t 
 
LECTURES, 
 
 UPON THE 
 
 Heart, 
 
 Lungs, 
 
 Pericardium, 
 
 Pleura, 
 
 Aspera Arteria, 
 Membrana Inter- 
 sepiens, or Me- 
 diastinum. 
 
 Together with the DIAPHRAGM. 
 
 INTERSPERSED WITH 
 
 A Variety of Practical Remarks. 
 
 By H. Mason, Surgeon. 
 
 Nulla enim re magis , quam exemplo docemur. 
 
 The above Lectures were lately delivered at 
 the Surgeons Theatre. 
 
 READING: 
 
 Printed for J. Carnan, and Co. in the Market - 
 Place ; and fold by J. Newbery, at the Bible and Sun, 
 ixijit. Paul’s Chunh-Yard , London* 
 

 . MtSM 
 
 
 
 
 Digitized by theJnternet Archive 
 in 2016 
 
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 https://archive.org/details/lecturesuponhear01maso 
 

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 T O 
 
 Mr. GRIND ALL, 
 
 Senior Surgeon to the Lon - 
 rf/0# Hofpital \ 
 
 A 
 
 Member of the Company of 
 Surgeons of London , 
 
 AND 
 
 Fellow of the Royal Society . 
 
 SIR, 
 
 Am induced to addrefs 
 T the following Lectures 
 
 jB?)k to you, from the Know- 
 
 ! 1 T u r V 
 ledge 1 have lome Years 
 
 had of your Abilities in Surgery ; 
 
 as alfo, from the favourable Cha- 
 
 A 2 radlerj 
 
i 
 
 iv DEDICATION, 
 rafter, you was pleafed to inform 
 me, the late Mr. Girle and Mr. 
 Nourse gave you of them, when 
 they were read at the Surgeons 
 Theatre. 
 
 I am, with the greateft Since- 
 rity and Refpeft, 
 
 Your moft obedient, 
 
 Humble Servant, 
 
 HENRY MASON, 
 
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 The Introduction. 
 
 KM^NATOMY, when remitted to 
 Surgery, i s that art, which teaches 
 =8f^ the fitruation, figure, connexions, 
 )k$£¥&¥;j£ fabrick, adtions, and ufes of the ie- 
 veral parts of the human body. 
 
 The intent and ends of this fcience are va- 
 rious : an admiration of one of the nobleft 
 works of the creator: a prefervation of our 
 health, as nothing can lead us more immedi- 
 ately to a knowledge of the means of preferv- 
 ing it, or reftoring it, when impaired by dif- 
 eafes, than a true knowledge of the ftrudture 
 of that frame which is injured by them. 
 
 Can a furgeon, who is unacquainted with the 
 human frame, make, for inftance, a deep inci- 
 fion into any part of the human body, without 
 running a rifque of opening fome confiderable 
 artery, or wounding fome nerve ? 
 
 B 
 
 Is 
 
ii INTRODUCTION. 
 
 Is it not a manifeft expofing of the patient 
 to terrible accidents, to bleed him, without 
 knowing the parts adjacent to the vein we are 
 about to open ? 
 
 Unlefs he is well acquainted with the fitua- 
 tion of the parts from anatomy, he will be al- 
 ways trembling, either with a vain fear, or elle 
 with a rafh affurance he will defpife the danger 
 of which he is ignorant. 
 
 Every chirurgical operation, therefore, proves 
 how indifpenfably necelfary the knowledge of 
 the parts of the human body is to Surgeons ; 
 and that flourifhing ftate of furgery we now fee 
 it in, is principally owing to thofe beautiful 
 difcoveries with which anatomy has been lately 
 enriched. 
 
 The want of this index magnet icus (for as the 
 needle is to a mariner, that is anatomy to a 
 Surgeon) will in no inftances be more felt by a 
 Surgeon, than in giving his teftimony in a court 
 of judicature upon the untimely death of per- 
 fons he lhall be appointed to examine ; and 
 particularly in cafes of wounds, for if the part 
 is found to have loft its ufe after the wound is 
 healed, and as the judge uiually inflifts a pe- 
 nalty proportionable to the damage the patient 
 fuftains, it is lor this reafon the council gene- 
 rally 
 
INTRODUCTION. 
 
 iii 
 
 rally ufe all the art they are mailers of to throw 
 moll of the ill confequences upon the negledt 
 or mifmanagement of the furgeon; therefore the 
 ill effedts which naturally follow fome wounds, 
 though ever fo llcillfully treated, Ihould be de- 
 clared very early, and which can be deduced 
 only from a knowledge of the anatomy, and 
 injured fundtions of the parts wounded. 
 
 But one who is acquainted from anatomy or 
 phyfiology with the ufes of the parts, as far 
 as they are at prefent known, will determine 
 the confequences or effedts of the wound as 
 foon as the parts affedted are known. 
 
 A maid-fervant fell down with a glafs mug 
 in her hand, and wounded her arm betwixt the 
 carpus and cubitus •, a profufe haemorrhage alfo 
 followed, from a divifion of the artery running 
 under the flexor carpi ulnaris mufcle : the hte- 
 morrhage was happily reftrained by compref- 
 flng the trunk of the artery againfl: the os hu- 
 meri in the upper part of the arm ; but then 
 the patient complained of a numbnefs in her 
 little finger, and in the middle of the next 
 finger, which the furgeon judged to arife from 
 the compreflure of the artery •, but being con- 
 firmed in my opinion by the accurate tables of 
 Eullachius, I boldly affirmed that the nerve 
 was divided which goes to the little finger, and 
 B 2 to 
 
IV 
 
 INTRODUCTION. 
 
 to the middle of the next adjacent finger, and 
 that therefore this complaint was irremediable. 
 The event demonft rated the truth of my af- 
 fertion : for after the cure was compleated, at 
 my requeft, ihe frequently put her finger into 
 the flame of a candle, without feeling the 
 
 leaft'pain. -Vid. Van Swieten Comment, in 
 
 Aphor. Boerhavii. Vol. i . 
 
 Another important end anatomy ferves, is, 
 the determining the caufe of the death of peribns 
 dying of natural difeafes, from a fubfequent 
 
 difledlion of the body This may be called 
 
 morbid anatomy. — Hereby we are Ihown the 
 difference between the dileafed and healthy ftate 
 of the parts ; and the latent caufes of multi- 
 tude of diieales have been long fince difcovered 
 by means of thele difledtions, which otherwife 
 we never could have known. Yet, there is 
 here fome caution neceffary ; for the dead body 
 only fhews us what its ftate was at the time of 
 death, and many changes will be found made 
 in it by the difeafe, which, however they may 
 be the effedts of the difeafe, would be very im- 
 properly reckoned to be the caufe of it. 
 
 The knowledge of the real caufes of a dif- 
 eafe, is the firft rational ftep towards its cure •, 
 and without the afliftance of difledtions, how 
 was the world to have known that the aefophogus 
 
 could 
 
INTRODUCTION. v 
 
 could have been burft in a violent fit of vomit- 
 ing, that the ipleen growing to an immenfe fize 
 could have fallen into the pelvis by an elonga- 
 tion of its connedting veffels, or have been in- 
 formed of the nature of an empiema, a cata- 
 radt, a hernia, and many others. 
 
 They are much miftaken, fays Baglivi, who 
 think they can cure difeafes happily becaufe 
 they are mafters of the Theory. They ought 
 to have much higher things in view. They 
 muft dilfedl the bodies of thofe who die of dif- 
 tempers, and foul their fingers , to the end they 
 may find out the feat of the complaint, the 
 caufe and iffue of antecedent fymptoms. 
 
 The ancients were fo well convinced of the 
 neceffity of this knowledge, and to take, as they 
 thought, the beft method of attaining it, pro- 
 cured criminals out of prifon, and diffedting 
 them alive, contemplated while they were even 
 breathing the parts which nature before had con- 
 cealed, confidering their pofition, colour, fize, 
 &c. for, fay they, as various diforders attack 
 the internal parts, they thought no perfon could 
 apply proper remedies to thofe parts, which he 
 was ignorant of. 
 
 The anatomical obfervations likewife made 
 upon brutes have not only given great light to 
 
 thofe 
 
VI 
 
 INTRODUCTION. 
 
 thofe made upon human bodies, but are exa&ly 
 of a piece with them, nay, fo certain and con- 
 flant is that mutual analogy, that the ftru&ure 
 of the vifcera, and an infinity of other things 
 have been dilcovered to the great happinefs of 
 the age we live in. 
 
 Without thefe neither would Herophilus 
 have dilcovered the la&eal vefifels in kids ; Eu- 
 {lachius and Pecquet their receptacuuim chili 
 and thoracic du& in the horfe and dog, nor 
 Harvey his celebrated circulation of the blood. 
 Add to thefe that the infpe&ions of carcafes by 
 prielts in their daily facrifices •, the cuftom of 
 embalming and opening the dead, as alfo dref- 
 fing of carcafes by the butcher, each afforded 
 fome knowledge of the anatomical ftru&ure of 
 found bodies, as well as the immediate and 
 abftrufe caufes of health, ficknefs, and death. 
 
 All this could hardly be done for many ages 
 together, without frequently dete&ing the la- 
 tent caufes of the moft fevere dileales as well 
 as the ftru&ure and fituation of the parts; 
 and hence the firft foundation of pra&ical ana- 
 tomy. 
 
 Frequent and deftru&ive war furnifhed op- 
 portunies of difcovering many of the muicles 
 
 and 
 
INTRODUCTION. vii 
 
 and larger veflels, with the articulation of the 
 bones, to the naked eye in the yet living fub- 
 je£t •, infomuch that fome have attempted to 
 extract a fyftem of anatomy from Homer, who 
 has in reality writ hiftories of wounds fldlfully 
 and anatomically Hated 
 
 We have been taught alfo from p radical 
 anatomy that difeafes frequently change the 
 natural fituations of the vifcera, and this we 
 are affured of from the moft certain obferva- 
 tions. The pofition of the ftomach efpecially 
 has been obferved to be furprizingly perverted 
 together with the other vifcera of the abdomen, 
 in the body of a woman after frequent vomit- 
 ings. (Mem. acad. 1716, page 238.) And it 
 feems very probable, that the vifcera are thus 
 even frequently difplaced, fince, fays Van Swi- 
 eten, I have feveral times made the like obfer- 
 vation, in the fubjefts which I either difteded 
 myfelf, or have feen differed by others. I 
 have feen the fpleen prolapfed into the pelvis, 
 the bottom of the ftomach continued below 
 the navel •, and have alio feen that part of the 
 colon which lies under the ftomach fo refleded 
 thence as to form an arch below the navel, the 
 convex part of which v/as towards the pelvis, 
 and its concavity towards the ftomach. 
 
 The 
 
viii INTRODUCTION. 
 
 The advantages which Surgery particularly 
 derives from Anatomy being very evident, I 
 fhall next proceed to what I intend in the fol- 
 lowing lectures, which is to confider thofe 
 bowels placed in die cavity of the Thorax. 
 
 j«r 
 
 PRiELECTIONES 
 

 PR^LECTIONES 
 
 IN QJJIBUS 
 
 Tradtandae veniunt partes quae in 
 Thorace funt contents; 
 
 Una cum 
 
 Velamentis extus circumpofitis. 
 
 Diaphragma, quod hujus ventris 
 pars efle magis quam infimi, 
 hoc loco defcribetur. 
 
 Variis inde dedudtis corollariis pradticis. 
 
 
[ 2 ] 
 
 ||*|| 
 
 11*11 t ’^^ s * s ^^ 5 ^ R ^ s 
 
 PR^LECTIO PRIMA. 
 
 F^sT^S the Diaphragm contributes in great 
 ^ A ^ meafure to the formation of the ca- 
 k_^Rik ^ t ^ ie Thorax, and a know- 
 
 ledge of its fituation and ample 
 extent being of fome confequence in practice, 
 I lhall begin with a defcription of this 
 mufcle. 
 
 We call the thorax that part of the trunk 
 of the body which is terminated before by 
 the fternum, behind by the twelve vertebrae 
 of the back, on the fides by the arched ribs, 
 above -by the two fuperior ribs, and below by 
 the diaphragm, which feparates it from the 
 cavity of the abdomen. 
 
 The diaphragm, or the mufculus forma mi- 
 nis, as diftinguifhed by Albinus, is a very broad 
 and thin mufcle, fituated at the bafis of the 
 thorax, and which ferves to partition off, by a 
 very broad furface, the lower vifcera, from thofe 
 of the bread:. It is placed obliquely, and forms 
 a kind of arched roof, or concave dome, with 
 
 its 
 
[ 3 ] 
 
 its convex part towards the breaft, and in fuch 
 a manner that its fore-part rifes much higher 
 than its back-part, which is inferted lower, 
 hence it is that the cavity of the thorax is much 
 larger behind than before. Since the cavity of 
 the thorax defcends deepeft towards the back, 
 from the inclined pofture of the diaphragm, 
 therefore when we are about to perform the pa- 
 racentelis of the breaft, we fhould make our 
 perforation as low as it can poflibly be done, 
 without danger of injuring the diaphragm. 
 And to avoid hurting the ftrong mufcles termed 
 facrolumbalis, longiflimus, dorfi, &c. which af- 
 cend thro’ the loins and back on each fide the 
 fpina dorfi, the opening ought to be made at 
 the diftance of four fingers breadth, at leaft, 
 from the vertebrae, and this is ufually made 
 betwixt the fecond and third, or betwixt the 
 third and fourth of the fpurious ribs, reckon- 
 ing from below upwards. But fince it appears 
 from anatomy ( Albini hijior. mufculorum homi- 
 nis) that the vault of the diaphragm afcends 
 higher in the right fide of the thorax, for this 
 reafon, when the perforation is made on the 
 right fide, it fhould be performed betwixt the 
 third and fourth rib •, but when on the left fide, 
 betwixt the fecond and third of the fpurious ribs. 
 
