SURGERY. 
is near the throat, a curved pair of forceps 
may remove it ; there is also an instrument 
made of strong flexible wire doubled and 
twisted together, and bent at the end into 
a noose, like a hook; and other mechanical 
contrivances have been suggested. A com- 
mon probary probably is the best instru- 
ment for pushing bodies onwards to the sto- 
ntach, which must be done, whatever their 
nature is, when they cannot be got out, and 
produce troublesome symptoms. Often 
they are loosened, after a time, by suppura- 
tion, if small ; or they may be discharged 
by abscesses ; or, as pins and needles, may 
traverse parts of the body, and appear at a 
considerable distance. 
Bronchotomy is an operation in which an 
opening is made into the trachea or larynx, 
for the purpose of inflating the lungs, in 
cases of suspended animation ; for the con- 
tinuance of respiration, when the natural 
passage is obstructed by disease ; or for the 
extraction of foreign bodies from the tra- 
chea. In instances of apparent death, from 
drowning, he. it is onr first olyect to re- 
store respiration ; the suspension of that 
function has caused the stoppage of the 
other actions, and its restoration is essential 
to the putting of the animal machine again in 
motion. If this cannot be done by the 
means laid down in the article Drowning, 
the simple operation which we shall de- 
scribe may be performed. Again in dis- 
eases or tumours about the throat or tra- 
chea, and in cases where suffocation is 
threatened by a foreign body in the latter 
tube, the same remedy is necessary. A lon- 
gitudinal incision of two inches sliould be 
made in the middle of the neck, com- 
mencing just above the sternum, and conti- 
nued upwards ; the parts should then be 
separated vvith the finger and handle of the 
knife, so as to expose the trachea, which 
may be opened by a longitudinal cut of 
half an inch. Some have advised this ope- 
ration to be performed by a transverse cut, 
between the thyroid and cricoid cartilages; 
and others by a longitudinal incision in the 
projecting part of the thyroid, called po- 
mum Adami. 
fVnj Neck, is a deformity in which the 
head is drawn towards one of the shoulders ; 
arising either from undue contraction of the 
sterno-cleido-mastoideus, (whose fibres will 
be found in a very tense state) or from a 
relaxation, or paralytic condition of the op- 
posite muscle. Perhaps cicatrices from 
wounds may sometimes be a cause. If it 
occurs in early life, and continues long, the 
VOL. VI. 
vertebrEB of the neck, and even of the 
back, may become deformed. 
Treatment ; camphorated mercurial fric- 
tions, and other stimulating applications ; 
electricity, blisters, issues, mechanical 
means being at the same time employed : 
this plan is more particularly proper when 
there is induration. Division of the clavi- 
cular portion of the muscle, by a surgical 
operation, is most to be depended on. 
Bronchocele, is an indolent enlargement of 
the tliyroid gland, the causes of which are 
unknown, but which often attains an im- 
mense magnitude, and is endemic in seve- 
ral mountainous countries, as Switzerland, 
Savoy, Derbyshire, he. Burnt sponge, in 
the dose of a scruple, two or three times a 
day, formed with syrup into troches, which 
should be placed under the tongue, and al- 
lowed to dissolve gradually, is the most cer- 
tain remedy for this disease. Previously 
to commencing tliis plan, a grain or two of 
calomel should be given at bed-time for 
three nights, and a dose of the magnesia vi- 
triolata on the following morning. This 
should be repeated again in three weeks, 
the .sponge being then omitted, and the 
same alternation should be observed during 
the cure. Topical means may be com- 
bined ; as friction witli a dry towel, or cam- 
phorated liniments, &c. 
Wounds of the Thorax. Much probing 
should not be employed to ascertain whe- 
ther the cavity is penetrated or no, as symp- 
toms will best indicate this point. Passage 
of air from the cavity, or protrusion of the 
lung, are appearances which show imme- 
diately that the cavity is exposed. 
Emphysema is an inflation of the cellular 
substance, commencing at the chest, and 
extending over the whole body, arising from 
a wound of the air-cells of the lungs, and 
generally produced from broken ribs, or 
narrow punctured wounds ; for, in either 
of these cases, the air, which issues from 
the wounded lung in inspiration, has no ex- 
ternal discharge, as in instances of large and 
open wounds. It is surprising to what ex- 
tent this inflation may proceed, and as the 
lung at the same time collapses, the great- 
est distress is experienced in breathing: 
yet the swelling of the body is not the dan- 
gerous part of the case. Our object is to 
give a free exit to the air, which may be 
done by a cut near the injured part, and 
even, if symptoms require it, into the chest. 
The air may be discharged from other parts 
by incisions through the skin, and preying 
towards the wound. In about three or four 
X 
