking it out by a fyringe, or an elaflic bottle, are common 

 propofals, but I am afraid can never be put in pra(5lice. The 

 bottom of the wound between the ribs is fo irregular, that they 

 can never be applied when the canula is out; and when it is in, 

 more air would be admitted during the time the fyringe, or 

 bottle, was fitting on, than could be extrad:ed by them. But 

 after all the water is evacuated, the wound mufl be healed up, 

 for if not, fuppuration will come on the wound, and when the 

 canula is then withdrawn, the fliin, that was intended to a(5l as 

 a valve, will have become fixed by the inflammation, and wall 

 not come down over the hole in the pleura, fo that air muft be 

 admitted, though it was excluded before. 



" Whether common air does hurt to any cavity, I doubt 

 much. Water, with a penetrating wound, would be as bad. 

 The inflammation of the wound is what is moft to be dreaded, 

 as it fpreads from that over the whole cavity. The canula, there- 

 fore, as inducing inflammation, mufl, in my opinion, be very 

 hurtful. 



"In place of the operation defcribed by Mr Bell, I would 

 propofe doing it in the following manner : I would place my 

 patient in the common pofture, and, after the fkin was well 

 pulled up, make my incifion in the ufual place and manner, till 

 I came down to the pleura. I would^ then make an opening 

 through it, about half an inch in length, merely dividing the 

 membrane. In cutting into the cavity, great care fhould be ta- 

 ken not to do it rafhly, lefl an adhefion of the lungs to the pleura 

 be over the incifion. At the fame time we muft expe(ft to find 



the 