 Hippocrates takes notice, that if the matter 
 or water be all of a fudden difcharged from a 
 C 2 patient 
 
[4 ] 
 
 patient who has an empiema or dropfy of the 
 thorax, it kills him •, therefore fome would not 
 have all the fluid extracted at once, but at feve- 
 ral times. Now in an empiema or dropfy of 
 the thorax, the lungs have lain a long time 
 macerating in the matter, or in the extrava- 
 fated ferum flowing all around, fo that upon 
 evacuating it all, at one and the fame time, the 
 lungs might have their weakened veflels burft 
 by the fudden dilatation of them with blood, 
 whence fudden death. "What renders this ope- 
 ration the more eafily pradlicable, is the com- 
 preflure of the lungs by the extravafated hu- 
 mours, and the deprefiure of the diaphragm 
 by their weight, by which means thofe two or- 
 gans are not eafily injured upon perforating the 
 pleura. 
 
 The diaphragm is looked upon as a double 
 and digaftric mufcle, made up of two different 
 portions, one large and fuperior called the great 
 mufcle of the diaphragm, the other fmall and 
 inferior, appearing like an appendix to the 
 other, called the fmall or inferior mufcle of the 
 diaphragm. 
 
 The great or principal mufcle is flelhy in its 
 circumference, and tendinous and aponeurotic 
 in the middle, to this part the ancients gave 
 the name of the nervous center of the dia- 
 phragm. 
 
[ 5 1 
 
 phragm. Senac has demonftrated, that the 
 center or tendinous part of the diaphragm does 
 not defcend in infpiration, the pericardium in- 
 cluding the heart being attac hed thereto for 
 the pofition and motion of the heart would 
 be difturbed fince the pericardium adheres with 
 its broadeft fide to the tendinous part of the 
 diaphragm. And that this part of the dia- 
 phragm does not defcend, he alfo proves, from 
 its ftrucfture and connexion. Lieutaud, in his 
 Effais Anatomiques, afierts, that the contrary is 
 eafily obferved in opening living animals. His 
 words are, “ l’on a dit que le centre tendineux 
 “ ne defcendoit point, a caufe de fes attaches 
 “ au mediaftin; mais il eft aife d’obferver le 
 “ contraire dans l’ouverture des animaux vi- 
 “ vans.” 
 
 This mufcle has a radiated flefhy circumfe- 
 rence, the fibres of which it is made up, being 
 fixed by one extremity to the edge of the mid- 
 dle aponeurofis, and by the other to all the ba- 
 fis of the cavity of the thorax, being inferted 
 by digitations in the lower parts of the appendix 
 of the fternum, of the loweft true ribs, of all the 
 falfe ribs, and in the neighbouring vertebra. 
 
 We have therefore three kinds of inferti- 
 ons, one fternal, twelve coftal, fix on each fide, 
 and two vertebral. 
 
 The 
 
[ 6 ] 
 
 The fmall or inferior mufcle of the dia- 
 phragm is thicker than the other, but of much 
 lefs extent. It is fituated along the forefide of 
 the bodies of the laft vertebrae of the back, 
 and feveral of thofe of the loins. 
 
 The oval opening of this inferior mufcle 
 gives palfage to the extremity of the sfopha- 
 gus, and the aorta lies in the interftice be- 
 tween the two crura. 
 
 In the middle aponeurofis of the great muf- 
 cle, is a round opening which tranfmits the 
 trunk of the lower vena cava. The circumfe- 
 rence of this opening is formed by an inter- 
 texture of tendinous fibres, and is confequently 
 incapable either of dilatation or contraction, by 
 the aCtion of the diaphragm. 
 
 We find therefore three confiderable open- 
 ings in the diaphragm, one round and tendi- 
 nous for the pafiage of the vena cava, one oval 
 and fiefhy for the extremity of the aefophagus, 
 and one forked, partly fiefhy and partly tendi- 
 nous, for the aorta. 
 
 The ufes of the diaphragm are to afiift in re- 
 fpiration, in which it is a principal inftrument, 
 defcending towards the abdomen in infpiration, 
 and rifing upwards into the cavity of the tho- 
 
 rax 
 
[ 7 1 
 
 rax in expiration : we are alfo to look upon this 
 mufcle as a power adding confiderably upon the 
 ftomach, and abdominal vifcera employed in 
 digeftion, for the diaphragm being deprefied at 
 every infpiration, all the contents of the abdo- 
 men are thereby comprefled, and again in ex- 
 piration they are reprefled by the abdominal 
 mufcles. 
 
 From recollecting the various parts the dia- 
 phragm lies near to, and others with which it 
 is immediately connected, it will not appear 
 wonderful that an inflammation of it is fome- 
 times taken for a diforder in fome of the other 
 parts. From thence alfo it will appear, that 
 various fymptoms may arife, according as dif- 
 ferent parts of the diaphragm become the feat 
 of the difeafe. We fee for certain that it growj; 
 to the pericardium, tranfmits or gives a paflage 
 to the aefophagus, aorta, vena cava, &c. lies 
 clofely incumbent about the liver, fpleen, kid- 
 neys, and the reft — from whence an inflamma- 
 tion, fwelling, or hard fcirrhous tumour in this, 
 or that part of the diaphragm may excite vari- 
 ous complaints by injuring one or the other or- 
 gan that lies next to it. 
 
 Leewenhoeck is perfuaded that the dia- 
 phragm puts the whole abdomen into a con- 
 tinual motion, whereby the food in the fto- 
 
 mach 
 
[ 8 ] 
 
 mach and inteftines is comminuted in fuch a 
 manner as to be reduced into a fluid matter, 
 fit to enter the abforbing veflels fo numerous 
 in the cavities of the inteftines. He computes 
 that, in a well conftituted body, there is 900 
 refpirations every hour, and fo often will the 
 ftomach and inteftines be comprefled. 
 
 Leewenhoeck rather inclines to Dr. Jurin’s 
 opinion, viz. that the palpitation of the dia- 
 phragm is better grounded than that of the 
 heart. 
 
 The very accurate Window obferves, that 
 the liver in the human body is fo firmly attached 
 by its ligaments, that it cannot eaflly flip from 
 one fide to the other; yet that it is not abfo- 
 lutely fufpended by them, but is in part fuf- 
 tained by the ftomach and inteftines, efpecially 
 when they are full. Hence after long fading, 
 the liver defcending by its own weight, pulls 
 down the diaphragm, and occafions an uneafy 
 fenfation, which the fame anatomift thinks is 
 unjuftly afcribed to the ftomach. 
 
 We have well attefted inftances of very fmall 
 wounds received in this part, through which 
 fome of the bowels of the lower belly have af- 
 cended into the thorax. For while the con- 
 tents of the abdomen are prefled by its mufcles 
 
 and 
 
[ 9 1 
 
 and the diaphragm, they are forced through 
 the wound in the latter, which they dilate, lb 
 as to pafs into the cavity of the breaft, and then 
 by compreffing the lungs and difturbing the 
 aftion of the heart itfelf, death is fooner of 
 later brought on. 
 
 Thus Parey affirms, he faw a man who was 
 wounded in the tendinous part of the diaphragm, 
 which, though no larger than the breadth of 
 one’s thumb, the ftomach was notwithftanding 
 forced through the wound into the cavity of the 
 thorax. “ Diffedto ventre inferiore (fays he) 
 “ ventriculum cum non reperirem, rem mon- 
 “ ftro fimilem arbitrabar. Sed tandem anxie 
 “ perquirens, raptum ipfum in thoracem ani- 
 “ madverti, etfivulnus pollicem vixeffet latum.” 
 
 In another perfon, who had been wounded 
 about eight months, and who died after the fe- 
 vered: cholicky pains, the inteftinum colon was 
 found the greateft part of it within the cavity 
 of the thorax, though the wound in the dia- 
 phragm was no larger than to be capable of 
 receiving the end of one’s little finger. 44 Mor- 
 “ tui cadaver Jacobi Guillemeau chirurgi pe- 
 <c ritiffimi manu diffectum eft, animadverfum- 
 <c que magnam coli partem, flatu multo tur- 
 “ gidam, ipfi per diaphragmatis vulnus in tho- 
 “ racem irrupiffe, vulneris tamen amplitudo 
 “ vix minimi digiti capax erat.” Parceus lib . 
 9. p. 30. D A 
 
[ 10 ] 
 
 A like example is alfo to be met with in Sen- 
 nertus, of a perfon who ftabbed himfelf, but 
 was cured of the wound within two months 
 after, and notwithftanding which he expired, 
 with frequent vomitings, feven months after 
 the wound was healed. Upon opening the 
 body, the wound appeared to have penetrated 
 through the diaphragm and lungs, but the 
 whole ftomach was forced up into the left cavity 
 of the thorax, and the heart with the pericar- 
 dium was thereby preffed into the right fide-, 
 when the patient was alive and cured of his 
 wound, he would often direft thofe about him 
 to feel the palpitation of his heart, by applying 
 their hand. Sennertus lib. ii. cap. i 3. pag. 372. 
 
 Thefe are fome of thofe wonderful fort of 
 Cafes, for difcovering which we have no certain 
 figns, and can feldom know them but by open- 
 ing the body after death, fo that the errors 
 which arife from our prognofticks of fuch 
 wounds are unavoidable; for who could alferc. 
 or foretel that the vifcera were thus difplaced, or 
 by what figns could any one difcover the fame ? 
 
 One ought to be well acquainted by anato- 
 my with the true fituation and connexion of 
 the diaphragm, and great caution is neceflary 
 in determining whether or no a wound pene- 
 trates into the cavity of the thorax, for as this ca- 
 vity, as has been oblerved, afcends much higher 
 
 before 
 
[ II ] 
 
 before, than behind, where it defcends lower, 
 very great errors have been fometimes commit- 
 ted, in thinking a wound penetrated the thorax, 
 when it really entered the cavity of the abdomen. 
 Thus we read in Ruyfch ( obf. anat. chir. obf. 65) 
 of an ignorant Surgeon, who being defirous to 
 perform the paracentefis of the thorax, fent for 
 him into confultation ; but Ruyfch being indif- 
 pofed and unable to go, the Surgeon by him- 
 felf perforated the thorax as he thought ; but 
 foon after, a large number of hydatids forced 
 themfelves out through the wound, and the 
 Surgeon, being affrighted, flopped the wound 
 with a tent, and had recource to Ruyfch, but 
 to no purpofe, for the unhappy woman died 
 foon after; and upon opening the body, no- 
 thing of water appeared in the thorax, but the 
 Surgeon, 'in perforating the abdomen inftead 
 of the thorax, had wounded the liver, which 
 in that part adhered to the peritonaeum, and 
 feemed to have degenerated into hydatids, 
 which burfl forth through the wound. 
 
 Haller alfo tells us, that he opened the body 
 of a man who died foon after the operation for 
 the empiema had been performed on him. In 
 the liver there was a purulent ulcer, but not 
 deep, fituated very near the furface of it and 
 the diaphragm. He does not mean he fays to 
 throw the leaft refledlion on thofe gentlemen who 
 D 2 had 
 
[ 12 ] 
 
 had the care of this patient. To determine at all 
 times where the liver terminates, and where the 
 lungs, requires no fmall knowledge in anatomy, 
 feeing the diaphragm diverges backwards from 
 its anterior border, where it is higheft, and de- 
 scends from the fourth or fifth rib, as low as the 
 twelfth, and even lower. Yet he concludes, open- 
 ing the bread, in a difeafe of the liver, does no 
 great honour to the operator. See his Pathologi- 
 cal obfervations. 
 
 Having done with our account of this part, 
 we fliould next pafs on to thofe bowels in the ca- 
 vity of the thorax, but before we proceed to 
 examine thefe particularly, it will be firft necef- 
 fary to take notice of that membrane which 
 lines its whole internal furface, known by the 
 name of the pleura, 
 
 The pleura is a denfe compaft membrane, 
 which adheres very clofely to the inner furface 
 of the ribs, fternum and intercoftal mufcles, 
 and to the convex fide of the diaphragm •, it re- 
 iembles the peritoneeum, and likewife in that it 
 is made up of an inner true membranous lamina, 
 and a cellular fubftance on the outfide. 
 
 The cellular portion goes quite round the in- 
 ner furface of the thorax, but the membranous 
 portion is difpofed in a different manner. Each 
 fide of the thorax has its particular pleura, in- 
 tirefy diftindf from the other, and making as it 
 
 were 
 
[ *3 1 \ 
 
 were two great bladders, fituated laterally with 
 refped to each other in the great cavity of the 
 breaft, in fuch a manner as to form a double 
 feptum or partition running between the ver- 
 tebrae and the fternum, their other fiaes adher- 
 ing to the ribs and diaphragm. 
 
