* [ 2 7I 1 
empyema with fuccefs. Since which time, I have per- 
formed the fame operation a fccond time with equal 
benefit ; and therefore prefume to lay this cafe lkewife 
before you, as a farther proof of its ufefulnefs under 
the like circumdances. 
J OHN Collier, aged iy years, was admitted into 
Guy’s Hofpital on the 10 of May, 1753, on ac- 
count of a complaint in his ched, which he had la- 
boured under for three or four weeks. His fymptoms 
were a continual pain in his left fide, a difficulty in 
breathing, and an inability of lying on his right fide, 
or of fitting upright, without greatly increafing his 
complaints. His pulfe was quick, and low; he had 
a fhort cough, was a good deal emaciated, and ap- 
pear'd fallow in his complexion. 
Upon examination, I perceived a fmall tumor, 
fituated on the anterior part of the thorax obliquely, 
on the left fide of the extremity of the dernum or 
bread-bone. There was not the lead difcoloration 
of the integuments. On preffing upon the tumor, 
his pain and difficulty of breathing were increafed, 
and there appear’d fomething like a fluctuation under 
my fingers. He had never any rigor, which is a 
fymptom generally attending the formation of matter; 
but from experience I have found, that the want of 
this fymptom is no proof of the contrary. 
From the foregoing circumflances, and fymptoms, 
I made no doubt of the propriety of the operation, 
which I performed in the following manner ; 
The patient being properly fituated and fecured, 
I began with making an incifion of about two inches 
long through the integuments, and tendinous ex- 
panfion 
