596 
EXCISION OF THE RIBS. 
formed without any permanent success, M. Cittadini suspected 
that the root of the evil was in the ribs, and that the disease 
might be effectually cured by their partial excision. By a cir¬ 
cular incision round the tumour, a portion of the skin, three 
inches in diameter, was removed, and the fibres of the rectus 
and great oblique muscles having been divided, the greater part 
of the sixth, seventh, and eighth cartilages were laid bare. It 
then appeared that the disease occupied a space of no more than 
about two inches. The cartilages were divided by a strong 
probe-pointed bistoury, and the tumour having been thus isolated, 
was detached by a spatula from its adhesion to the pleura. 
This was followed by an abundant hemorrhage, which could be 
stopped only by the actual cautery. Cicatrization took place 
very slowly, and was not completed until after three months, when 
the patient was quite recovered. 
A young man of plethoric habit and a strong constitution, 
who laboured under delirium from inflammation of the brain, 
stabbed himself with a stiletto in the left side of the chest, the 
instrument entered below the right nipple, and glided along 
the upper margin of the sixth rib, in which it remained fixed. 
The hemorrhage from the wound was abundant, but was soon 
arrested. The patient recovered from the inflammation of the 
brain, but a considerable suppuration took place in the wound ; 
and, two months afterwards, a fistulous passage had formed, 
leading to the diseased bone. Incisions and cauterization were 
employed in vain ; and it having been found that the cartilage 
and the osseous part of the sixth rib were denuded and rough, 
M. Cittadini determined upon excision. The integuments hav¬ 
ing been divided, the cartilage was removed by a probe-pointed 
bistoury, and the diseased part of the rib by the cutting forceps. 
The principal arteries were tied, and the smaller branches com¬ 
pressed. On removing the diseased portion of the pleura, the 
chest was opened on several points. At this part of the opera¬ 
tion the breathing became very short and laborious, but ceased to 
be so after a few hours. After two months the wound had per¬ 
fectly healed. 
In a fourth patient suppuration and caries of the sixth rib had 
taken place after a violent attack of pleurisy, and a fistulous pas¬ 
sage had been formed. During the operation, the rib and carti¬ 
lage were found so swelled and indurated, that M. Cittadini was 
obliged to use the trephine instead of the bistoury ; the hemorr¬ 
hage was considerable, but no difficulty of breathing arose during 
the operation. The recovery was very tedious, and not completed 
before the end of six months. 
In the fifth case, the disease of the bone was the consequence 