 This particular duplicature, which is formed 
 by a conjunction of the two lacculi of the 
 pleura, is termed mediaftinum ; the two lami- 
 nse of which it is made up are clofely united 
 together near the fternum and vertebra, but 
 in the middle and towards the lower part of 
 the forefide, they are feparated by the pericar- 
 dium and heart — a little more backward they 
 are parted in a tubular form by the asfophagus, 
 to which they ferve as a covering-, and in the 
 moft pofterior part, a triangular fpace is left 
 between the vertebra and the two pleura from 
 above downward, which is filled chiefly by the 
 aorta. 
 
 Before the heart, from the pericardium to the 
 fternum, the two laminae adhere very clofely, 
 and there the mediaftinum is tranfparent, ex- 
 cept for a fmall fpace near the upper part, 
 where the thymus is fituated ; fo that in this 
 place there is naturally no interftice or particu- 
 lar cavity. Where the contrary has been fhewn, 
 it has been owing entirely to the common me- 
 thod of raifing the fternum, as is plainly de- 
 monftrated by Bartholjne in his treatife of the 
 diaphragm. At 
 
[ H ] 
 
 At the upper part of the mediaftinum, we 
 find fituated an oblong glandular body, called 
 the thymus, which is round on its upper part, 
 and divided below into two or three lobes, of 
 which that towards the left hand is the lon<y- 
 
 CD 
 
 eft. In the foetus it is of a pretty large fize, 
 lefs in children, and very fmall in aged per- 
 fons. The greateft part of the thymus lies 
 between the duplicature of the fuperior and 
 anterior portion of the mediaftinum, and the 
 great vefiels of the heart, from whence it 
 reaches a little higher than the tops of the two 
 pleurze, fo that fome part of it is out of the 
 cavity of the thorax, and in the foetus and 
 children it lies as much without the thorax 
 as within it. 
 
 There are various conjectures about its ufe, 
 but as they are not fupported by any proofs, 
 ffiall forbear to mention them. And what the 
 real purpofes are, which it does ferve, we are 
 as yet unacquainted. 
 
 I once faw a fuppuration in this gland in a 
 lad I opened, and obferved that the matter 
 had emptied itfelf into the trachea. 
 
 Bonetus relates a cafe, where it was fo much 
 enlarged as to prefs upon the trachea, and oc- 
 cafion a difficulty of breathing. 
 
 Platerus 
 
I *5 1 
 
 Platerus, in his obfervations, tells us that 
 he has found it of fo extraordinary a fize, as 
 by its compreffion to caule fuffocation and 
 death. 
 
 The mediaftinum does not commonly termi- 
 nate along the middle of the fternum, as has 
 been generally fuppofed. And which at any 
 time may eafily be proved before the thorax is 
 opened, by running a (harp inftrument thro’ 
 the middle of the fternum ; we fhall find there 
 will be the breadth of a finger between the 
 inftrument and the mediaftinum, provided the 
 fternum remain in its natural fituation, and the 
 cartilages of the ribs be cut at the diftance of 
 an inch from it on each fide. 
 
 From all this we fee, not only that the tho- 
 rax is divided into two cavities, entirely fepa- 
 rated from each other by a middle feptum with- 
 out any communication, but alfo that by the 
 obliquity of this partition, the right cavity is 
 greater than the left. 
 
 The cellular portion of the pleura connefls. 
 the membranous portion to the fternum, ribs, 
 and mufcles, and in a word, to whatever lies 
 next the convex fide of the membranous por- 
 tions of the pleura. It likewife infinuates it- 
 felf between the laminae of the duplicature, of 
 
 which 
 
[ 16 ] 
 
 which the mediaftinum is formed, and unites 
 them together. It even penetrates the muf- 
 cles, and communicates with the cellular fub- 
 ftance placed at the back of the peritonaeum, 
 fo that if an inflammation is fucceeded by a 
 fuppuration here, the matter confined in the 
 cellular fubftance, that lies between the plates 
 of the mediaftinum, may procure to itfelf 
 wonderful paflages (as it defcends by its own 
 weight) betwixt the pleura and the bodies of 
 the vertebrae, where it may evidently form in- 
 curable finufles and fiftulae, and make its ap- 
 pearance by a fwelling in fome very diftant 
 
 part of the body.- Inftances of this kind 
 
 are by no means uncommon. 
 
 And to what amazing diftances matter will 
 fometimes make its way, we read an example 
 of in that excellent lurgeon and faithful wri- 
 ter La Motte, “ Traite complet de Chirurgie, 
 
 <c Tom. I. page 3 57.” where he traced 
 
 the matter of an abfcefs from the loins to the 
 foie of the foot. 
 
 This always happens in the panniculus adi- 
 pofus ; it not appearing, from any credible ob- 
 lervations, that the proper fubftance of the 
 mufcles has been at any time pervaded by a 
 finus or fiftula. 
 
 We 
 
[ i7 ] 
 
 We are well allured that the cellular mem- 
 brane extends almoft into every part of the 
 body, and acquires different denominations, 
 according to the different matter which it con- 
 tains. In thofe parts of the body where this 
 membrane is thinnefl, its cells, being empty of 
 oil or fat, efcapes the eye, and is termed Am- 
 ply cellulofa — We fhould confider, that not 
 only all the mufcles and tendons are invefted 
 with fuch a cellular membrane, but that even 
 every mufcular fibre, as far as the eye and pa- 
 tient hand of the mofl acute and dexterous 
 anatomifl has been able to penetrate, is alfo 
 invefted with the fame j almoft every vef- 
 fel in the body runs in or through fuch a 
 cellular fubftance, which in part conftitutes 
 the fabric of the veffels and vifcera them- 
 
 felves.* For a beautiful and extenfive account 
 
 of this membrane , fee Scobingerus de dignitate 
 tels cellulofae in corpore humano. 
 
 To return to the pleura We meet with, 
 
 in the celebrated Dr. Haller, a remarkable cafe 
 of an hydrops faccatus pleurae, or an incyfted 
 dropfy of this membrane : upon opening the 
 thorax, to the no fmall aftonifhment of the 
 perfons prefent, there were no lungs (he fays) 
 to be found, but only a bag full of a green wa- 
 tery liquor, which, upon a further enquiry, was 
 obferved to have been extravafated between the 
 intercoftal mufcles and the pleura, and that this 
 E mem- 
 
[ i8 ] 
 
 membrane, the ufe of which is to line the in- 
 fide of the ribs, was feparated from them in 
 fuch a manner as to form a bag as large as the 
 whole cavity of the bread:. Hence the left 
 lobe of the lungs was fo much comprefied, as 
 to be rendered thinner than one’s hand, and 
 the cavity in which it was lodged no larger 
 than a glove. This (he obferves) is a very 
 rare cafe, and Ihews, that an incyfted dropfy 
 may be produced in the thorax, from water 
 collected in the cells of the pleura. 
 
 The fame ingenious gentleman, from fome 
 diflfedtions of perfons dying of a pleurily, is of 
 opinion, that the pleura is much feldomer the 
 feat of the difeafe, than is fuppofed-, in thole 
 he opened, the pleura was perfectly found, the 
 feat of the abfcefs being in that part of the 
 lungs which is contiguous to the diaphragm. 
 This obfervation, he fays, he could confirm by 
 innumerable inftances of the fame kind. To 
 this he adds, that the fpitting in pleuretic pa- 
 tients, owing to the inflammation, is eafily un- 
 derftood, if the feat of the difeafe is granted 
 to be in the lungs ; feeing, by the inflammation, 
 part of the obftrufting matter will make its 
 way through the relaxed, exhaling, or mucous 
 veflels into the bronchia. But how that mat- 
 ter can pafs from the pleura to the al'pera ar- 
 teria, while the lungs remain found, he leaves 
 to thofe who are of that opinion to explain. 
 
 And 
 
[ i9 ] 
 
 And from the rarenefs of the cafe of an in- 
 flammation of the pleura proving mortal, or 
 producing that pus which is collected in the 
 empiema, he would advife thofe who have the 
 treatment of pleuretic people, to fufpedl the 
 caufe of that difeafe to be rather an inflamma- 
 tion of the lungs than of the pleura, and to 
 have immediate recourfe to the moll powerful 
 remedies. — See his Pathological obfervations. 
 
 In fupport of this opinion of Dr. Haller’s, 
 I fhall bring the teftimony of Peter Servius, 
 from Triller’s valuable treatife de Pleuritide, 
 who, after opening three hundred perfons de- 
 ceafed of pleurifies at Rome, always found one 
 lobe of the lungs corrupted and diftended with 
 a putrid matter, but the pleura appeared not 
 in the leaft affefted. 
 
 Mr. Chefelden likewife ever found this to be 
 the cafe, (he fays) in opening fuch who were 
 fuppofed to have died of pleurifies. 
 
 It is no novel opinion, that the lungs are 
 the parts affe£ted in a pleurify — for Aurelianus 
 reckons up a number of antient phyficians, 
 who defended this fentiment. 
 
 But to the mediaftinum, the ufes of this par- 
 tition are to cut off all communication be- 
 tween the two cavities, by which, if one lobe 
 E 2 of 
 
[ 20 ] 
 
 of the lungs is ulcerated, the other may not be 
 immediately affedted ; that matter, water, or 
 any thing elfe contained in one part of the 
 thorax might not affect the other, and that, 
 in cafe of a wound in one fide of the thorax, 
 refpiration might be kept up in the other, and 
 the perfon not immediately fuffocated. Ano- 
 ther general ufe it has, is, to fupport the heart 
 with its pericardium as well as the diaphragm, 
 by means of which, the ftomach, the liver, 
 and the other vifcera of the abdomen attached 
 thereto, cannot, in drawing down the dia- 
 phragm too forcibly towards the inferior parts, 
 interrupt the adtion of the heart and refpi- 
 ration. 
 
 It may here be queftioned, whether a la- 
 tent abfcefs under the fternum cannot have a 
 difcharge of its matter by an opening through 
 the fternum, left the pericardium and heart 
 fhould be corroded by the confined and putrid 
 matter ? 
 
 Examples are not wanting in writers too of 
 great credit, of the trepan’s having been fuc- 
 cefsfully applied over this part, in order to 
 o-ive vent to a colledtion of matter or water 
 underneath. 
 
 Galen gives a remarkable cafe of a lad, who 
 received a blow upon his fternum, and being 
 
 negli- 
 
[ 21 ] 
 
 negligently treated, that part of the fternum 
 appeared afterwards corrupted by a fphacelus. 
 Galen, trufting to anatomy in which he was 
 fo well {killed, cut out the carious part of the 
 fternum, and tells us, he was able to lee the 
 naked heart, whofe pericardium was eaten 
 through, under the carious part of the bone ; 
 yet this lad was cured in a Ihort time. 
 
 We are allured, by the celebrated Van 
 Swieten, that he has feen matter, after a fup- 
 puration in the thorax, making its way through 
 the fternum, which Ihews luch a method of 
 cure is polfible. 
 
 We may therefore reafonably conclude, that 
 when there are evident figms demonftratino; a 
 latent empiema feated beneath the fternum, 
 an opening into it may be very fafely at- 
 tempted ; notwithstanding the affurance given 
 us by Dionis in his anatomy, that he faw the 
 fternum unluccefsfully trepanned in a wounded 
 gentleman, who afterwards expired: for it does 
 not in that cafe appear that his death could be 
 afcribed to the operation, but rather to his 
 wound •, and enough has been faid to fhew that 
 people have furvived an opening made through 
 their breaft-bone, and as a further confirma- 
 tion, lhall produce one more inftance from 
 Haller’s Pr^lefliones Academics, where we 
 are told, that a certain Divine at Amfterdam 
 
 had 
 
[ 22 ] 
 
 had the trepan fuccefsfully applied to this part, 
 and who was by this means freed from a great 
 quantity of matter, and the heart was thus 
 left fo naked, that by applying a looking- 
 glafs oppofite to the wound, he could fee his 
 own heart beating, which he appeared to take 
 fome pleafure in, he being a man of uncom- 
 mon tafte, and the author of a celebrated trea- 
 dle, denying the exiftence of devils. 
 
 PRiELECTIO secunda. 
 
 H AVING gone through the defcription 
 of the pleura with its reduplicated plates 
 compofing the mediaftinum, I fhall next pro- 
 ceed to the examination of the heart, with its 
 capfula the pericardium. 
 
 The pericardium is a membranous fack of 
 a pretty firm texture, which immediately in- 
 cludes the heart, and is placed between the 
 two laminae of the mediaftinum. 
 
 The capacity of the pericardium is equal 
 to the fize of the heart, and is not as large 
 again, as ibme anatomifts have imagined; and 
 if it feems larger than neceffary to cover the 
 
 heart 
 
[ 2 3 ] 
 
 heart when a body is opened, it is wholly ow- 
 ing to the heart’s emptying itfelf at the mo- 
 ment of death, not only of the blood contained 
 in its ventricles, but alio that of the coronary 
 arteries, by which means, its volume is prodi- 
 gioufly diminifhed — This is an obfervation of 
 Lieutaud’s. 
 
