cheek, and sometimes a discharge of mat' or 
takes place from the nostrils or the roots ot 
the teeth. 1 Ins disease is to be cured by 
making a free opening for the- discharge dr 
tin; matter, either by extracting one of the 
molares and perforating the antrum with a 
trocar, (fig. 37.) through, the bottom of the 
socket ; or else, without extracting a tooth, the 
peiforation may be made with a tubular in- 
Sii ument through that part ot the antrum 
winch projects over the molares. Astring- 
ent solutions may be thrown occasionally into 
the cavity. 
Of runula. An obstruction in the duct of 
one of the salivary glands sometimes pro- 
duces a tumour under the tongue, of such a 
size as to impede the motion of this organ, 
-and at length to threaten suffocation. This 
tumour is to be laidfully open, and the month 
may afterwards be washed with some as- 
tringent solution. 
Enlarged tonsils and uvula are not unfre- 
quent occurrences. When these by their 
size interfere with respiration or swallowing, 
they are to be removed by ligature . in the 
same manner as polypi. When the enlarged 
tonsil is of a conical shape, Cheselden’s 
needle (tig 38.) may be employed, which, 
threaded with a double ligature, is to be push- 
ed through the base of the tumour ; the liga- 
ture now being taken hold of by a hook is to 
be pulled forward, divided, and tied, so as 
that each division shall surround each half of 
the swelling. Idris kind of ligature may he 
employed for an enlarged uvula or for 
polypi. 
Deafness, when consequent upon an inor- 
dinate accumulation or hardening of the wax, 
is best removed by syringing the ear witli 
warm water in which some soap has been dis- 
solved. \\ hen deafness arises from mere 
•tkyness in the meatus, some drops of sweet 
oil should be put into the passage. The sup- 
purative discharge from the ears in young 
children may generally be relieved by* some 
slightly .astringent lotion, such as a weak so- 
lution of vitriolated zinc or sugar of lead. 
When deafness is_ consequent upon loss of 
nervous power, either focal or general, no 
relief can be expected from these topical ap- 
plications. Electricity has been tried with 
apparent benefit in these cases. 
IV ry neck generally depends upon a pre- 
ternatural contraction of the mastoid muscle 
on one side. The muscle in this case to be 
carefully divided, lest the parts below it be 
injured. Mr. B. Bell has proposed a machine 
(iig. 40.) for supporting the head after the di- 
vision of the muscle, until it unite and regain 
its power. 
Bronchotomy. When the trachea is to be 
opened, we are directed to make a longitu- 
dinal incision, of about an inch and a half, 
through the skin and cellular substance, com- 
mencing at the under end of the thyroid car- 
tilage ; the muscles are then to be separated, 
the operator taking care to avoid the thyroid 
gland: when the trachea is laid bare, and the 
bleeding vessels secured, a puncture is to be 
made with a common lancet between two of 
the rings of the trachea, of such size as to ad- 
mit a canula. Dr. Monro directs that a 
double canula be used, and the inner one 
withdrawn from time to time, and cleared of 
the obstructing mucus. He directs the in- 
strument to be fixed by a strap round the 
Uteck. As soon as the purposes are accom- 
. SURGERY, 
plished for which an opening was made into 
the trachea, the canula is to be taken out, and 
the wound closed by adhesive plaster. 
Paracentesis of the thorax. When the 
chest is opened in order to evacuate purulent 
matter, or water, from this cavity, an inci- 
sion should be made with (he scalpel through 
the skin and cellular membrane, between 
the sixth and seventh ribs, from one to two 
inches long; and, in the direction of the ribs, 
the muscles are next to be divided, and the 
incision made as near as possible to the up- 
per edge of the inferior rib. The pleura now 
exposed is to be gently opened ; if the 
lungs adhere to the ribs where the incision is 
made, the fluid will not immediately dis- 
charge itself from the opening: in this case, 
fne adhesion may be separated by a blunt 
probe, or the incision may be carried a little 
on towards the sternum. When the fluid 
begins to How out, a silver canula (tig. 43.) 
may be intioduecd into the wound, attached 
to the patient’s body ; and being provided 
with a cork to it, the operator is either to let 
out the whole of the matter at once, or to 
draw it off at different times according to the 
strength of the patient. The wound, after 
the evacuation of the fluid, is to be kept open 
for some time. 1 1 
Paracentesis of the abdomen. Tapping is 
usually performed by puncturing the abdo- 
men at about midway between the spine 
of the ilium and the navel. Others di- 
rect the opening to be made in the linea 
alba. An equal pressure is required during 
this operation upon the belly; such pressure 
may either he made by bandage, or by the 
hands of assistants ; the part at which the 
puncture is to be made being drawn a litt’e 
over the edge of the bed, if the patient be 
found lying in a horizontal situation, the sur- 
geon fixes the head of the instrument (a 
trocar) while the fore-finger directs its poini; 
he is then to push it forward till it ceases to 
meet with resistance. The perforator is now 
to be taken out, and the water allowed to 
discharge, while the pressure on the surround- 
mg parts is continued and increased. After 
the whole of the water is drawn off, the wound 
may be covered with a pledget of simple 
ointment, over this may he- laid some flannel 
nipped in spirits, and bandages are now to 
lie applied round the body with firmness. 
