SURGERY. 
days, the wound in the lung heals, and the 
air in the chest and cellular substance is 
absorbed. Bleeding, and other parts of the 
antiphlogistic regimen, must be used with- 
out restraint. Bandages on the chest ge- 
nerally increase the distress. 
Jt'ounds of the lungs are indicated by 
the coughing of blood, by the discharge 
of that fluid, with air, from the wound, 
impaired respiration, &c. Though they 
are often very speedily mortal, yet pa- 
tients have, in many instances, recovered. 
Tile freest use of the lancet is required, 
with every other part of tlie antiphlogistic 
treatment ; perfect rest ; light dressing of 
the vs’ound, which must not be probed. Pa- 
racentesis thoracis is required, where it ap- 
pears tiiat water, air, blood, or pus, are ac- 
cumulated in tiie cavity, and give rise to 
danger by their presence. When there are 
symptoms indicative of these circumstances, 
the operation is easy ; and it may be done, 
unless the circumstances point out any other 
spot, between the sixth and seventh true 
ribs about midway between the sternum 
and spine. The ipteguments should be 
drawn aside before the first incision, that 
the opening may be valvular. After cutting 
about two inches through the skin, dissect 
down cautiously to the pleura, keeping 
close on the upper edge of the rib ; when a 
small puncture is made in the pleura, it may 
be enlarged to the requisite extent with the 
director and curved knife. 
Removal of a diseased breast. In this 
operation, and in the extirpation of tumours 
in other parts, the surgeon must attend 
carefully to remove all tlie disease ; hence 
integuments should be included, when they 
deviate at all from tb« healthy condition ; 
and the pectoral muscle should also be ta- 
ken away, if the tumour adheres to it, as far 
as it may have become indurated. In all can- 
cerous complaints it is most advisable to 
extend the incision even beyond the scat of 
actual disease ; as a morbid disposition mav 
have been formed, and would lead to tlie 
reproduction of the disorder. Where the 
skin does not participate in the disease, its 
removal is unnecessary; the first incision, 
therefore, may be a simple cut in such a 
case ; while in others two semicircular cuts 
should be made, meeting at their extremities 
in acute angles. The tumour should then 
be separated all round from the surrounding 
parts ; and lastly, the base is to be detached 
frosi its connections from above down- 
wards. The cut surface should then be 
carefully examined, to see if any indurated 
parts have been divided , for in that case 
some portions have been left behind, and 
ought to be taken away. Arteries may be 
tied as they are divided, if they bleed pro- 
fusely. When enlarged glands in the axilla 
require removal, the incision must be ex- 
tended in that quarter, and the indiuated 
parts completely removed, caution being 
necessary, on account of the proximity of 
the large vessels apd nerves. When the 
hemorrhage is stopped, the sides of the 
wound must be brought together by stick- 
ing plaister. 
Wounds of the abdomen. These may, or 
may not, injure the contents of the cavity ; 
but the mere circumstance of their pene- 
trating it constitutes a source of great dan- 
ger, from the peritoneal inflammation which 
is likely to ensue. We may not be able to 
discover whether the cavity is exposed or 
no; but this is of no consequence. A small, 
feeble, and contracted pulse; pallid coun- 
tenance; coldness of the extremities; great 
and sudden debility; hiccough; vomiting; 
and tension of the abdomen ; show that 
some important parts are injured. A 
bloody state of the urine; discharge of blood 
by vomiting and stool ; escape of urine, 
feces, or chyle, by the wound, indicate to us 
what particular parts are included in the 
injury. A protrusion of the viscera is a 
frequent attendant on these cases. The 
subsequent occurrence of the symptoms 
described as belonging to peritonitis (see 
Medicine) is the natural consequence of 
the injury, and brings the greatest danger to 
the patient. 
Tile treatment divides itself into two 
parts ; as regarding the wound, and the 
constitution in general. An over anxiety 
to discover the extent of the wound, and 
the parts injured, is useless and reprehen- 
sible ; if these facts cannot be made out 
with facility, the surgeon must be contented 
to remain ignorant of tiiem. Protruded 
parts musj; be immediately restored in th«^ 
most gentle way, and the wound may pro- 
bably require dilatation for this purpose ; 
which the surgeon may accomplish with tlio . 
probe-pointed curved knife, guided by his 
finger or a director. Fomentation of sugli 
parts is perfectly useless, A discoloured 
state of intestine is no reason why it should 
not be replaced, if it looks very suspicious 
it may be retained near the wound by a 
suture through the mesentery. If the gut 
be wounded, Tiiree simple stitches may ba 
made at three different parts of the cir- 
cumference, and the part retained near the 