 The pericardium is compofed of two mem- 
 branes, and of a cellular web which joins them 
 too-ether: the outward membrane is tendinous 
 
 tD 
 
 and very compadt, and the inward is thin and 
 poliftied, being moiftened on all fides by a wa- 
 tery vapour. It muft be obferved, that not 
 only this cavity, but the interftices in the ab- 
 domen, thorax, and all other cavities of the 
 living animal, are replenifhed with moift va- 
 pours difcharged by exhaling vefiels — the ex- 
 iftence of which, in the fuperficies of the heart 
 and its auricles, may be proved by a fimilar 
 tranludation of water or fifh-glue injedted into 
 the large arteries : with this moifture, the heart 
 will be lubricated, and that fridtion prevented, 
 which might inflame and occafion its adheflon 
 to the pericardium. But if thefe exhaling ar- 
 teries difcharge more plentifully than the veins 
 abforb, this fluid will be accumulated to the 
 quantity in which we often find it. By this 
 means, when the abforbing power declines irj 
 chronical diforders, there is frequently pro- 
 duced a dropfy of the pericardium, and in 
 
 which 
 
[ 24 ] 
 
 which cafe it has been found diftended with 
 feveral pounds of liquor. 
 
 We may be fenfible how neceflary this moif- 
 ture is to lubricate and feparate the vifcera, and 
 efpecially the heart, from the hiftories given 
 us by Peyerus, in which the patients were trou- 
 bled with the molt violent oppreflions and pal- 
 pitations, becaufe for want of this moifture 
 the heart was found dry, and adhering to the 
 pericardium. 
 
 The tendinous part of this bag has nine a- 
 pertures or holes, as well for the paffage of 
 thofe veflels which enter into its cavity, as thofe 
 which iflue out of it ; that is, two for the venae 
 cavas, four for the pulmonary veins, one for 
 the trunk of the aorta, and two for the pul- 
 monary arteries. 
 
 > , 
 
 The connexions of the pericardium are, with 
 the principal veflels, juft now mentioned ; it is 
 alfo adherent, in a great part of its extent, to 
 the aponeurotic portion of the diaphragm, fo 
 as to be infeparable without laceration •, by 
 which means, it fuftains that broad mulcle with 
 the feveral vifcera connected pendulous to it, 
 fo that the diaphragm cannot by their weight 
 be drawn down too low in the abdomen in our 
 eredl pofture. 
 
 The 
 
f 2 5 J 
 
 It has been faid, that this capfule has Tome- 
 
 times been found wanting. Columbus tells 
 
 us that he opened a ftudent who died of a fit 
 in the univerfity of Rome, and that in this 
 fubjeft he could find no pericardium, but it 
 feems more probable, that from a preceding 
 inflammation, it had united itfelf fo clofely with 
 the heart as to have deceived him : certain it is, 
 that the coalition of this membrane is much 
 more probable, than the entire want of it. 
 
 Ruyfch kept by him the heart of a man 
 who laboured under a continual fever, with an 
 intolerable pain about the fore-part of his 
 bread: ; but the outer furface of this heart was 
 altogether rough or unequal, from the pericar- 
 dium being grown to its furface. 
 
 Lower produces a like inftance of its ad- 
 hering every where fo clofely to the heart, that 
 he found it difficult to feparate it with his fingers. 
 
 It is probable, inflammations of the medi- 
 aftinum and pericardium happen oftener than 
 is commonly believed *, for the caufes produc- 
 ing them may very powerfully aft upon thefe 
 parts, namely, the cold air, or the drinking of 
 large draughts of cold liquors by perfons much 
 heated; but the pericardium is feated betwixt 
 the lungs, by which it is almoft every way fur- 
 rounded, fo that the cold air infpired is, by the 
 F dilated 
 
[ 26 ] 
 
 dilated lungs, applied to the contiguous medi- 
 aftinum and pericardium, and the sefophagus, 
 tranfmitting cold drinks, go along betwixt the 
 two receding plates of the mediaftinum, and 
 pafles the diaphragm behind the pericardium ; 
 the principal figns of this malady are fuch 
 caufes already mentioned, and a great heat felt 
 in the midft of the thorax; to which add a 
 great difturbance of the pulfe, and fainting 
 fits, when the inflammation has fpread to the 
 pericardium.- — If a fuppuration fhall be formed 
 in the pericardium, it may penetrate the cavity 
 of that bag, and lie round the furface of the 
 heart. — Columbus (de re anatomica , lib. xv. 
 y>. 267.) found the heart every way furrounded 
 by an abfcefs, by which it was almoft con- 
 fumed. 
 
 An inflammation of the mediaftinum is very 
 fairly confirmed by the oblervations of Aven- 
 zoar, who writes that himfelf laboured under 
 this malady — Upon his firft diforder, which 
 happened in a journey, he felt a pain in that 
 part, which increafed with a cough; he found 
 his pulfe very hard and his fever very acute. 
 The fourth night, he took away a pint of 
 blood; his fymptoms were but little relieved; 
 but in the night, and while afleep, the bandage 
 of the arm came off; upon waking, he found 
 the bed fwimming with blood, and foon after 
 recovered. The fymptoms in this difeafe are 
 
 generally. 
 
[ *7 ] 
 
 generally, he fays, a continual fucceffive cough, 
 a tenfive pain lengthways, a difficulty in breath- 
 ing, an acute fever, great thirft, and a hard 
 unequal pulfe. 
 
 This phyfician not only takes notice of an 
 abfcefs in the mediaftinum, but in the pericar- 
 dium likewife. 
 
 Salius Diverfus, who has withgood judgment 
 given us an account of feveral diftempers, over- 
 looked by the generality of writers, defcribes this 
 diforder in a different chapter by itfelf, and fays, 
 it had been taken notice of by no pradtical au- 
 thor before him. His defcription of the fymp- 
 toms, which follow upon an inflammation here, 
 is very exadt and particular ; and becaufe the cafe 
 is one pretty much out of the way, tho’ without 
 difpute, fuch as does often occur in practice, 
 and may be eafily difcerned, if well attended 
 to, I fhall juft give a Iketch of what he ob- 
 ferves, (which indeed anfwers to what I have 
 recited from Avenzoar) from the learned Dr. 
 Friend’s hiftory of phyfic — There is (fays he) 
 an acute fever, inquietude, thirft, breathing 
 thick and quick, great heat in the thorax, little 
 pain except at the fternum, a cough always 
 with it, and a hard pulfe. When the pericar- 
 dium was inflamed too, there was a more in- 
 tenfe heat, and a frequent fyncope ; in one 
 word, all the fymptoms worfe. And for a 
 proof of what he afferts, he gives the cafe of 
 F 2 one 
 
I 28 ] 
 
 one, who died on the ninth day after fome fits 
 of thefyncope: where, upon difle&ion, there 
 appeared an inflammation of the interfepient 
 membranes, as he calls them, and fome part 
 of the pericardium. And this diftemper, I don’t 
 queftion, happens oftener than our praftitioners 
 commonly are aware of. He confefles that he 
 gave a more diligent attention to all thefe cir- 
 cumftances, becaufe, being then young and 
 compleating his ftudies under very eminent 
 profefiors, he had feen a man of quality la- 
 bouring under the above diftemper, which had 
 all the fymptoms before enumerated, and who, 
 beyond all expedtation, expired, when every 
 thing feemed to change for the better ; but he 
 was feveral times troubled with fainting fits 
 before his death. But as the phyficians were 
 here doubtful of the malady, and his friends 
 fufpedted poifon had been given him, they de- 
 fired an enquiry to be made after the caufe. 
 Upon opening the thorax, an inflammatory 
 fwelling of confiderable bulk was found in the 
 mediaftinum •, and an inflammation had in part 
 feized upon the pericardium. Nor was there 
 any other apparent caule of death found in the 
 body of the deceafed. 
 
 Columbus takes notice of collections of 
 matter in the mediaftinum, and which he and 
 Barbette order to be taken out by trepan- 
 ning the fternum. 
 
 As 
 
[ e 9 1 ' 
 
 As a further and more convincing proof of 
 what has been remarked, a gentleman, juftly 
 efteemed (fays Dr. Friend) for his long expe- 
 rience and found judgment in every thing re- 
 lating to furgery, informed him, that abfceflfes 
 of the mediaftinum particularly happened in 
 venereal diftempers, and that, in fuch cafes, 
 he has frequently ufed the trepan with great 
 fuccefs. We may from hence be fatisfied, how 
 little ground there is for that hint of Parey, 
 where he feems to think this operation a ridi- 
 culous attempt. 
 
 Since the treatife of Peter Salius is rarely to 
 be found, you may read the chapter of Schen- 
 kius that contains the whole, “ de inflamma- 
 “ tione membranarum interfepientium et pe- 
 “ ricardii — de tabe ex affedtu pericardii- — 
 w de tumoribus diaphragmatis.” 
 
 Of the Heart. 
 
 The heart is a mufcular body, lituated in 
 the cavity of the thorax, being placed nearly 
 in a tranlverfe or horizontal pofture, with its 
 balls in the right fide of the thorax, and its 
 apex in the left, while its broadeft and flat 
 fide, from the balls to the apex lies inclined 
 and fupported on the diaphragm, to the tendi- 
 nous or middle part of which it is firmly, con- 
 nected by the vena cava, and right venous 
 
 fmus 
 
[ 30 ] 
 
 (intis below; and above, in the thorax, it is 
 conne&ed within the duplicature of the medi- 
 aftinum, and lodged betwixt the foft lobes of 
 the lungs; by all which means, it avoids too 
 great a preflure on any fide, and is moft com- 
 modioufly adapted to receive the blood from, 
 and propel it into all parts of the body. 
 
 This is the true pofition of the heart in the 
 human body. — The figures in many of our 
 modern anatomifts are -erroneous in this re- 
 fpett — But the figures of Vefalius, Euftachius, 
 and Ruyfch, (hew the heart in its natural 
 pofture. From what has been faid here, we 
 may refolve the queftion, why over- eating 
 Caufes a palpitation of the heart ; for fince the 
 heart is only feparated from the ftomach by 
 the diaphragm, when the ftomach is over dif- 
 tended, it will force up the diaphragm, and 
 prefs upon the heart. Hence alfo we may 
 fee how the heart comes to be prefled up fo 
 high in the thorax of thofe who die of a 
 dropfy in the abdomen, and why it is forced 
 fo far down in the abdomen of thofe who die 
 of a dropfy in the thorax-, becaufe the dia- 
 phragm, to which the heart is connefted by 
 its pericardium, is forced either way by the 
 contained water. 
 
 At the bafis of the heart are fituated two 
 /mufcular bags, one towards the right ventri- 
 cle. 
 
. L 3 1 1 
 
 cle, the other towards the left, and joined to- 
 gether by an inner leptum, much in the fame 
 manner with the ventricles, one of them being 
 called the right auricle, the other the left. 
 They are very uneven on the infide, but 
 fmoother on the outfide, and terminate in a 
 narrow fiat indented edge, reprefenting in fome 
 meafure the ear of a dog; they open into the 
 orifices of each ventricle, called by the name 
 of the auricular orifices, and they are tendinous 
 at their opening, in the fame manner as the 
 ventricles. 
 
 The right auricle is larger than the left, 
 and it joins the right ventricle by a common 
 tendinous opening, juft: taken notice of. It 
 has two other openings united into one, and 
 formed by two large veins which meet and 
 terminate there almoft in a dired line, called 
 vena cava fuperior and inferior. 
 
 In opening a dog, not long fince, at the re- 
 queft of a lady, I found the pericardium amaz- 
 ingly ftretched with blood, fo as to fill half 
 the fpace of the thorax, with an aperture at 
 the meeting of the tw 7 o vense cavae, large e- 
 nough to admit the end of a finger. In Bone- 
 tus’s Sepulchret. Anatomic, we meet with two 
 or three inftances of ruptures in this vein in 
 the human iubjed. — 'Tom. i. p. xi. 
 
 de morte repentina .- — Obf i . Mors fubita ob ef- 
 
 fufum 
 
[ 32 ] 
 
 fufum [anguinem in dextrum cordis finum et peri- 
 cardium, d ruptura vena cava. — Obf 2. Cui- 
 dam morte concidente , fodiendi labore fatigato , 
 vena cava prope cor difrupta , [anguine inundavit 
 vifcera. 
 
 The whole inner furface of the right auricle 
 is uneven, by reafon of a great number of 
 prominent lines which run acrofs the fides of 
 it. In the interftices between thefe lines, the 
 Tides of the auricle are very thin and almoft 
 tranfparent. There is an obfervation in Dio- 
 nis, where he found this auricle fo far dilated, 
 that it was equal to the head of a new-born 
 infant. 
 
 The left auricle is in the human body a kind 
 of mufcular bag, or refervoir of a pretty con- 
 fiderable thicknefs, into which the four pulmo- 
 nary veins open. The whole common cavity 
 of this auricle is fmaller in an adult fubjedb, 
 than that of the right. 
 
 The fleihy or mufcular fibres of which the 
 heart is made up, are difpofed in fo fingular a 
 manner, that their courfe will be much eafier 
 underftood by feeing than defcribing them. 
 
 The heart is divided by a feptum, which 
 runs between its edges into two cavities called 
 ventriculi, one of which is thick and folid, the 
 
 other 
 
[ 33 1 
 
 other thin and foft : this latter is termed the 
 right or anterior ventricle, the other the left or 
 pofterior ventricle. 
 
 Lower, in his treatife de cord ? , tells us, that 
 in a perlon who died of a confumption, and 
 was fubjeft to fainting fits in his life time, he 
 found both the ventricles of the heart nearly 
 clofed up, particularly the right, by a flefhy 
 fubftance, fo as fcarce to leave room for the 
 admifiion of a goofe-quill. 
 