1 he bandages should not he removed for one 
or two days succeeding the operation; after 
tins time they may be taken off' daily for a ' 
little while, and the abdomen rubbed with 
some stimulant embrocation. 
Hernia:. From malconformation, pre-dis- 
position, or accident, the contents of the ab- 
domen may protrude beyond their bound- 
aiies, and thus constitute hernia, or rupture, 
i he most usual places of this descent are 
tin ougli the ring ot the external oblique mus- 
cle, constituting bubonocele or inguinal and 
scrotal hernia,, and hernia congenita, from 
under the ligament of fallopius or poupart, 
forming femoral hernia, and from the navel 
constituting umbilical hernia. 
-The causes of rupture we have said are 
either pre-disposition, accident, or malcon- 
iormation. Where the constitutional ten- 
dency is observed, the exciting causes should 
with solicitude be avoided. These are vio- 
lent muscular exertion, particularly of those 
muscles whose action is principally upon the 
contents of the abdomen, such are especialV 
called into action in violent‘Strainings-to' pro’* 
cure stool, in tits ot coughing, hurried respi- 
ration, laughter, Ac. 
It is hernia congenita alone that imme- 
diately follows upon malconformation, stiicf- 
!y speaking. 1 his is occasioned by the pro- 
trusion of some portion of the bowels through 
the passage by which, just previous to birth, 
the testicles descend from the abdomen into 
t!ie scrotum: such passage is commonly 
shortly closed after the descent, atid thus the 
intestine prevented from entering the bag of 
lie tdsticle. In the case of congenital hernia 
the opening is preserved. 
Herniai, with the exception of the one just 
mentioned, are invested with peritoneum, and 
thus enclosed ip a sac ; and to whatever ex- . 
tent the protrusion may have taken place, 
the tumour still forms in a manner a part of 
the abdominal cavity. Rupture is an im- 
proper apeliation for the disorder. 
it may easily be conceived tha't parts thus 
protruded, even independently of the imme- 
diate inconvenience with which they are at- 
tended, are in no measure free from danger of 
serious and alarming consequences. Wo 
have a large swelling, for instance; a pait, in 
many cases,, of the canal, -by which the 
faeces are constantly passing forward to the 
anus; and this swelling, so disproportionate 
to the passage through which it has been 
protruded, that it is only in some situations of 
the body, when the parts are not full and 
tense, that in any case, and with duly ma- 
naged piessutepthey can even for a time be 
made to resume Uteir former and natural situ- 
ation. 
The reduction of hernia ought then, by all 
means, to be attempted as soon as it is "per- 
ceived ; and future descents prevented by 
constant and uniform pressure over the part 
where the displacement had taken place. For 
the diffeient kinds of trusses used for this pur- 
pose, see figs. 42, 43, 44. 
V. hen, from neglect on the part of the pa- 
tient, a hernia is incapable of reduction, and 
is at the same time free from pain or stricture 
of any kind, especial care should be observed 
in avoiding a repetition of the causes which 
pioduced the disease. Die alvine discharges 
are to'be regularly maintained, and all violent 
exertions guarded against ; and, with due caje,- 
an irreducible and increasing hernia often 
continues through life without any impedi- 
ment in the functions, or any interruption in 
the communication between the protruded 
and contained portions ot the abdominal 
contents. 
; r l’ he dangerous symptoms in hernia: ori- 
ginate either from spasmodic stricture of the 
aperture through which the sac and its con- 
tents have passed, or from distention and in- 
flammation of the parts protruded: in this 
last case, indeed, the symytoms may be 
attiibuted to stricture; for the opening, al- 
though of sufficient size to aijow of the com- 
munication between the tumour and the ab- 
dominal cavity previous to their falling into 
disease, now that the contents of the tumour 
are preternaturally enlarged and inflamed, 
becomes too narrow' for such communication; 
its unyielding edges form a stricture on the 
inflamed vessels, and thus increase the iiv? 
flammation and its consequences. The dis- 
order is now called strangulated hernia. The 
