A manual of operative surgery . of eucain may be chosen,but this will not pre-vent the pain involvedin the excision of partof a rib. The patient isbrought to the extremeedge of the table, andis allowed to lie asnearly as possible uponthe back. It is more conve-nient to the surgeon ifthe patient be rolledover upon the soundside ; but such a posi-tion is apt seriously tointerfere with thebreathing, especiallywhen the patient isunder the influence ofthe anaesthetic. The arm must beraised, but not beyonda right angle. The lifting of the arm involves a displacing upwards of the making h
A manual of operative surgery . of eucain may be chosen,but this will not pre-vent the pain involvedin the excision of partof a rib. The patient isbrought to the extremeedge of the table, andis allowed to lie asnearly as possible uponthe back. It is more conve-nient to the surgeon ifthe patient be rolledover upon the soundside ; but such a posi-tion is apt seriously tointerfere with thebreathing, especiallywhen the patient isunder the influence ofthe anaesthetic. The arm must beraised, but not beyonda right angle. The lifting of the arm involves a displacing upwards of the making his incision the surgeon must note to what extentthe integument is displaced by raising the limb, and must makehis incision so far above the spot at which it is intended to dividethe intercostal muscles as will correspond to that spot whenthe limb is brought to the side. It is essential that the incisionbe not valvular, and that the opening into the thorax bequite direct, the skin wound and the deeper wound RIB .SHEARS. 306 OPERATIONS ON THE THORAX [part iv An incision, from one and a half to three inches in length, ismade transversely, so as to correspond to the upper border of the lower rib boundingthe space. The intercostal mus-cles are divided close tothe rib. The periosteum isfreely incised and peeledoff the bone round itswhole circumference. It is important todetach the periosteumand pleura on the innerside intact, so that pusmay not escape until therib has been least one inch of thebone should be best instrument forthis purpose is thespecial curved resectionshears (Fig. 307). The intercostal vesselsand nerve have beendetached with the latter is now incisedabove these, and theopening enlarged if neces-sary with dressing soon as the drain-age tube is inserted thepatient should be turnedso that the opening isdependent. The pus, if considerable in quantity, should be allowed toescape slowly. The abscess cavi
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