 We had lately a melancholly inflance of a 
 rupture, in the fide of the right ventricle j and 
 which occafioned the death of our late King, 
 
 Each ventricle opens at the bafis by two 
 orifices, one of which anfwers to the auricles, 
 the other to the mouth of a large artery, there- 
 fore one of them may be termed the auricu- 
 lar orifice, the other the arterial orifice. The 
 right ventricle opens into the right auricle, and 
 into the trunk of the pulmonary artery, the 
 left into the left auricle, and into the great 
 trunk of the aorta. 
 
 At the edges of thefe orifices are found fe- 
 veral moveable pelliculae called valves, of 
 which fome are turned inward towards the 
 cavity of the ventricles called tricufpides, others 
 are turned towards the great velfels called 
 femilunares. 
 
 G 
 
 The 
 
[ 34 ] 
 
 1 he inner furface of the ventricles is very 
 uneven, many eminences and cavities being 
 obfervable therein; the moil confiderable emi- 
 nences are thick fleihy productions, called 
 columns, to whofe extremities are fattened 
 feveral tendinous chords, the other ends of 
 which are joined to the valvuls tricufpides. 
 
 The valves at the orifices of the ventricles 
 are of two kinds, one kind allows the blood 
 to enter the heart, and hinders it from soino; 
 out the fame way, the other kind allows the 
 blood to go out of the heart, but hinders it 
 from returning. The valves of the firft kind 
 terminate the auriculae, and thofe of the fecond 
 lie in the openings of the great arteries. 
 
 The tricufpidal valves of the right ventricle 
 are fixed to its auricular orifice, and turned in- 
 ward toward the cavity of the ventricle. They 
 are three triangular productions, very fmooth 
 and polilhed on that fide which is turned towards 
 the auricle, and on the fide next the cavity of 
 the ventricle, they have feveral membranous 
 and tendinous expanfions. 
 
 The valves of the auricular orifice of the left 
 ventricle are of the fame fhape and ftruCture, but 
 are only two in number, and from ibme fmall 
 refemblance to a mitre, they have been named 
 mitrales. Thefe five valves are very thin, and 
 fattened by feveral tendinous ropes to rne 
 fleftry columnar of the ventricles. d'h; 
 
[ 35 1 
 
 The femilunar valves are fix in number, 
 three belonging to each ventricle, fituated at 
 the mouths of the great arteries, and may pro- 
 perly be called valvulae arteriales. The great 
 artery that goes out from the left ventricle is 
 termed aorta *, as it goes out, it turns a little 
 toward the right hand, and then bends ob- 
 liquely backward to form what is called aorta 
 
 defcendens. 
 
 ■% 
 
 It is at the arch or curvature of this great 
 vefiel, that we oftner meet with the true aneu- 
 rifm than elfewhere ; though Dr. Haller, in 
 his pathological obfervations, cites an inftance 
 of one in the carotid artery, which reached 
 from the fubclavian to the divifion of the two 
 branches of the carotid, and the furgeon, mif- 
 led by a kind of undulation, was preparing 
 to lay it open. 
 
 It appears from anatomy, that the arteries, 
 efpecially the larger, have pretty thick coats, 
 partly cellular and partly mufcular ; fo that 
 when the ftrength of the fades of an artery is 
 diminifhed by any caufe, the confequence will 
 be, that it will be dilated moft in its injured'parr, 
 fo as to change the natural figure of the vei- 
 fel, by diftending its weakeft part into a facculus. 
 
 We find, upon examining the hiftories of 
 this difeafe, that they have for the moft part 
 G 2 arofe 
 
[ 3<5 ] 
 
 arofe from blows and contufions about the 
 break, fome again from an overftretching of 
 their coats in violent ftraining, others from ero- 
 fion. — Examples, where they have fprung from 
 each of thefe caufes, we meet with in Lancifius. 
 
 Ruyfch has an obfervation of one at the cur- 
 vature of the aorta, which was fo large as to 
 equal a common cufhion. 
 
 It is found that in procefs of time the blood 
 in thefe tumours begins to corrupt and be- 
 come fo acrimonious, as to corrode the adja- 
 cent foft parts, and does not even fpare the 
 compact bones. And Ruyfch obferves in his 
 cafe, that almofl: all the ribs and flernum of 
 the patient were reduced nearly to nothing. 
 
 ■ — Sometimes thefe poor unhappy patients ex- 
 pire hereby in a moment. We read of a foldier, 
 in the Academ. des Sciences, who fuftained a 
 large aneurifm of this kind for fome time, 
 when a flux of blood l'uddenly burft forth from 
 his mouth, of which he expired in a minute. 
 Upon opening the body it was found, that the 
 aneurifm adhered to the trachea, into which it 
 had an opening betwixt the fixth and feventh 
 cartilage, by which the blood efcaped into the 
 windpipe and out of the mouth. 
 
 Surgeons fhould be very careful to diftin- 
 guifli well this kind of tumour from others, 
 
 fince 
 
[ 37 1 
 
 fince we are taught, by many obfervations, that 
 feveral, in other refpedts Ikilful men, have im- 
 prudently deftroyed the patient by opening 
 them. — That it is an aneurifm, may be col- 
 lected — from the fore-mentioned caufes having 
 preceded, from the tumor being feated in a 
 part, where we know from anatomy, there is 
 lome large artery feated, but more efpecially 
 when it has a manifeft puliation, and if the 
 tumor diminifhes by a flight prefiure, and re- 
 turns again when the preflure is removed. 
 
 As aneurifms in the internal parts of the 
 body are inacceflible, all that can be done for 
 the patient is, to abate the impetus of the 
 blood’s motion by a thin diet, and repeated 
 bleeding, by which means, the diforder may 
 be prevented from increafing a^ much as pofli- 
 ble, and the patient at the fame time be or- 
 dered to refrain from all commotions of body 
 and mind. 
 
 The trunk of the artery, which goes out 
 from the right ventricle, is called arteria pul- 
 monaris. — This I lball leave to the particular 
 hiftory of the lungs. 
 
 Befides the great common vefiels, the heart 
 has veflels peculiar to itfelf, called the coro- 
 nary arteries and veins, fo named from their 
 crowning in fome meafure the bafis of the 
 
 heart, 
 
[ 3 * 3 
 
 heart, they go out from the beginning of the 
 aorta, and fend numerous ramifications to the 
 fubftance of the heart. 
 
 This organ, with the parts belonging to it, 
 are the principal inftruments of the circulation 
 of the blood. 
 
 The heart is made up of a fubftance capa- 
 ble of contraction and dilatation •, when the 
 fiefhy fibres of the ventricles are contracted, 
 the two cavities are leflened in an equal and 
 direCt manner, not by any contortion or twift- 
 ing, as fome have imagined; and from confi- 
 dering its ftruCture, we muft fee, that it tends 
 to make an even and uniform contraction, 
 more according to the breadth or thicknefs, 
 than according to the length of the heart, be- 
 caufe the number of fibres, fituated tranf- 
 verfely, is much greater than the number ot 
 longitudinal fibres. 
 
 The fiefhy fibres thus contracted do the of- 
 fice of fuckers, by preffing upon the blood 
 contained in the ventricles, which blood, being 
 thus forced towards the bafts of the heart, 
 prefles the tricufpidal valves againft each other, 
 opens the femilunares, and rufhes through the 
 arteries and their ramifications, as through fo 
 many elaftic tubes. 
 
 The 
 
[ 39 1 
 
 The blood thus pulhed on by the contrac- 
 tion of the ventricles, and afterwards prefled 
 by the elaftic arteries, enters the capillary vef- 
 lels, and is from thence forced to return by 
 the veins to the auricles, which, like porches 
 or antichambers, receive and lodge the blood 
 returned by the veins, during the time of a 
 new r contraction. 
 
 This contraction is called the fyftole of the 
 heart. 
 
 The contraction or fyftole, ceafing immedi- 
 ately by the relaxation of the flelhy fibres, and 
 in that time, the auricles w'hich contain the 
 venal blood being contracted, force the blood 
 through the tricufpidal valves into the ventri- 
 cles, the fides of which are thereby dilated, 
 and their cavities enlarged. 
 
 This dilatation is termed the diaftole of the 
 heart. 
 
 In this manner does the heart, by the alter- 
 nate fyftole and diaftole of its ventricles and 
 auricles, pulh the blood through the arteries 
 to all parts of the body. Therefore the au- 
 thors of the hypothefis, which makes the right 
 ventricle to con t raft itfelf before the left, have 
 been deceived, as Haller has clearly evinced, 
 by fome experiments you will find in a late 
 
 ingenious 
 
[ 40 ] 
 
 ingenious treatife of his 4 Sur le Mouvement 
 4 du fang.’ 
 
 Wounds, which penetrate the cavities of this 
 bowel, or by which any of the large blood 
 veffels iffuing out of it are opened, are confi- 
 dered as abfoiutely mortal. 
 
 It is to be remarked in wounds of the rio-ht 
 
 CD 
 
 ventricle of the heart, that the lungs continue 
 to aft, and by their dilatation, give an eafy 
 paffage to the blood to enter into them from 
 that ventricle ; hence therefore there will not 
 be fo much blood expelled by the wound dur- 
 ing the fyftole of the heart, becaufe of the 
 free palfage which it meets with into the lungs, 
 whence again fuch a wound will have the 
 greater opportunity to unite and heal. 
 
 But wounds of the left ventricle feem to be 
 much more dangerous, fince, if it be not to- 
 tally perforated, the wound will of neceflity 
 be continually enlarging by the very ftrong 
 power with which the left ventricle contrafts, 
 and which greatly exeeeds the force of the 
 right ventricle, in order to protrude its con- 
 tained blood into the ftrongly refilling aorta, 
 fo as to dilate the fame and all its brandies 
 throughout the whole body. 
 
 However, 
 
[ 4 * 3 
 
 However, we ought never to defpair even 
 in the molt dangerous wounds. For there are 
 fome obfervations which (hew, that men have 
 often lived a confiderable time after wounds of 
 the heart, efpecially when the right ventricle 
 only has been perforated. Even fome obfer- 
 vations teach us, that wounds of the heart are 
 curable. See Bartholine's Centur. i. Hifior. 77. 
 — Schenckii Obfer. Med. Rar. p. 275.— -Samar d 
 and others. 
 
 For while the patient continues only in a 
 very weak and languid ftate, we may have 
 feen in praftice, I dare fay, that wounds have 
 been healed, which no one would have thought 
 poflible-, and the likelieft method to fucceed 
 is to keep the patient very quiet, and to avoid 
 exciting the circulation by any ftimulus > 
 efpecially thofe called cordials, which fhould 
 be carefully avoided ; the life of ther patient 
 may poflibly be preferved, and the wound 
 healed. 
 
 For nobody would believe with how fmall 
 a quantity and motion of the blood a perfon 
 may live, who is not acquainted with the in- 
 ftances given us by practical writers in the 
 cafes of wounds, and in the mifcarriages of 
 women. 
 
 H 
 
 It 
 
[ 42 ] 
 
 It is to be remarked in wounds of the right 
 ventricle of the heart, that the lungs continue 
 to a6t, and by their dilatation give an eafy 
 paflage to the blood to enter into them from 
 that ventricle •, hence therefore there will not 
 be fo much blood expelled by the wound 
 during the fyllole of the heart, becaufe of 
 the free paflage v/hich it meets with into the 
 lungs, whence again fuch a wound will have 
 the greater opportunity to unite and heal. 
 
 But wounds of the left ventricle feem to be 
 much more dangerous ; fince if it be not to- 
 tally perforated, the wound will of neceflity 
 be continually enlarging by the very ftrong 
 power with which the left ventricle contradls, 
 and which greatly exceeds the force of the 
 right ventricle, in order to protrude its con- 
 tained blood into the ftrongly refilling aorta, 
 fo as to dilate the fame and all its branches 
 throughout the whole body. 
 
 There is a diforder that pretty often occurs, 
 though not much remarked, nor well de- 
 ferred, which is, an aneurifm of the hearty or 
 a preternatural enlargement of its cavities-, for 
 while the heart’s force exceeds the refiltance 
 of the arteries, it continues of the fame dimen- 
 flons, but when the refiftance of thefe laft from 
 
 being 
 
[ 43 3 
 
 being grown rigid and boney exceeds the force 
 of the heart, its cavities then enlarge. 
 
 Pra&ical anatomy furnifhes us with many 
 obfervations, teaching that the heart is thus 
 frequently diftended: we meet with one in the 
 pnilofophical tranfadtions, where the left ven- 
 tricle was found three times larger than the 
 
 right. Fernelius, (in his Pathologia lib. v. 
 
 cap. 12.) gives an account of a very uncom- 
 mon and furprizing cafe of this kind ; where 
 he fays, the frequent concuflions of the heart 
 were fo violent and ftrong, as not only to 
 luxate, but even to break fome of the adjoin- 
 ing ribs. 
 
 Marchettis in his anatomy, tells us, that he 
 found a heart fo big, as to poflefs the whole 
 thorax, and the ventricles of a prodigious ex- 
 tent, chiefly the right, that a natural fized 
 heart might be contained in it. 
 
 But among the rarer caufes of this preter- 
 natural diftenfion of its ventricles, we may 
 reckon the air, which has been fometimes 
 found in the cavities of the heart, diftending 
 them immenfely. 
 
