A manual of operative surgery . 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
A manual of operative surgery . 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 cavity may be examined with theforefinger as the fluid is escaping, or after it has been entirelyevacuated. All thick curdy material within reach of the fingershould be FIG. 308.—SCHUMACHERS RIB SHEARS. chap, i] THORACOTOMY 307 Experience has shown that it is unwise to wash the cavityof the empyema out at the time of the operation. All thatcan be done at first is to provide a free opening for theescaping pus. If for any reason the incision has not been quite conveni-ently placed for drainage, a counter-opening lower down in thethorax should be made. A steel bladder-sound, or other suitable instrument, is intro-duced into the incision, and its point is made to project in oneof the lower spaces. Upon the instrument thus held, a cut withthe knife is made. Two drainage-tubes should, in such cases,be inserted. There is nothing to recommend the plan of passinga single tube from one opening to the other. The drainage-tubes employed should be large and not toorigid. They should not be inserted at great depth. It is onlynecessary that their open ends should project into the pleuralcavity, and that they should not impinge dire
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