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The ceremonies of invocation in behalf of sick people have already been described in the account of the sickness of the late king's daughter; the sacrifices adopted on similar occasions are tootoonima and nawgia : cutting off fingers and strangling children ; these also have been described, the latter is only done for very great chiefs. We shall now proceed to speak of their operative surgery, and constitutional diseases, as far as Mr Mariner's observation can lead him to speak with accuracy.
No native of Tonga undertakes to practise surgery unless he has been at the Fiji Islands, where constant wars afford great opportunities of becoming skilful; and no native of Tonga would employ a surgeon who had not been thus schooled: nor would any one, as Mr Mariner believes, undertake an important surgical operation, unless he feels himself confident in what he is about to perform. When a surgeon performs an operation, he never fails to obtain a present from the patient or his friends. The three most important operations are cawso, (paracentesis thoracis); tocolosi, (an operation for the cure of tetanus, which consists in making a seton of the urethra); and boca, or castration.
Cawso is an operation which is performed to allow of the escape of extravasated blood, which may have lodged in the cavity of the thorax, in consequence of wounds, or for the extraction of a broken arrow. There are no other instances where they think of performing it. The instruments they use are a piece of bamboo and a splinter of shell; sometimes a probe made of the mid-rib of the cocoa-nut leaf. Mr Mariner has seen a number of persons on whom the operation had been performed, and who were in perfect health; and to two instances of the fact itself he was an eyewitness. The one we are about to describe was performod upon a Fiji Islander, who had received a barbed arrow in the right side, between the fifth and sixth ribs; not in a line directly below the nipple, but about an inch backwards. The arrow had broken off about three inches from the point, * under the third row of barbs, and from the rise and fall of the thorax in the act of respiration the whole piece was perfectly concealed from any external view ; the barbs and the point were of the same piece with the rest of the head of the arrow.
A countryman of the wounded man wished to perform the operation, but the patient desired that a friend of his, a native of Vavaoo, should manage it, which proved that
They are made thin under each barb, on purpose that they may break. The barbs of this arrow were about a quarter of an inch transverse diameter, and the stem of the arrow under each row of barbs about the eighth of an inch.
he placed at least equal confidence in his skill as in that of his countryman ;-indeed he had seen him perform the operation several times before, at the Fiji 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 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 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 fit 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 expiration. 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 rib, and thereby preserved the arrow from receding at every inspiration. 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 VOL. II,
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 a 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 upon 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 mself with a more superficial pledget, that the external orifice
not heal too soon ; and the patient was allowed to change ure occasionally, but not for a long time togetlær, 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 bis house about two months, and was not perfectly recovered till near a twelvemonth, when he seemed as bealthy and as 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 acquaiòted either with the exact situation or existence of the intercostal arteries,
felt often happens that the arrow, not being a barbed one, is withdrawn without any difficulty ; but still the surgeon thinks proper to perform the operation of cawso, not by enlarging the wound made by the arrow, but by making another at some little distance from it, in a part which, either from judgment or education, he deems more safe and proper. In all those persons whom Mr Mariner knew to have undergone the cawso it had been performed in nearly the same situation as the one above stated.
We have observed in the before-mentioned case that the wound was not washed, and it may here be noticed, that in all cases of considerable wounds produced by pointed instruments, the patient is not allowed to wash himself till he is tolerably well recovered, nor to shave, cut his hair, nor his nails : for all these things they say are liable to produce gita (tetanus), unless the wound be of such a nature, and in such a situation, that it may with safety be first laid completely open : then there is no dana ger. Mr Mariner never witnessed a case of tetanus produced by these means; but he met with many who said they had seen it in persons who had got nearly well of their wounds, but happening to wash themselves too soon, spasm supervened, and death was the consequence. They notice that wounds in the extremities, particularly in the feet and hands, are liable to produce tetanus : also, in persons already wounded, sudden alarms, or even any sudden noise that calls the attention abruptly, is liable to produce this complaint. They never allow females to be near men thus wounded, lest the stimulus of desire should induce this dangerous complaint. As to cutting the hair and nails, they positively assert that the mere sensation of these simple and common operations has not unfrequently been productive of these dreadful consequences.
The man whose case we have just mentioned, was eight months without being washed, shaved, or having his hair or nails cut.
Gita is a disease very common among the Tonga people; but still more common among the natives of the Fiji Islands, who, from their warlike habits, arë more frequently in the way of it. They adopt, however, a remedy which the 'Tonga people har
borrowed of them, and consists in the operation of tocolósi, or passing a reed first wetted with saliva into the urethra, so as to occasion a considerable irritation, and discharge of blood. If the general spasm is very violent, they make a seton of this passage, by passing down a double thread, looped over the end of the reed, and when it is felt in the perinæum they cut down upon it, seize hold of the thread, and withdraw the reed ; so that the two ends of the thread hang from the orifice of the urethra, and the doubled part from the artificial opening in the perinæum: the thread being occasionally drawn backwards and forwards, which excites very great pain, and abundant discharge of blood. The latter operation Mr Mariner has seen performed several times; but only twice for tetanus, arising in both instances from wounds in the foot. In these cases the spasms, but particularly the convulsive paroxysms, were exceedingly violent, extending to the whole body, neck, face, trunk, and extremi
but in neither case was the jaw permanently locked, though on every accession it was violently closed for a few seconds. A native of the Fiji Islands performed one operation, and Hala A'pi A'pi the other. They both happened at Vavaoo, at different times. In either case the disease came on suddenly, three or four days after the wound was received, which was from an arrow not barbed. The moment the symptoms became evident tocolósi was performed. In the short space of two hours one of them was greatly relieved, and the other in about six or eight hours. The following day the one on whom Hala A'pi A'pi operated was quite well
, and afterwards had no other attack; consequently the thread was withdrawn : but the other on the second day was not quite free from spasmodic symptoms, and a paroxysm coming on, the seton was moved frequently, which in two or three hours gave him great relief, and he afterwards bad no other attack. It was thought prudent, however, to keep in the seton till the fourth or fifth day, when it was withdrawn. The effect of this opera. tion was a considerable pain and tumefaction of the penis, but which gradually subsided (in about five or six days): the artificial openings in both cases healed spontaneously, without any difficulty. These are the only two cases of tetanus in which this operation was performed that Mr Mariner can speak of with certainty, having been an eye-witness of them. He heard of se. veral others at the Hapai Islands, at the Island of Tonga, &c., some of which were equally fortunate. From what he has heard and seen of the success of this operation at the Tonga Islands, he is disposed to believe that about three or four in ten recover by the aid of it. The Fiji Islanders, however, speak of the happy effects of this singular mode of cure with much more contidence than the natives of Tonga ; but as they claim the merit of