 In a woman, who died fuddenly, Ruyfch 
 found the heart of a flupendous magnitude, 
 from the air, with which it was full, contain- 
 H 2 ing 
 
[ 44 ] 
 
 mg fcarce any blood, as appeared from enter- 
 ing the point of a knife into it, the heart 
 fuddenly fubfiding, as if one had punctured a 
 bladder full of air. 
 
 Morbid difledtions convince us, fhat in the 
 heart have been found, inflammations — fuppu- 
 rations — erofions. 
 
 I fliall add to that of our late King an in- 
 ftance of this fort, from the Academ. des Sci- 
 ences — Where, upon opening the body of 
 the Duke of Brunfwick, the heart was found 
 eroded by ulcers, and the right ventricle ap- 
 peared burft, from fuch an ulceration and 
 eroflon. 
 
 Morand, in the fame papers, furniflies us 
 with another more furprizing inftance — Who, 
 upon fearching after the caufe of fudden death 
 in the body of a nobleman, there appeared, 
 .upon flitting up the pericardium, a large mafs 
 of congealed blood, and in the left ventricle, 
 a perforation, which was equal to eight lines 
 in length, and the flelhy fubftance of the heart 
 appeared fo infirm, that the probe made its 
 way through, in every part, by its own weight. 
 
 -The two foregoing extraordinary cafes we 
 
 meet with, in the Acad, des Sciences for the 
 year 1732, under the following title, Sur 
 
 Quelou.es 
 
[ 45 1 
 
 Quelques Accidens remarquables dans les Organes 
 de la Circulation du Sang. 
 
 When the caufe of a gangrene in the extre- 
 mities of old people lies in the weaknefs of 
 the heart, fo as to be unable to propel the 
 blood into the extremities, we may well de- 
 fpair of a cure. 
 
 In the following hiftories, the powers of the 
 heart feem to have been fo weak, as not to be 
 able to difentangle the veflels, which were 
 folded together by the flighted; preflure that 
 could be. 
 
 Tulpius records a remarkable cafe of an old 
 dotard, who had long ftruggled with weak- 
 nefs, and the heat of the parts fo far extin- 
 guished, that every the leaft preflure upon any 
 part of the body was immediately followed with 
 a gangrene ; fo that in a Short time every part 
 about him was almofl: mortified before the poor 
 miferable wretch was actually dead. 
 
 The celebrated Van Swieten tells us, that 
 he had feen himfelf a refembling cafe in a 
 woman of 90, whofe extreme parts were not 
 only mortified before lhe died, but alfo the 
 cheek which lay on the pillow while fhe Slept. 
 
 From 
 
[ 46 ] 
 
 From polypous concretions, whether formed 
 in the heart or in its greater veffels, arife many 
 irregular and terrible fymptoms. 
 
 Sometimes they have been found lying loofe 
 in the cavity of the heart — at other times 
 they have been found adhering to the veffels 
 themfelves, and to the coiumnae and auricles 
 of the heart j of which there is a very re- 
 markable one, both hiftory and reprefentation, 
 
 in Bartholine’s Centurite. Thole who are 
 
 curious to know more of this matter, may 
 confult Malpighius’s treatife of the polypus 
 of the heart, who was the firft (and fince him 
 Ruyfch) who threw any light upon this fub- 
 }ect, which before his time was entirely in the 
 dark. 
 
 There is but little hope of curing a con- 
 firmed polypus. AH that can be aimed at, is, 
 to dilute the blood, and fo throw it into a 
 ftate moft remote from concretion, i. e. to in- 
 troduce by art that cachochymy which con- 
 fifts in the blood’s being too thin, to the end 
 the polypus may not be increafed by the ap- 
 pofition of new matter, but by degrees be 
 worn away by the conftant attrition of the 
 blood, which is every moment paffing by it. 
 
 PRiELECTIO 
 
[ 47 ] 
 
 
 
 PRyELECTIO TERTIA. 
 
 H AVING confidered the heart with its 
 pericardium, we come next to the de- 
 fcription of the lungs. 
 
 The bags of the pleura are exactly filled by 
 the lungs, which are tv/o large fpungy bodies 
 filling the whole cavity of the thorax, one 
 being feated in the right fide, the other in 
 the left, parted by the mediaftinum and heart, 
 and of a figure anfwering to that of the ca- 
 vity which contains them ; that is, convex 
 next the ribs, concave next the diaphragm, 
 and irregularly flatted and deprefled next the 
 mediaftinum and heart. 
 
 The right lung is larger than the left, an- 
 fwerable to that cavity of the breaft, and to 
 the obliquity of the mediaftinum, and more 
 frequently divided or half cut through into 
 three diftindl lobes or portions; but the left 
 lung is not fo often divided into three. 
 
 At the lower edge of the left lung there is 
 an indented notch or finus, (and which Eu- 
 
 ftachius 
 
[ 48 ] 
 
 ftachius has taken care to exprefs in his Ta- 
 bles) oppofite to the apex of the heart, which 
 is therefore never covered by that lung even 
 in the ftrongeft infpirations, and confequently 
 the apex of the heart may always ftrike againft 
 the ribs, the lungs not furrounding the heart 
 in the manner commonly taught. 
 
 The fubftance of the lungs is almoft all 
 fpungy, being made up of an infinite num- 
 ber of membranous cells, and of different 
 forts of veffels fpread among the cells, in in- 
 numerable ramifications. 
 
 This whole mafs is covered by a membrane 
 reflected from each pleura. Betwixt the lungs 
 and pleura is found a watery or ferous va- 
 pour, of a coagulable nature, like that of 
 the pericardium, which vapour tranfudes from 
 the furface of the lungs and pleura, (fee the 
 celebrated Kaau , de perfpirat. difta Hippocrati 
 per univerfum corpus anatomice illujlrata ) and is 
 fometimes accumulated fo as to form a dropfy 
 of the thorax. 
 
 The chief veffels of which the fubftance 
 of the lungs is compofed are the air veffels and 
 blood veffels-, the air veffels make the chief 
 part, and are termed bronchia, and which are 
 branches or ramifications of a large canal, 
 
 partly 
 
t 49 1 
 
 partly cartilaginous and partly membranous, 
 called trachea or afpera arteria. 
 
 The trachea or afpera arteria is a tube or 
 canal, extended from the mouth down to the 
 lungs. The larynx or head of the trachea 
 forms the protuberance in the upper and an- 
 terior part of the neck, called commonly 
 pomutn adami. 
 
 It is conftituted of five cartilages, viz. the 
 cartilago thyroides, which is the anterior and 
 largeft, cricoides the inferior, and bafis of the 
 reft •, two arytenoides, the pofterior and 
 fmalleft; and the epiglottis, which is above all 
 the reft. 
 
 The ventricles or facculi, mentioned by the 
 antients and reftored by Morgagni, (who has 
 given an excellent defcription of them, and 
 of the whole ftrufture of the afpera arteria) 
 lie under the glottis, and are formed by a con- 
 tinuation of the internal membrane of the 
 larynx. 
 
 The larynx ferves particularly to admit and 
 let out the matter of refpiration •, and the 
 folidity of the pieces of which it is com- 
 pofed hinders not only external objects, but 
 alfo any hard thing which we fwallow, from 
 difordering this paffage. The glottis being a 
 I very 
 
[ 5° I 
 
 very narrow flit modifies the air which we 
 breathe, and as it is very eafily dilated and. 
 con t rafted, it forms the different tones of the 
 voice, chiefly by means of the different muf- 
 cles inferted in the arytenoide cartilages. 
 
 The facility of varying and changing the 
 tone of the voice depends on the flexibility of 
 the cartilages of the larynx, and decreafes in 
 proportion as we advance in age, becaufe thefe 
 cartilages gradually harden and oflify, though 
 not equally fbon in all perfons. 
 
 The general ufe of the epiglottis is to cover 
 the glottis like a penthoufe, and thereby hin- 
 der any thing from falling into it, when we 
 eat or drink; and which is fometimes the cafe 
 when we laueji or talk at the time of fwal- 
 lowing. 
 
 Haller tells us, that upon tracing the caufe 
 of low voice, and at laft an entire lofs of 
 fpeech in a woman. He found that one half 
 of the epiglottis was covered with an ulcerous 
 tumor here and there eroded, and which he 
 imagined to be the caufe of the defeft in her 
 voice, and was aftonifhed that fire was not 
 fuffocated. 
 
 The anterior and convex fide of the larynx 
 is covered with the thyroide gland. The 
 
 learned 
 
[ 5i 1 
 
 learned Morgagni has remarked, that this 
 gland is reprefented double by moft authors, 
 though in reality it is Tingle, and refembles the 
 moon in its increafe, the horns pointing up- 
 wards. 
 
 Euftachius has very accurately delineated 
 this gland, in his Anatomical Tables, but it 
 is there four times fmaller than natural. 
 
 With ree;ard to its ufe — notwithftanding the 
 
 JD O 
 
 excretory au£cs have not been afcertained, yet 
 it is probable, from its fituation and connexion 
 with the trachea and asfophagus, that they 
 pour a lubricating fluid into them, and it is 
 not likely, that To large a gland upon the tra- 
 chea fhould be To clofely connefted in that 
 place without Tome ufe. 
 
 Tumors very often happen in this gland; 
 but fuch a fwelling is not properly a bron- 
 chocele, (though fometimes lb mifcalled) but 
 a ftruma. 
 
 In morbid bodies this gland has been found 
 enlarged to an extraordinary bignefs, fo as to 
 reach down aimoft to the clavicles-, and in fuch 
 cafes they generally turn fcirrhous when it is 
 very large, neither any inward medicine nor 
 outward application can diflolve it. Neither 
 would any prudent furgeon, I prefume, at- 
 I 2 tempt 
 
[ 52 ] 
 
 tempt to extirpate fuc.h a large tumor, for fear 
 of an haemorrhage, or wounding the recur- 
 rent nerves. And Petit, in his Edit, of Pal- 
 fin s anatomy, vol. II. chap. ix. p. 313, gives 
 us a fufficient caution, in telling the ftory of 
 a daring furgeon, whofe patient in fuch a cafe 
 expired under his hands, to the great fcandal 
 of the profeflion. 
 
 / 
 
 There are other forts of tumors feated in 
 the forepart of the neck, and particularly de- 
 fcribed by Albucafis, and which defcription I 
 fhail tranfcribe from Dr. Friend. 
 
 In treating of a bronchocele, or a rupture in 
 the forepart of the neck, which he fays is 
 molt frequent in women, he is fuller than the 
 Greeks or Cellus ; he makes two fpecies, one 
 like a tumor which contains fome grofs fub- 
 ftance, the other like an aneurifm. But tho’ 
 he is fo bold in ufing the knife, he advifes the 
 operation only in the former cafe j and even 
 not there neither unlefs the tumor be loofe, 
 and little, and enclofed in a cyftis. 
 
 Sometimes thefe excrefcencies are full of 
 water, and fometimes they have nothing in 
 them but air. 
 
 This is a very frequent diftemper in thofe 
 countries where they drink great quantities ot 
 
 cold 
 
[ 53 1 
 
 cold water, efpecially where they do not cool 
 their waters in fnow, as in other warm cli- 
 mates-, but pour ice into it, as the way is with 
 the ordinary people who live upon the black 
 mountains of Genoa and Piedmont. The 
 matter of fa£t is as true, as that they them- 
 felves attribute it to the drinking this watery 
 and from the nature of cold, it is not diffi- 
 cult perhaps to account for the effect. And 
 that the coldnefs not only of the liquors, but 
 of the climate itielf in other countries, may 
 produce the fame effects, feems to be plain, 
 from the obfervations we find in writers, that 
 thefe fweliings about the throat and head, are 
 more frequent among the northern nations 
 than the fouthern. 
 
 We have feveral inftances of difeafes which 
 are peculiar to fome particular country, and 
 feldom known any where elle. T-hus in Eu- 
 rope the plica polonica is proper to the Poles — 
 the fcurvy to the borderers upon the Baltic 
 Sea — and the guttur tumidum to fuch as 
 dwell below the Alps. Thus in Afia, the 
 vena medinenfis or dracunculus is peculiar to > 
 the Arabians. So in Africa, the eliphantiafis 
 was always the peculiare malum fEgypti, as 
 v/e learn from Pliny. 
 
 The 
 
L 54 J 
 
 The following quotation from De la Faye’s 
 notes upon Dionis, des Operations de Ckirurgie , 
 p. 640, will {hew that a true bronchocele takes 
 place here fometimes. 
 
 “ Le Goetre, comme Dionis le remarque, 
 “ n’eft pas une hernie, parce qu’il n’eft pas 
 “ forme de parties deplacees. Mats il furvi- 
 “ ent quelquefois a la gorge une veritable 
 “ hernie qu’on peut appeller proprement bron- 
 “ chocele ou hernie de la trachee artere; car 
 “ elle eft formee par le deplacement d’une 
 “ partie de la membrane interieure de ce con- 
 ** duit. Cette membrane en fe dilatant pafle 
 “ entre les anneaux cartilagineux de la tra- 
 “ chee artere, et forme a la partie anterieure 
 “• du col un tumeur molafle, fans douleur, de 
 “ meme couleur que la peau, et qui s’etend 
 “ quand on retient fon haleine. Cette efpece 
 « de maladie dont M. Muys dans fes obfeiwa- 
 “ tions, et Manget dans fes notes fur Bar- 
 “ bette, font mention, eft fort rare, et nuit 
 “ beaucoup a la voix et a la relpiration.” 
 
