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A countryman of the wounded man wished to perform the operation, but the patient de. sired that a friend of his, a native of Vavaoo, should
manage it. This proved that he placed at least equal confidence in his skill as in that of his countrymen, for he had seen himn perform the operation several times before at the Feejee Islands.
The patient was now lying on his back, but a little inclined to his left side; and this was considered a favourable posture for the operation. It was a fine clear day, and the weather warm; had it been rainy or cloudy, or had the patient felt himself cold, fires would have been lighted in the house, and a burning torch held to his side, to relax the integuments, and to render by such means the wound more favourable. The wound had been received the day before, and on pressing the finger upon its orifice the broken end of the arrow could not now be felt, except by the pain which such pressure gave the patient. In the first place, the operator marked with a piece of charcoal the situation and length of the intended incision, which was about two inches, the small wound made by the arrow being in the centre of it. The integuments were now drawn upwards, so that the black line lay upon and parallel with the superior rib, an assistant pressing his hand
above and another below the situation of the intended incision, with a view to keep the integuments firm and steady. The operator having now chosen a piece of bamboo, began his incision, and carried it down to the bone, the whole length of the mark, which was done with five or six motions of the hand, aided by considerable pressure. In this part of the operation a shell could not be used, on account of its liability to break. The integuments being now allowed to return to their natural situation, the incision was cautiously continued with a splinter of shell, midway between the two ribs, dividing the intercostal muscles to nearly the same extent as the external wound, to allow of the introduction of a finger and thumb to lay hold of the arrow. During this part of the operation, however, the end of the arrow became perceptible, protruding between the costæ at every inspiration. The operator as soon as possible secured it with the finger and thumb of his left hand, whilst with his right he proceeded to widen the incision on either side, that he might take a deeper and firmer hold, and secure, if possible, the second row of barbs. To facilitate the operation, he now slipt the noose of a string over the barbs he held between his finger and thumb, and having secured which, his left hand was no longer in the way of his right, for
by drawing the string as far as prudence would allow, he kept it prest upon the superior, and thereby preserved the arrow from receding at every respiration. The incision was now carried through the intercostal muscles and the pleura, sufficiently to allow of the introduction of the finger and thumb of the right hand, with which he endeavoured to disengage, as much as possible, what might obstruct the barbs; whilst with his left finger and thumb he laid hold of the end of the arrow, and kept gently twisting it always one way, so as to break down those obstructions which could not be removed with the other hand : taking care, however, not to use so much force as might be supposed liable to break the barbs : and in this way, in the course of two or three minutes, he withdrew the arrow, bringing with it a small portion of the substance of the lungs which could not be disengaged. During this part of the operation the patient was almost insensible. He was held by those about him, to prevent any mischief arising from his struggles, which at times were violent. The operator now carefully examined the arrow, and being satisfied that every barb (of which there were three rows) was entire, he ordered him to be gently turned on the right side, so that the wound was depending; and to make it more completely so, a quantity of gnatoo
was placed under him in two situations, viz. under the shoulder and under the pelvis, in such a way, that the orifice of the wound was evidently the most depending portion of the thorax. The patient being now perfectly sensible, the operator desired him to make a full inspiration, inquiring whether it gave him much pain; and being answered that he could bear it tolerably well, he desired him to make several full inspirations from time to time, but not so as to fatigue himself, and occasionally to move his body gently: by these means a considerable quantity of blood was discharged. A few hours afterwards the operator introduced between the ribs à portion of banana leaf, smoothly folded several times, and anointed with cocoa-nut oil, as a pledget to keep open the wound. He ordered his patient to be kept perfectly quiet, not to be spoken to, no noise to be made, nor his attention to be attracted in any way; to live chiefly on vegetable diet, or if he had any kind of meat, fowl in preference to pork; or if pork, it was to be very small in quantity and without the least fat, with cocoa-nut milk for drink, in any quantity that he felt disposed to take. The first night he had a great deal of pain, much thirst, and little sleep; the following day he was much easier. A great deal of blood was found to have been discharged, and a fresh pledget was
introduced, which was renewed every morning, as long as any discharge was apparent. When the discharge of sanguineous fluid ceased, which was in about nine or ten days, the operator introduced his probe, to be sure that the cessation of the discharge was not occasioned by any obstruction. He then contented himself with a more superficial pledget, that the external orifice might not heal too soon, and the patient was allowed to change his posture occasionally, but not for a long time together. As he grew better a little more meat was allowed him, but the use of cava was interdicted until he got tolerably well. The wound healed in about six weeks, without any sort of dressing or washing. The patient was confined to his house about two months, and was not perfectly recovered till near a twelvemonth, when he seemed as healthy and strong as ever, with scarcely any cough having supervened in the meanwhile. This was considered a very dangerous wound, and a very well-conducted cure. Mr. Mariner does not know that they are acquainted either with the exact situation or the existence of the interiostal arteries.
Tetanus is a disease very common among the Tonga people, but still more common among the natives of the Feejee Islands, who from their warlike habits are more frequently in the way