70 , SURGERY. 



The treatment will vary with the causes producing it. If it result 

 from spasm ; purgatives, leeches, and fomentations should be used ; 

 if from paralysis of the opposite side, general tonic treatment and 

 stimulating friction will be useful. If the contraction be permanent, 

 the muscle must be divided. 



INJURIES AND SURGICAL AFFECTIONS OF 

 THE CHEST. 



Wounds of the chest may be inflicted by a sharp instrument, a 

 fractured rib, or a bullet. Danger results from hemorrhage, and 

 subsequent inflammation from air, or clot of blood in the pleura. 

 The intercostal may be the source of the bleeding, and it is some- 

 times difficult to arrest it by the ordinary means. A curved needle, 

 armed with a ligature, is the best means of securing the vessel, 

 when deeply concealed in the intercostal groove. The entrance of 

 air into the chest (pneumothorax) through the wound, is to be pre- 

 vented as much as possible by the early and accurate closure of the 

 wound ; otherwise there may be compression of the lung. The 

 suppuration of the wound may lead to inflammation and suppuration 

 of the pleura. This collection of pus in the chest is called empyema. 



When the lung is wounded, there is still greater danger from hemor- 

 rhage,- inflammation, and the air. It is attended with great prostra- 

 tion, difficult breathing, anxiety of countenance, and expectoration 

 of blood. The danger of bleeding results not only from the direct 

 loss, but from its collecting in the pleura (hssmatothorax), and its 

 filling up the bronchial tubes and trachea. The inflammation may 

 subsequently destroy the lung and the life of the patient also by 

 hectic. The air may also more readily enter the cavity of the 

 chest, and not being readily discharged through the external wound, 

 may infiltrate it into the subcutaneous cellular tissue. 



The hemorrhage is to be controlled by venesection, rest, antiphlo- 

 gistic means, acetate of lead, and opium. A careful examination of 

 the wound should be made, in, order that no foreign matters remain ; 

 the patient should lie on the wounded side, so as to favour the dis- 

 charge of blood or pus, and it may also be necessary to prevent a 

 closure of the wound. Emphysema may be overcome by compres- 

 sion, or an incision. 



Paracentesis thoracis. — Puncture of the thorax, may be required 

 for accumulated air, blood, or pus. The opening is most frequently 

 for empyema. The point selected is usually between the sixth and 

 seventh ribs, half way between the spine and sternum. If made too 

 low, the diaphragm may be wounded ; if too high, the fluid will not 

 so readily escape. The opening should be closed with care, to avoid 

 the entrance of air. 