 The afpera arteria or windpipe, conftfting 
 of femicircular cartilaginous fegments with 
 their back parts membranous and connec- 
 ted together by ftrong mufcular ligaments, 
 gives a free ingrefs and egrefs to the air from 
 the glottis which is always open, and lined 
 with a fmooth lubricated membrane, fo that 
 
 it 
 
[ 55 ] 
 
 it will expand circularly by the air, give way 
 to the aefophagus in deglutition, follow the 
 poiture on bending of the neck, and become 
 either elongated or contracted, as there may 
 be occafion. The whole membrane, which 
 conftitutes the back of the trachea, where the 
 circular cartilages are deficient, is befet with 
 fmall glands, which feparate an unftuous hu- 
 mour, difcharged by their du£ts, into the ca- 
 vity of the trachea. 
 
 This canal is lined on the infide by a fine 
 membrane fo extremely fenfible, that nature 
 has placed it as a guard to watch at the door 
 of our breath and life, that we might not be 
 fuffocated by any particles falling into the tra- 
 chea-, for all bodies irritate it but the pure 
 air ; even a drop of clear water excites a con- 
 vulfive and troublefome cough, which does 
 not ceafe till the liquor is ejected. This mem- 
 brane has feveral fmall duels (as has been ob- 
 ferved) opening into it, which continually pour 
 out a mucilaginous fluid, and which is of the 
 greateft ufe in defending it from being injured 
 by any acrimonious particles that may float in. 
 
 the air. This mucus, when left long undif- 
 
 turbed, may become fo tough and folid as to 
 take the form of blood veifels ; which, as 
 Ruyfch juftly obferves, has made fome of the 
 moil diligent obfervators give' us hiftories of 
 clutters of veifels of great bulk being at once 
 
 ejected- 
 
[ 56 ] 
 
 ejefted by coughing, (Tulpius among others 
 has done this with two figures reprefenting, 
 as he thought, the vefiels coughed up) whereas 
 in fact it was only matter infpiflated and 
 moulded in the lungs. 
 
 If the windpipe be injured even with a 
 large wound, and the air has a free pafiage 
 into the lungs, that wound will not always 
 prove mortal ; there are cafes which inconteft- 
 ably prove this, in which people being weary 
 of their lives have laid violent hands on them- 
 felves, or in which the throat has been cut by 
 robbers, and yet they have been cured. 
 
 There are many who believe all wounds of 
 the trachea mortal, and fome have declared as 
 much in their writings. But the true ftate of 
 the cafe is, that when any of the large adja- 
 cent blood vefiels are wounded, it is from the 
 injury done to them that the patient dies. 
 
 In Heifter’s obfervations, there is an in- 
 ftance of a gun-Ihot wound of the trachea 
 cured, and where a piece of the trachea was 
 carried away. (See cb. 80.) — and of which, 
 fays he, as much as I can call to mind, I have 
 not met with an example of in other authors. 
 
 Van Swieten remembers a foldier who ufed 
 to beg his way, and make a Ihow of a large 
 
 wound 
 
[ 57 ] 
 
 wound or aperture in the windpipe, which he 
 would ftop with a fpunge, and then he could 
 fpeak very well, but by opening the hole he 
 loft his voice. This accident arofe from part 
 of the windpipe being torn off by a bullet in 
 battle, fo that the lips of the wound could not 
 be afterwards brought together without leav- 
 ing a confiderable aperture, yet he furvived 
 the accident many years. 
 
 This laft cafe brings to my remembrance a 
 device I ufed in a wound of this part, which 
 a gentlewoman under a difcontent of mind 
 had inflifled upon herfelf with a razor, juft 
 below the larynx, between the thyroide and 
 cricoide cartilages, with a lofs of part of the 
 fubftance of the latter-, as there was here (be- 
 fides bringing the divided parts as near toge- 
 ther as poffible) another intention, that of con- 
 tributing to reftore the lofs of fubftance — I re- 
 colledled Marchetti’s contrivance in a fiftula 
 which penetrated the afpera arteria, and which 
 I fhall give in his own words, “ Multas lanavi 
 “ fiftulas colli, potiffimum vero qua laboravit 
 “ adolefcens quatuordecim annorum, in parte 
 cc ejufdem anteriori, infra laryngem, oborto 
 “ primum ex contufione tumore, cui a barbi- 
 “ tonfore fanato, fuperftes fuit fiftula inter 
 “ utrumque annulum afperte arterite, cum lae- 
 “ fione utriufque cartilaginis, ex qua fpiritus ef- 
 <c flabatur.” Having firft prepared him (he fays) 
 “ Deveni ad topicaj et primo quidem quatuor 
 K in- 
 
[ 58 ] 
 
 “ integumenta dilatavi turunda ex fpongia, 
 “ deinde fcalpro abraforio partes ipfas carti- 
 “ lagineas utrinque lafas accurate abrafi , turn 
 “ filamenta arida fupra eafdem applicui ; poll 
 “ modum unguento iridis, quod occalefcere 
 “ coeperat, in parte carnofa attrivi. Tandem 
 tc globulis ex filamentis, imbutis unguento ex 
 “ tutia, cavitatem opplevi ■, atq; fenfim et fen- 
 “ fim imminutis globulis, cerato ex diachalci- 
 “ tide, cum filamentis aridis cicatrice fiftulam 
 “ obduxi. — -Vide Marchettis Obs. Medico. — 
 Chirurgicar. Ob. 37, p. 52. 
 
 In imitation of the above method I (lightly 
 (every other day) fcratched the edges of the 
 wound in the trachea with a fcalpel, drdfing it 
 up with dry lint and a retentive bandage, go- 
 ing on thus for about three weeks, I had the 
 pleafure to fee the opening contradt apace, 
 when my patient, in the abfence of her nurfe, 
 and undefirous of living, accomplilhed what 
 fhe had before mifcarried in, (the deftroying 
 herfelf) by giving herfelf a fecond wound, and 
 dividing the left carotid artery hereby depriv- 
 ing me of the expeftation I reafonably had of 
 fucceeding in the cure. 
 
 The ingenious Dr. Muzell, author of fome 
 medical and chirurgical cafes, which occurred 
 to him in the Charite at Berlin, afiures us, 
 that he had Teen the good effects of fcarifica- 
 
 tion 
 
[ 59 1 
 
 tion in much the fame manner, in many cafes, 
 particularly ulcers of the velum palati, and 
 fdftulas in perinaeo — ■ — Patience and a conftant 
 repetition of the fcarification is required ; for 
 it is difficult to touch all the parts- with the 
 lancet, and they do not heal, till they become 
 raw and inflamed ; he further fays, that he 
 once faw this method profecuted with fuccefs 
 in a diforder of the nofe, where there was a 
 confiderable aperture in the cartilaginous part 
 of the left noftril, which, after a long conti- 
 nuance of the fcarification, was cured. He di- 
 rects that the incifions fhould always be made 
 as near as poffible to each other, and to be re- 
 peated twice a day till the callofities are gone, 
 and equal granulations of flelh appear. 
 
 Upon the facility with which even fome of 
 the moft complicated wounds of the trachea 
 arteria have been cured, bronchotomy has, 
 both by the antients and moderns, been prin- 
 cipally eftablilhed. 
 
 Sometimes extraneous bodies are fo engaged 
 in the aefophagus, that we can neither extract 
 nor deprefs them. And this happens when 
 the extraneous body is of a confiderable bulk, 
 and comprefies the trachea arteria to fuch a de- 
 gree, that the patient is in imminent danger 
 of fuffocation. 
 
 K 2 
 
 Habicot 
 
L to ] 
 
 Habicot (Queftion Chirurgicale fur la Bron- 
 chotomie cap. 16 .) in this extremity infills 
 upon the operation being performed as it ought 
 to have been (fays he) on him, who on a fefti- 
 val day, fwallowed a fmall bone of a leg of 
 mutton, which remaining in his pharynx, fuf- 
 focated him in the prefence of the phyficians 
 and furgeons, who did not relieve him by this 
 method. 
 
 A boy fwallowed nine piftoles wrapt up in 
 a Jinnen cloth, in order to hide them from rob- 
 bers, but this bundle being too big, flopped 
 at the narroweft part of the pharynx. He was 
 almoft fuffocated from the prefTure made on 
 the trachea ; his neck and countenance was fo 
 inflated, that his acquaintance did not know 
 him. Habicot, feeing him in fuch danger, 
 and not able to diflodge it, performed bron- 
 chotomy upon him ; this was no fooner done, 
 than the inflation and livid colour of the neck 
 and face difappeared. And he made the parcel 
 defcend into the flomach by means of a whale- 
 bone probe. Eight or ten days after, the pa- 
 tient at different times, difcharged the nine 
 piftoles by ftool. — This operation may alfo be 
 of another ufe than to make the patient re- 
 fpire, and which Habicot does not mention, 
 and that is to open a paffage for the extrac- 
 tion of bodies which flip into the trachea, and 
 are engaged in it. 
 
 Haller 
 
[ 6i ] 
 
 Haller tells us in his Pathological Obferva- 
 tions, that he difle&ed a boy who had been 
 fuddenly choaked by a filberd, which had ftuck 
 below the glottis, under the inferior ligaments, 
 below the thyroide cartilage, immediately above 
 the orifice of the afpera arteria. This misfor- 
 tune, fays he, might probably have been pre- 
 vented by bronchotomy, if, when the accident 
 happened, the alperia arteria had been imme- 
 diately opened, and fo the fatal nut taken out 
 with a fpoon. 
 
 The following cafe, though not relie vable by 
 fuch an operation, I mention only as a very 
 extraordinary inftance of fuffocation, from the 
 fame author — A girl of ten years of age, and 
 whofe only complaint was worms •, in differing 
 her, he found the mouth and throat quite full, 
 two of which he alfo found in the afpera arte- 
 ria, near the feat of the heart, and at the be- 
 ginning of the lungs. 
 
 Our countryman Willis feems to have been 
 the firft, who in fuch cafes thought of per- 
 forming the operation of bronchotomy — Willis 
 being once oppofed in a cafe which required it, 
 the patient died, and he afterwards performed 
 it in the prefence of thofe who were againft 
 it, and very eafily extracted a long and trian- 
 gular bone. 
 
 Heifter 
 
[ 62 ] 
 
 Heifter tells us, that he performed it on a 
 young man, by making a longitudinal incifion, 
 upon the trachea, and then cut through four 
 or five rings longitudinally, and took out a 
 mulhroom. 
 
 We are alfo told, that Rauu opened the 
 trachea, in order to extra# a bean, which had 
 flipped into the larynx. 
 
 The obfervations are fo many, which might 
 be adduced to prove the fafenefs of the opera- 
 tion, (and if an operation fo confiderable has 
 been performed with fuccefs in a fwelling and 
 inflammation of this part, it muft fucceed much 
 more furely, when it is performed on a found 
 part, whofe functions are only interrupted by 
 the prefence of an extraneous body) that we 
 muft neceffarily impute the death of fuch pa- 
 tients, to the timidity of thofe called unto their 
 afliftance. 
 
 Verdue allures us, that this operation was in 
 his time fuccefsfully performed by a furgeon, 
 who was fo dexterous, as to extra# by it a 
 fmall bone through the opening, after which, 
 the wound of the trachea was foon cured. 
 Without this fpeedy and bold operation, con- 
 tinues he, nothing but death could have been 
 expe#ed. 
 
 Let 
 
L 63 ] 
 
 Let this ferve us as a caution on fimilar oc- 
 cafions, and let us not be fo cowardly and ti- 
 morous, as to let a patient die without affift- 
 ance -/for in cafes of necefllty every thing is to 
 be rilked. 
 
 We now and then meet with wounds of the 
 throat, through which the food elcapes; we are 
 not for this reafon always to fuppofe, that the 
 
 sfophagus and trachea are wounded Thefe 
 
 wounds paffing fometimes only between the 
 glottis and root of the tongue. 
 
 Young furgeons Ihould know, that a conli- 
 derable and fudden emphyfema is an occur- 
 rence not unufual in penetrating wounds of the 
 trachea, and this happens when the wound is 
 very fmall, or that in the trachea is not op- 
 pofite to that of the integuments •, owing to 
 which it is that the air inlinuates itfelf into 
 the cellular membrane, not only of the neck, 
 but the head, breaft, belly, fcrotum, and even 
 the upper and lower extremities, an inftance of 
 which I lately faw. — I Ihall fay more of this 
 fymptom under my reflections upon the lungs. 
 
 The bronchial glands are of various fizes, 
 fome larger, fome fmaller ; they are of a blackifh 
 colour, and are connected by a cellular fub- 
 ftance to the loweft part of the trachea, and 
 to the diviiions of the bronchia, and are fup- 
 
 pofed 
 
[ *4 ] 
 
 pofed to communicate by fmall openings with 
 the cavity of the bronchia. 
 
 The bronchia have their origin from the 
 trachea, and are firfl divided into branches af- 
 terwards fubdivided again, and into almoft in- 
 numerable ramifications : they finally terminate 
 in thofe fmall cells or veficles, which form the 
 greater part of the fubftance of the lungs. 
 
