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boo, 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 rib, and thereby preserved the arrow from receding at every expiration. 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, wbich at times were violent. The operator now carefully examined the arrow, and be. ing 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, enquiring whether it gave him much pain; and being answered that he could bear it tolerably well, he desired him to make severai 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 bis 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, withcocoa-nut milk for drink, in any quan. uity 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 in. troduced, 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 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 acquainted either with the exact situation or existence of the intercostal arteries.
It often happens that the arrow, not being a barbed one, is withdrawn withoutany 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 danger. Mr. Mariner never witnessed a case of tetanus produced by these means; but he met with many who said they had seen it in person who had got nearly well of their wounde: bot happening to wash themselvet WoW , prasm supervened, and death was the con S K.. They notice that wounds in the extremita, particularly in the feet and hand, 4141