258 
Dr. Davy on 
Having, in cases of empyema, found many inconveniences 
attending the puncturing the pleura between an intercostal 
space, I was induced, in this instance, to follow the method 
described by Hippocrates, of perforating one of the ribs.* 
The fifth rib was selected ; and having cut down upon it 
with a scalpel just below the papilla of the breast, I bored 
through its substance with a carpenter’s auger, and punctured 
the pleura with a small trochar, as nearly as possible of the 
same size as the auger. On withdrawing the stilette, it was 
followed by a stream of transparent fluid, fourteen ounces of 
which were allowed to escape ; and then leaving the canula 
in the perforation, it was closed with a cork, and secured by 
proper dressings. 
Daily, during six weeks, more or less fluid was discharged 
through an opening in the rib, amounting altogether to rather 
more than twenty pints. At first, the fluid was transparent, 
of specific gravity 1021 ; it coagulated when heated, and con- 
tained some alkali in the state of subcarbonate. In a few 
days pus appeared in it, and gradually increased in quantity 
till the 15th of July, when the discharge was almost entirely 
purulent ; after which, the proportions of pus and serum 
varied considerably ; one sometimes predominating, and 
sometimes the other. It may be deserving of notice, that at 
no time was I able to detect free carbonic acid in the fluid 
discharged. 
Though from the sound of fluctuation in the chest, air was 
evidently contained in the pleura, yet none escaped with the 
fluid during the first fortnight ; after which a considerable 
quantity was daily expelled. By means of the perforation in 
* Hippocrat. de interm. adfec.t. cap. xxiv. 