 In two or three bodies dying of peripneu- 
 monies, Dr. Haller found thefe cells loaded 
 with blood, that a great part of the lungs were 
 become quite black, and though the lungs na- 
 turally fwim when put into water, thefe on 
 the contrary funk, wherefore, he concludes, 
 that it is not in the veffels only that the blood 
 of perfons in a peripneumony is congefted, but 
 that there is a true error loci ; and that the 
 blood exhales into the veficles of the lungs, 
 inftead of that fubtle vapour with which they 
 are naturally moiflened. 
 
 Hence we are able to derive a truer idea of 
 the nature of inflammations in general •, and 
 that the blood in fuch cafes is not alone fhut 
 up within the veffels of the inflamed part, but 
 that there is an effufion of it alfo into the cel- 
 lular membrane' This new, or rather re- 
 
 vived theory of inflammations (for he is fo 
 candid as to fay, H#c eft antiquijftma inftamali- 
 
 cnis 
 
[ 65 ] 
 
 tionis theoria , quam Galenus propofuit ) he has 
 beautifully confirmed by inftances deduced 
 from fome particular cafes of furgery, and 
 which you will meet with in the firft volume of 
 his Elementa Phifiolog. and further illuftrated 
 in his Pathological Obfervations, 
 
 All the bronchial cells are furrounded by a 
 very fine reticular texture of the fmall extre- 
 mities of arteries and veins, which communi- 
 cate every way with each other. 
 
 The blood veffels of the lungs are of two 
 kinds •, one common, called the pulmonary ar- 
 teries and veins ; the other proper, called the 
 .bronchial artery and vein. 
 
 The pulmonary artery goes out frotn the 
 right ventricle of the heart, and its trunk, hav- 
 ing run almofl dire&ly upwards as high as 
 the curvature of the aorta, is divided into two 
 lateral branches, one called the right, the 
 other the left pulmonary artery. 
 
 The right artery pafies under the curvature 
 of the aorta, and is confequently longer than 
 the left. They both run to the lungs, and 
 are difperfed through their whole fubflance by 
 ramifications nearly like thofe of the bronchia. 
 
 L 
 
 The 
 
[ 66 ] 
 
 The pulmonary veins, having been diftri- 
 buted through the lungs in the lame manner, 
 go out on each fide by two great branches 
 which open laterally into the refervoir or muf- 
 cular bag of the left auricle. Thefe three or- 
 ders of veffels, with their courfe and nume- 
 rous divifions, will belt be underftood by fee- 
 ing fome preparation of them. 
 
 Befides thefe capital blood velfels there are 
 two others, called the bronchial artery and 
 vein by Ruyfch, who defcribed and gave 
 them that denomination, becaufe creeping or 
 fpreading upon the bronchia, they are extended 
 even to their extremities. 
 
 The great velfels appear deftined for the 
 circulation of the blood through the lungs. 
 The bronchial vellels are fuppofed to ferve for 
 their nutrition. For it appears to be a con- 
 ftant rule of nature, that the vifcera, which 
 change by their fabric the common humours 
 brought to them for the ufe of the whole 
 body, have Hill other arteries peculiar to them- 
 felves, which bring the vital blood appointed 
 for their nutrition. 
 
 The lungs are the principal organs of re- 
 fpiration — hereby it is that parts noxious and 
 redundant are exhaled from the blood, and 
 
 there- 
 
[ 6 ; ] 
 
 therefore not improperly defined by fome the 
 pulmonary tranfpiration. 
 
 Refpiration is alfo neceffary to facilitate the 
 paffage of the blood through the lungs, by 
 which means it has the cohefion of its parts 
 broken, attenuated, and pounded as it were,, 
 And it is by this force, that the abdomen with 
 all its vifcera are continually compreffed. By 
 virtue of this, the ftomach, inteftines, gall- 
 bladder, receptacle of the chyle, urinary 
 bladder, inteftinum redtum, and the uterus 
 itfelf, difcharge their contents j and by this 
 adlion, the aliments are principally ground or 
 dilfolved, and the blood is urged through the 
 fluggifh veffels of the liver, fpleen, and me- 
 fentery. 
 
 We fhould fcarce believe that part of the 
 vital vifcera might be amputated when they 
 are expofed by wounds, if it was not proved 
 fafe by experience. 
 
 We read in Tulpius of a man who received 
 a large wound under his left bread, part of 
 the lungs on that fide protruded through the 
 wound, to the breadth of three fingers, which 
 being negledted, begun to mortify, a ligature 
 was immediately made round it, and then cut 
 off with a pair of fciffars, to the quantity of 
 about three ounces, in fourteen days the wound 
 L 2 w 
 
[ 68 ] 
 
 was healed, "and the man furvived for fix years 
 afterwards. 
 
 Hildanus likewife certifies, that part of the 
 lungs being prolapfed through a wound of the 
 thorax, it was afterwards cut off with a hot 
 inftrument of fteel, the patient being after- 
 wards cured. 
 
 Nay Celfus formerly boldly pronounced. 
 Si quid aut ex jecinore , Uene aut ■pulmone duntaxat 
 extremo defendeat, id pracidatur. 
 
 Ruyfch tells us, (ob. 53.) that a fervant 
 being wounded in the bottom of the fore-part 
 of the thorax into its cavity, a furgeon was 
 called, who feeing fomething thruft out of the 
 wound, immediately made a ftrong ligature 
 about the whole part that was expelled, think- 
 ing it to be a portion of the omentum, and 
 immediately fent for him into confultation ; 
 but upon hearing him fay that the wound 
 was not inflicted in the abdomen, but into 
 the cavity of the thorax, and that the part 
 thruft out, which he had tied with the liga- 
 ture, was a portion of the lungs, he ftood like 
 one aftonifhed. Things being thus ftated, 
 Ruyfch advifed him to leave the wound as it 
 was, till he found that part of the lungs inter- 
 cepted by the ligature mortified, hoping that 
 
 it 
 
C 69 ] 
 
 it would be then feparated, and the remainder 
 of the lungs healed in the wound itfelf, 
 which lb happily lucceeded, that the patient 
 was cured in a little time after. 
 
 There is a fymptom which is fometimes ah 
 attendant on penetrating wounds of the bread: 
 and lungs, .and of fo extraordinary a nature, 
 that it will be inexcufable not to take notice 
 of it. It is the emphyfema, or that amazing 
 inflation which arifes from the air veflels of 
 the lungs, being injured by the wound, fo as 
 to depofit their injured air into the cavity of 
 the thorax. It appears from medical obferva- 
 tions, that the air having entered the cellular 
 membrane may pervade almoft all parts of the 
 body, and produce wonderful tumors, efpeci- 
 ally as thefe cells are every where open, and 
 form one continuous cavity throughout the 
 whole body, fo that none of the cellular fa- 
 bric is excepted from this communication, 
 nay even the vitreous body itfelf of the eye 
 has received the flatus of an emphyfema. We 
 meet with (in the Academ. des Sciences) the 
 hiftory of a man who was wounded into the 
 thorax, and who, before his death, had his 
 whole body furprizingly fwelled with one of 
 thefe kind of tumors, excepting the foies ' of 
 his feet and the palms of his hands ; upon the 
 thorax the tumor was eleven inches thick, 
 and upon the abdomen nine, the eyes in this 
 
 fubjed 
 
[ 70 ] 
 
 fubjed were in a great meafure thrud out of 
 their orbits, from the cellular membrane beino- 
 
 O 
 
 diltended with a great quantity of air. 
 
 There is another cafe of this kind in the 
 fame work, of a fatal emphyfema, from a frac- 
 ture of the ribs, the fkin remaining entire. 
 
 Wherever fuch inflations are found, the 
 curative indication diredls to difcharge the elaf- 
 tic matter from the cellular membrane which it 
 didends. — Parey gives us a fair inftance of the 
 fuccefs of fcarification in a cafe of this nature. 
 For while the miferable patient was given over 
 by every one, a fkilful furgeon (he fays) boldly 
 perforated the Ikin with a great many very 
 deep fcarifications, and thereby difcharged the 
 included air, fo that the patient was redored 
 to his health, and in a manner fnatched from 
 death. 
 
 The like tumors arife from a putrefaftion of 
 the extravaiated humours, fince it is evident 
 from experience, that putrefaction will pro- 
 duce or extricate the eladic matter which lay 
 concealed in bodies, and which, if it is not 
 real air, has at lead the fame eladic power, 
 by which it will expand greatly by heat. 
 
 The air dilating itfelf in the blood after 
 death occafions various motions. Haller fays, 
 
 that 
 
[ 7 * 1 
 
 that he has feen the blood in the heart of a 
 young man filled with air, to refolve itfelf into 
 froth and to difcharge itfelf from the opening 
 he made in the heart. He adds^ that he has 
 alfo feen the blood difcharge itfelf from the 
 mouth of a very fine woman who died in child- 
 bed, fo as to fill the fhroud. 
 
 There are many cafes of this nature-, and 
 perhaps this is the only caufe of the bleeding 
 in dead people, which the fuperftition of the 
 ancients hath regarded as an index of divine 
 vengeance, which difcovered the criminal by 
 this bleeding his prefence had created in the 
 body of the perfon he had deprived of life. 
 
 To return to our reflexions upon the lungs 
 ■ — Should a large abfcefs in this part break 
 fuddenly, fo that the matter cannot be dif- 
 charged flowly, and in a fmall quantity at a 
 time, by coughing, but vents itfelf at once 
 in a violent flood into the windpipe, fo as to 
 fill it, there will be no paflage left for the 
 admiflion of the air; whence hidden death. — 
 I faw two unhappy inftances of this not long 
 fince. 
 
 Sometimes the abfcefs burlting, the matter 
 falls into the cavity of the breaft, and this 
 with a fatal event, unlefs there is a paflage 
 
 made 
 
[ 7 2 ] 
 
 made for its difcharge by a timely aperture 
 into the thorax. 
 
 Boerhaave faw, he tells us, in the body of one 
 who expired of a fuppuration in the thorax, 
 that the lungs on one fide were converted 
 into a lack-full of matter, of fuch a prodigi- 
 ous bulk, that it not only difplaced the heart 
 from its fituation, and comprelfed the lungs 
 into a fmall compafs, but likewife thruft down 
 the diaphragm, and made it protuberate into 
 the abdomen. 
 
 Haller likewife faw a molt terrible diforder 
 of this part, in a body which he opened — 
 The lungs on the left fide were not to be 
 found, but inftead of them, a large quantity 
 of matter ; the afpera arteria (which if himfelf 
 had not l’een, he fhould fcarce have believed) 
 and the larger arteries and veins opened with 
 wide orifices into the cavity of the thorax, as 
 if they had been cut through, fo that it was 
 very hard to difcover what it was that pre- 
 vented the efflux of the blood. 
 
 As the lungs from an inflammation often 
 adhere to the contiguous parts, the abfcefs 
 may break outwardly •, which would prove a 
 good eflfeft, though from a bad caufe. 
 
[ 73 1 
 
 We are taught by morbid diffedtions, that 
 the matter has eat through the diaphragm, 
 and even into the ftomach itfelf; I have feen 
 where it has got from the lungs through the 
 diaphragm and into the liver. 
 
 Though the principal feats of calculi are 
 the urinary or gall bladders, yet hiftory {hews 
 us, that fcarce any part of the human body 
 are excepted from ftony concretions, not even 
 that organ we have now been defcribing. 
 
 The great Boerhaave relates, that the fa- 
 mous Botanift Vaillant fpit up four hundred 
 ftones from his lungs, and that he has feen 
 afthmas of the worft kind, where calculi have 
 been brought up from the windpipe, when the 
 refpiration would be free till more calculi were 
 formed. 
 
 Kerckringius (in his Spicelegium Anatom.) 
 has a cafe of this kind to which he has fub- 
 joined the figure of the calculi adhering to the 
 bronchia. 
 
 Le Dran tells us, that he knew two in- 
 ftances, where they were often difcharged by 
 expedtoration. 
 
 There ftill remains another interefting re- 
 mark to make upon this part. Every one has 
 M heard 
 
[ 74 ] 
 
 heard of the experiment upon the lungs made 
 to difcover whether an infant has died before 
 or after the birth. 
 
 It is the common opinion, that to be con- 
 vinced ol the truth in this cafe, we ought to 
 put a piece of the infant’s lungs into the wa- 
 ter, and if it fwims, it is a proof that it 
 has breathed, and confequently been alive. 
 
 Though this experiment appears convincing 
 to abfolve or condemn perfons accufed of de- 
 ftroying their children, yet it is proved, by 
 many fadts, that it is not fo infallible as it is 
 imagined. 
 
 The lungs of a child, dead before its birth, 
 fometimes fwim in water. This happens when, 
 immediately after its birth, we blow into its 
 mouth, as fometimes midwives do, when they 
 doubt whether the child is really dead. 
 
 We meet with an example (in the Norim- 
 berg Tranfadtions) by a phyfician; where, he 
 fays, the child was certainly born dead, whofe 
 body was not difledted, till it was confiderably 
 pu trified ; its veffels were full of air, and ve- 
 ficles, diftended with it, were feen on the 
 lungs-, pieces of the lungs fwam when put 
 into water. 
 
 Hence 
 
 I 
 
[ 75 ] 
 
 Hence we may fee how great the uncer- 
 tainty of this experiment is, and how cau- 
 tious we ought to be, when we examine the 
 bodies of infants, in order to make a report 
 to a court of judicature : upon this head, fee 
 Bohnius , de renunciatione vulnerum , differt. de 
 infanticidio , fag. 171. 
 
 FINIS . 
 
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