Modern surgery, general and operative . iseased side beingat or over the edge of the table. He must never be placedon the sound side, because he breathes only with that side,and pressure on it may be dangerous. The arm of the diseased side should be elevated to aright angle with the body. If the surgeon desires to ob-tain only intercostal drainage, he should make a longitudi-nal incision about 3 inches in length at the upper bor-der of the sixth or seventh rib, and the middle of this inci-sion should correspond to the midaxillary Hne. This inci-sion is carried, layer by layer, to the pleura. I
Modern surgery, general and operative . iseased side beingat or over the edge of the table. He must never be placedon the sound side, because he breathes only with that side,and pressure on it may be dangerous. The arm of the diseased side should be elevated to aright angle with the body. If the surgeon desires to ob-tain only intercostal drainage, he should make a longitudi-nal incision about 3 inches in length at the upper bor-der of the sixth or seventh rib, and the middle of this inci-sion should correspond to the midaxillary Hne. This inci-sion is carried, layer by layer, to the pleura. If, as willusually be the case, he wishes to remove a portion of a rib,he will make an incision about 3 inches in length directlyupon the outer surface of the rib he wishes to remove,and the middle of this incision corresponds to the midaxillary line. Somesurgeons resect a portion of the fifth rib, some remove a bit of the eighth rib,and Munro^ shows that at the level of the eighth rib there is no danger of1 Medical News, Sept. 2, Fig. 572.—Resectionof a rib (Esmarch andKowalzig). Thoracotomy 909 injuring the diaphragm. By many operators a portion of the seventh or eighthrib is removed in front of the line of the posterior a>dllary fold. I agree with Hutton that a portion of the sixth rib in the inidaxillar\-line should be removed.^ The reasons given by Hutton for the selectionof this rib are: (i) It is over the portion of the lung which expands last. Anempvema is drained only partly by gra\ity, and most of the fluid is reallyforced out and the cavit}- is obliterated by lung expansion. If an incision ismade anterior or posterior to this point the expanding lung will block the drain-age opening, and a pus-cavity -nithout drainage -^ill remain in the midaxillaryline. (2) Such an incision permits a patient to lie on his back without mak-ing pressure on the drainage-tube. The periosteum of the outer surface of the rib must be di\-ided in thesame direction as the superlic
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
