I2O Anatomy Applied to Medicine and Surgery. 



These effects are: (a) A nodular condition of the ribs at 

 their junction with the cartilages "rickety rosary" ;(b) a 

 depression on the outer side of these nodules; (c) a pro- 

 jection anteriorly of the body of the sternum, i.e., pigeon 

 breast, and (d) a groove, "Harrison's groove," running 

 transversely outwards from the ensiform cartilage to- 

 wards the axilla the result of the inward traction of the 

 diaphragm during respiration. 



Operations on the Thorax. The ordinary oper- 

 ation for the removal of the breast is performed by mak- 

 ing two elliptical incisions, joining, externally, near the ax- 

 illa, and, internally, towards the sternum. The general di- 

 rection of these incisions will be, if possible, from above 

 downwards and inwards, and the upper end may be pro- 

 longed into the axilla if it be found necessary to remove 

 any axillary glands. Hoisted' s operation for mammary 

 cancer is employed when it is desirable to remove all the 

 soft tissues, and the usaul incision starts on the humerus 

 and sweeps inwards over the thorax in a curved man- 

 ner, so as to enclose the breast. The incision resembles 

 an inverted figure 6, and through it, the breast and the 

 muscles down to the ribs with the adipose tissue and the 

 glands of the axilla, are removed. To render the opera- 

 tion as bloodless as possible, from sixty to one hundred 

 pairs of forceps may have to be employed. Thoracotomy, 

 or incision into the thorax, is generally performed for em- 

 pyema, and in this operation the pleura is opened through 

 an incision two or three inches in length. The arm is 

 raised from the side and a skin incision, about half an inch 

 higher than the intended opening in the pleura, is made, 

 bo that, when afterwards the arm is brought down to the 

 side, the completed opening will not be valvular. The di- 

 vision of the intercostal muscles should be made close to 

 the upper border of the rib below, so as to avoid any pos- 

 sibility of wounding the trunk of the intercostal artery 



